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Dengue is spread by several species of mosquito of the Aedes type, principally A. aegypti.[1] The virus has five different types;[7][8] infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others.[1] Subsequent infection with a different type increases the risk of severe complications.[1] A number of tests are available to confirm the diagnosis including detecting antibodies to the virus or its RNA.[2]
A novel vaccine for dengue fever has been approved and is commercially available in a number of countries.[4] Other methods of prevention are by reducing mosquito habitat and limiting exposure to bites.[1] This may be done by getting rid of or covering standing water and wearing clothing that covers much of the body.[1] Treatment of acute dengue is supportive and includes giving fluid either by mouth or intravenously for mild or moderate disease.[2] For more severe cases blood transfusion may be required.[2] About half a million people require admission to hospital a year.[1] Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should not be used.[2]
Dengue has become a global problem since the Second World War and is common in more than 110 countries.[9][10] Each year between 50 and 528 million people are infected and approximately 10,000 to 20,000 die.[11][5][6][12] The earliest descriptions of an outbreak date from 1779.[10] Its viral cause and spread were understood by the early 20th century.[13] Apart from eliminating the mosquitoes, work is ongoing for medication targeted directly at the virus.[14] It is classified as a neglected tropical disease.[15]
Signs and symptoms
Schematic depiction of the symptoms of dengue fever
Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as an uncomplicated fever.[11][16][17] Others have more severe illness (5%), and in a small proportion it is life-threatening.[11][17] The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days.[18] Therefore, travelers returning from endemic areas are unlikely to have dengue if fever or other symptoms start more than 14 days after arriving home.[9] Children often experience symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea)[19] and have a greater risk of severe complications,[9][20] though initial symptoms are generally mild but include high fever.[20]
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Clinical course
Clinical course of dengue fever[21]
The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, and a rash. The alternative name for dengue, "breakbone fever", comes from the associated muscle and joint pains.[11][22] The course of infection is divided into three phases: febrile, critical, and recovery.[21]
The febrile phase involves high fever, potentially over 40 °C (104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days.[21][22] Nausea and vomiting may also occur.[20] A rash occurs in 50–80% of those with symptoms[22][23] in the first or second day of symptoms as flushed skin, or later in the course of illness (days 4–7), as a measles-like rash.[23][24] A rash described as "islands of white in a sea of red" has also been observed.[25] Some petechiae (small red spots that do not disappear when the skin is pressed, which are caused by broken capillaries) can appear at this point,[21] as may some mild bleeding from the mucous membranes of the mouth and nose
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