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Dengue Fever Overview Dengue Fever Symptoms and Signs Causes of Dengue Fever Diagnosis of Dengue Fever Dengue Fever Treatment Self-Care at Home Dengue Fever Risk Factors Dengue Fever Complications Dengue Fever Prognosis Dengue Fever Prevention For More Information Synonyms and Keywords Author and Editor

Dengue Fever Symptoms and Signs

The symptoms and signs for dengue begin about three to 15 days after a mosquito bite transfers a virus (dengue virus serotype 1-4) to a person previously unexposed to the viruses. Fever and painful muscle and joint aches can occur during the first few hours of symptoms when headache, chills, rash, and swollen lymph nodes first appear. Pain behind the eyes is also a common symptom. These symptoms usually last about two to four days and then diminish, only to reappear again with a rash that covers the body and spares the face. The rash also may occur on the palms of the hands and the bottom of the feet, areas frequently spared in many viral and bacterial infections. The symptoms may last about one to two weeks with complete recovery, in most cases, in a few weeks. However, some people can develop more severe symptoms and complications, such as hemorrhagic areas in the skin, gums, and the gastrointestinal tract. This clinical problem is termed dengue hemorrhagic fever (DHF). The majority of DHF is seen in children under 15 years of age, but it can occur in adults. Another clinical variation of dengue fever is termed dengue shock syndrome (DSS); DHF usually precedes DSS. The patients eventually develop severe abdominal pain, heavy bleeding, and blood pressure drops; this syndrome, if not treated quickly, may cause death.

Dengue

Dengue [DEN-ghee] is a flu-like viral disease spread by the bite of infected mosquitoes. Dengue hemorrhagic fever is a severe, often fatal, complication of dengue. Dengue occurs in most tropical areas of the world. Most U.S. cases occur in travelers returning from abroad, but the dengue risk is increasing for persons living along the Texas-Mexico border and in other parts of the southern United States. There is no specific treatment for dengue.

Prevention centers on avoiding mosquito bites in areas where dengue occurs or might occur and eliminating breeding sites.

What is dengue fever? What is dengue hemorrhagic fever? Dengue fever is a flu-like illness spread by the bite of an infected mosquito. Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.

What is the infectious agent that causes dengue? Dengue and dengue hemorrhagic fever are caused by any of the dengue family of viruses. Infection with one virus does not protect a person against infection with another.

How is dengue spread? Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an infected person and then biting someone else.

Where is dengue found? Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet. The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause malaria, dengue mosquitoes bite during the day.

What are the signs and symptoms of dengue fever and dengue hemorrhagic fever? Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.

Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.

How soon after exposure do symptoms appear? The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to 6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons but can be a source of dengue virus for mosquitoes for about 6 days.

How is dengue diagnosed? Dengue is diagnosed by a blood test.

Who is at risk for dengue? Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus. Persons who were previously infected with one or more types of dengue virus are thought to be at greater risk for developing dengue hemorrhagic fever if infected again.

What is the treatment for dengue and dengue hemorrhagic fever? There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.

How common is dengue? In tropical countries around the world, dengue is one of the most common viral diseases spread to humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of thousands of cases of dengue hemorrhagic fever occur each year. In the United States, approximately 100 cases of dengue are reported each year in travelers returning from tropical areas. Many more cases probably go unreported. A few persons have

become infected with dengue while living in the United States. Aedes mosquitoes are found in Texas, Florida, and other southern states, and locally acquired dengue has been reported three times since 1980 in southern Texas.

Is dengue an emerging infectious disease? Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent epidemics, especially in cities in the tropics. The emergence of dengue as a major public health problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic levels in Central America and is threatening the United States. Several factors are contributing to the resurgence of dengue fever:

No effective mosquito control efforts are underway in most countries with dengue. Public health systems to detect and control epidemics are deteriorating around the world. Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and substandard sanitation, allowing more mosquitoes to live closer to more people. The increase in non-biodegradable plastic packaging and discarded tires is creating new breeding sites for mosquitoes. Increased jet air travel is helping people infected with dengue viruses to move easily from city to city.

Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more forms of dengue virus are at greater risk for the more severe disease. With the increase in all types of virus, the occurrence of dengue hemorrhagic fever becomes more likely.

How can dengue be prevented? There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the TexasMexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure. Avoid mosquito bites when traveling in tropical areas:

Use mosquito repellents on skin and clothing. When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks. Avoid heavily populated residential areas. When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not screened or air-conditioned. If you have symptoms of dengue, report your travel history to your doctor.

Eliminate mosquito breeding sites in areas where dengue might occur:

Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires. Regularly change the water in outdoor bird baths and pet and animal water containers.
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Medical Author: John P. Cunha, DO Medical Editor: Melissa Conrad Stppler, MD

What is dengue fever? What areas are at high risk for contracting dengue fever? How is dengue fever contracted? What are dengue fever symptoms and signs? What is the treatment for dengue fever? What is the prognosis for typical dengue fever? What is dengue hemorrhagic fever? How can dengue fever be prevented? Where can people get more information on dengue fever? Dengue Fever At A Glance Patient Discussions: Dengue Fever - Symptoms Patient Discussions: Dengue Fever - Describe Your Experience

Dengue Fever Symptoms and Signs

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen. Learn more about dengue fever symptoms and signs

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Picture of the typical dengue fever rash.

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles. Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed. Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait. Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.
What areas are at high risk for contracting dengue fever?

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to the areas of the world that harbor malaria and yellow

fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia. A 2009 outbreak of dengue fever in Key West, Fla., showed that three patients who did not travel outside of the U.S. contracted the virus. Subsequent testing of the population of Key West has shown that up to 55 of the people living in the area have antibodies to dengue. As of July 17, 2010, 17 individuals have been identified that acquired dengue in Key West in 2010. Dengue fever is common, and statistics show it may be increasing in Southeast Asia. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases. According to the U.S. Centers for Disease Control and Prevention (CDC), there are an estimated 100 million cases of dengue fever with several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue.
How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease. The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person