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Dengue fever

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Jump to: navigation, search "Dengue Fever" redirects here. For the band of the same name, see Dengue Fever (band). Dengue virus

A TEM micrograph showing Dengue virus virions (the cluster of dark dots near the center).

Virus classification Group: Family: Genus: Species: Group IV ((+)ssRNA) Flaviviridae Flavivirus Dengue virus

Dengue fever
Classification and external resources ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH A90. 061 3564 001374 med/528 C02.782.417.214

Dengue fever (pronounced UK: /ˈdɛŋɡeɪ/, US: /ˈdɛŋɡiː/) and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae.[1] It is also known as breakbone fever. The geographical spread includes northern Australia, northern Argentina, and the entire Singapore, Malaysia, Taiwan, Thailand, Vietnam, Indonesia,

having not been properly diagnosed at the height of their illness. Dengue is transmitted to humans by the Aedes aegypti or more rarely the Aedes albopictus mosquito. Suriname. Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash is present. muscle and joint pains (myalgias and arthralgias—severe pain that gives it the nick-name break-bone fever or bonecrusher disease).3 Potential antiviral approaches 6 Etymology 7 History 8 Use as a biological weapon 9 External links 10 See also 11 References [edit] Signs and symptoms The disease manifests as a sudden onset of severe headache.[4] The WHO says some 2. Pakistan. Puerto Rico. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. fever.1 Traditional and emerging treatments 4 Epidemiology 5 Prevention o 5.5 billion people. in some patients. are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. Brazil. Venezuela. Dominican Republic. Trinidad and Samoa[3].Honduras. or diarrhea.2 Mosquito control o 5. which feed during the day. Bolivia[2].[5] Contents [hide] • • • • • • • • • • • 1 Signs and symptoms 2 Diagnosis 3 Treatment o 3. Philippines. Thus travelers from tropical areas may pass on dengue in their home countries inadvertently. India. nausea. two fifths of the world's population.1 Vaccine development o 5. Mexico. Panama. Patients with dengue can pass on the infection only through mosquitoes or blood products . Unlike malaria. Bangladesh. dengue is just as prevalent in the urban districts of its range as in rural areas. and rash.[6] The dengue rash is characteristically bright red petechiae and usually appears first on the lower limbs and the chest. Jamaica. Guyana. Sri Lanka. Barbados. vomiting. it spreads to cover most of the body. Costa Rica. The disease is now epidemic in more than 100 countries. There may also be gastritis with some combination of associated abdominal pain.

The classic picture is high fever with no localising source of infection. Hemorrhagic tendency (positive tourniquet test. spontaneous bruising. . [7] Serology and polymerase chain reaction (PCR) studies are available to confirm the diagnosis of dengue if clinically indicated. Clinically. or drop in haematocrit of 20% or more from baseline following IV fluid. ascites. 1. Fever. 2. etc.000 platelets per mm³ or estimated as less than 3 platelets per high power field) 4. constant headaches. A dependable immediate information of the Dengue diagnostics in the rural areas can be performed by the introduction of Rapid Diagnostic Test kits which also differentiates between primary and secondary dengue infections. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate. [edit] Diagnosis The diagnosis of dengue is usually made clinically. Normally HCC does not occur in a cirrhotic liver for ten or more years after the cessation of the poisoning agent. or bloody diarrhea) 3. Narrow pulse pressure (less than 20 mm Hg) Cold. this is an avenue for further research as HCC is among the top five cancerous causes of death outside Europe and North America. variable haemorrhagic phenomena. gingiva.and only while they are still febrile. the platelet count will drop until the patient's temperature is normal. and haemoconcentration. clammy skin and restlessness. The classic dengue fever lasts about six to seven days. pleural effusion. bladder problem. Care has to be taken as diagnosis of DHF can mask end stage liver disease and vice versa. Evidence of plasma leakage (hematocrit more than 20% higher than expected. thrombocytopenia. bleeding from mucosa.. DHF patients can develop HCC within one year of cessation of poisoning agent. hypoproteinemia) 5.low platelet and white blood cell count. Dengue shock syndrome is defined as dengue hemorrhagic fever plus: • • • Weak rapid pulse. with a smaller peak of fever at the trailing end of the disease (the so-called biphasic pattern). vomiting blood. Encephalitic occurrences. Given that the Dengue virus (DEN) is related to the Hepatitis C virus. Thrombocytopenia (<100. Cases of DHF also show higher fever. DHF combined with a cirrhotic liver has been suspected in rapid development of hepatocellular carcinoma (HCC). severe dizziness and loss of appetite. Dengue can be a life threatening fever. a petechial rash with thrombocytopenia and relative leukopenia . injection sites.

which is for inflammation and does not prevent dengue. Red: Epidemic dengue. and platelets).000) or if there is significant bleeding. aegypti and A.[edit] Treatment The mainstay of treatment is timely supportive therapy to tackle shock due to hemoconcentration and bleeding. however. Dengue may also be transmitted via infected blood products (blood transfusions. though no evidence has yet shown effectiveness. dengue is treated with cat's claw herb.[citation needed] The treatment is speculated to be able to arrest and reverse the viral infection and prevent the disease from advancing into a critical stage. Mas Amirtha and Semalu developed by the Alternative Medicine Research Institute. particularly A. Close monitoring of vital signs in critical period (between day 2 to day 7 of fever) is critical. Dengue is transmitted by Aedes mosquitoes. have not yet been done. Initial experiments showed a fivefold increase in defective viral RNA production by cells treated with each drug.[8] [edit] Traditional and emerging treatments Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication. Increased oral fluid intake is recommended to prevent dehydration. lack of adequate global interest and funding greatly hampers the development of treatment regime. 2006. but the scale of this problem is unknown.[9] In vivo studies. Supplementation with intravenous fluids may be necessary to prevent dehydration and significant concentration of the blood if the patient is unable to maintain oral intake. The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion. plasma. A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20. Unlike HIV therapy. Patients may receive paracetamol preparations to deal with these symptoms if dengue is suspected. In Brazilian traditional medicine.[10] In Malaysia. albopictus. Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding tendency associated with some of these infections. Blue: Aedes aegypti.[citation needed] [edit] Epidemiology Worldwide dengue distribution. dengue is treated by some using natural medicine.[11] . Center for Asia. In Philippines dengue patients use tawa-tawa herbs and sweet potato tops juice to increase the platelets counts and revived the patients.

Africa.Worldwide dengue distribution. with around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year. When the cross-immunity wears off the population is more susceptible to transmission whenever the next seasonal peak occurs. The cyclical rise and fall in numbers of dengue cases is thought to be the result of seasonal cycles interacting with a short-lived cross-immunity[clarification needed] for all four strains in people who have had dengue. By the late 1990s. Côrtes said. including 30 deaths. and North America in the 1780s. Thus over time there remain large numbers of susceptible people in affected populations despite previous outbreaks due to the four different serotypes of dengue virus and the presence of unexposed individuals from childbirth or immigration. Epidemic dengue has become more common since the 1980s. had been recorded in the state in less than three months. and the secondary infection becomes far more serious. The first recognized Dengue epidemics occurred almost simultaneously in Asia. Halstead in the 1970s. 2008. the immune system is not able to adequately respond to the stronger infection.[12] This process is also known as superinfection. the secretary of health of the state of Rio de Janeiro. Sérgio Côrtes. shortly after the identification and naming of the disease in 1779.[13][14] Reported cases of dengue are an under-representation of all cases when accounting for subclinical cases and cases where the patient did not present for medical treatment. and by 1975 DHF had become a leading cause of death among children in the region.B. A pandemic began in Southeast Asia in the 1950s.555 cases of dengue. known as original antigenic sin. originally suggested by S. that dengue hemorrhagic fever is more likely to occur in patients who have secondary infections by another one of dengue fever's four serotypes. There was a serious outbreak in Rio de Janeiro in February 2002 affecting around one million people and killing sixteen. dengue was the most important mosquito-borne disease affecting humans after malaria. One model to explain this process is known as antibody-dependent enhancement (ADE). "I am treating this as an epidemic because the number of cases is extremely high. Significant outbreaks of dengue fever tend to occur every five or six months." Federal . which allows for increased uptake and virion replication during a secondary infection with a different strain. announced that 23. On March 20. There is significant evidence. Through an immunological phenomenon. 2000.

and the government is fumigating with insecticide in order to control the mosquito population. three and four in the region. José Gomes Temporão also announced that he was forming a panel to respond to the situation. Salta. Outbreaks were subsequently declared the neighbouring cities and towns of Townsville (outbreak declared 5 January 2009). March 4 2009. Jujuy. in the indian ocean. saying that the incidence of cases was in fact declining from a peak at the beginning of February. two. Major efforts to control the epidemic in Argentina are focused on preventing its vector (the Aedes mosquitoes) from reproducing. 2008. with over 9673 cases reported as of April 11. In the year 2004.000–5.000 infected. in Argentina. and Corrientes. [edit] Prevention [edit] Vaccine development There is no commercially available vaccine for the dengue flavivirus. Catamarca. there were seven deaths from dengue shock syndrome[17].000 reported cases of dengue fever or dengue haemorrhagic fever every year. As at 3 March 2009 there were 503 confirmed cases of dengue fever. In 2009. in a residential population of 152. [15] By April 3. in other countries. The statement said that although the woman had other health problems. 2009 by the Health Ministry [1].[18] The first cases of dengue are currently being reported on the island of Mauritius. Port Douglas (6 February 2009). Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns. Injinoo (24 February 2009). known as "descacharrado"). An epidemic broke out in Bolivia in early 2009. Innisfail (27 February 2009) and Rockhampton (10 March 2009). This is addressed by asking people to dry out all possible water reservoirs from where mosquitoes could proliferate (which is. There have been occurrences of dengue types one.000 [16] In Singapore. mayor of the city of Rio de Janeiro. Australia on 1 December 2008. Cesar Maia. Some travelers from the affected zones have spread the fever as far south as Buenos Aires [2]. a dengue outbreak was declared the northern provinces of Chaco. in which 18 people have died and 31. one of the many ongoing vaccine development programs is the Pediatric Dengue Vaccine Initiative which was set up in 2003 with the aim of accelerating the development and . in the first fatality since the epidemic began last year. denied that there was serious cause for concern.Minister of Health.137. there are 4. There have also been information campaigns concerning prevention of the dengue fever. Yarrabah (19 February 2009). she tested positive for dengue and the disease probably contributed to her death. However. located in the tropical north of Queensland. An outbreak of dengue fever was declared in Cairns. the number of cases reported rose to 55.

from southeast United States. and requires the continuing participation of the community. Florida. The Mesocyclops can survive and breed in large water containers.[citation needed] Prevention of mosquito bites is another way of preventing disease. Mesocyclops are hosts for the guinea worm.[22] This method is viewed as being more cost-effective and more environmentally friendly than pesticides.[citation needed] In urban areas. Aedes mosquitos breed on water collections in artificial containers such as plastic cups. flower pots. but would not be able to do so in small containers of which most urban area have within their homes. Aedes aegypti.[citation needed] Larvicide treatment is another effective way to control the vector larvae but the larvicide chosen should be long-lasting and preferably have World Health Organization clearance for use in drinking water.000 human volunteers after having successfully conducted tests on animals and a small group of human volunteers. Periodic draining or removal of artificial containers is the most effective way of reducing the breeding grounds for mosquitos. in water tanks and discarded containers where the Aedes aegypti mosquito was known to thrive. though not as effective. not much is known about how effective it could be if applied to cities and urban areas. the crustacean Mesocyclops. Also. mosquito traps or mosquito nets. pyriproxyfen). a pathogen that causes a parasite infection. . a major effort was made to eradicate the principal urban vector mosquito of dengue and yellow fever viruses.[21] [edit] Mosquito control A field technician looking for larvae in standing water containers during the 1965 Aedes aegypti eradication program in Miami. This can be achieved by using insect repellent.[23] Even though this method of mosquito control was successful in rural provinces. In the 1960s.g.[19] Thai researchers are testing a dengue fever vaccine on 3. There are some very effective insect growth regulators (IGRs) available which are both safe and long-lasting (e. broken bottles.introduction of dengue vaccine(s) that are affordable and accessible to poor children in endemic countries. For reducing the adult mosquito load. In 1998.000–5. used tires. There are two primary methods: larval control and adult mosquito control. scientists from the Queensland Institute of Medical Research (QIMR) in Australia and Vietnam's Ministry of Health introduced a scheme that encouraged children to place a water bug.[20] A number of other vaccine candidates are entering phase I or II testing. Primary prevention of dengue mainly resides in mosquito control. fogging with insecticide is somewhat effective. etc.

GPS and internet technology. The biggest dilemma with Mesocyclops is that its success depends on the participation of the community. a project to identify novel protease disruption mechanisms has been launched. Brazil.[36] The Swahili word "dinga" may possibly have its origin in the Spanish word . The result is a complete map of the mosquitoes in urban areas.[31] In cell culture[32] and murine experiments. no full scale studies have been conducted.[25] The technology was recognized with a Tech Museum Award in 2006. Possible laboratory-based modification of the yellow fever vaccine YF-17D to target the dengue virus via chimeric replacement has been discussed extensively in scientific literature. a full-scale biological attack against the insects could be launched within five years. this method would not be successful. West Nile and Yellow fever viruses among others.[30] In 2006. which could be specifically attacked by disrupting the viral RNA polymerase. [edit] Etymology The origins of the word dengue are not clear. which describes the disease as being caused by an evil spirit. discovered a fast way to find and count mosquito population inside urban areas.000 mosquito embryos with the bacterium.[33][34] morpholino antisense oligos have shown specific activity against Dengue virus. The technology. super-fine needles were used to inject 10. which includes the hepatitis C virus. updated in real time and accessible remotely. the bacterium would spread via its eggs to the next generation. If no problems are discovered. the adult lifespan was reduced by half. uses traps with kairomones that capture Aedes gravid females. In 2007 scientists' attenuated virus replication by interfering with activity of the dengue viral protease.[35] subsequently. [27] In the study. A pilot release of infected mosquitoes could begin in Vietnam within three years. scientists from the School of Integrative Biology at The University of Queensland revealed that by infecting Aedes mosquitos with the bacterium Wolbachia.[24] In 2004.and so this method of mosquito control cannot be used in countries that are still susceptible to the guinea worm. [26] In 2009. and without the support and work of everyone living in the city. but one theory is that it is derived from the Swahili phrase "Ka-dinga pepo". that can inform control methodologies. and upload insect counts with a combination of cell phone. This idea of a possible parasite bearing creature in household water containers dissuades people from continuing the process of inoculation. scientists from the Federal University of Minas Gerais. [28] [edit] Potential antiviral approaches Dengue virus belongs to the family Flaviviridae. a group of Argentine scientists discovered the molecular replication mechanism of the virus. however. Once an insect was infected. named Intelligent Monitoring of Dengue (in Portuguese).[29] To date.

[38] Also known as "Dandy Fever". [38] The first definitive case report dates from 1789 and is attributed to Benjamin Rush. the use of the Spanish word may derive from the similar-sounding Swahili. who coined the term "breakbone fever" because of the symptoms of myalgia and arthralgia. A pandemic of dengue began in Southeast Asia after World War II and has spread around the globe since then. slaves in the West Indies who contracted dengue were said to have the posture and gait of a dandy. [39] [edit] History The first recorded potential case of dengue fever comes from a Chinese medical encyclopedia from the Jin Dynasty (265–420 AD). The Chinese referred to a “water poison” associated with flying insects. Population movements during World War II spread the disease globally.[37] Alternatively.[42] . which would describe the gait of a person suffering the bone pain of dengue fever.[40] The viral etiology and the transmission by mosquitoes were deciphered only in the 20th century.[41] [edit] Use as a biological weapon Dengue fever was one of more than a dozen agents that the United States researched as potential biological weapons before the nation suspended its biological weapons program."dengue" meaning fastidious or careful.