Recent emergence of dengue hemorrhagic fever in the Indian subcontinent has been well documented in Sri Lanka. We compare recent (2003)(2004)(2005)(2006) and past (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997) dengue surveillance data for Sri Lanka. The 4 dengue virus (DENV) serotypes have been cocirculating in Sri Lanka for >30 years. Over this period, a new genotype of DENV-1 has replaced an old genotype. Moreover, new clades of DENV-3 genotype III viruses have replaced older clades. Emergence of new clades of DENV-3 in 1989 and 2000 coincided with abrupt increases in the number of reported dengue cases, implicating this serotype in severe epidemics. In 1980-1997, most reported dengue cases were in children. Recent epidemics have been characterized by many cases in children and adults. Changes in local transmission dynamics and genetic changes in DENV-3 are likely increasing emergence of severe dengue epidemics in Sri Lanka. D engue viruses (DENVs) are mosquito-borne fl aviviruses that each year infect millions of persons living in tropical and subtropical regions of the world. Several hundred thousand of these infections, especially in children, progress to a life-threatening disease known as dengue hemorrhagic fever (DHF). Dengue has emerged in many regions of the world and the number of cases and the range of the virus continue to increase every year (1).The DENV complex consists of 4 distinct serotypes, designated DENV-1, DENV-2, DENV-3, and DENV-4. Infection with 1 DENV serotype is believed to provide long-term immunity to the homologous serotype but not to the other serotypes (2). Thus, persons can be infected with multiple serotypes during their lifetime. People with a repeat (secondary) DENV infection have a greater risk for DHF than persons infected for the fi rst time, indicating that preexisting serotype cross-reactive immunity is a risk factor for severe disease (3,4). Furthermore, all 4 serotypes of DENV can cause DHF, but within each serotype some genotypes or clades within genotypes are linked to severe disease and others to mild disease (5-7).Factors driving global emergence of dengue fever (DF) and DHF are complex and include viral and host factors as well as environmental changes that favor transmission. The epidemiology of dengue in Sri Lanka is particularly interesting because before 1989 all 4 serotypes were present and many repeat infections occurred, but few cases of DHF were documented (8,9). Incidence of DHF dramatically increased in 1989, and hundreds to thousands of cases of DHF have been documented every year since (8). Genetic studies with DENV-3 strains from Sri Lanka demonstrated that viruses isolated before and after emergence of DHF belonged to 2 distinct clades (DENV-3, genotype IIIA and IIIB, respectively), indicating that DENV-3 strain differences are likely to have contributed to emergence of DHF (7).The magnitude of DF and DHF epidemics in Sri Lanka has continued to increase; 2 of the largest epidemics occurred ...

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BackgroundSpontaneous splenic rupture is a rare but known complication of dengue fever. Previously reported cases have occurred early during the course of the disease and most cases have led to a fatal outcome. Here we report a case of spontaneous splenic rupture in a patient with dengue fever, which occurred during the recovery phase of the illness.Case presentationA 28-year-old Sinhalese, Sri Lankan man presented with a history of fever, myalgia and vomiting of 4 days duration. Investigations revealed a diagnosis of dengue fever with no signs of plasma leakage. He was managed in the ward as per local protocol. During the recovery phase the patient developed severe abdominal distention with circulatory failure. Radiology revealed splenic rupture with massive amounts of abdominal free fluid. The patient was resuscitated and Emergency laparotomy with splenectomy was performed. The outcome was excellent with the patient making a complete recovery.ConclusionAlthough splenic rupture is a known complication of dengue fever it may be manifested late in the disease process. A high degree of suspicion should be maintained and patients must be monitored even during the recovery phase of dengue fever. Early diagnosis and intervention can prevent mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1234-5) contains supplementary material, which is available to authorized users.

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