Dengue

“ Although toward the end of the last century dengue once prevailed epidemically in the temperate zone, at Philadelphia, it must nevertheless be considered as a disease especially at home in the tropical and semi-tropical regions, where it prefers to haunt low lands, particularly along the sea-coast, leaving almost untouched more elevated places. ”

“ In these experiments, Culex fatigans, a common tropical or subtropical mosquito, was used. The same parasite that is found in the human blood may be found in the stomach and blood of the mosquitoes up to the fifth day after it has fed on a dengue patient.
Sick and healthy individuals were allowed to remain in close contact in a room from which the mosquitoes had been excluded, and the disease was not spread. Mosquitoes that had bitten dengue patients were taken to a higher region where dengue had never occurred and allowed to bite two healthy persons. ”

“ Some writers state that the gravity of any given case is in direct proportion to the abundance of the eruption; others deny this. In Europeans an attack of dengue very often leads to a condition of debility necessitating temporary change of climate, or even return to Europe. In both Europeans and natives the attendant lowering of the resisting powers predisposes to other and more dangerous diseases, such as malaria, dysentery, phthisis, and so forth; consequently dengue, otherwise a benign disease, may become a source of public danger. ”

“ But, leaving aside its origin, it is authentically known that wherever dengue has appeared it has almost always been in the form of an epidemic, spreading from place to place and from family to family, without respect to race or nationality, to age, occupation or position, until every one susceptible to the disease was affected. Slaughter reports from India that even domestic animals, especially dogs and cats, were not exempt, as they appeared to suffer from rheumatoid affections of the joints. ”

“ Graham describes an intracorpuscular amœba, resembling Babesia bigemina, which he states he found in great profusion in the blood of dengue patients in Beyrout, Syria. He maintains that his experiments tend to show that, like yellow fever, dengue is communicated by a mosquito, Culex fatigans. Acting on this hypothesis he was able to protect families from dengue by means of mosquito nets. Ross is said to have extinguished the yearly epidemics in Port Said by anti-mosquito measures. ”

“ An attack produces quite an immunity.
The disease has chiefly been studied in the Balkan States but undoubtedly it is widespread.
The disease is almost never fatal so that we know nothing of its pathology.
Symptomatology.—The symptoms will answer perfectly for cases of dengue one sees in a dengue epidemic in which, instead of the saddle-back course of fever, we have a three-day primary rise and then a fall to normal without any secondary fever rise. Cases of phlebotomus fever are occasionally reported where the fever continues seven or eight days. ”

“ In 1872 it was so prevalent in Calcutta that among those in the service of the E. I. Railway Company, European and native, prior to August in that year, 70 per cent. had suffered from {305b}the disease; and whole households were sometimes attacked at once. It became endemic in Lower Bengal for several seasons. When the present writer (H. Y.) left India (in 1862) the name dengue may have been known to medical men, but it was quite unknown to the lay European public.
1885.—The Contagion of Dengue Fever. ”

“ If the soil of China is peculiar in one way, that of the West Coast of Africa is peculiar in another. Without entering on the large question of “malaria” in each of them, I shall take an old illustration of the miasmata of the West Coast of Africa as a [Pg 424] cause of dengue-fever, a disease curiously like influenza in its symptoms, and like it also in its occasional wave-like dispersion over wide regions. ”

“ In female patients an attack of dengue not unfrequently causes the reappearance of the menstrual flow, while the pains attending the disease equally predispose to premature labor in pregnant women.
In severe cases of dengue the prostration following upon the subsidence of the fever is very great, for the patient is affected with a general weakness both of body and mind, indicating a great loss of nervous energy. ”

“ As a rule, elevated places enjoy a relative immunity; if the disease is introduced into such localities, it does not spread. To this, again, there are exceptions, for the Syrian epidemic referred to prevailed in certain spots 4,000 to 5,000 ft. above the sea. In the Mediterranean basin dengue is a disease of autumn months and generally follows the summer outbreak of phlebotomus fever. ”

“ In the later stages haemorrhages into the skin (petechiae) are common.
Trypanosomiasis.—Patchy areas of erythema are often noted in Europeans affected with this disease. These are frequently circinate with fading in the center and tend to appear on the trunk.
In natives a dry skin is more often noted.
Rat Bite Disease.—An eruption of purplish spots may accompany the fever. There is a resemblance to erythema multiforme.
Dengue.—The true eruption of dengue is the one that appears about the fourth or fifth day as a measles-like eruption, starting about wrists or ankles. ”

“ Treatment.— Were it possible to secure perfect isolation for the individual during an epidemic of dengue, doubtless he would escape the disease. Even comparative isolation is attended with diminished liability. In Amoy, in the epidemic of 1872, those foreigners who lived in a more or less isolated suburban situation were very much less affected than were those who lived in the native town, or than those whose occupations threw them much into contact with the natives. ”

“ Specially delicate individuals, particularly the subjects of tubercular or renal disease, should be isolated, or, better, should leave for a time the epidemic locality.
Like the allied fevers, dengue runs a definite course; therefore it is useless to attempt to cut it short. The patient should go to bed so soon as he feels ill, and he should keep his room till the terminal eruption has quite disappeared and he feels well again. Ten days is not too long to allow in severe attacks. ”

“ Cause.—The organism of dengue fever is unknown, but the infection has been proved to be carried by at least one species of mosquito.
Symptoms.—The incubation period varies from about five to ten days. The onset is very sudden, the temperature rising rapidly. Within an hour or two an initial rash appears, which varies in appearance and is transient. The patient suffers from severe headache and pain in the joints and back. Indeed, the condition closely resembles a sharp attack of influenza, but, as a rule, there are no signs of coryza. The eyes are very painful and insomnia is present. ”

“ Desquamation is very rare; a point which, together with the absence of an eruption, serves to differentiate this fever from dengue, a disease resembling it in many respects. The mortality is nil in the healthy. ”

“ Similar stories, illustrative of the sudden incidence of the symptoms, circulate during every epidemic of dengue. Sometimes the fever is ushered in by a feeling of chilliness or even by a smart rigor; sometimes a deep flushing of the face is the first sign of the disease.
However introduced, fever rapidly increases. The head and eyeballs ache excessively, and some limb or joint, or even the whole body, is racked with peculiar stiff, rheumatic-like pains, which, as the patient soon discovers, are very much aggravated by movement. ”

“ Of the winged pests Mosquitoes are undoubtedly the most important in the tropics, as they are known to transmit such diseases as malaria, yellow fever, dengue fever and filariasis. The anopheline mosquitoes are those responsible for transmitting malaria, and they can easily be recognized by the facts that their wings are usually spotted and that they appear as it were to stand on their heads when resting on any flat surface. ”

“ Then, a man who has once had a bad attack of malaria has it for life.
And almost all this fever is malarial.
Cholera destroys life, but does no more.
Fever destroys the life of the country; saps the world in which it is.
Look at the Burdwan fever; look at the Dengue fever.
'Dengue' is rarely fatal, but in its districts 'Dengue' is master, and 60 or 70 out of every 100 are 'down' with it!
Irrigation.Irrigation is essential in many parts of India, but irrigation with stagnant water is almost as injurious to crops as to health. ”

“ Pathology.—Yellow fever, dengue and phlebotomus fever have several important points in common, a circumstance suggestive of the possibility of a common or, at all events, a similar origin. Each is transmitted by an insect; their germs occur in the blood-stream and are ultramicroscopic; they are diseases of warm climates only; and, clinically, they are characterized by a short incubation period, a short and rapidly developed fever which is usually associated with relatively slow pulse and leucopenia, with relative decrease of the polynuclears. ”

“ Aedes (Stegomyia) albopictus (Skuse, 1895) is nowadays the most notorious invasive Culicidae. From its native range in Asia, the species has spread throughout the Americas, Europe and Africa, mainly via international trade in used tires [1] . Its capacity to transmit a large number of arboviruses is well documented. Although less efficient than Aedes aegypti for the dengue viruses transmission, it was responsible for large dengue epidemics in Japan in 1942–1945 [2] , for the DEN-1 outbreak in Hawaii in 2001 [3] and for the DEN-2 outbreaks in La Reunion in 1977–78 and 2004 [4] , [5] . ”

“ Patients develop a mild dengue-like syndrome, including fever, headache, rash, arthralgia and conjunctivitis. This clinical similarity with other, more commonly diagnosed arboviral infections such as chikungunya (CHIKV) and dengue (DENV) , might delay the diagnosis and/or lead to underestimation of ZIKV infections.
Here, we report the first direct evidence of ZIKV epidemic activity in Central Africa, and its occurrence in an urban environment during concomitant CHIKV/DENV outbreaks in Libreville, the capital of Gabon, in 2007. ”

“ However this may be, the essential symptoms in well-marked cases are the same practically everywhere, and in all epidemics; these are, suddenness of the rise of temperature, an initial stage of skin congestion, limb and joint pains, and a terminal rubeoloid eruption.
Relapses are not uncommon in dengue, and second and even third attacks during the same epidemic have been recorded. As a rule, however, susceptibility to the disease is exhausted by one attack. According to Hare, in a recent Australian epidemic the immunity acquired by an attack did not persist beyond one year. ”

“ Instead, nowadays, parasitic organisms are blamed for most of the aches and pains of humanity, while their distributors are searched for in the realm of insects and animals. The mosquito has, perhaps, fallen a prey to her own weakness. Had she talked less, it is possible that she might have evaded her doubtful celebrity. As it is, she stands accused of being concerned with a no less formidable array of maladies than elephantiasis, yellow fever, dengue, and malaria. ”

“ The earliest epidemic of which anything is known occurred in 1779-1780 in Egypt and the East Indies. The chief epidemics have been those of 1824-1826 in India, and in the West Indies and the southern states of North America, of 1870-1875, extending practically over the whole of the tropical portions of the East and reaching as far as China. In 1888 and 1889 a great outbreak spread along the shores of the Aegean and over nearly the whole of Asia Minor. Perhaps “dengue” is most nearly endemic in equatorial East Africa and in the West Indies. ”

“ Since Aedes spp. has very limited spatial dispersal, overlapping high population densities of mosquitoes and humans would be needed to sustain a focus of infection. However, as A. aegypti is distinctly anthropophilic, future control strategies for Zika should be considered in tandem with the continuing threat to human wellbeing that is presented by dengue, yellow fever and Japanese encephalitis, all of which are transmitted by the same vector species. ”

“ Elephantiasis is caused by worm-like parasites transmitted through the bites of certain mosquitoes of the genus Culex in the East and West Indies. Dengue fever and malta fever are probably disseminated by mosquitoes.
It is thought that the germs of leprosy are transmitted by the bites of mosquitoes, flies, fleas, lice, mites or bedbugs. Dr. Patton, of the Indian Medical Service, has demonstrated that the fatal and infectious tropical disease called "kala-azar" is transmitted by the bites of the Indian bedbug, Cimex rotundatus. ”

“ Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban environments; manifests as sudden onset of fever and severe headache; occasionally produces shock and hemorrhage leading to death in 5% of cases. Yellow fever - mosquito-borne viral disease; severity ranges from influenza-like symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South America and sub-Saharan Africa, where most cases are reported; fatality rate is less than 20%. Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease associated with rural areas in Asia ”

“ In tropical work we combine the large mononuclears and transitionals in a differential count. They are the phagocytes of animal cells or parasites. The disease in which their increase is best recognized is malaria and an increase to 15% where the blood shows moderate leucopenia is very significant. The melaniferous leucocytes of malaria are cells of this type.
Other protozoal infections, as kala-azar, trypanosomiasis and amoebiasis cause it. Filterable-virus diseases may show a mononuclear increase, thus yellow fever and dengue both give an increase about the fifth or sixth day. ”