DRHOOK- The buzz: Nothing takes the sting out of dengue

the handsome doctor John Hong of Charlottesville

Mosquitoes! I hate them. There can be 100 people in a room and one mosquito, and I will be the only one in that room bitten. Once bitten, twice– not shy, itchy! I used to swell up from mosquito bites like Tom Cruise's ego. I have a can of "Off!" everywhere I go– even that little blue thing that blows "Off" around (although my niece said I look like a goober with it). 

Can mosquito bites make you sick?

Dengue is the number-one mosquito-borne viral disease in the world: over 50 million infections a year.

Dengue is most common in hot climates like Southeast and South Central Asia, the Caribbean, and South and Central America. Usually in this country we have seen dengue only in people who have traveled to these areas. However, Florida has now reported cases of dengue! 

About 3-14 days after someone is infected, symptoms start. Dengue presents in different ways depending on age, the virus type, and the way the person reacts to the virus. So illness can range from just a mild fever to a life-threatening case of shock.

Kids under 15 years of age often have minimal symptoms or don't have any– although if ill, they are more likely to die from dengue. (About 25,000 people die a year from dengue, mostly kids.) Adults, on the other hand, can have the classic dengue symptoms: sudden fever, headache, pain behind the eyes, body aches, and joint aches. The fever lasts about a week, and to make things worse, fatigue follows for weeks. Rash can occur, more often in women, for some reason. 

People infected a second, a third, or even a fourth time with a different strain of dengue can have GI problems like nausea, vomiting, and diarrhea. (Yes, there are several strains of dengue, and so people can get sick again from those darn mosquitoes. To make things worse, subsequent infections make the previously infected person even sicker.) 

When can dengue cause more trouble than you can imagine? Bleeding problems from dengue can cause nosebleeds, GI bleeds, and uterine bleeds. Purpura (bruises all over the body) is a bad sign. Out of control vomiting can lead to dehydration and vomiting blood. Fluid can start leaking into the abdomen and chest, which is bad news because it makes it hard to breathe, hard for the heart to pump, and the blood pressure drops like WorldCom stock.

Rarely, liver failure occurs in dengue. Kids with dengue who take aspirin can get liver failure known as Reye's syndrome. Also, rarely, the brain and nervous system can be affected to cause paralysis, brain inflammation, seizures, and loss of feeling. (Wow, now I really hate mosquitoes.)

Diagnosis is usually made on a clinical basis, i.e. no labs or tests. Blood tests can confirm dengue but aren't used much around the world. Most places with dengue don't have the means to do the tests. 

Cure? No cure. There is just supportive care. No vaccines exist because these viruses are trickier than a crooked politician. 

I have a sneaky suspicion, since dengue is now in the U.S., that scientists are going to work on a vaccine to fight this potentially lethal virus. In the meantime, mosquito-bite prevention is all we have. Make sure there's no free-standing water around the house where mosquitoes can breed, wear protective clothing, apply DEET, and consider getting a bat house.

Could you imagine if laryngitis were spread by mosquito bites? Would we be silent about finding a vaccine or cure?


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.