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Dengue Fever


Alan Spira, M.D., DTM&H

Somewhere in Tanzania, maybe it was in Uganda, a lucky mosquito found its prey, zoomed in on its target and stole some blood from an unlucky human. This bite began innocently enough - happening during the day, not causing much of an itch - but several days later it lost all pretense of innocence. Lethargy, an unusual amount of tiredness, was the first sign that something was going awry. It was soon followed by a headache behind the eyes that throbbed and pounded, with a sensation of pressure like a kettle brewing and boiling. A fever, mild at first, but later intense with sweating, came bundled with ferocious muscle aches. These aches were rooted deep in the calves and back, and felt like being punched from the inside-out. The once-dinner-for-a-stray mosquito became apathetic and lost all appetite. What on earth could this be? Malaria? Typhoid? What, what, what?

A funny pink rash showed up soon after. It didn't itch, it didn't bleed, it didn't hurt. It just spread - over the chest, belly, and back. It, along with the fever, lightened after two days but just two days later returned with even greater dramatic force. Ah, I think we have enough clues and a diagnosis now...

Dengue Fever (pronounced 'Dhen Gey') is a viral infection common throughout the tropical regions of the world. It is spread by the day-biting Aedes aegypti and Aedes albopictus mosquitoes, and the poor sap above happens to be yours truly. Epidemics occur roughly every three to five years, and a worldwide pandemic is happening now. Among the areas most affected recently are India, Viet Nam and the Caribbean. Cases happen in Mexico often, and even in South Texas. This virus has four flavors, called serotypes, which are creatively named 1,2,3 and 4. Getting infected with one serotype does not protect you against the other serotypes; in fact, getting a second dengue infection, particularly with type 2, leads to an even worse infection. This manifests as either Dengue Hemorrhagic Fever or Dengue Shock Syndrome, which can be fatal. These are particularly dangerous in children, who suffer the most and who are at the greatest risk of dying from dengue. Still, most cases of dengue are benign (not-serious), ending after approximately 7 days.

Dengue has a short incubation period - often days, usually less than a week. The signs and symptoms of dengue include a sudden, rapidly climbing fever, a severe headache, nausea & vomiting, loss of appetite, rash and deep muscle and joint pains. The disease is nicknamed 'breakbone fever' for these last two symptoms. The rash usually shows up 3-4 days after the start of the symptoms and begins on the torso, spreading out to the face, arms and legs.

There can be a few days respite but the fever and rash often recur, and this is known as the 'saddleback pattern'. With Dengue Hemorrhagic Fever the blood cells are crippled and bleeding develops - in the gums, the skin, the intestinal tract. With the shock syndrome the blood vessels don't work quite right, and the blood pressure drops precipitously; as a result the blood fails to meet the metabolic demands of the cells in the body - which is the definition of shock.

Well then, what can we do about it? There is no vaccine and there is no cure, so if one contracts dengue, the treatment is 'supportive' - which means rest, plenty (and I mean plenty) of fluids, acetaminophen (Tylenol), and hospitalization if the hemorrhagic fever or shock forms develop.

This leaves us with prevention, the most sensible option (well, really the only option). To prevent contracting this nasty little virus, let's learn a little more about its flying harbinger of ill. The Aedes mosquito likes to bite in the morning and afternoons, often indoors or in the shade. The mosquito, Aedes species, is a day biter; so during daylight hours, in areas where mosquitoes are present, protect yourself by properly using anti-mosquito measures. These include wearing repellents, such as DEET (20-30% is safe and effective) and spraying clothing with permethrin (spraying mosquito nets and tents is important, too). Alternatives include Neem oil from India, which can be drunk as a tea or worn as a lotion. Avon's Skin-So-Soft is good, but wears off too quickly to be practical. Mosquito coils do work; Vitamin B and garlic, I am sorry to report, do not work. Wearing clothing is usually a good idea, especially long sleeves, long pants or skirts. To keep from over-heating and from aggressive mosquito punctures one should wear loose-fitting clothes.

Most cases happen in urban areas, and usually at altitudes less than 4,500 feet. Aedes mosquitoes like to breed in standing water such as may be found in empty tires, flower pots, artificial ponds, etc., especially after rains. These are quite common in tropical urban areas, even around hotels. The local authorities may try to eradicate the mosquito population with spraying but these pesky aviators just keep coming back for more. Protect yourself!

Should you travel to an area where dengue is possible? Absolutely. Just remember to pack common sense with you, and protect yourself against mosquito bites. While there is no guarantee against contracting it, the odds are definitely in your favor of escaping unharmed.

Healthy Travels!

© 1998 Alan Spira M.D., The Travel Medicine Center Beverly Hills, California.

Document Date: February 13, 1998

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