Haitian Child

Haitian Child

Monday, December 7, 2015

Dengue Fever in Haiti

Dengue is the most common mosquito-related illness in humans. There are four serotypes of the RNA flavivirus.

In 50 to 90% of individuals the infection is asymptomatic. Some, especially children, experience a non-specific febrile illness. Classic Dengue Fever is more common in non-immune, non-indigenous adults and children.  

With classic Dengue the infection often starts with chills, a red mottling of the skin, and facial flushing, which is a sensitive and specific feature of Dengue Fever. There is a rapid onset of high fever up to 41 degrees, headache, retro-orbital pain, muscle and bone pain, weakness, vomiting, and sore throat. Dengue fever is typically a self-limiting disease with a mortality rate of less than 1%.

The rash begins on day three and lasts 2 or 3 days. The rash is macular popular or macular confluent and shows on the face, thorax, and flexor surfaces. The muscle pain is prominent in the lower back, arms, and legs. The joint pain is usually in the knees and shoulders.

A small percentage of persons who have previously been infected by one dengue serotype develop Dengue Hemorrhagic Fever (DHF) when infected with another dengue serotype. DHF typical develops 3 to 7 days after infection with a second dengue serotype. When treated, dengue hemorrhagic fever has a mortality rate of 2-5%, but when untreated, the mortality rate is as high as 50%.

Most cases are self-limited and should be treated with analgesic, hydration, and rest. The fever might last 5 to 7 days and recovery takes another 5 to 7 days.

Patients with dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after the fever resolves to look for evidence of DHF.

I performed a Google Scholar search on Dengue in Haiti. Two articles contained pertinent information.

2010 - A study of 166 children 7 to 36 months of age revealed
evidence of past infection with Dengue virus serotype 1 in 40%, serotype 2 in 12%, serotype 3 in 11%, and serotype 4 in 2%. Fifty-three percent of infants and young children less than 12 months of age had already experienced infection with a Dengue virus and by 36 months this rose to 65%.

2014 - A two-year prospective study in an outpatient clinic in LĂ©ogane found that 2% of patients presenting with undifferentiated fever tested positive for Dengue infection. Similarly, 4% of 885 patients with fever admitted to four hospitals in Haiti during 2012–2013 tested positive for Dengue.

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