What you should know about Dengue – on steroids

Now that I want to go deeper still into the science of Dengue, I recall reading an excellent post on the subject by Yahoo! 360 blogger Gholamreza.  I thought, why should I reinvent the wheel when there is already this perfect resource to call on.  Therefore, I cleared the publication of the article with him so I could bring it to you in full.

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Dengue

An acute, infectious tropical disease caused by an arbovirus transmitted by female mosquitoes, and characterized by high fever, rash, headache, and severe muscle and joint pain.  Also called breakbone fever, dandy fever; also called dengue fever.    

The arthropod-borne viruses or arboviruses are a group of infectious agents that are transmitted by blood-sucking arthropods from one vertebrate host to another.  They multiply in the tissues of arthropod without evidence of disease or damage.  The vector acquires a long life infection through the ingestion from a viremic vertebrate.  Some arboviruses are maintained in nature by transovarian and possibly sexual transmission in arthropods.       

Note: Microorganism is a microscopic organism; those of medical interest include bacteria, viruses, fungi, and protozoa.  Not all of the microorganisms are pathogens (cause disease) in humans and plants but are beneficial. 

 

Dengue is caused by one of four closely related virus serotypes of the genus Flavivirus, family Flaviviridae, each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur.   Dengue is transmitted to humans by the mosquito Aedes aegypti.

What is dengue fever?

Dengue fever is a disease caused by a virus that is transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever, prostration, 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.  

Dengue (pronounced DENG-gay) is now reaching the peak of a roughly five-year cycle. It strikes people with low levels of immunity.  An attack of dengue produces immunity for a year or more.  Once this outbreak ebbs, more people will be resistant to the viral disease and the cycle will begin again.  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.  

Areas at high risk for contracting Dengue fever?

Dengue is endemic throughout the tropics and subtropics.  Outbreaks have, for example, occurred in the Caribbean, including Puerto Rico, the US Virgin Islands, and Cuba.  Cases have also been imported via tourists returning from areas with endemic dengue including Tahiti, the South Pacific, SE Asia, the West Indies, India and the Middle East. 

Dengue fever is thriving elsewhere in SE Asia.  Thailand, Vietnam, Singapore and Malaysia have all reported an increase in cases. 

In Thailand, dengue fever killed 31 people in the first three months of 1998, three times as many in the first quarter of last year. Officials in Thailand fear the worst dengue outbreak in four decades.  In Vietnam, more than 3,880 people have been infected this month, an increase of 13% over last April, and at least 39 persons have died this year.  In Singapore, there have been 1,701 cases, double 1997′s toll.  In Malaysia, dengue cases have risen 6% since last year.  And in the north Australian city of Cairns as well as Fiji and other South Pacific islands, there were larger than normal outbreaks of dengue fever early in 1998.  

How is dengue contracted? 

TEM showing dengue virus

It comes from a virus (the dengue virus) carried by the striped Aedes aegypti mosquito.  The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags and cans year round.  One mosquito bite can inflict the disease.  The incubation period ranges from 3 to 15 (usually five to eight) days before the signs and symptoms of dengue appear.    

Dengue Fever Definition

Dengue fever is a disease caused by one of a number of viruses that are carried by mosquitoes.  These mosquitoes then transmit the virus to humans.  

Description

The virus that causes dengue fever is called an arbovirus, which stands for arthropod-borne virus.  Mosquitoes are a type of arthropod. In a number of regions, mosquitoes carry this virus and are responsible for passing it along to humans.  These regions include the Middle East, the Far East, Africa, and the Caribbean Islands.  In these locations, the dengue fever arbovirus is endemic, meaning that the virus naturally and consistently lives in that location.  The disease only shows up in the United States sporadically.      

In order to understand how dengue fever is transmitted, several terms need to be defined.  The word “host” means an animal (including a human) that can be infected with a particular disease.  The word “vector” means an organism that can carry a particular disease-causing agent (like a virus or bacteria) without actually developing the disease.  The vector can then pass the virus or bacteria on to a new host.    

Many of the common illnesses in the United States (including the common cold, many viral causes of diarrhea, and influenza or “flu”) are spread because the viruses that cause these illnesses can be passed directly from person to person. However, dengue fever cannot be passed directly from one infected person to another.  Instead, the virus responsible for dengue fever requires an intermediate vector, a mosquito that carries the virus from one host to another.  The mosquito that carries the arbovirus responsible for dengue fever is the same type of mosquito that can transmit other diseases, including yellow fever. This mosquito is called Aedes aegypti.  The most common victims are children younger than 10 years of age.

Causes and symptoms

Dengue fever can occur when a mosquito carrying the arbovirus bites a human, passing the virus on to the new host. Once in the body, the virus travels to various glands where it multiplies.  The virus can then enter the bloodstream.   

The presence of the virus within the blood vessels, especially those feeding the skin, causes changes to these blood vessels. The vessels swell and leak. The spleen and lymph nodes become enlarged, and patches of liver tissue die. A process called disseminated intravascular coagulation (DIC) occurs, where chemicals responsible for clotting are used up and lead to a risk of severe bleeding (hemorrhage).   

After the virus has been transmitted to the human host, a period of incubation occurs.  During this time (lasting about five to eight days) the virus multiplies.  Symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints.   

This initial period of illness lasts about two–three days.  After this time, the fever drops rapidly and the patient sweats heavily.  After about a day of feeling relatively well, the patient’s temperature increases again, although not as much as the first time.  A rash of small red bumps begins on the arms and legs, spreading to the chest, abdomen, and back.  It rarely affects the face. 

The palms of the hands and the soles of the feet become swollen and turn bright red.  The characteristic combination of fever, rash, and headache are called the “dengue triad.”  Most people recover fully from dengue fever, although weakness and fatigue may last for several weeks. Once a person has been infected with dengue fever, his or her immune system keeps producing cells that prevent reinfection for about a year.   

More severe illness may occur in some people.  These people may be experiencing dengue fever for the first time.  However, in some cases a person may have already had dengue fever at one time, recovered, and then is reinfected with the virus.  In these cases, the first infection teaches the immune system to recognize the presence of the arbovirus.  When the immune cells encounter the virus during later infections, the immune system over-reacts.   

These types of illnesses, called dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), involve more severe symptoms.  Fever and headache are the first symptoms, but the other initial symptoms of dengue fever are absent.  The patient develops a cough, followed by the appearance of small purplish spots (petechiae) on the skin.  These petechiae are areas where blood is leaking out of the vessels. 

Large bruised areas appear as the bleeding worsens and abdominal pain may be severe.  The patient may begin to vomit a substance that looks like coffee grounds.  This is actually a sign of bleeding into the stomach.  As the blood vessels become more damaged, they leak more and continue to increase in diameter (dilate), causing a decrease in blood flow to all tissues of the body.  This state of low blood flow is called shock.  Shock can result in damage to the body’s organs (especially the heart and kidneys) because low blood flow deprives them of oxygen.   

Diagnosis

Diagnosis should be suspected in endemic areas whenever a high fever goes on for two to seven days, especially if accompanied by a bleeding tendency. Symptoms of shock should suggest the progression of the disease to DSS.   

The arbovirus causing dengue fever is one of the few types of arbovirus that can be isolated from the serum of the blood.  The serum is the fluid in which blood cells are suspended.  Serum can be tested because the phase in which the virus travels throughout the bloodstream is longer in dengue fever than in other arboviral infections. 

A number of tests are used to look for reactions between the patient’s serum and laboratory-produced antibodies.  Antibodies are special cells that recognize the markers (or antigens) present on invading organisms.  During these tests, antibodies are added to a sample of the patient’s serum.  Healthcare workers then look for reactions that would only occur if viral antigens were present in that serum.   

Treatment

There is no treatment available to shorten the course of dengue fever, DHF, or DSS. Medications can be given to lower the fever and to decrease the pain of muscle aches and headaches. Fluids are given through a needle in a vein to prevent dehydration. Blood transfusions may be necessary if severe hemorrhaging occurs. Oxygen should be administered to patients in shock.

Prognosis

The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients fully recover.  However, as many as 6 –30% of all patients die when DHF occurs.  The death rate is especially high among the youngest patients (under one year old).  In places where excellent medical care is available, very close monitoring and immediate treatment of complications lowers the death rate among DHF and DSS patients to about 1%.

       

Prevention

Prevention of dengue fever means decreasing the mosquito population.  Any sources of standing water (buckets, vases, etc.) where the mosquitoes can breed must be eliminated.  Mosquito repellant is recommended for those areas where dengue fever is endemic.  To help break the cycle of transmission, sick patients should be placed in bed nets so that mosquitoes cannot bite them and become arboviral vectors.