Dengue fever facts

Dengue fever facts

 

 Picture of the typical dengue fever rash.

• Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
• Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.
• Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and in Paraguay in South America, and Costa Rica in Central America.
• Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic).
• The acute phase of the illness with fever and myalgias lasts about one to two weeks.
• Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
• The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.
• There is currently no vaccine available for dengue fever.

 

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.

What geographic areas are at high risk for contracting dengue fever?

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to the areas of the world that harbor malaria and yellow fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia.

In 2011, Bolivia, Brazil, Columbia, Costa Rica, El Salvador, Honduras, Mexico, Peru, Puerto Rico, and Venezuela reported a large number of dengue cases. Paraguay reported a dengue fever outbreak in 2011, the worst since 2007. Hospitals were overcrowded, and patients had elective surgeries canceled due to the outbreak.

The U.S. Centers for Disease Control and Prevention (CDC) reports that from 1946 to 1980, no cases of dengue acquired in the continental United States were reported. Since 1980, a few locally acquired U.S. cases have been confirmed along the Texas-Mexico border, temporally associated with large outbreaks in neighboring Mexican cities.

A 2009 outbreak of dengue fever in Key West, Fla., showed that three patients who did not travel outside of the U.S. contracted the virus. Subsequent testing of the population of Key West has shown that up to 55 of the people living in the area have antibodies to dengue. In total, 28 people were diagnosed with dengue fever in this outbreak.

Dengue fever is common, in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases.

According to the CDC, there are an estimated 100 million cases of dengue fever with several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue. The World Health Organization (WHO) estimates that 22,000 deaths occur yearly, mostly among children.

 

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can cause the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway. 

What are dengue fever symptoms and signs?

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relatively low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.

Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

How is dengue fever diagnosed?

The diagnosis of dengue fever is usually made when a patient exhibits the typical clinical symptoms of headache, fever, eye pain, severe muscle aches and petechial rash and has a history of being in an area where dengue fever is endemic. Dengue fever can be difficult to diagnose because its symptoms overlap with those of many other viral illnesses, such as West Nile virus and chikungunya fever.

In 2011, the U.S. Food and Drug Administration (FDA) approved a blood test to diagnose people with dengue fever, called the DENV Detect IgM Capture ELISA. The FDA notes that the new test may also give a positive result when a person has a closely related virus, such West Nile disease.

 

What is the treatment for dengue fever?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms. Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision because of the possibility of worsening bleeding complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for joint and muscle pain (myalgia).

 

What is the prognosis for typical dengue fever?

Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks.

 

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).

In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

The mortality (death) rate with DHF is significant. With proper treatment, the World Health Organization estimates a 2.5% mortality rate. However, without proper treatment, the mortality rate rises to 20%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.

How can dengue fever be prevented?

The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.

The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.

To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever, except living in or traveling to an area where the mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

There is currently no vaccination available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2015.

 

Where can people get more information on dengue fever?

"Dengue," Centers for Disease Control and Prevention
http://www.cdc.gov/Dengue/

REFERENCES:

Canada. Public Health Agency of Canada. "Dengue Fever: Global Update." June 3, 2011. <http://www.phac-aspc.gc.ca/tmp-pmv/thn-csv/dengue-eng.php>.

Canada. Public Health Agency of Canada. "Dengue in South East Asia." Aug. 23, 2007. <http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070823_e.html>.

"Dengue Fever in Key West." Florida Department of Health. <http://www.doh.state.fl.us/Environment/medicine/arboviral/Dengue_FloridaKeys.html>.

Hendrick, Bill. "FDA OKs Test for Dengue Fever." WebMD.com. Apr. 13, 2011. <http://www.webmd.com/news/20110413/fda-oks-test-for-dengue-fever>.

Switzerland. World Health Organization. "Dengue and Dengue Hemorrhagic Fever." Mar. 2009.<http://www.who.int/mediacentre/factsheets/fs117/en/>.

Switzerland. World Health Organization. "Planning Social Mobilization and Communication for Dengue Fever Prevention and Control." <http://www.who.int/tdr/publications/publications/pdf/planning_dengue.pdf>.

Switzerland. World Health Organization. "Vector-Borne Viral Infections." <http://www.who.int/vaccine_research/diseases/vector/en/index.html>.

United States. Centers for Disease Control and Prevention. "Chikungunya." Oct. 6, 2010. <http://www.cdc.gov/ncidod/dvbid/chikungunya/>.

United States. Centers for Disease Control and Prevention. "Dengue." May 20, 2010. <http://www.cdc.gov/Dengue/>.

United States. Centers for Disease Control and Prevention. "Dengue." Oct. 28, 2010. <http://www.cdc.gov/dengue/epidemiology/index.html>.

United States. Centers for Disease Control and Prevention. "Dengue Hemorrhagic Fever --- U.S.-Mexico Border, 2005." Aug. 8, 2007. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a1.htm>.

United States. Centers for Disease Control and Prevention. "Locally Acquired Dengue -- Key West, Florida, 2009-2010." Morbidity and Mortality Weekly Report 59.19 May 21, 2010: 577-581. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5919a1.htm>.

"Why a Vaccine." Dengue Vaccine Initiative. <http://www.denguevaccines.org/why-a-vaccine>.

Last Editorial Review: 9/9/2011

Comment from: 25-34 Male (Patient) Published: August 12

I am just getting over Dengue which I got in South India or Thailand. I had a rash on my arms that alerted me. Next I knew I had a 105 temp (41 c) for 3-4 days and extremely intense joint and muscle pain. This makes it nearly impossible to sleep so you become quite delirious. Then came blood in stool (GI Bleeding) - and complete loss of appetite. I was put on IV - but still lost about 10 lbs (5kg). I didn't experience nausea, but a horrible rash came on that is itchy and painful and makes it difficult to sleep. I'm about 3 days into the rash which the doctors indicate is the final phase of the illness. I am feeling very weak and exhausted.

Related Reading: rash | muscle pain | sleep

 

Published: July 28

I spent the summer of 1978 serving a summer missionary internship working in a children's hospital in Haiti, West Indies. I must have been bitten by a carrier of Dengue because I became quite sick within about a week of returning to my home in Dallas. I had a slight rash, low grade fever, petechiae, and terrible, terrible pain. I was quite ill for about two weeks, not even able to get out of bed! I was basically given Valium by my internist because there was no treatment and he determined that the Valium would at least keep me from struggling with the terrible pain. Interestingly, I have immune problems (which may have made me a "target" for the illness) and I also developed significant fibromyalgia within a short tine after recovering from Dengue. I have no idea if there is a relationship between the two, but the coincidence is certainly interesting.

Related Reading: fever | fibromyalgia

 

Published: July 24

I just returned from Costa Rica. Seems there was an outbreak of Dengue Fever when I was there and I believe I had it, although I never got the blood test done. At first I was feeling a bit ill and got a rash on my stomach, which I attributed to a heat rash after a day at the beach. The next day I was supposed to go scuba diving, but after walking about .25 miles to the dive shop, I decided not to go. Felt like I had a killer hangover (but had not drank alcohol the night before) and a really bad lower backache. They drove me home and I spent the day in bed, fever, nausea, and headache. The next day, felt much better so the next day I did go diving and by noon was covered in the bright red rash and thought I had been run over by a truck. Ended up taking a tour that weekend with a group and went through fever and chills the whole time. Would drag myself around but always found an excuse to rest/sit. We went to a "hot springs" that had a warm pool and a cool pool and I spent a couple hours in them and it was great - brought the fever down and I felt much better. Each day fewer symptoms but I still get tired easily. Some people say there is no way I had it because I wasn't "sick enough". I don't know...never had a rash like that before!

Related Reading: Dengue Fever | heat rash | headache

 

Published: July 23

I have had dengue fever years ago as I live in Jamaica. Ever since then I seem to get the same symptoms for 3-4 days three or four times per year: achy sensation, tiredness, and painful headache behind the eyes. The fever rises upon exertion. Is this the same virus still in my system? I continue to live here in Jamaica and wonder if I am slightly more immune but continue to get a version of it.

 
Comment from: rhom, 3-6 Male (Caregiver) Published: September 15

My 6-year old son is now in the hospital and is being suspected of having Dengue Fever. He had fever for 3 days. His body temperature reached 39.9.On the 4th day, the temperature dropped, and we thought that he will be okay, but he had fever at night time on the same day again. It was 38 degrees high. On the 5th day, he had fever until early afternoon and the temperature lowered until the next day. We decided to bring him to the doctor for a check-up and were advised to be hospitalized. My heart is still breaking whenever he will undergo CBC. He gets blood test everyday. The rashes on his skin became more visible on the 6th and 7th day. He doesn't have fever anymore. I just hope that he will continue on fighting against this disease. His appetite is regaining again though it wasn't as good as his normal yet. His stool is still watery and his lower lip is very dry. He is being forced to drink plenty of water to avoid dehydration.

Related Reading: dehydration

Comment from: SXM, 19-24 Female (Patient) Published: September 15

I live in St. Martin. I actually felt severe headaches for a week and then one night I got up vomiting and had loose bowels. I thought I had the rota virus but I realized that I get really high fevers and shortness of breathe. Then I got a rash on my face, and red eyes. I have had it for one week already.