$Unique_ID{BRK03651} $Pretitle{} $Title{Dengue Fever} $Subject{Dengue Fever Breakbone Fever Dandy Fever Duengero Seven Day Fever Dengue Hemorrhagic Fever Dengue Shock Syndrome Colorado Tick Fever Typhus (Typhoid Fever) Yellow Fever Other Hemorrhagic Fevers} $Volume{} $Log{} Copyright (C) 1988, 1989 National Organization for Rare Disorders, Inc. 514: Dengue Fever ** IMPORTANT ** It is possible the main title of the article (Dengue Fever) is not the name you expected. Please check the SYNONYMS listing on the next page to find alternate names and disorder subdivisions covered by this article. Synonyms Breakbone Fever Dandy Fever Duengero Seven Day Fever Includes: Dengue Hemorrhagic Fever Dengue Shock Syndrome Information on the following disorders can be found in the Related Disorders section of this report: Colorado Tick Fever Typhus (Typhoid Fever) Yellow Fever Other Hemorrhagic Fevers General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Dengue Fever is an acute viral infection characterized by fever. It is caused by a bite from mosquitoes carrying dengue virus. The primary form of Dengue Fever is characterized by a skin rash and a high fever with severe pain in the head and muscles. The secondary forms of this disorder are called Dengue Hemorrhagic Fever and Dengue Shock Syndrome. These usually are caused by a secondary infection with a different type of Dengue virus (Type 2), but may also be caused by the same virus that causes Dengue Fever. Several days after onset fever, bleeding under the skin and in the intestines occurs. A marked fall in blood pressure (shock) occurs in very severe cases. Symptoms Dengue Fever is a disorder transmitted by mosquitoes carrying dengue virus. The disorder is characterized by a sudden onset of symptoms. There is an incubation period of 5 to 8 days after the mosquito bite occurs. The patient has chills or chilly sensations, with a fever. Pain behind the eyeballs (postorbital) occurs on moving the head. The head, lower back, legs and joints ache. The patient feels very weak. The temperature rises rapidly, sometimes to as high as 40C or 104F, accompanied by a relatively slow heart beat (bradycardia) and abnormally low blood pressure. The lymph glands in the neck, shoulder, and groin are usually enlarged. Two or three days after the first fever, a rash of flat or elevated (maculopapular) spots appears, particularly on the face. A second temperature rise follows. The presence of Dengue virus in the blood (viremia) can confirm the diagnosis. The patient subsequently develops immunity against this type of Dengue virus. However, reinfection with a different type of this virus is possible. Secondary forms of Dengue Fever are Dengue Hemorrhagic Fever, and Dengue Shock Syndrome. These forms of the disorder primarily affect children between 3 and 6 years of age who have been infected a second time with dengue virus, and infants 7 to 8 months of age. These forms of the disorder are characterized by sudden fever, headache, nausea, vomiting, and abdominal pain. Coughing, throat infection and difficulty in breathing also occur. Shock may occur 2 to 6 days after the beginning of the fever, with sudden collapse, cool clammy extremities (the trunk is often warm), a weak pulse, and bluish discoloration of the skin around the mouth (cyanosis). In serious cases, a tendency to bleed excessively occurs, either as purpura or in pinpoint spots (petecchiae). The bleeding may appear in many parts of the body. Blood vessels become dilated and congested, and swelling (edema) may also occur. Gastrointestinal bleeding may lead to vomiting of blood (hematemesis) and passing of dark stools stained with blood pigment (melena). Causes Dengue Fever is transmitted by a mosquito infected with a Dengue virus. These viruses belong to a group of 4 B arboviruses (flaviviruses). Affected Population Dengue Fever occurs mainly in subtropical or tropical climates including southern Asia, South America (particularly Brazil), and the Caribbean including Puerto Rico and the U.S. Virgin Islands. The virus has also been imported into the U.S. by tourists from these areas. Dengue Hemorrhagic Fever, and Dengue Shock Syndrome usually occur in children between 3 and 6 years of age. Infants between 7 and 8 months of age may also develop these conditions even after receiving antibodies for Dengue Fever prenatally from a previously infected mother. The afflicted infants do not have antibodies to the Dengue Type 2 virus. Related Disorders The Dengue virus is a B Arbovirus which has 4 distinct serogroups. Colorado Tick Fever (Mountain Fever; Mountain Tick Fever) is a virus infection transmitted by ticks which is prevalent in the western United States. Fever, headaches, muscle aches, and generalized discomfort characterize the illness, which resolves spontaneously. (For more information on this disorder, choose "Colorado Tick Fever" as your search term in the Rare Disease Database.) Epidemic Typhus (European Typhus; Classic Typhus; Louse-Born Typhus; Jail Fever) is a severe infectious disorder which begins suddenly and is characterized by prolonged high fever, persistent headache, and a rash of elevated spots on the skin. Epidemic Typhus is caused by Rickettsia prowazekii, an organism that resembles viruses and bacteria. This disorder can be transmitted by lice. Yellow Fever is an arbovirus infection characterized by sudden onset and variable severity of symptoms. The disorder is characterized by a fever of 102 degrees to 104 F (39 degrees to 40 C), and an abnormally slow heart beat. In a few severe cases, excessive amounts of protein are present in the urine. In these few cases a yellow skin color (jaundice), bleeding and coughing up blood also tend to occur. The virus which causes Yellow Fever is transmitted by the bite of a mosquito. (For more information on this disorder, choose "Yellow Fever" as your search term in the Rare Disease Database.) Other Hemorrhagic Fevers which are characterized by internal bleeding are caused by a variety of viruses. Some of these fevers that occur in Africa and South America are: Lassa Fever, Machupo Fever (Bolivian Hemorrhagic Fever), Junin Fever (Argentinian Hemorrhagic Fever), Lymphocytic Choriomeningitis, Marburg Virus (Hemorrhagic Fever), and, Ebola Virus (Hemorrhagic Fever). Blood tests may be used to identify the virus. Therapies: Standard Dengue Fever is diagnosed by testing a blood sample for presence of the Dengue virus or its antibodies. However, a different type of the Dengue virus might cause a second infection. Aspirin and codeine may be prescribed for severe headache and muscle pain. Complete bedrest is important. Patients should take measures to avoid additional mosquito bites in order to prevent reinfection. Fluids should be given to compensate for dehydration. Treatment for Dengue Hemorrhagic Fever depends on the patient's degree of dehydration. Patients should be closely monitored to prevent shock. When skin appears bluish in color, oxygen should be given. Collapse of blood vessels and loss of fluid from the circulation (hemoconcentration) require immediate fluid replacement, preferably with a solution like Ringer's lactate. Plasma or human serum protein (albumin) should also be given if there is no response in the first hour. Fresh blood or blood platelet transfusions may control bleeding. Agitated patients may be given paraldehyde, chloral hydrate, or diazepam. Therapies: Investigational Scientists have studied the effect of human interferon on Hemorrhagic Dengue Fever. More research is needed before this drug will be available for more general use in treating Dengue Fever. Additionally, scientists are trying to develop a vaccine which may someday prevent this infectious disorder. This disease entry is based upon medical information available through June 1988. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Dengue Fever, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 Centers for Disease Control (CDC) Office of Public Inquiries 1600 Clifton Road NE Atlanta, GA 30333 (404) 329-5354 NIH/National Institute of Allergy and Infections Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 References DENGUE FEVER IN THE UNITED STATES. A REPORT OF A CLUSTER OF IMPORTED CASES AND REVIEW OF THE CLINICAL, EPIDEMIOLOGIC, AND PUBLIC HEALTH ASPECTS OF THE DISEASE: M.D. Malison, et al.; JAMA (January 28, 1983: issue 249(4)). Pp. 496-500. DENGUE VIRUS TYPE 2 VACCINE: REACTOGENICITY AND IMMUNOGENICITY IN SOLDIERS: W.H. Bancroft, et al.; Journal Infect Dis (June 1984: issue 149(6)). Pp. 1005-1010. DENGUE AND HEPATIC FAILURE: M.E. Alvarez, et al.; American Journal Med (November 1985: issue 79(5)). Pp. 670-674. EFFECT OF INTERFERONS ON DENGUE VIRUS MULTIPLICATION IN CULTURED MONOCYTES/MACROPHAGES: H. Hotta, et al.; Biken Journal (December 1984: issue 27(4)). Pp. 189-193.