Although dengue fever has been known for some time, the disease is recurring in epidemic proportions in many parts of the world, and now has become the most common mosquito-born viral disease. The agent that causes dengue is a flavivirus, in the same family as yellow fever and West Nile virus. There are four serotypes that cause nearly identical patterns of disease. The female mosquito, Aedes culprit is the vector that transmits the virus between humans. Unlike the Anopheles which transmits malaria, Aedes bites during the day, and on the other hand, is primarily an urban, mostly in the lowland tropical or subtropical.
After an incubation period of approximately one week, the disease begins with a fever, which can reach 104 degrees or higher, headaches, joint pains, which can be severe, and sometimes a rash lightly. These nonspecific symptoms are difficult to distinguish from the "flu" or malaria. Although the isolation of the virus is possible, the diagnosis is usually confirmed by serological tests, if applicable. Although vaccines are developed an effective vaccine will not be available for at least 5-10 years. The course of dengue is usually self-limited, with total recovery within 2 weeks. Unfortunately, about 5% of patients go on to develop a much more serious form, known as dengue hemorrhagic fever or dengue hemorrhagic fever with few platelets and bleeding from multiple sites, often progressing capillary leak, vascular collapse and shock, the so-called syndrome Dengue shock (DSS). Without fluid intensive therapy at the hospital, the mortality rate among DSS can be 50% or more. It is important to avoid the use of aspirin and other non-steroidal anti-inflammatory drugs, in all cases of suspected dengue. Acetaminophen is safe
Who is sensitive to this more severe form of dengue? Each infection with any of the four serotypes confers lifelong immunity as long serotype, but no protection against the other three. In fact, after infection with a different serotype cause the body's immune system to overreact, which results in a much more severe disease, dengue haemorrhagic fever / DSS. Thus, those who have recurrent dengue will be much more likely to have a life-threatening disease. For reasons that are not entirely clear, the incidence of DHF / DSS is much higher in some parts of South-East Asia, where it has reached epidemic proportions, especially in small infants, usually between 5 and 8 months of age. One explanation is that these babies have residual antibodies passed from the mother, but this hypothesis remains to be tested.
What has caused this remarkable resurgence of dengue? WHO estimates that there are 50 to 100 million cases each year. Dengue fever is endemic in more than 100 countries and more than 30 countries have recently been outbreaks, including Puerto Rico and Hawaii. Many explanations have been offered for this increase. Most epidemiologists blame rapid urbanization, population growth, as a result of overcrowding and unsanitary conditions that have occurred over the past few decades. In many developing countries, public health infrastructure has deteriorated considerably. Pockets of stagnant water have enabled the city loving breeding of Aedes mosquitoes exponentially.
When he was recognized in the 50 years that the Aedes mosquito is the vector of both yellow fever and dengue, a vast campaign of spraying and the elimination of breeding grounds significantly reduced the mosquito population. This campaign has been dropped in 70 years due to the marked reduction in cases of yellow fever, and concerns relating to the toxicity of DDT, spraying pesticides most commonly used. Aedes control efforts have not been included. Increased ease of travel, especially by air, increasing the risk of dengue fever in travellers, and have resulted in the mixing of serotypes, which led to an increased incidence of DHF / DSS.
A recent report in the Journal of the American Medical Association (1) has raised concerns about a possible outbreak of dengue in the continental United States. Two species of Aedes mosquitoes are becoming increasingly numerous, and many cases of dengue were reported as returning residents and travellers in the southern states, particularly along the border with Mexico Texas. The authors believe that "dengue will be a rapidly expanding international health problem for the foreseeable future."
Dengue is a question increasingly being used for acute febrile disease in many parts of the world and is likely to occur in tropical epidemics in urban areas. As missionaries in the short term we still need to include dengue as an examination in the diagnosis of febrile patients we see, and evaluation of fever in the return trip. We must also be aware of the potential threat to life dengue shock syndrome, and be prepared to provide emergency fluid therapy.
After an incubation period of approximately one week, the disease begins with a fever, which can reach 104 degrees or higher, headaches, joint pains, which can be severe, and sometimes a rash lightly. These nonspecific symptoms are difficult to distinguish from the "flu" or malaria. Although the isolation of the virus is possible, the diagnosis is usually confirmed by serological tests, if applicable. Although vaccines are developed an effective vaccine will not be available for at least 5-10 years. The course of dengue is usually self-limited, with total recovery within 2 weeks. Unfortunately, about 5% of patients go on to develop a much more serious form, known as dengue hemorrhagic fever or dengue hemorrhagic fever with few platelets and bleeding from multiple sites, often progressing capillary leak, vascular collapse and shock, the so-called syndrome Dengue shock (DSS). Without fluid intensive therapy at the hospital, the mortality rate among DSS can be 50% or more. It is important to avoid the use of aspirin and other non-steroidal anti-inflammatory drugs, in all cases of suspected dengue. Acetaminophen is safe
Who is sensitive to this more severe form of dengue? Each infection with any of the four serotypes confers lifelong immunity as long serotype, but no protection against the other three. In fact, after infection with a different serotype cause the body's immune system to overreact, which results in a much more severe disease, dengue haemorrhagic fever / DSS. Thus, those who have recurrent dengue will be much more likely to have a life-threatening disease. For reasons that are not entirely clear, the incidence of DHF / DSS is much higher in some parts of South-East Asia, where it has reached epidemic proportions, especially in small infants, usually between 5 and 8 months of age. One explanation is that these babies have residual antibodies passed from the mother, but this hypothesis remains to be tested.
What has caused this remarkable resurgence of dengue? WHO estimates that there are 50 to 100 million cases each year. Dengue fever is endemic in more than 100 countries and more than 30 countries have recently been outbreaks, including Puerto Rico and Hawaii. Many explanations have been offered for this increase. Most epidemiologists blame rapid urbanization, population growth, as a result of overcrowding and unsanitary conditions that have occurred over the past few decades. In many developing countries, public health infrastructure has deteriorated considerably. Pockets of stagnant water have enabled the city loving breeding of Aedes mosquitoes exponentially.
When he was recognized in the 50 years that the Aedes mosquito is the vector of both yellow fever and dengue, a vast campaign of spraying and the elimination of breeding grounds significantly reduced the mosquito population. This campaign has been dropped in 70 years due to the marked reduction in cases of yellow fever, and concerns relating to the toxicity of DDT, spraying pesticides most commonly used. Aedes control efforts have not been included. Increased ease of travel, especially by air, increasing the risk of dengue fever in travellers, and have resulted in the mixing of serotypes, which led to an increased incidence of DHF / DSS.
A recent report in the Journal of the American Medical Association (1) has raised concerns about a possible outbreak of dengue in the continental United States. Two species of Aedes mosquitoes are becoming increasingly numerous, and many cases of dengue were reported as returning residents and travellers in the southern states, particularly along the border with Mexico Texas. The authors believe that "dengue will be a rapidly expanding international health problem for the foreseeable future."
Dengue is a question increasingly being used for acute febrile disease in many parts of the world and is likely to occur in tropical epidemics in urban areas. As missionaries in the short term we still need to include dengue as an examination in the diagnosis of febrile patients we see, and evaluation of fever in the return trip. We must also be aware of the potential threat to life dengue shock syndrome, and be prepared to provide emergency fluid therapy.
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