Tag Archives: Dengue fever


Today someone came into the surgery handed me a copy of an article on Chikungunya virus found on the Internet and said, ” My mother and I are going to Jamaica and should we be worried?” Strangely enough I had just read about Chikunyunya Virus and remembered probably because the name fascinated me.

Chikungunya is a mosquito-borne viral disease first described during an outb

reak in southern

imageTanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae.

The virus is passed to humans by two species of mosquito of the genus Aedes: A. albopictus and A. aegypti.


  Animal reservoirs of the virus include monkeys, birds, cattle, and rodents.

    This is in contrast to dengue, for which only humans are hosts.

The name ‘chikungunya’ derives from a word in the Kimakonde language, meaning “to become contorted” and describes the stooped appearance of sufferers with joint pain (arthralgia).

Yes it does exist and is found globally as illustrated below :-

Where Has Chikungunya Virus Been Found?

Countries and territories where chikungunya cases have been reported* (as of March 10, 2015)


* Prior to 2013, chikungunya virus outbreaks had been identified in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In fact last year there Were 4 reported cases in Montpelier,France

* In late 2013, the first local transmission of chikungunya virus in the Americas was identified in Caribbean countries and territories. Local transmission means that mosquitoes in the area have been infected with the virus and are spreading it to people.


* Since then, local transmission has been identified in 44 countries or territories throughout the Americas with more than 1.2 million suspected cases reported to the Pan American Health Organization from affected areas.

To verify exactly which countries go to the following link:


* Symptoms are generally self-limiting and last for 2–3 days. The virus remains in the human system for 5-7 days

* Most patients recover fully and the illness is mild and it is rarely fatal and then usually in vulnerable people.

* It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.      image

* Joint pain can be  debilitating and can vary in duration and may last months or even years.

* Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death.

* The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.

* There is no treatment or cure for the disease. Treatment is focused on relieving the symptoms using painkillers and anti- inflammatory drugs. It is diagnosed by a simple blood test which can differentiate it from Dengue Fever. There is no vaccine available at present.


The most effective means of prevention are protection against contact with the disease-carrying mosquitoes and mosquito control.

* These include using insect repellents with substances such as DEET (N,N-diethyl-meta-toluamide; also known as N,N’-diethyl-3-methylbenzamide or NNDB), icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535.

* Wearing bite-proof long sleeves and trousers also offers protection.

* In addition, garments can be treated with pyrethroids, a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents.

* Securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day-active A. aegypti and A. albopictus, however, this will have only a limited effect, since many contacts between the mosquitoes and humans occur outside.


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Posted by on March 30, 2015 in Training and Advice


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imageDengue is widespread in Brazil, which many travellers will visit this year for the football World Cup and in 2016 for the Olympic Games.Dengue fever

Dengue is a flavivirus infection transmitted by the bites of female mosquitoes, mainly of the species Aedes aegypti and Aedes albopictus, which are daytime biters. It is only the female mosquito that feeds off blood to provide protein for the eggs;the males feed off plant nectar.

Map dengue fever

From its origins in south-east Asia, it has spread to many parts of the tropical and sub-tropical world. Aedes mosqitoes are capable of breeding in small quantities of water, such as accumulated rainwater in oil drums and old tyres, as a consequence of which,
dengue often occurs in urban areas.

What are the main symptoms?

The incubation period is usually between two and five days, but may occasionally be longer. This is followed by fever, which may abate after a day or two, only to rise again. This is known as saddleback fever.

Common symptoms are severe arthralgia and myalgia, giving rise to the name breakbone fever, and headache.

Up to 50% of patients develop a maculopapular rash and there may be widespread lymphadenopathy. Recovery may be accompanied by prolonged fatigue and/or depression.

About 2% of patients may develop severe complications
of dengue such as haemorrhagic fever (DHF) or dengue shock
syndrome (DSS).
Warning signs for the rare dengue haemorrhagic fever include:
tiny bloods spots or large patches of blood under your skin, bleeding from the gums or nose, persistent vomiting and severe abdominal pain, vomiting blood or black, tarry stools. If you have any of these symptoms, you must seek immediate medical assistance.

Dengue fever

To establish if the rash is haemorrhagic use the glass or tumbler test as used in meningitis:-
Glass test

Can it be diagnosed by blood test?

Dengue fever can be diagnosed by isolating the virus in the blood during first five days. Also, on examining the blood there can be low white cell count and platelets and a raised alanine amino transferase (a liver enzyme) but this is not specific to Dengue Fever.
IgM antibodies may persist in the blood for two to three months
and a positive test may indicate recent or previous dengue
infection. If a traveller has had no previous exposure to dengue, a positive test is likely to be due to recent infection, but there is also cross-reactivity with other flaviviruses,

Is there a vaccine?
There is no vaccine

How can Dengue Fever be prevented?
It is a viral infection transmitted by mosquitos that bite in the day. It is important to wear clothing that covers as much of the skin as possible and use effective insect repellents such as diethyltoluamide (DEET) from dawn until dusk (in contrast to malaria prevention throughout the night from dusk until dawn)

How can it be treated?

There is no specific treatment for dengue. In most people symptoms can be managed by taking paracetamol (you should avoid aspirin, ibuprofen or other similar drugs), drinking plenty of fluids and resting.
Most people will recover within one to two weeks.

Before travelling it is advisable to attend a travel centre to obtain appropriate immunisations and advice.
Most immunisations can be given by our practise nurse or at one of the local travel clinics
Travel advice for Brazil

Having said this I had an amazing trip to Brazil several years ago to see my daughter who was studying there and absolutely loved Rio de Janeira, swimming on Copacabana beach, sky-diving on to the beach, dancing Salsa and even visited a Favela under escort. Then going on to explore the incredible Amazon river and Amazonian jungle and fortunately remained very well.



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Last year I wrote about Dengue Fever
and this blog was visited by many readers.
dengue fever
Last weekend I was working in West Middlesex in the PCC at the weekend and a mother came in with her sick child and was very worried as she had just returned from Malaysia and Dengue fever was rife. Her child had a high fever and was very unwell and needed to be referred to the paediatricians promptly.

KUALA LUMPUR, Malaysia—Deaths from dengue in Malaysia shot up last year, doubling that of 2012, as the tropical country battles with a raging mosquito-borne virus that claims hundreds of lives annually in Southeast Asia.

Four patients — three women and one man — died in the week ending Dec. 21, leaving 88 dead in Malaysia in the first 51 weeks of this year. In 2012, 35 people died in Malaysia of dengue, data from the Ministry of Health show.
Malaysia suffered the worst dengue bout on record in 2010, when 134 people died and 46,171 cases were reported. In 2011, 36 people died in Malaysia, with 19,884 people infected.

As of Dec. 21, dengue cases totaled 41,226 , nearly doubling from 21,444 cases in same period in 2012.

“As long as infection and outbreak of dengue fever continues, the risk of death remains,” said Lokman Hakim, deputy director general at Malaysia’s Ministry of Health.

The virus, which is transmitted by the Aedes aegypti mosquito, causes severe fever, headaches, rashes and muscle and joint pain. Severe forms can cause hemorrhagic fever. No vaccine is currently available, and treatment is largely limited to intravenous rehydration.
Dengue fever
Selangor state, which borders the capital city of Kuala Lumpur, has been hit the hardest, reporting 24 deaths, the Ministry said. The southern state of Johor that borders Singapore, has recorded 21 fatalities.

Selangor is home to 88 of the 89 dengue “hotspots,” or areas that have witnessed a jump in outbreaks, with Negeri Sembilan accounting for the other.

refer to the previous blog  for further links and advice.

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Posted by on January 22, 2014 in Training and Advice


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Dengue Fever

DENGUE FEVER (Breakbone Fever)

dengue fever

Increased incidences of this condition has been recorded recently in the press.

My first recollection of this disease was whilst watching the film ‘Bridge over the River Kwai’ many years ago and associating the condition with travel in Thailand under poor social conditions.

In fact, I did see a patient with this condition 1-2 years ago and now that more people are taking holidays or working in these parts of the world, I am not surprised the incidence has increased, as sadly many people are not taking proper travel advice. If you are traveling, it may be appropriate to get advice by contacting :

Dengue fever is a condition caused by an RNA virus (arbovirus), which is common in tropic and subtropical areas, particularly India, South East Asia and the Pacific . An estimated 50 to 100 million dengue infections and 200,000 to 500,000 cases of Dengue hemorrhagic fever (DHF) occur annually. It is transmitted to humans by the bite of infective female mosquitoes of the genus Aedes J.

The incidence of dengue fever has tripled in the past 3 months. Since January, there have been 141 “confirmed and probable” cases of the severe infection among those from this country, among those who have traveled to places such as Thailand, Sri Lanka and Barbados – compared with just 51 during the same period last year.

“The increase in the numbers of people returning with dengue fever is concerning so we want to remind people of the need to practice strict mosquito bite avoidance at all times in order to reduce their risk of becoming unwell,” said Dr Jane Jones, an infection expert at PHE.

If you are traveling to this part of the World you are advised to take care in applying insect repellent and wearing long sleeved clothing at dusk and dawn.
There is no vaccination or preventative medicine available for this condition.

If you develop severe flu-like symptoms including fever, headache and bone, muscle and joint pain during or after your stay you should seek medical advise.

There is no specific treatment and for most people symptoms can be managed by taking paracetamol, drinking fluids, and resting. But some of those infected can develop more serious complications and need to be treated in hospital, and the disease can be fatal.

Further details can be found on:-

Written by Dr Jacqueline Bayer

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Posted by on May 17, 2013 in Training and Advice


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