In Reply

Letters to the editor regarding the article Dengue Fever Diagnosis, Risk Stratification, and Treatment by Paul Witte, Stefan Venturini, Helene Meyer, Andreas Zeller, and Michael Christ in issue 23/2024

We are pleased that our article on dengue fever (1) generated so much interest, and we thank our readers for their extremely interesting additional points.

Bittmann adds important aspects on dengue in children and adolescents. Because of the predetermined scope of the article and our technical expertise we concentrated on explaining dengue infection in adults. Ultimately, however, the points raised by Bittmann as regards dengue-associated Kawasaki syndrome are of the utmost importance. Co-infections after an Aedes mosquito bite were not dealt with owing to their low prevalence: infections with Dirofilaria are known primarily in cats and dogs; individual case reports have focused on human infection with Dirofilaria immitis or repens (thread-like nematodes) (2). The possibility of simultaneous infection with dengue and microfilariae should be considered especially in symptoms of fever, cough, and blood-tinged sputum as a potential differential diagnosis (2).

We thank Slesak and Schäfer for their clear distinction between the symptoms of limb pain and arthralgia as regards the diagnosis of dengue or chikungunya. In older studies the diagnostic evaluation of these important infectious diseases is blurred or overlapping and therefore not exact, owing to methodological issues. This resulted in a mix-up in naming the typical symptoms of these diseases (3). Considering the now notably reduced case fatality rate of dengue, we refer readers to reference 4 cited in our article (1). It is conceivable that the case fatality declined owing to the fact that the diagnostic and therapeutic management improved over the years.

Our thanks go to Früh et al. for critically working out a vaccination recommendation for dengue. As rectified in the erratum in issue 25/2024, the Qdenga vaccine is licensed for seronegative and seropositive persons from age 4 in Europe. We took our steer from the STIKO recommendations, even though it is possible to deviate from these in individual cases (5). In our view, for most travelers into endemic regions, in view of the primarily touristic, time-limited trips and provided that basic preventive measures are followed (insect repellents, light-colored clothing), no indication for vaccination exists that goes beyond the STIKO recommendation.

DOI: 10.3238/arztebl.m2025.0026

On behalf of the authors

Dr. med. Paul Witte, Prof. Dr. med. Michael Christ

Notfallzentrum Luzerner Kantonsspital, Luzern

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Witte P, Venturini S, Meyer H, Zeller A, Christ M: Dengue fever—diagnosis, risk stratification, and treatment. Dtsch Arztebl Int 2024; 121: 773–8

2. Riebenbauer K, Weber PB, Walochnik J, et al.: Human dirofilariosis in Austria: The past, the present, the future. Parasit Vectors 2021; 29;14: 227

3. Halstead SB: Reappearance of chikungunya, formerly called dengue, in the Americas. Emerg Infect Dis 2015; 21: 557–61

4. World Health Organization (WHO): Dengue guidelines for diagnosis, treatment, prevention and control: New edition. Switzerland 2009.

5. Kling K, Külper-Schiek W, Schmidt-Chanasit J, et al.: STIKO-Empfehlung und wissenschaftliche Begründung der STIKO zur Impfung gegen Dengue mit dem Impfstoff Qdenga. Epid Bull 2023; 48: 3–43.