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.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Graphic Jump Location
Viruses that cause dengue pose complex challenges in vaccine development. A tetravalent vaccine is needed to protect against 4 serotypes of related flaviviruses.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.