Dengue fever and rheumatic disease 4/5 (1)

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Dengue fever (A90) ("Breakbone fever")

Definition

Dengue fever is a tropical disease caused by dengue virus (ARBO virus, a flavivirus).

  • Rheumatic pain ("breakbone fever") may be part of the disease picture

Contamination

Transferring via mosquito. Four types.

Occurrence

Dengue fever is a frequent cause of infant mortality in Asia, especially Thailand and South America, are also found in the Caribbean (Cuba) and south of the United States. Increased sharply since the 1960 years: Between 50 and 528 million are infected annually. Most frequent virus scams as tourists import from the tropics!

Incubation time (from infection to symptom)

From infection to symptom: 2 - 10 days

Symptoms

Over 90% are without symptoms or as flu-like for approx. one week

  • Less than 10% gets high fever:
    • 1. stage 1-2 days of high fever, sweating redness of the face
      • Strong rheumatic joint pain in spinal column, arms and legs ("breakbone fever")
      • Bradycardia (slow pulse)
      • Headache most behind eyes, sore throat, fatigue
      • Bitter metal taste in the mouth
      • Viral Myositis may occur
    • 2. Stage (after 4-5 days)
    • 3. stage after 5-6 days recovery that lasts for months. Some get prolonged (several months) lethargy and experience transient hair loss
  • Second-time infection
    • For example, occurs in previously infected immigrants who have been home on holiday
    • Fever first days. When the fever goes back, bleeding occurs in the skin and severe stomach bleeding

Rheumatic symptoms

  • Strong joint pain in vertebral column, arms and legs ("breakbone fever")

Complications

  • Children in particular can have superinfection with different dengue virus species
  • 2% get bleeding with too low platelet count
  • Meningoencephalitis (inflammation of the brain)
  • Transient visual disturbances in the eyesight (retina)

Differential Diagnoses / Similar Diseases

Diagnosis

History and investigation findings

  • Blood tests
    • Slight leukopenia (low white blood cell count)
    • Relative lymphocytosis (increased number of white blood cells)
    • Thrombocytopenia (low platelet count)
    • Transaminases (liver enzymes)
    • Viral RNA
    • Antibodies
    • Quick Tests
  • Stasis test: Blood pressure cuff clamps around the upper arm for 2 minutes (pumped up between systolic and diastolic blood pressure): Many small bleeds (petechiae) below the cuff (more than 10 x Petechia per square inch)

Treatment

  • Symptomatic, fluid intravenously
  • Blood transfusion in severe cases
  • Not aspirin (ASA) due to bleeding risk

Prognosis

  • Good life expectancy at first infection
  • Immunity lasts for a few months and no cross-immunity to other species
  • Next infection is more severe
    • 20% mortality if untreated
    • Children have the worst prognosis

Prevention

Avoid mosquito, air conditioning. It is being researched on vaccines, but they are not available yet (per 2017)

Literature

Tropic diseases, BINDEVEVSSYKDOMMER.no


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