Dengue Fever

"A danger foreseen is half avoided." - Chinese fortune cookie

It’s sad in our modern age of medicine to see many old diseases returning like whooping cough, measles, TB, etc. Part of the fault is overconfidence, we think the disease is gone and stop taking the shots that protect us. Then one sick person visits from overseas and sets off an epidemic.

Another cause for diseases spreading is a change in habitat or habitat invasion. When a new housing development is built next to a marsh, expect mosquitoes. Global warming is also causing animals and insects to move into new locations. For example, the Florida Keys is experiencing a wave of Dengue fever – huh, what? Isn’t that something out of old jungle stories?

Dengue (pronounced den’ gee) is a viral disease spread by mosquitoes for which there is no immunization and no cure. It affects 100 million people each year – usually in the tropics. An extreme case of Dengue, called Dengue hemorrhagic fever (DHF), can be fatal but with hospitalization the survival rate is 99%.

The principal symptoms of dengue are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.

Dengue hemorrhagic fever (DHF) produces a fever that lasts from 2 to 7 days, with symptoms consistent with dengue fever. When the fever declines new symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (the capillaries) become “leaky” allowing the blood plasma to escape into the body. This can lead to shock and death, if circulatory failure is not corrected.

Treatment

For normal dengue fever the “treatment” is pain relievers with acetaminophen like Tylenol. Do NOT use aspirin – you don’t want to thin the blood any further. Rest, drink plenty of fluids, and consult a physician.

If you feel worse (e.g., develop vomiting, severe abdominal pain, bleeding) in the first 24 hours after the fever declines, go immediately to a hospital for evaluation. You may need a plasma drip to keep you alive during the high risk period of DHF.

Bottom Line

Everything old is new again. Each of us needs to brush up on the symptoms and treatment of “lost” diseases that used to plague our grandparents.