(10 am. – promoted by ek hornbeck)
Just recently, Salon columnist and constitutional lawyer, Glenn Greenwald was hospitalized with what he thought was the “flu”. It wasn’t. Mr,. Greenwald found that he was infected with the most common mosquito-born virus in the world, dengue, (pronounced DENgee), which yearly infects 50 to 100 million people causing about 24,000 deaths, primarily children. It is endemic in more than 110 countries with 2.5 billion people living in areas where it is prevalent.
The disease is caused by four closely related viruses, or serotypes, that can manifest in a couple of different ways. The most common is dengue fever, or illness, which presents with high fever, joint pain, severe headache and a a petechial rash (fine, red rash). The severity of the joint pain has given dengue the name “breakbone fever.” Dengue can progress to dengue hemorrhagic fever, which may lead to severe hemorrhage or dengue shock syndrome, where a very low blood pressure can cause organ dysfunction. Both can be fatal but with good medical management mortality can be less than 1%.
While dengue is very similar to other viruses transmitted by mosquitoes like West Nile and malaria, it is classified as a “Neglected Tropical Diseases” by the World Health Organization, meaning it is prevalent in tropics, yet has not received attention commensurate with its burden like other diseases such as malaria. There is no vaccine for prevention. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
What are the symptoms?
From the CDC:
The principal symptoms of dengue are:
* High fever and at least two of the following:
o Severe headache
o Severe eye pain (behind eyes)
o Joint pain
o Muscle and/or bone pain
o Rash
o Mild bleeding manifestation (e.g., nose or gum bleed, petechiae, or easy bruising)
o Low white cell countGenerally, younger children and those with their first dengue infection have a milder illness than older children and adults.
Watch for warning signs as temperature declines 3 to 7 days after symptoms began.
Go IMMEDIATELY to an emergency room or the closest health care provider if any of the following warning signs appear:* Severe abdominal pain or persistent vomiting
* Red spots or patches on the skin
* Bleeding from nose or gums
* Vomiting blood
* Black, tarry stools (feces, excrement)
* Drowsiness or irritability
* Pale, cold, or clammy skin
* Difficulty breathing
How is it treated?
Since dengue is caused by a virus, there is no effective antibiotic treatment. For typical dengue, the treatment is the relief of symptoms, rest and hydration. Aspirin and non-steroidal anti-inflammatory drugs are used cautiously under a doctor’s supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen and codeine may be given for severe headache and for the joint and muscle pain. It may or may not require hospitalization dependent on whether the patient can remain hydrated as other symptoms, nausea, vomiting and diarrhea, can increase fluid loss. The more severe manifestations, require hospitalization and may require oxygen and blood transfusions. Most deaths occur in children. Infants under a year of age are especially at risk of dying from the hemorrhagic form.
How is it transmitted?
Dengue is transmitted to humans by the bite of the Aedes aegypti and Aedes albopictus, which are found throughout the world. There is no other means, or vector, of transmission. For the mosquito to transmit the disease, it must bite a person who has been infected during a 5- day period when large amounts of virus are in the blood. That period is usually before the person is symptomatic and there are many who never exhibit symptoms but can still infect mosquitoes. The virus requires another 8 to 12 days of incubation before the mosquito can transmit the virus. The mosquito remains infected for the rest of its life which can be as long as a few weeks.
How is dengue prevented?
If you live in or travel to an endemic area, the best prevention is to avoid getting bit by a mosquito by using bug repellents with Deet, when possible, wear long sleeves and pants for additional protection. Also, make sure window and door screens are secure and without holes. If available, use air-conditioning and use mosquito netting in sleeping areas.
Control of the mosquito population is very important. The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels. Look for standing water indoors such as in vases with fresh flowers and clean at least once a week.
Is dengue here in the US?
Yes, it is but most of the cases are in patients who have traveled from countries where it is endemic, mostly from Caribbean, Puerto Rico, South and Central America. There have been isolated cases in very southern parts of Florida, mostly the Keys, along the Gulf and in the Southwestern United States along the Mexican border. The last significant out break occurred in 2010, when there were 46 cases reported in Key West, Florida, mostly among the residents who had not traveled. The CDC has said that it is unlikely that dengue will become endemic in the US but it is important to control mosquito populations and limit exposure to mosquito bites.
Sources for this article:
Brandeis study shows economic impact of dengue virus in Americas
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He has been discharged from the hospital and is resting at home. He hasn’t resumed blogging, yet, but he is Tweeting.