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Definition

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Dengue fever is spread by mosquitos.[1]

Onset of illness

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It causes symptoms similar to the flu, with some key differences. The characteristic sign that someone has been infected by dengue, is a rash that looks very similar to measles.[2]

Blanching of rash

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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 technical term for this, is blanching of the skin with pressure.

Symptoms

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There are some other, less specific symptoms, that dengue fever causes including a high fever, headaches, vomiting, and intense muscle and joint pains. In fact, the joint pain is so pronounced with dengue, that its alternative name is "breakbone fever".[3][4]

Recovery

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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, [1] and it 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.

Severe dengue

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However, not everyone has a simple recovery from dengue. In contrast to the majority now depicted 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.

Severe dengue symptoms

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The signs of severe dengue are bleeding gums, worsening abdominal pain, uncontrollable vomiting, or liver enlargement. But most importantly, the person becomes more ill, rather than better, three to six days after the rash first develops. [5]

Dengue shock syndrome

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Severe dengue is notable because in roughly 5% of cases[6], it can lead to dengue shock syndrome. Dengue shock causes a drop in the levels of blood platelets, which normally help stop bleeding.

Dengue shock hospital

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The bleeding can be severe, and life-threatening, if it causes the blood pressure to drop, and critical body systems to fail. Dengue shock also requires immediate attention from medical professionals and hospitalization. [1][2]

Causes

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Dengue is a Flaviviridae virus, with five genetic types.[7][8] Here is the virus drawn as a 3-dimensional model of the envelope protein.[9] 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[10].

Spread

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The Dengue virus is spread by several species of female mosquitoes, of the Aedes type.[2][1] The fact that mosquitoes are the vector for the virus means that the disease is much more common in warmer climates, and below an elevation of 1000m (or 3000 feet). [11] [12]

Global warming

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It also means that, the disease is more likely to be spread in the early morning and evening hours when mosquito's are more active. However all of this could change with global warming, shown here in a global animation of regional temperature over the years, with redder or warmer colors indicating higher temperatures. Recent 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. [13]

Immunity

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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.

No immunity

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However, infection with one type of the virus, provides only short-term immunity to the others,[1] and subsequent infections, with a different type of the virus, increases the risk of severe complications.[1]

Repeated infections

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

Prevention

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A vaccine for dengue fever has been approved, and is commercially available in a number of countries.[14] However it is only recommended in those who have been previously infected.[15]

Remove standing water

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

Prevent mosquito bites

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and using mosquito nets, especially when sleeping, to limit the risk of bites.[1]

Treatment

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

Management of fever

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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][16]

Severe dengue treatment

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Each year about half a million people require hospital admission for dengue related illnesses and blood transfusion.[2] [1]

Epidemiology

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Dengue has become a global problem since the Second World War and is common in more than 110 countries mainly in Asia and South America.[6][17]

Global burden

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Each year between 50 and 528 million people are infected, and between 10,000-20,000 die from it.[18][19][3][20]

History

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The earliest descriptions of an outbreak date from the year 1779.[17] Its viral cause and spread, were understood by the early 20th century.[21]

Current efforts

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

References

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  1. ^ a b c d e f g h "Dengue and severe dengue Fact sheet N°117". WHO. May 2015. Archived from the original on 2 September 2016. Retrieved 3 February 2016.
  2. ^ a b c d e f g Kularatne SA (September 2015). "Dengue fever". BMJ. 351: h4661. doi:10.1136/bmj.h4661. PMID 26374064. S2CID 1680504.
  3. ^ a b 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. S2CID 2452280.
  5. ^ 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. hdl:11343/191104. PMID 22494122.
  6. ^ a b 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. S2CID 10135251.
  7. ^ 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.
  8. ^ 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.
  9. ^ 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 (New York, N.Y.). 319 (5871): 1834–1837. doi:10.1126/science.1153264. ISSN 1095-9203. PMID 18369148. S2CID 42267698.
  10. ^ Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". Lancet. 371 (9611): 500–9. doi:10.1016/S0140-6736(08)60238-X. PMID 18262042. S2CID 205949828.
  11. ^ WHO (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (PDF). Geneva: World Health Organization. ISBN 978-92-4-154787-1.
  12. ^ "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.
  13. ^ 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. 4 (9): 1508–1515. doi:10.1038/s41564-019-0476-8. ISSN 2058-5276. S2CID 182951214.
  14. ^ 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.
  15. ^ "Dengue vaccine: WHO position paper – September 2018" (PDF). Weekly Epidemiological Record. 36 (93): 457–476. 7 September 2018.
  16. ^ "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.
  17. ^ a b Gubler DJ (July 1998). "Dengue and dengue hemorrhagic fever". Clinical Microbiology Reviews. 11 (3): 480–96. doi:10.1128/CMR.11.3.480. PMC 88892. PMID 9665979. Archived from the original on 5 January 2011.
  18. ^ Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar JJ, Hay SI (April 2013). "The global distribution and burden of dengue". Nature. 496 (7446): 504–7. doi:10.1038/nature12060. PMC 3651993. PMID 23563266.
  19. ^ Carabali M, Hernandez LM, Arauz MJ, Villar LA, Ridde V (July 2015). "Why are people with dengue dying? A scoping review of determinants for dengue mortality". BMC Infectious Diseases. 15: 301. doi:10.1186/s12879-015-1058-x. PMC 4520151. PMID 26223700.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  20. ^ Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, Hay SI, Bedi N, Bensenor IM, Castañeda-Orjuela CA, Chuang TW, Gibney KB, Memish ZA, Rafay A, Ukwaja KN, Yonemoto N, Murray CJ (June 2016). "The global burden of dengue: an analysis from the Global Burden of Disease Study 2013". The Lancet. Infectious Diseases. 16 (6): 712–723. doi:10.1016/S1473-3099(16)00026-8. PMC 5012511. PMID 26874619.
  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, et al. (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.
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