Dengue fever

Abstract

Dengue fever, also known as breakbone fever, is a mosquito-borne, virus disease characterized by fever, headache, myalgia, and arthralgia, and often an exanthem. Epidemics of dengue-like illness have been recognized for more than 200 years and were common in Asia, along the Atlantic and Gulf coasts of the United States, and the Caribbean until the first half of this century. 1,2 During World War II, thousands of soldiers contracted dengue fever in the Pacific and Asia. 3 A more severe clinical form of dengue infection, dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), was first recognized in the Philippines in 1954 and subsequently spread throughout Southeast Asia. 4,5 DHF/DSS is currently a major cause of morbidity and, without appropriate treatment, mortality in children in tropical Asia and is occurring with increasing frequency in the Western Hemisphere. 6 The etiologic agents of dengue fever are four serologically related RNA viruses, dengue 1,2,3 and 4, that belong the the family Flaviviridae. This virus group also includes yellow fever, St. Louis encephalitis, and Japanese encephalitis viruses. The principal mosquito vector of dengue and urban yellow fever is Aedes aegypti. This species breeds in water that has collected in natural and artificial containers around human habitations. Diminished mosquito control efforts in the Western Hemisphere over the past two decades have resulted in increased distribution of this mosquito vector in the region. Ae. aegypti is found throughout the southeastern United States. Another important mosquito vecter of dengue, Aedes albopictus, has recently become established in this country through the importation of tires from Asia. 7 Dengue fever currently occurs in tropical and subtropical zones in the Caribbean, Mexico, central and South America, Africa, Asia, and the Pacific. Cases of dengue-like illness in travelers returning to the United States from these areas are reported each year. 8 In 1986, 33 serologically confirmed cases were reported from 10 states and the District of Columbia. 9 In areas where potential mosquito vectors of dengue are present, introduction of the virus may result in secondary transmission. Indigenous transmission of dengue was documented in Texas during 1986 for the second time in 6 years. 9