DENGUE FEVER
General Information
September 6, 2005

Dengue fever, Aden fever, bouquet fever, breakbone fever, dandy fever, solar fever /deng'ge, den'ga/, also called Aden fever, bouquet fever, breakbone fever, dandy fever, solar fever . A serious virus infection given to humans by the Aedes mosquito, it occurs in tropical and subtropical regions. The disease, which usually causes fever, rash, and severe head, back, and muscle pain, most often occurs in two phases. In the first attack, the patient has a fever, weakness, headache, sore throat, muscle pains, and swelling of the hands and feet. The second attack follows a day after these symptoms stop. It is marked by a return of fever and by a bright-red rash. The infection clears up without treatment, though it may take patients several weeks to recover. See also Aedes , arbovirus .

dengue hemorrhagic fever shock syndrome (DHFS) , an often fatal form of dengue fever. It is marked by shock with collapse, clammy arms and legs, a weak pulse, breathing problems, and the symptoms of dengue fever. Severe bleeding, bruises, small reddish spots on the skin, and bloody vomit, urine, and feces may occur. This is followed by failure of the circulatory system.

Also called BREAKBONE FEVER , OR DANDY FEVER , acute, infectious, mosquito-borne hemorrhagic fever that temporarily is completely incapacitating but is rarely fatal. Besides fever , the disease is characterized by an extreme pain in and stiffness of the joints (hence the name "breakbone fever "). Dengue is caused by a virus and may occur in any country where the carrier mosquitoes breed.

The carrier incriminated throughout most endemic areas is the yellow- fever mosquito, Aedes aegypti . The Asian tiger mosquito, A . albopictus, is another prominent carrier of the virus. A mosquito becomes infected only if it bites an infected individual (humans and perhaps also certain species of monkey) during the first three days of the victim's illness. It then requires 8 to 11 days to incubate the virus before the disease can be transmitted to another individual. Thereafter, the mosquito remains infected for life. The virus is injected into the skin of the victim in minute droplets of saliva. The spread of dengue is especially unpredictable because there are four serotypes of dengue virus. Infection with one type--though it confers lifetime immunity from reinfection with that type of dengue --does not prevent an individual from being infected by the other three types.

Diagnosis is made on clinical findings, namely, sudden onset, moderately high fever , excruciating joint pains, intense pain behind the eyes, a second rise in temperature after brief remission, and particularly the type of rash and decided reduction in neutrophilic white blood cells. There is no specific therapy; therefore attention is focused on relieving the symptoms. Temporary preventive measures must be taken to segregate suspected as well as diagnosed cases during their first three days of illness and, by screens and repellents, to keep mosquitoes from biting more people.

The potentially fatal fever is prevalent in parts of Asia, and in the late 20th century it spread to areas of South and Central America and to Cuba , Puerto Rico , and other nearby islands. Fundamental in the control of the disease is the destruction of mosquitoes and their breeding places.

plural MOSQUITOES, OR MOSQUITOS (family Culicidae), any of the familiar insects, numbering about 2,500 species, that are important in public health because of the bloodsucking habits of the females. Mosquitoes are known to transmit such serious diseases as yellow fever, malaria, filariasis, and dengue. ( See also dipteran .)

The slender, elongated body of the adult is covered with scales; in addition the mosquito is characterized by its long, fragile-looking legs and its mouthparts, which are contained in an elongated proboscis. The threadlike antennae of the male are generally bushier than those of the female. The males, and sometimes the females, feed on nectar and other plant juices. In most species, however, the females require a blood meal in order to mature their eggs, which are laid on the surface of water. Different species of mosquitoes show preferences and, in many cases, narrow restrictions as to host animals.

The eggs laid by mosquitoes hatch into aquatic larvae, or wrigglers, which swim with a jerking, wriggling movement and feed on algae and organic debris; a few are predatory and may even feed on other mosquitoes. Unlike most insects, mosquitoes in the pupal stage, called tumblers, are active and free-swimming. The pupae breathe by means of tubes on the thorax. The adults mate soon after emerging from their pupal cases. The duration of the life cycle varies greatly depending on the species.

Mosquitoes are apparently attracted to host animals by moisture, lactic acid, carbon dioxide, body heat, and movement. The mosquito's hum results from the high frequency of its wingbeats; the female's slightly lower frequency may serve as a means of sex recognition.

Measures used to control mosquitoes include the elimination of breeding sites, the application of surface films of oil to clog the breathing tubes of wrigglers, and the use of larvicides. Synthetic organic insecticides may be used to destroy adult mosquitoes indoors.

There are three important mosquito genera. Anopheles , the only known carrier of malaria, also transmits filariasis and encephalitis. Anopheles mosquitoes are easily recognized in their resting position, in which the proboscis, head, and body are held on a straight line to each other but at an angle to the surface. The spotted colouring on the wings results from coloured scales. Breeding usually occurs in water containing heavy vegetation. The female deposits her eggs singly on the water surface. Anopheles larvae lie parallel to the water surface and breathe through posterior spiracular plates on the abdomen instead of through a tube, as do most other mosquito larvae. The life cycle is from 18 days to several weeks.

The genus Culex is a carrier of viral encephalitis and, in tropical and subtropical climates, of filariasis. It holds its body parallel to the resting surface and its proboscis is bent downward relative to the surface. The wings, with scales on the veins and the margin, are uniform in colour. The tip of the female's abdomen is blunt and has retracted cerci (sensory appendages). Breeding may occur on almost any body of fresh water, including standing polluted water. The eggs, which float on the water, are joined in masses of about 100 or more. The long and slender Culex larvae have breathing tubes that contain hair tufts; they lie head downward at an angle of 45 from the water surface. The life cycle, usually 10 to 14 days, may be longer in cold weather. C. pipiens pipiens is the most abundant house mosquito in northern regions; C. pipiens quinquefasciatus is abundant in southern regions.

The genus Aedes carries yellow fever, dengue, and encephalitis. Like Culex, it holds its body parallel to the surface with the proboscis bent down. The wings are uniformly coloured. Aedes may be distinguished from Culex by its silver thorax with white markings and posterior spiracular bristles. The tip of the female's abdomen is pointed and has protruding cerci. Aedes usually breeds in floodwater, rain pools, or salt marshes, the eggs being capable of withstanding long periods of dryness. The short, stout larvae have a breathing tube containing a pair of tufts; the larvae hang head down at a 45 angle from the water surface. The life cycle may be as short as 10 days or, in cool weather, as long as several months. A. aegypti, the important carrier of yellow fever, has white bands on its legs and spots on its abdomen and thorax. This domestic species breeds in almost any kind of container, from flower pots to discarded car-tire casings. A. sollicitans, A. taeniorhynchus, and A. dorsalis are important salt-marsh mosquitoes. They are prolific breeders, strong fliers, and irritants to animals, including humans.

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Excerpted from Mosby's Medical Encyclopedia . Copyright (c) 1994-5, 1996, 1997 The Learning Company Inc. All Rights Reserved