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Denuge Fever - Generally very bad. Another mosquito born plague.

Dengue fever is a mosquito-borne tropical disease caused by the dengue virus.[1] Symptoms typically begin three to fourteen days after infection.[2] These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin itching and skin rash.[1][2] Recovery generally takes two to seven days.[1] In a small proportion of cases, the disease develops into a more severe dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.[1][2]

Dengue is spread by several species of female mosquitoes of the Aedes genus, principally Aedes aegypti.[1][2] The virus has five serotypes;[9][10] infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others.[1] Subsequent infection with a different type increases the risk of severe complications.[1] A number of tests are available to confirm the diagnosis including detecting antibodies to the virus or its RNA.[2]

A vaccine for dengue fever has been approved and is commercially available in a number of countries.[6][11] As of 2018, the vaccine is only recommended in individuals who have been previously infected, or in populations with a high rate of prior infection by age nine.[12][7] Other methods of prevention include reducing mosquito habitat and limiting exposure to bites.[1] This may be done by getting rid of or covering standing water and wearing clothing that covers much of the body.[1] Treatment of acute dengue is supportive and includes giving fluid either by mouth or intravenously for mild or moderate disease.[2] For more severe cases, blood transfusion may be required.[2] Paracetamol (acetaminophen) is recommended instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for fever reduction and pain relief in dengue due to an increased risk of bleeding from NSAID use.[2][13][14]

The earliest descriptions of an outbreak date from 1779.[15] Its viral cause and spread were understood by the early 20th century.[16] Dengue has become a global problem since the Second World War and is common in more than 120 countries, mainly in Southeast Asia, South Asia and South America.[7][17][15] About 390 million people are infected per year, about half a million require hospital admission,[1] and approximately 40,000 die.[7][8] In 2019, a significant increase in the number of cases was seen.[18] Apart from eliminating the mosquitos, work is ongoing for medication targeted directly at the virus.[19] It is classified as a neglected tropical disease.[20]

Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as an uncomplicated fever.[22][23][24] Others have more severe illness (5%), and in a small proportion it is life-threatening.[22][24] The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days.[25] Therefore, travelers returning from endemic areas are unlikely to have dengue fever if symptoms start more than 14 days after arriving home.[17] Children often experience symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea)[26] and have a greater risk of severe complications,[17][27] though initial symptoms are generally mild but include high fever.[27]
Clinical course

The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, and a rash. An alternative name for dengue, "breakbone fever", comes from the associated muscle and joint pains.[22][28] The course of infection is divided into three phases: febrile, critical, and recovery.[21]

The febrile phase involves high fever, potentially over 40 °C (104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days.[21][28] Nausea and vomiting may also occur.[27] A rash occurs in 50–80% of those with symptoms[28][29] in the first or second day of symptoms as flushed skin, or later in the course of illness (days 4–7), as a measles-like rash.[29][30] A rash described as "islands of white in a sea of red" has also been observed.[31] Some petechiae (small red spots that do not disappear when the skin is pressed, which are caused by broken capillaries) can appear at this point,[21] as may some mild bleeding from the mucous membranes of the mouth and nose.[17][28] The fever itself is classically biphasic or saddleback in nature, breaking and then returning for one or two days.[30][31]

In some people, the disease proceeds to a critical phase as fever resolves.[27] During this period, there is leakage of plasma from the blood vessels, typically lasting one to two days.[21] This may result in fluid accumulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and decreased blood supply to vital organs.[21] There may also be organ dysfunction and severe bleeding, typically from the gastrointestinal tract.[17][21] Shock (dengue shock syndrome) and hemorrhage (dengue hemorrhagic fever) occur in less than 5% of all cases of dengue;[17] however, those who have previously been infected with other serotypes of dengue virus ("secondary infection") are at an increased risk.[17][32] This critical phase, while rare, occurs relatively more commonly in children and young adults.[27]

The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream.[21] This usually lasts two to three days.[17] The improvement is often striking, and can be accompanied with severe itching and a slow heart rate.[17][21] Another rash may occur with either a maculopapular or a vasculitic appearance, which is followed by peeling of the skin.[27] During this stage, a fluid overload state may occur; if it affects the brain, it may cause a reduced level of consciousness or seizures.[17] A feeling of fatigue may last for weeks in adults.[27]

Associated problems

Dengue can occasionally affect several other body systems,[21] either in isolation or along with the classic dengue symptoms.[26] A decreased level of consciousness occurs in 0.5–6% of severe cases, which is attributable either to inflammation of the brain by the virus or indirectly as a result of impairment of vital organs, for example, the liver.[26][31][33]

Other neurological disorders have been reported in the context of dengue, such as transverse myelitis and Guillain–Barré syndrome.[26][33] Infection of the heart and acute liver failure are among the rarer complications.[17][21]

A pregnant woman who develops dengue is at higher risk of miscarriage, low birth weight birth, and premature birth.[34]

And on and on and on it goes.