Dengue Fever Dengue is a mosquito-borne infection which in recent years has become a major international public health concern.

Caused by any of four related dengue viruses, this disease used to be called break-bone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Dengue (DF) and dengue hemorrhagic fever (DHF) are caused by one of four closely related, but antigenically distinct, virus serotypes (DEN-1, DEN-2, DEN-3 and DEN-4), of the genus Flavivirus. Infection with one of these serotypes provides immunity to only that serotype for life, so persons living in a dengue-endemic area can have more than one dengue infection during their lifetime. Infections produce a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal hemorrhagic disease. Dengue is found in tropical and sub-tropical regions around the world, predominately in urban and peri-urban areas. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized during the 1950s and is today a leading cause of childhood mortality in several Asian countries. There are four distinct, but closely related, viruses which cause dengue. Recovery from infection by one provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. Indeed, there is good evidence that sequential infection increases the risk of more serious disease resulting in DHF.

Transmission of Dengue Virus by Aedes aegypti

Transmission The transmission cycle of dengue virus by the mosquito Aedes aegypti begins with a dengue-infected person. This person will have virus circulating in the blooda viremia that lasts for about five days. During the viremic period, an uninfected female Aedes aegypti mosquito bites the person and ingests blood that contains dengue virus. Although there is some evidence of transovarial transmission of dengue virus in Aedes aegypti, usually mosquitoes are only infected by biting a viremic person. Then, within the mosquito, the virus replicates during an extrinsic incubation period of eight to twelve days. The mosquito then bites a susceptible person and transmits the virus to him or her, as well as to every other susceptible person the mosquito bites for the rest of its lifetime. The virus then replicates in the second person and produces symptoms. The symptoms begin to appear an average of four to seven days after the mosquito bitethis is the intrinsic incubation period, within humans. While the intrinsic incubation period averages from four to seven days, it can range from three to 14 days. The viremia begins slightly before the onset of symptoms. Symptoms caused by dengue infection may last three to 10 days, with an average of five days, after the onset of symptomsso the illness persists several days after the viremia has ended.

Replication and Transmission of Dengue Virus

1. The virus is inoculated into humans with the mosquito saliva.

2. The virus localizes and replicates in various target organs, for example, local lymph nodes and the liver. 3. The virus is then released from these tissues and spreads through the blood to infect white blood cells and other lymphatic tissues. 4. The virus is then released from these tissues and circulates in the blood. 5. The mosquito ingests blood containing the virus. 6. The virus replicates in the mosquito midgut, the ovaries, nerve tissue and fat body. It then escapes into the body cavity, and later infects the salivary glands. 7. The virus replicates in the salivary glands and when the mosquito bites another human, the cycle continues.

Characteristics Dengue fever is a severe, flu-like illness that affects infants, young children and adults but rarely causes death. The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a nonspecific febrile illness with rash. Older children and adults may have either a mild febrile syndrome or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue haemorrhagic fever is a potentially deadly complication that is characterized by high fever, haemorrhagic phenomenaoften with enlargement of the liverand in severe cases, circulatory failure. The illness commonly begins with a sudden rise in temperature accompanied by facial flush and other non-specific constitutional symptoms of dengue fever. The fever usually continues for 2-7 days and can be as high as 40-41 C, possibly with febrile convulsions and haemorrhagic phenomena. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 1224 hours, or quickly recover following appropriate volume replacement therapy.