Dengue

O Dengue |DEN-ghee| is a Ilu-like viral disease spread by the bite oI inIected mosquitoes.
Dengue hemorrhagic Iever is a severe, oIten Iatal, complication oI dengue.
O Dengue occurs in most tropical areas oI the world. Most U.S. cases occur in travelers
returning Irom abroad, but the dengue risk is increasing Ior persons living along the
Texas-Mexico border and in other parts oI the southern United States.
O There is no speciIic treatment Ior dengue.
O !revention centers on avoiding mosquito bites in areas where dengue occurs or might
occur and eliminating breeding sites.

What is dengue fever? What is dengue hemorrhagic fever?
Dengue Iever is a Ilu-like illness spread by the bite oI an inIected mosquito.
Dengue hemorrhagic Iever is a severe, oIten Iatal, complication oI dengue Iever.

What is the infectious agent that causes dengue?
Dengue and dengue hemorrhagic Iever are caused by any oI the dengue Iamily oI viruses.
InIection with one virus does not protect a person against inIection with another.

How is dengue spread?
Dengue is spread by the bite oI an 0/08 mosquito. The mosquito transmits the disease by biting
an inIected person and then biting someone else.

Where is dengue found?
Dengue viruses occur in most tropical areas oI the world. Dengue is common in AIrica, Asia, the
!aciIic, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most
common in cities but can be Iound in rural areas. It is rarely Iound in mountainous areas above
4,000 Ieet.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, Ilower
pots, old oil drums, and water storage containers close to human dwellings. Unlike the
mosquitoes that cause malaria, dengue mosquitoes bite during the day.

What are the signs and symptoms of dengue fever and dengue hemorrhagic fever?
Dengue Iever usually starts suddenly with a high Iever, rash, severe headache, pain behind the
eyes, and muscle and joint pain. The severity oI the joint pain has given dengue the name
"breakbone Iever." Nausea, vomiting, and loss oI appetite are common. A rash usually appears 3
to 4 days aIter the start oI the Iever. The illness can last up to 10 days, but complete recovery can
take as long as a month. Older children and adults are usually sicker than young children.
Most dengue inIections result in relatively mild illness, but some can progress to dengue
hemorrhagic Iever. With dengue hemorrhagic Iever, the blood vessels start to leak and cause
bleeding Irom the nose, mouth, and gums. Bruising can be a sign oI bleeding inside the body.
Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock
syndrome). Dengue hemorrhagic Iever is Iatal in about 5 percent oI cases, mostly among
children and young adults.

How soon after exposure do symptoms appear?
The time between the bite oI a mosquito carrying dengue virus and the start oI symptoms
averages 4 to 6 days, with a range oI 3 to 14 days. An inIected person cannot spread the inIection
to other persons but can be a source oI dengue virus Ior mosquitoes Ior about 6 days.

How is dengue diagnosed?
Dengue is diagnosed by a blood test.

Who is at risk for dengue?
Anyone who is bitten by an inIected mosquito can get dengue Iever. Risk Iactors Ior dengue
hemorrhagic Iever include a person's age and immune status, as well as the type oI inIecting
virus. !ersons who were previously inIected with one or more types oI dengue virus are thought
to be at greater risk Ior developing dengue hemorrhagic Iever iI inIected again.

What is the treatment for dengue and dengue hemorrhagic fever?
There is no speciIic treatment Ior dengue. !ersons with dengue Iever should rest and drink plenty
oI Iluids. They should be kept away Irom mosquitoes Ior the protection oI others. Dengue
hemorrhagic Iever is treated by replacing lost Iluids. Some patients need transIusions to control
bleeding.

How common is dengue?
In tropical countries around the world, dengue is one oI the most common viral diseases spread
to humans by mosquitoes. Tens oI millions oI cases oI dengue Iever and up to hundreds oI
thousands oI cases oI dengue hemorrhagic Iever occur each year.
In the United States, approximately 100 cases oI dengue are reported each year in travelers
returning Irom tropical areas. Many more cases probably go unreported. A Iew persons have
become inIected with dengue while living in the United States. 0/08 mosquitoes are Iound in
Texas, Florida, and other southern states, and locally acquired dengue has been reported three
times since 1980 in southern Texas.

s dengue an emerging infectious disease?
es. All types oI dengue virus are re-emerging worldwide and causing larger and more Irequent
epidemics, especially in cities in the tropics. The emergence oI dengue as a major public health
problem has been most dramatic in the western hemisphere. Dengue Iever has reached epidemic
levels in Central America and is threatening the United States.
Several Iactors are contributing to the resurgence oI dengue Iever:
O No eIIective mosquito control eIIorts are underway in most countries with dengue.
O !ublic health systems to detect and control epidemics are deteriorating around the world.
O Rapid growth oI cities in tropical countries has led to overcrowding, urban decay, and
substandard sanitation, allowing more mosquitoes to live closer to more people.
O The increase in non-biodegradable plastic packaging and discarded tires is creating new
breeding sites Ior mosquitoes.
O Increased jet air travel is helping people inIected with dengue viruses to move easily Irom
city to city.
Dengue hemorrhagic Iever is also on the rise. !ersons who have been inIected with one or more
Iorms oI dengue virus are at greater risk Ior the more severe disease. With the increase in all
types oI virus, the occurrence oI dengue hemorrhagic Iever becomes more likely.

How can dengue be prevented?
There is no vaccine to prevent dengue. !revention centers on avoiding mosquito bites when
traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-
Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is
another key prevention measure.
Avoid mosquito bites when traveling in tropical areas:
O Use mosquito repellents on skin and clothing.
O When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long
pants tucked into socks.
O Avoid heavily populated residential areas.
O When indoors, stay in air-conditioned or screened areas. Use bednets iI sleeping areas are
not screened or air-conditioned.
O II you have symptoms oI dengue, report your travel history to your doctor.
Eliminate mosquito breeding sites in areas where dengue might occur:
O Eliminate mosquito breeding sites around homes. Discard items that can collect rain or
run-oII water, especially old tires.
O Regularly change the water in outdoor bird baths and pet and animal water containers.

Dengue fever facts
O Dengue Iever is a disease caused by a Iamily oI viruses that are transmitted by
mosquitoes.
O Symptoms such as headache, Iever, exhaustion, severe joint and muscle pain, swollen
glands (lymphadenopathy), and rash. The presence (the "dengue triad") oI Iever, rash,
and headache (and other pains) is particularly characteristic oI dengue Iever.
O Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred
recently in the Caribbean, including !uerto Rico, the U.S. Virgin Islands, Cuba, and in
!araguay in South America, and Costa Rica in Central America.
O Because dengue Iever is caused by a virus, there is no speciIic medicine or antibiotic to
treat it. For typical dengue Iever, the treatment is purely concerned with relieI oI the
symptoms (symptomatic).
O The acute phase oI the illness with Iever and myalgias lasts about one to two weeks.
O Dengue hemorrhagic Iever (DHF) is a speciIic syndrome that tends to aIIect children
under 10 years oI age. It causes abdominal pain, hemorrhage (bleeding), and circulatory
collapse (shock).
O The prevention oI dengue Iever requires control or eradication oI the mosquitoes carrying
the virus that causes dengue.
O There is currently no vaccine available Ior dengue Iever.
What is dengue fever?
Dengue Iever is a disease caused by a Iamily oI viruses that are transmitted by mosquitoes. It is
an acute illness oI sudden onset that usually Iollows a benign course with symptoms such
as headache, Iever, exhaustion, severe muscle andjoint pain, swollen glands (lymphadenopathy),
and rash. The presence (the "dengue triad") oI Iever, rash, and headache (and other pains) is
particularly characteristic oI dengue. Other signs oI dengue Iever include bleeding gums, severe
pain behind the eyes, and red palms and soles.
Dengue (pronounced DENG-gay) can aIIect anyone but tends to be more severe in people with
compromised immune systems. Because it is caused by one oI Iour serotypes oI virus, it is
possible to get dengue Iever multiple times. However, an attack oI dengue produces immunity
Ior a liIetime to that particular serotype to which the patient was exposed.
Dengue goes by other names, including "breakbone" or "dandy Iever." Victims oI dengue oIten
have contortions due to the intense joint and muscle pain, hence the name breakbone Iever.
Slaves in the West Indies who contracted dengue were said to have dandy Iever because oI their
postures and gait.
Dengue hemorrhagic Iever is a more severe Iorm oI the viral illness. Symptoms include
headache, Iever, rash, and evidence oI hemorrhage in the body. !etechiae(small red or purple
splotches or blisters under the skin), bleeding in the nose orgums, black stools, or easy
bruising are all possible signs oI hemorrhage. This Iorm oI dengue Iever can be liIe-threatening
and can progress to the most severe Iorm oI the illness, dengue shock syndrome.

Causes
Four diIIerent dengue viruses are known to cause dengue hemorrhagic Iever. Dengue
hemorrhagic Iever occurs when a person catches a diIIerent type dengue virus aIter being
inIected by another one sometime beIore. !riorimmunity to a diIIerent dengue virus type plays
an important role in this severe disease.
Worldwide, more than 100 million cases oI dengue Iever occur every year. A small number oI
these develop into dengue hemorrhagic Iever. Most inIections in the United States are brought in
Irom other countries. It is possible, but uncommon, Ior a traveler who has returned to the United
States to pass the inIection to someone who has not traveled.
Risk Iactors Ior dengue hemorrhagic Iever include having antibodies to dengue virus Irom prior
inIection and being younger than 12, Iemale, or Caucasian.
Symptoms
Early symptoms oI dengue hemorrhagic Iever are similar to those oI dengue Iever, but aIter
several days the patient becomes irritable, restless, and sweaty. These symptoms are Iollowed by
a shock -like state.
Bleeding may appear as tiny spots oI blood on the skin (petechiae) and larger patches oI blood
under the skin (ecchymoses). Minor injuries may cause bleeding.
Shock may cause death. II the patient survives, recovery begins aIter a one-day crisis period.
Early symptoms include:
O Decreased appetite
O Fever
O Headache
O oint aches
O Malaise
O Muscle aches
O Vomiting
Acute phase symptoms include:
O Restlessness Iollowed by:
4 Ecchymosis
4 Generalized rash
4 !etechiae
4 Worsening oI earlier symptoms
O Shock-like state
4 Cold, clammy extremities
4 Sweatiness (diaphoretic)
xams and Tests
A physical examination may reveal:
O Enlarged liver (hepatomegaly)
O ow blood pressure
O Rash
O Red eyes
O Red throat
O Swollen glands
O Weak, rapid pulse
Tests may include:
O Arterial blood gases
O Coagulation studies
O Electrolytes
O Hematocrit
O iver enzymes
O !latelet count
O Serologic studies (demonstrate antibodies to Dengue viruses)
O Serum studies Irom samples taken during acute illness and convalescence (increase
in titer to Dengueantigen)
O Tourniquet test (causes petechiae to Iorm below the tourniquet)
O -ray oI the chest (may demonstrate pleural eIIusion)
Treatment
Because Dengue hemorrhagic Iever is caused by a virus Ior which there is no known cure or
vaccine, the only treatment is to treat the symptoms.
O A transIusion oI Iresh blood or platelets can correct bleeding problems
O Intravenous (IV) Iluids and electrolytes are also used to correct electrolyte imbalances
O Oxygen therapy may be needed to treat abnormally low blood oxygen
O Rehydration with intravenous (IV) Iluids is oIten necessary to treat dehydration
O Supportive care in an intensive care unit/environment
utlook (Prognosis)
With early and aggressive care, most patients recover Irom dengue hemorrhagic Iever. However,
halI oI untreated patients who go into shock do not survive.
Possible Complications
O Encephalopathy
O iver damage
O Residual brain damage
O Seizures
O Shock
When to Contact a Medical Professional
Call your health care provider iI you have symptoms oI dengue Iever and have been in an area
where dengue Iever is known to occur, especially iI you have had dengue Iever beIore.
Prevention
There is no vaccine available to prevent dengue Iever. Use personal protection such as Iull-
coverage clothing, netting, mosquito repellent containing DEET, and iI possible, travel during
periods oI minimal mosquito activity. Mosquito abatement programs can also reduce the risk oI
inIection.
Alternative Names
Hemorrhagic dengue; Dengue shock syndrome; !hilippine hemorrhagic Iever; Thai hemorrhagic
Iever; Singapore hemorrhagic Iever

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