Dengue in Panama

Dengue is an infectious disease carried by the anopheles mosquito. A case of Dengue may be mild or very severe with a high fever and shakes, thus the nick name “breakbone fever.” A possible, sometimes fatal, late complication of Dengue is Dengue hemorrhagic fever (DHF). Dengue is present throughout the tropics including Panama.No Vaccination, No Curative TreatmentThere is no vaccination for Dengue and there is no specific curative treatment. Patients, especially children, should use acetaminophen (Tylenol) and not aspirin, advil (ibuprofen), or other anti inflammatory agents for fever with Dengue to avoid Reye’s syndrome, an inflammation of the brain and liver.Treatment is supportive, namely acetaminophen and fluids. Most cases are very mild. Severe cases require hospitalization.

Prevention

The best treatment is prevention. The following advice is copied from the Centers for Disease Control (CDC) website.

“The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels.  Look for standing water indoors such as in vases with fresh flowers and clean at least once a week.

“The adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect yourself, use repellent on your skin while indoors or out. When possible, wear long sleeves and pants for additional protection.   Also, make sure window and door screens are secure and without holes. If available, use air-conditioning.

“If someone in your house is ill with dengue, take extra precautions to prevent mosquitoes from biting the patient and going on to bite others in the household.  Sleep under a mosquito bed net, eliminate mosquitoes you find indoors and wear repellent!”

The best and most effective repellants have at least 70 percent DEET.

Symtoms and Signs

A person with classical Dengue will have a high fever and as least two of the following:

•    Severe eye pain
•    Joint pain
•    Muscle of bone pain
•    Rash
•    Mild bleeding manifestations (gums bleed, pin point rash called petechiae, easy bruising)

Definitive diagnosis is by a blood test called a serology. There are four possible types or serotypes of Dengue so, even if you had it before somewhere else, you can get it again if the local type or serotype is different from that to which you have developed immunity.

Treatment

During a mild to moderate case of Dengue it is important to treat fever with acetaminophen and not aspirin and take lots of fluids. A typical case will last a week or so. A rule of thumb is that if you still have a fever after two weeks it is not Dengue.

Complication

If one is to develop the severe late manifestation, Dengue hemorrhagic fever (DHF), it will come on as one’s temperature is coming down at three to seven days after onset.

Go immediately to an emergency room if any of the following develop:

•    Severe abdominal pain or persistent vomiting
•    Red spots or patches on the skin
•    Bleeding from nose or gums
•    Vomiting blood
•    Black, tarry stools (feces, excrement)
•    Drowsiness or irritability
•    Pale, cold, or clammy skin
•    Difficulty breathing

The defining property of DHF is that the capillaries or smallest blood vessels leak fluid which can lead the patient into shock. Treatment requires hospitalization with close observation and intravenous fluids as well as other supportive measures.

Notes:

1)    Panama has excellent reference laboratory facilities so it is unlikely that a blood sample would need to be sent out of the country.

2)    It is probably safer to treat Dengue in Panama where the disease is more common than in the United States and Canada where it is comparatively rare.

3)    Dengue is the most prevalent mosquito-borne viral disease in people surpassing malaria and yellow fever. The World Health Organization (WHO) estimates that there are around 50 million cases of Dengue each year, the vast majority of which are mild febrile illnesses and never come to medical attention. WHO estimates that 250,000 to 500,000 people each year contract more severe disease.

4)    Dengue was confined to South Asia until troop and materiel movement during World War II carried infected mosquitoes throughout the world.

Information for this article was gathered from the World Health Organization and Communicable Disease Centers websites.