question,” he said. “We’re warming up some, and with warmth comes damp air and mosquitoes.”
Mosquitoes transmit dengue, and the only way to prevent infection is to avoid mosquito bites. According to the Centers for Disease Control and Preven- tion (CDC), the virus infects up to 400
million people annually, and it is the leading cause of illness and death in the tropics and subtropics. But the disease is also spreading in
Texas. According to the Texas Depart- ment of State Health Services (DSHS), 23 Texas patients acquired dengue lo- cally in 2013 — a fourfold increase from
the prior 10 years combined. Dr. Mat- thew has practiced medicine in Texas for 40 years.
“I’ve been taught there’s dengue in South Texas since I was a medical stu- dent,” he said. “It’s around.” Once-rare tropical diseases like den-
Identifying dengue
Peter Jay Hotez, MD, founding dean of the National School of Tropical Medicine at Baylor College of Medicine, says to spot dengue, physicians should look for patients with a fever, rash, headaches, and problems clotting blood. Newer laboratory tests can help physicians identify the disease quickly, he says. Though no vaccine exists for dengue or chikungunya, death
is rare, according to the Texas Department of State Health Ser- vices. In most cases, patients need only to treat the symptoms by resting, drinking fluids, and taking aspirin-free fever medica- tions. But patients who develop dengue shock syndrome, Dr. Hotez says, need intensive care. He says normally a patient with dengue will experience about a weeklong incubation period, followed by a fever, chills, and eye pain. The patient may develop a skin rash toward the end of the symptomatic portion of the disease. By day five, the fever starts to go down. The Centers for Disease Control and Prevention reports the
condition can worsen and become dengue hemorrhagic fever (DHF), which causes the patient to bruise easily and spit up blood; the condition can be fatal. Dr. Hotez says DHF occurs frequently in patients with more
than two types of dengue; four types exist. He says warning signs of severe dengue include abdominal pain or tenderness, persistent vomiting, bleeding from the gums or other mucosal bleeding, liver enlargement, and a rapid decrease in platelet count.
He says doctors should always manage dengue or other
tropical diseases in consultation with an infectious disease physician or contact the National School of Tropical Medicine at (713) 798-1000.
42 TEXAS MEDICINE September 2014
gue are becoming more commonplace in the state. DSHS officials identified the first case of chikungunya in Texas in July in a patient who traveled to the Ca- ribbean and acquired the disease. DSHS urges physicians statewide to be on the lookout for warning signs, such as fever and body aches, especially in patients who have recently traveled to a tropical location. (See “Consider Chikungunya,” opposite page.) Dr. Matthew says he has not seen any dengue cases in Corpus Christi, but many cases are asymptomatic. Physi- cians might never identify other cases because they would not think to test for dengue, he says. “We could have it, but we wouldn’t re- ally know,” he said. “Summertime severe flulike symptoms should be a sign, but they can occur with other systemic viral syndromes, like enteroviruses or early West Nile.” Dr. Matthew says Texas’ severe
drought is currently providing some pro- tection for residents against disease-car- rying mosquitoes. For more than three years, large portions of the state have operated under drought conditions. “We haven’t had rain in so long, we
don’t know what a mosquito looks like,” he joked.
But, he says, an increase in rainfall will bring out more mosquitoes, and South Texas could wind up with a den- gue outbreak, which could then spread to other areas of the state.
“Dengue is going to be the one we’ll most likely have a problem with,” he said.
Degree of suspicion Dr. Matthew says if a patient comes to you with a fever and terrible body aches, you should consider dengue, which is nicknamed “breakbone fever.” “It feels like all your bones are going
to break,” he said, adding the virus is not easy to identify or diagnose.
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