Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Dengue fever is a disease caused by viruses that are transmitted to people by
mosquitoes. Dengue fever usually causes fever (high, about 104 F-105 F), skin
rash (see Figure 1), and pain (headaches and often severe muscle and joint
pains). The disease has also been termed "breakbone" or "dandy fever" because
the unusually severe muscle and joint pains can make people assume distorted
body positions or exaggerated walking movements in an effort to reduce their
pain.
Dengue fever is endemic in tropical and subtropical areas. Dengue fever is
estimated by the WHO (World Health Organization) to cause about 50-100 million
infections per year worldwide. The CDC considers dengue fever to cause the
majority of acute febrile illnesses in travelers returning to the U.S. In 2009,
dengue fever was noted to occur in Key West, Florida, in residents who did not
travel outside the U.S. More cases were identified in 2010, which suggests that dengue
fever may become endemic in Florida, and possibly south Texas, due to new
infections also diagnosed in this area. The first clinical report of dengue
fever was in 1789 by B. Rush, although the Chinese may have described the
disease associated with "flying insects" as early as 420 AD. Africans described
"ka dinga pepo" as cramp-like seizure caused by an evil spirit. The Spanish may
have changed "dinga" to dengue since it means fastidious or careful in Spanish,
which describes the gait of people trying to reduce the pain of walking.
Unfortunately, the disease incidence seems to be increasing in Thailand, India,
Singapore, Philippines, Puerto Rico, Mexico, and Cape Verde with new outbreaks in
2009-10. Researchers suggest the surge in dengue fever may be due to several
factors:
Increased urban crowding with more sites for mosquitoes to develop
International commerce that contains infected mosquitoes, thus introducing the
disease to areas previously free of the disease
Local and world environmental
changes that allow mosquitoes to survive the winter months
International
travelers who carry the disease to areas where mosquitoes have not been
previously infected
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The symptoms and signs for dengue begin about three to 15 days after a mosquito bite
transfers a virus (dengue virus serotype 1-4) to a person previously unexposed
to the viruses. Fever and painful muscle and joint aches can occur during the first
few hours of symptoms when headache, chills, rash, and swollen lymph nodes first
appear. Pain behind the eyes is also a common symptom. These symptoms usually
last about two to four days and then diminish, only to reappear again with a rash that
covers the body and spares the face. The rash also may occur on the palms of the
hands and the bottom of the feet, areas frequently spared in many viral and
bacterial infections. The symptoms may last about one to two weeks with complete
recovery, in most cases, in a few weeks. However, some people can develop more
severe symptoms and complications, such as hemorrhagic areas in the skin, gums,
and the gastrointestinal tract. This clinical problem is termed dengue
hemorrhagic fever (DHF).
