帶箸疼痛的傳染病：登革熱

Infectious Disease with Pain: Dengue fever

登革熱是目前世界上最重要的蟲媒病毒，每年約有一億個新病例。最常見的症狀包括：發燒、皮疹、不適、噁心、嘔吐，以及肌痛。雖然是種自限性疾病，約三分之一的病人產生嚴重的併發症，包括登革出血熱以及登革休克症候群。疼痛是重要的診斷環節。登革熱亦可能以急性腹痛表現，造成診斷上的困境。在另一方面，登革熱病人的頭痛常被描述為嚴重、前額痛，以及眼窩後疼痛。登革熱的頭痛與偏頭痛有些相似，因為兩者都是搏動痛，伴隨著嘔心、畏光，以及畏聲。相關的臨床表徵，像發燒以及肌痛，就能輕易地區分。總之，登革熱雖然以發燒為主，但也會有急性腹痛。在流行區域，必定要將登革熱列為急性腹痛的鑑別診斷。頭痛也是登革熱最常見的症狀之一。因此，在登革熱流行區域遭遇頭痛與急性腹痛病患，我們都應注意登革熱感染的可能性。

Dengue fever (DF) is the most important arbovirus illness worldwide, with an estimated incidence of nearly 100 million cases every year. The common symptoms of DF include fever, rash, malaise, nausea, vomiting, and myalgia. Although it is generally a mild and self-limited disease, about one-third of patients develop severe complications, such as dengue hemorrhagic fever or dengue shock syndrome. Pain is an important component of the World Health Organization (WHO) dengue diagnostic criteria. In the WHO 2009 guidelines, the diagnostic criteria for DF comprised fever along with two symptoms out of nausea and vomiting, rash, aches and pains, positive tourniquet test, leucopenia, and any warning sign. Possible warning signs included abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, hepatomegaly, and an increase in hematocrit with a rapid decrease in platelet count. DF patients may present with an acute abdomen, causing a diagnostic dilemma. The serious acute surgical complications of DF include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. The reason that DF patients can present with an acute abdomen is unclear. Serological tests might not provide an early diagnosis; however, dengue nonstructural protein 1 (NS1) antigen detection can be used to detect DF early in the disease. The headaches in patients with DF have been described as severe and frontal with retroocular pain. The DF headache has some features in common with migraine; it most commonly causes throbbing pain and is usually associated with nausea, photophobia, and phonophobia. However, the presence of other DF clinical signs, such as fever and muscle pain, allows an easy distinction between these two conditions. In conclusion, although DF usually presents as a febrile viral illness, it can present as an acute abdominal emergency, mimicking acute appendicitis. It is important to consider DF as a differential diagnosis for acute abdomen in patients returning from dengue endemic regions. Meanwhile, headache is one of the most frequent and disabling symptoms in dengue infection. Therefore, when encountering headache or acute abdominal emergencies in endemic areas, we should be aware of the possibility ofDF.