DENGUE FEVER

Dengue Fever is also called or known as Breakbone Fever, Dandy Fever, Duengero Fever, and Seven-Day Fever. There are four serotypes of this virus found in tropical and most subtropical areas. It is a mosquito (the A. aegypti) - transmitted arbovirus infection and found more commonly in densely populated urban areas. There is no prophylactic treatment as there is for Malaria. It takes 3 to 15 days from exposure to the onset of symptoms. The symptoms include an abrupt onset of chills, fever, headache, severe arthralgia or muscle and joint pains and often upper respiratory symptoms. Acquired immunity is prolonged and often life-long.

The course of the illness is in stages.

• Sudden onset of fever, headache and pain. There is a steady fever for 3 - 4 days before it falls. Pain or soreness in eyes and everywhere especially in areas where old injuries had occurred. Nausea, change in taste, vomiting and diarrhea may occur. May have respiratory symptoms also. Generally the person feels very ill, weak and miserable.
• There is a period of 1 - 3 days of feeling a bit better with or without a low grade fever.
• About the 3^rd - 5^th day the fever and symptoms reoccur and a rash develops starting with the bottoms of the feet and palms of the hands. The rash is red and may be very itchy like hives. The rash spreads up the legs and arms to the rest of the body, not the face. The rash may appear like petechia or small hemorrhages in the skin. See NOTE.
• The fever ends. Feeling of fatigue.
• Itching of skin as the rash fades.
• Peeling of skin, especially of feet and hands.

NOTE: The major causes of the hemorrhagic type rash is capillary damage or DIC in severe Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). These are an unusual response to the infection and most cases occurring in young children or persons who have had evidence of previous exposure to Dengue or another group B arbovirus infection.

Lab Testing:

• Early viremia - virus isolation
• Rising antibody titres
• After the first week, compliment fixing and neutralizing antibodies present
• Leukopenia

Home Treatment:

• Fluids
• Rest
• Fever control - Tylenol, Ibuprofen - not Aspirin
• Pain control
• Benadryl or local skin preparations for itching

Prevention:

• Control of mosquitos - local screens, bug sprays, coils, plus in the region, etc.
• Personal protective bug sprays, clothing and netting.

Sources:

DeGowin & Degowin's, Diagnostic Examination, 6^th Edition, 1994 p. 878.

Bell, Dion R., Tropical Medicine, 4^th Edition, 1995, p. 77-82.

Personal Experience of Carla Warnock, R.N., Haiti, February 1999 and September 2000.

Prepared March 31, 1999 / Updated October 2000

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