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The Informed Parent

Trouble In Paradise

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 28, 2002
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I was attending one of my son’s basketball games, watching intently with a group of other parents. Another parent joined the group and said, “Can I talk to you during the half? I have a quick question for you.” I sensed a medical-type inquiry and responded, “Well, it’s almost halftime now. Why don’t we go outside where we can talk.”

Once outside, away from the frenzied noises of the sport, Mrs. B. explained, “My husband and I always take the kids to Hawaii for Christmas vacation...it has become sort of a family tradition. The whole family meets in Maui on Christmas night. We bring my parents. My sister flies there from Chicago with her family, and my brother brings his whole family from Northern California. We’ve been doing this for the past 12 years. As she paused in her premise I was perplexed as to where this was leading.

Then she caught me completely off-guard with her next question. “My sister called me to say that she didn’t think she was going to make it to Maui this year. A report on the news stated that there was an epidemic of dengue fever in Hawaii, and she didn’t think ANY of us should go. What do you think?”

I told her that I couldn’t answer her question at this time simply because I did not know all the facts. However, I would find out the answer and get back to her as soon as possible.

The question intrigued me, and I called the Public Health Department the next day. Much to my surprise, I was informed that Hawaii WAS, in fact, experiencing her first outbreak of dengue fever in over 56 years. As of the middle of November 2001, there were 62 confirmed cases on the Island of Maui, 17 on Oahu and 5 on Kauai. Three hundred more cases were still being investigated.

Dengue fever is a viral illness that is caused and spread by a specific type of mosquito, the Aedes mosquito. There are at least four distinct types of dengue viruses. These occur in endemic proportions in the tropics of the South Pacific, the Caribbean, and in Africa.

The symptoms of dengue fever vary from patient-to-patient. However, there is usually an incubation period of 1-7 days. This is abruptly followed by a high fever that may reach up to 105-106 degrees, and quite often a severe headache that is located in the forehead region or behind the eyes. Many patients report a back pain that occurs shortly after the fever starts. There may be a brief and fleeting rash that comes and goes at this stage of the disease. As the illness progresses, the muscles and joints begin to ache and hurt. By this time there is usually vomiting, diarrhea, enlarged lymph nodes and hypersensitive skin. One’s sense of taste may be altered.

After the fever breaks, a generalized body rash appears, and this rash spares the palms and soles. The rash disappears after 1-5 days, and the skin may actually peel. The fever may recur at this stage of the disease, and it may actually be quite high.

A small number of patients with dengue fever might experience nosebleeds, bruising, or irregular heartbeats, but this is not common. Because a virus causes dengue fever, it does not respond to an antibiotic or specific treatment. The treatment is solely supportive, which means that one must treat the specific symptoms. Fever control is important, as is bed rest and pain control. Aspirin containing products should be avoided, and particular attention should be made to insure that the patient does not become dehydrated from the vomiting and diarrhea.

There is a special viral test that can be used to diagnose dengue fever. However, an astute physician with a high index of suspicion and a thorough history and physical should be able to make a diagnosis on a clinical basis. Most cases of dengue fever are self-limiting, self-resolving, relatively benign, and carry a good prognosis.

Although dengue fever occurs in endemic areas where the Aedes mosquito thrives, travelers to these areas are susceptible to catching the illness. The Department of Health and Human Services has outlined some protective measures that one can use.

  1. Use an insect repellent on the skin that contains 25-35% DEET. Be sure to avoid using the repellent on the face, and, remember, when using a repellent on children, there must not be more than 10% DEET.
  2. Whenever possible, one should try to wear a long-sleeved shirt and long pants to minimize skin exposure.
  3. Spray or apply the repellent to boots, backpacks, tents, etc.
  4. Air conditioners, screened windows and doors will help reduce the risk of being bitten by a mosquito indoors.

The Center for Disease Control has additional information on dengue fever in Hawaii at: www.state.hi.us.doh/dengue/index.html.

After doing my homework I called my apprehensive friend to let her know what I had found out. She was appreciative and felt much better about going to Hawaii with the rest of her family. As it turned out, her parents were the ones who bought the plane ticket for the entire family. There was no way that they were going to let ANYONE back out at this point. I told her to go, and have a wonderful trip.




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