“It’s not like strep throat, where we have a screening test. It’s not as simple as that,” he said. “There’s so many other infections that present like it at onset, and it’s not economically feasible to test for all of the possibilities.” The key to identifying the disease,
Dr. Matthew says, is a healthy dose of suspicion. Also, determine whether the patient recently traveled to a tropical lo- cation or whether other cases of dengue have emerged in your practice area. “You just have to think about it,” he
said. “You have to have a degree of sus- picion that this is what you’re dealing with.”
If you suspect a patient has dengue or another tropical illness, he says, take a blood sample from the patient and per- form an antibody test during the acute stage of the illness and another test two to three weeks later, when the antibod- ies have increased. (See “Identifying Dengue,” opposite page.)
If the patient’s antibody levels for a specific disease are significantly higher in the second test, the physician can di- agnose the illness and report it to DSHS, he says. Texas law requires doctors to notify DSHS of suspected or confirmed cases of dengue within a week. Reporting forms are available at
www.dshs.state.tx.us/ idcu/investigation/forms. Unfortunately, tests can cost $200 to $300 each. If Dr. Matthew is unsure about the diagnosis during the acute stage of the illness, he says, “I’ll draw blood and put it in the freezer.” In a few weeks, if he’s still suspicious of dengue, he says he will then draw a second blood sample and send both to the lab. “During the acute illness, you can have too many false positives,” he said.
Be on the lookout Raquel Castillo, public health prepared- ness program director at the Cameron County Department of Health and Hu- man Services, says health care profes- sionals reported more than 50 cases of dengue in Cameron, Hidalgo, and Wil- lacy counties combined in 2013. Twenty- three of those patients acquired the dis- ease locally.
In comparison, only five patients ac-
quired dengue locally in all three coun- ties from 2003 to 2012, according to DSHS statistics. For more dengue sta- tistics and information, visit the DSHS website,
www.dshs.state.tx.us/idcu/dis ease/dengue. Just before the 2013 outbreak, Ms. Castillo says, the department saw a number of cases of dengue emerge di- rectly across the Mexican border. “Then, we started seeing cases here,” she said.
Ms. Castillo says the health depart- ment conducted an investigation of the outbreak. She and other officials, in- cluding the health inspector, went to the homes of patients with dengue and provided educational materials for the family on measures to take to avoid mos- quito bites.
The health officials searched homes for standing water, including in buckets and potted plants outside the homes. According to DSHS, leaky pipes, outside faucets, air conditioner drain hoses, and
Consider chikungunya
Dengue is not the only tropical disease to emerge in the United States. Chikungunya, a virus also transmitted by mosquitoes, has spread rapidly across the globe in the past decade. In December 2013, the Caribbean saw its first local transmis- sion of chikungunya. The Pan American Health Organization re- ports more than 5,000 confirmed cases and more than 180,000 suspected cases of chikungunya in the Caribbean as of June 20. More recently, chikungunya has popped up in the United
States. Texas health officials identified the first case of chi- kungunya in July in a patient who acquired the disease in the Caribbean. The Georgia Department of Public Health reported its first case in June in a patient who had also traveled to the Caribbean. For more about that case, visit
http://1.usa.gov/ UUAT3T.
As of June, the Tennessee Department of Health had con- firmed two cases of chikungunya, and the North Carolina De- partment of Health and Human Services had confirmed one. All the U.S. patients with chikungunya acquired the disease in the Caribbean, but the mosquitoes that transmit the virus are of the Aedes species, which can also transmit dengue and which live in parts of the United States, including Texas. The TMA Committee on Infectious Diseases encourages you
to consider chikungunya virus infection in patients who have traveled to areas with known outbreaks, such as the Caribbean, and who present with common symptoms such as acute fever and severe joint pain.
September 2014 TEXAS MEDICINE 43
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60