Video:Dengue fever

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Definition

Dengue fever is a tropical disease spread by mosquitos.[1]

Onset of illness

It may cause symptoms similar to the flu.[1] A characteristic sign that someone has been infected by dengue is a rash that looks similar to measles.[2]

Denguerash.JPG

Blanching of rash

Another classic sign is that if handpressure is applied to the skin, an imprint will be seen for a couple of seconds after it's taken away. The term for this is blanching of the skin with pressure.

Symptoms

Dengue fever causes other, less specific symptoms including a high fever, headaches, vomiting, and intense muscle and joint pains. The joint pain is so pronounced that an alternative name for dengue is "breakbone fever".[3][4]

Recovery

This graph illustrates time running to the right with tick marks for days, and a rising line means more severe symptoms. Recovery from dengue, as illustrated here, generally takes two to seven days,[5] and is associated with a full body red rash that has small pale areas. This characteristic appearance is described as white islands in a sea of red.

Basic dengue curve gif.gif
Dengue recovery rash (White islands in red sea).jpg

Severe dengue

Not everyone has a simple recovery from dengue. In contrast to the majority depicted here as a dashed line, a small proportion of people will have worse symptoms, rather than getting better three to six days after they first get sick. This is called severe dengue, or sometimes dengue hemorrhagic fever.

Dengue critical gif.gif

Severe dengue symptoms

The signs of severe dengue are bleeding gums, worsening abdominal pain, uncontrollable vomiting, or liver enlargement. The person becomes more ill, rather than better, three to six days after the rash first develops.[6]

Dengue shock syndrome

Roughly 5% of severe dengue cases lead to dengue shock syndrome.[7] Dengue shock causes a drop in the levels of blood platelets that normally help stop bleeding.

Dengue shock gif.gif

Dengue shock hospital

When it causes the blood pressure to drop, and critical body systems to fail, bleeding can be severe and life-threatening. Dengue shock requires immediate attention from medical professionals and hospitalization.[5][2]

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Causes

Dengue is a Flaviviridae virus, with five genetic types.[8][9] Here is the virus drawn as a 3-dimensional model of the envelope protein.[10] Dengue is in the same family as other well known viruses carried by mosquitoes that cause tropical diseases, such as yellow fever, West Nile, and Zika virus.[11]

Spread

The Dengue virus is spread by several species of female mosquitoes, of the Aedes type.[5][2] Because mosquitoes are the vector for the virus, the disease is more common in warmer climates, and below an elevation of 1000 meters (or 3000 feet).[12][13]

Global warming

The disease is more likely to be spread in the early morning and evening hours when mosquitos are more active. Global warming could impact how the virus is spread, as shown in this animation of regional temperature over the years, with redder or warmer colors indicating higher temperatures. Research indicates that there could be a large jump in the number of dengue cases as mosquito populations expand to more northern climates as they get warmer.[14]

Immunity

Since Dengue fever can be caused by five different variations of the virus, immunity is complex. Infection with one type usually gives lifelong immunity to that type.[1]

No immunity

Infection with one type of the virus provides only short-term immunity to the others,[5] and subsequent infections with a different type of the virus increase the risk of severe complications.[5]

Repeated infections

A number of tests are available to confirm the diagnosis, including those that detect antibodies to the virus or its RNA.[2]

Prevention

A vaccine for dengue fever has been approved and is commercially available in a number of countries,[15] but it is only recommended in individuals who have been previously infected or populations with a high rate of infection by the age of 9.[16][17]

Young woman about to receive a vaccine (48545967116).jpg

Remove standing water

Other methods of prevention include either removing or covering standing water to reduce the mosquito habitat.

Prevent mosquito bites

Using mosquito nets—especially when sleeping—helps limit the risk of bites.[5]

Treatment

Treatment of mild or moderate dengue is supportive, and includes giving fluid either by mouth, or through an intravenous line.[2]

Management of fever

For fever reduction and pain relief, paracetamol (or acetaminophen) is recommended instead of nonsteroidal anti-inflammatory drugs (like ibuprofen and aspirin), to minimize the risk of bleeding.[2][18]

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Severe dengue treatment

Each year about half a million people require hospital admission for dengue—related illnesses and blood transfusion.[5][2]

Blood transfusion.gif
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Epidemiology

Dengue became a global problem after the Second World War and is common in more than 110 countries mainly in Asia and South America.[7][19]

Dengue world map-Deaths per million persons-WHO2012.svg

Global burden

Each year about 390 million people are infected,[1] and forty thousand die from it.[20]

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History

The earliest descriptions of an outbreak was in 1779.[19] Its viral cause and spread were understood by the early 20th century.[21]

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Current efforts

Dengue fever is classified as a neglected tropical disease.[22] Apart from efforts to eliminate mosquitos, work is ongoing for medication targeted directly at the virus.[23]

Mosquitos messed up (1888750788).png

References

  1. 1.0 1.1 1.2 1.3 "Dengue and severe dengue". www.who.int. Retrieved 29 February 2020. CS1 maint: discouraged parameter (link)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Kularatne SA (September 2015). "Dengue fever". BMJ. 351: h4661. doi:10.1136/bmj.h4661. PMID 26374064.
  3. Whitehorn J, Farrar J (2010). "Dengue". British Medical Bulletin. 95: 161–73. doi:10.1093/bmb/ldq019. PMID 20616106.
  4. Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Current Opinion in Infectious Diseases. 23 (5): 438–44. doi:10.1097/QCO.0b013e32833c1d16. PMID 20581669.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 "Dengue and severe dengue Fact sheet N°117". WHO. May 2015. Archived from the original on 2 September 2016. Retrieved 3 February 2016.
  6. Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". The New England Journal of Medicine. 366 (15): 1423–32. doi:10.1056/NEJMra1110265. PMID 22494122.
  7. 7.0 7.1 Ranjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes". Pediatric Critical Care Medicine. 12 (1): 90–100. doi:10.1097/PCC.0b013e3181e911a7. PMID 20639791.
  8. Normile D (October 2013). "Tropical medicine. Surprising new dengue virus throws a spanner in disease control efforts". Science. 342 (6157): 415. doi:10.1126/science.342.6157.415. PMID 24159024.
  9. Mustafa MS, Rasotgi V, Jain S, Gupta V (January 2015). "Discovery of fifth serotype of dengue virus (DENV-5): A new public health dilemma in dengue control". Medical Journal, Armed Forces India. 71 (1): 67–70. doi:10.1016/j.mjafi.2014.09.011. PMC 4297835. PMID 25609867.
  10. Yu, I.-Mei; Zhang, Wei; Holdaway, Heather A.; Li, Long; Kostyuchenko, Victor A.; Chipman, Paul R.; Kuhn, Richard J.; Rossmann, Michael G.; Chen, Jue (2008-03-28). "Structure of the immature dengue virus at low pH primes proteolytic maturation". Science. 319 (5871): 1834–1837. doi:10.1126/science.1153264. ISSN 1095-9203. PMID 18369148.
  11. Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". Lancet. 371 (9611): 500–9. doi:10.1016/S0140-6736(08)60238-X. PMID 18262042.
  12. WHO (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (PDF). Geneva: World Health Organization. ISBN 978-92-4-154787-1.
  13. "Travelers' Health Outbreak Notice". Centers for Disease Control and Prevention. 2 June 2010. Archived from the original on 26 August 2010. Retrieved 27 August 2010.
  14. Messina, Jane P.; Brady, Oliver J.; Golding, Nick; Kraemer, Moritz U. G.; Wint, G. R. William; Ray, Sarah E.; Pigott, David M.; Shearer, Freya M.; Johnson, Kimberly (2019-06-10). "The current and future global distribution and population at risk of dengue". Nature Microbiology. doi:10.1038/s41564-019-0476-8. ISSN 2058-5276.
  15. East, Susie (6 April 2016). "World's first dengue fever vaccine launched in the Philippines". CNN. Archived from the original on 18 October 2016. Retrieved 17 October 2016.
  16. "Dengue vaccine: WHO position paper – September 2018" (PDF). Weekly epidemiological record. 36 (93): 457–476. 7 September 2018.
  17. Torres, JR; Falleiros-Arlant, LH; Gessner, BD; Delrieu, I; Avila-Aguero, ML; Giambernardino, HIG; Mascareñas, A; Brea, J; Torres, CN; Castellanos-Martinez, JM (8 October 2019). "Updated recommendations of the International Dengue Initiative expert group for CYD-TDV vaccine implementation in Latin America". Vaccine. 37 (43): 6291–6298. doi:10.1016/j.vaccine.2019.09.010. PMID 31515144.
  18. "Dengue". United States Centers for Disease Control and Prevention. 28 March 2016. Retrieved 27 April 2018. Use acetaminophen. Do not take pain relievers that contain aspirin and ibuprofen (Advil), it may lead to a greater tendency to bleed. CS1 maint: discouraged parameter (link)
  19. 19.0 19.1 Gubler DJ (July 1998). "Dengue and dengue hemorrhagic fever". Clinical Microbiology Reviews. 11 (3): 480–96. PMC 88892. PMID 9665979. Archived from the original on 5 January 2011.
  20. Roth, Gregory A; Abate, Degu; Abate, Kalkidan Hassen; Abay, Solomon M; Abbafati, Cristiana (November 2018). "Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017". The Lancet. 392 (10159): 1736–1788. doi:10.1016/S0140-6736(18)32203-7.
  21. Henchal EA, Putnak JR (October 1990). "The dengue viruses". Clinical Microbiology Reviews. 3 (4): 376–96. doi:10.1128/CMR.3.4.376. PMC 358169. PMID 2224837. Archived from the original on 25 July 2011.
  22. "Neglected Tropical Diseases". cdc.gov. 6 June 2011. Archived from the original on 4 December 2014. Retrieved 28 November 2014.
  23. Noble CG, Chen YL, Dong H, Gu F, Lim SP, Schul W, Wang QY, Shi PY (March 2010). "Strategies for development of Dengue virus inhibitors". Antiviral Research. 85 (3): 450–62. doi:10.1016/j.antiviral.2009.12.011. PMID 20060421. Unknown parameter |displayauthors= ignored (help)