Adriane Cross Trout, MD, had only a few puzzling clues. Her patient had fever and intense retro-orbital headache. Treatment for a presumed urinary tract infection provided no relief. Tests were positive for Romberg sign, but negative for meningitis. Severe joint aches developed, as well as a few particularly revealing symptoms: petechial rash, thrombocytopenia, and atypical lymphocytes.
“I knew I was dealing with some kind of virus, but frankly, I didn't really know what was going on,” said Trout, a family physician in Rochester, NY. She heard the proverbial hoof beats, but knew it was time to think zebras, not horses. Trout consulted Mark Shelly, MD, an infectious disease specialist she had worked with during her residency. Her patient recently had traveled to Key West, Fla, another critical clue that led Trout and Shelly to the correct diagnosis: dengue.
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Viruses that cause dengue pose complex challenges in vaccine development. A tetravalent vaccine is needed to protect against 4 serotypes of related flaviviruses.
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