Jonathan Goodison-Orr

11/25/13


Dengue Fever

Dengue Fever. Although Americans are not particularly aware of the
severity of the diseases spread, it is definitely a large and ever expanding
problem. With more than one-third of the worlds population living in areas at
risk for transmission, dengue infection is a leading cause of illness and death
in the tropics and subtropics. As many as 100 million people are infected
yearly. Dengue is caused by any one of four related viruses transmitted by
mosquitoes. There are not yet any vaccines to prevent infection with dengue
virus and the most effective protective measures are those that avoid
mosquito bites. A little known fact about Dengue Fever is that it has been
wreaking havoc for centuries. The first record of a case of probable dengue
fever is in a Chinese medical encyclopedia from the Jin Dynasty (265420
AD), which referred to a "water poison" associated with flying insects. The
primary cause of transmission, the A. aegypti mosqito, spread out of Africa
and Asia in the 15th to 19th centuries due in part to increased globalization
secondary to the slave trade. There have been descriptions of epidemics in
the 17th century, but the most plausible early reports of dengue epidemics are
from 1779 and 1780, when an epidemic swept across Asia, Africa and North
America. From that time until 1940, epidemics were infrequent. In 1906,
transmission by the Aedes mosquitoes was confirmed, and in 1907 dengue
was the second disease (after yellow fever) that was shown to be caused by a
virus. Further investigations by John Burton Cleland and Joseph Franklin Siler
completed the basic understanding of dengue transmission. The marked
spread of dengue during and after the Second World War has been attributed
to ecologic disruption. The same trends also led to the spread of different
types of the disease to new areas, and to the emergence of dengue
hemorrhagic fever. This severe form of the disease was first reported in the
Philippines in 1953; by the 1970s, it had become a major cause of child
mortality and had emerged in the Pacific and the Americas 9 (Chakraborty,
2013).
The dengue virus (DENV) in one of five serotypes is the cause of
dengue fever. It is a mosquito-borne RNA virus of the family Flaviviridae;
genus Flavivirus. The dengue type 1 virus appears to have evolved in the
early 19th century (Time, 2013).
Dengue virus is primarily transmitted by Aedes mosquitoes, particularly
A. aegypti (See Image 3). They typically bite during the day, particularly in the
early morning and in the evening, but they are able to bite and thus spread
infection at any time of day all during the year. The virus seems to have no
detrimental effect on the mosquito, which remains infected for life. Aedes
aegypti prefers to lay its eggs in artificial water containers (Image 2), to live in
close proximity to humans, and to feed on people rather than other
vertebrates (CDC, 2013).
Dengue can also be transmitted via infected blood products and
through organ donation. In countries such as Singapore, where dengue is
endemic, the risk is estimated to be between 1.6 and 6 per 10,000
transfusions. Vertical transmission (from mother to child) during pregnancy or
at birth has been reported. Other person-to-person modes of transmission
have also been reported, but are very unusual. The characteristic symptoms
of dengue are sudden-onset fever, headache (typically located behind the
eyes), muscle and joint pains, and a rash (Image 5). The alternative name for
dengue, "breakbone fever", comes from the associated muscle and joint
pains.
The course of infection is divided into three phases: febrile, critical, and
recovery (Image 4). The febrile phase involves high fever, potentially over 40
C (104 F), and is associated with generalized pain and a headache; this
usually lasts two to seven days. Nausea and vomiting may also occur. A rash
occurs in 5080% of those with symptoms in the first or second day of
symptoms as flushed skin, or later in the course of illness (days 47), as a
measles-like rash. In some people, the disease proceeds to a critical phase
around the time fever resolves and typically lasts one to two days. During this
phase there may be significant fluid accumulation in the chest and abdominal
cavity due to increased capillary permeability and leakage. The recovery
phase occurs next, with resorption of the leaked fluid into the bloodstream.
This usually lasts two to three days. The improvement is often striking, and
can be accompanied with severe itching and a slow heart rate. Dengue can
occasionally affect several other body systems, either in isolation or along
with the classic dengue symptoms. A decreased level of consciousness
occurs in 0.56% of severe cases, which is attributable either to inflammation
of the brain by the virus or indirectly as a result of impairment of vital organs,
for example, the liver (Mayo Clinic, 2013).
Infections are most commonly acquired in the urban environment. In
recent decades, the expansion of villages, towns and cities in endemic areas,
and the increased mobility of people has increased the number of epidemics
and circulating viruses. Dengue fever, which was once confined to Southeast
Asia, has now spread to countries in the Pacific Ocean and America, and
might pose a threat to Europe (Image 1).
The mortality is 15% without treatment, and less than 1% with
adequate treatment. Access to Healthcare tends to be poor in Endemic areas.
There are no specific antiviral drugs for dengue, however maintaining proper
fluid balance is important. Treatment depends on the symptoms, varying from
oral rehydration therapy at home with close follow-up, to hospital admission
with administration of intravenous fluids and/or blood transfusion. A decision
for hospital admission is typically based on the presence of the "warning
signs".
A case study conducted by Duke Universitys pediatric division shows
19yo Latino male who had recently been diagnosed with Dengue had
reported symptoms of Fever to 104F, chills, myalgias, Lightheadedness,
Back pain and waxing and waning symptoms every three hours. He had also
been In the Dominican Republic for weeks, where Dengue Fever continues to
be a major Issue.
Research efforts to prevent and treat dengue include various means of
mosquito control, vaccine development, and antiviral drugs. Apart from
attempts to control the spread of the Aedes mosquito and work to develop a
vaccine against dengue, there are ongoing efforts to develop antiviral drugs
that would be used to treat attacks of dengue fever and prevent severe
complications. Discovery of the structure of the viral proteins may aid the
development of effective drugs. As of 2012, a number of vaccines were
undergoing testing. The most developed is based on a weakened
combination of the yellow fever virus and each of the four dengue serotypes.
It is hoped that the first products will be commercially available by 2015
(NCBI, 2013).


Image 1: Global Distribution of Dengue-
Worst Areas in Red

Image 2: Trying to remove standing water

Image 3:The mosquito Aedes aegypti

Image 4: Symptoms of Dengue

Image 5: The Typical Rash seen with Dengue Fever


Primary References

Books:
Chakraborty, T., & Babcock, H. (2008). Dengue fever and other
hemorrhagic viruses. New York, NY: Chelsea House.
Magazines:
Magazine. (2013, November 17). If You're Not Worried About Dengue
Fever, Here's Why You Should Be. time, 173, 1.
Internet Resources:
CDC. (2013, November 20). CDC-Dengue. Centers for Disease Control and
Prevention. Retrieved November 24, 2013, from
http://www.cdc.gov/dengue/

staff, M. (2011, September 30). Definition. Mayo Clinic. Retrieved
November 21, 2013, from
http://www.mayoclinic.com/health/dengue-fever/DS01028

Dengue Fever. (n.d.). NCBI. Retrieved November 22, 2013, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002350/
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Also:
http://pediatrics.duke.edu/files/documents/case_1_yin.pdf


I Have Completed this in accordance with the Newark Academy Honor Code.


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