Tropical Diseases: Dengue, Leptospirosis, Malaria Dengue Fever, Dengue Hemmorhagic Fever 1. 2. 3. 4. 5.

Describe chain of transmission of arthropod-borne viruses Describe the clinical syndrome associated with arthropod-borne viruses Characterize dengue virus Discuss usual clinical course Differentiate clinical features Dengue fever Dengue hemorrhagic fever Dengue shock syndrome

6. Discuss supportive measures necessary in the care of dengue patient 7. Advocate proper preventive measure against dengue

8. Dengue Fever 9. All four distinct dengue viruses (dengue 14) have Aedes aegypti as their principal vector, and all cause a similar clinical syndrome. In rare cases, second infection with a serotype of dengue virus different from that involved in the primary infection leads to dengue HF with severe shock (see below). Sporadic cases are seen in the settings of endemic transmission and epidemic disease. Year-round transmission between latitudes 25N and 25S has been established, and seasonal forays of the viruses to points as far north as Philadelphia are thought to have taken place in the United States. Dengue fever is seen in the Caribbean region, including Puerto Rico. With increasing spread of the vector mosquito throughout the tropics and subtropics, large areas of the world have become vulnerable to the introduction of dengue viruses, particularly through air travel by infected humans, and both dengue fever and the related dengue HF are becoming increasingly common. Conditions favorable to dengue transmission exist in Hawaii and the southern United States, and bursts of dengue fever activity are to be expected in this region, particularly along the Mexican border, where water may be stored in containers and A. aegypti numbers may therefore be greatest. This mosquito, which is also an efficient vector of the yellow fever and chikungunya viruses, typically breeds near human habitation, using relatively fresh water from sources such as water jars, vases, discarded containers, coconut husks, and old tires. A. aegypti usually inhabits dwellings and bites during the day. Closed habitations with air-conditioning inhibit transmission of many arboviruses, as has been particularly well illustrated by studies along the Texas-Mexico border. Aedes albopictus has now extended its range from Asia to the United States, the Indian Ocean, and parts of Europe. For example, A. albopictus has transmitted dengue virus in Hawaii, chikungunya virus in Italy, and chikungunya virus in the Indian Ocean (see below). 10. After an incubation period of 27 days, the typical patient experiences the sudden onset of fever, headache, retroorbital pain, and back pain along with the severe myalgia that gave rise to the colloquial designation "break-bone fever." There is often a macular rash on the first day as well as adenopathy, palatal vesicles, and scleral injection. The illness may last a week, with additional symptoms usually including anorexia, nausea or vomiting, marked cutaneous hypersensitivity, andnear the time of defervescencea

maculopapular rash beginning on the trunk and spreading to the extremities and the face. Epistaxis and scattered petechiae are often noted in uncomplicated dengue, and preexisting gastrointestinal lesions may bleed during the acute illness. 11. Laboratory findings include leukopenia, thrombocytopenia, and, in many cases, serum aminotransferase elevations. The diagnosis is made by IgM ELISA or paired serology during recovery or by antigen-detection ELISA or RT-PCR during the acute phase. Virus is readily isolated from blood in the acute phase if mosquito inoculation or mosquito cell culture is used.