Dengue Fever: A Quick Look

Dengue fever is a viral disease transmitted by several mosquito species and first recognized in the late 1770s. Although dengue fever has a red rash similar to measles and a much lower mortality rate than yellow fever, in the 1700s it was often mistaken for yellow fever, which was prevalent in the West Indies during the Napoleonic Wars. In fact, Napoleon Bonaparte sent an army under the command of his brother-in-law General Charles Leclerc (married to Pauline Bonaparte) to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for about 35,000 to 45,000 of the casualties that happened there and resulted in Leclerc’s death. At the time there was no clear understanding of dengue or yellow fever, and dengue fever, similar to yellow fever, occurred in the warmer months in subtropical climates when mosquitoes were active, which thereby caused the two diseases to often be thought of as the same illness.

Dengue fever was originally known by several names. The origins of the word dengue is uncertain, but it is suspected to have originated from a Swahili phrase, Ka-dinga pepo, which means evil spirit. It was also called “dandy” fever by slaves in the West Indies because the posture and gait of those who contracted the disease was similar to a dandy. Benjamin Rush, who was a Founding Father of the United States and an American physician, called it bonebreak fever because of the accompanying muscle and joint pain. It was also called stiff-necked fever (corrupted into bucket fever) and knockle-koorts fever. However, by 1828, it was generally known as dengue fever.

Dengue fever is transmitted by the female mosquito and symptoms often start with a frontal headache, sudden fever, and overall body aches. Those symptoms expand to include a rash, nausea, vomiting, severe eye pain, with eyes so sore it hurts to move them, and then depression and fatigue. One description given by Rush in the 18th century states:

“The pains which accompanied this fever were exquisitely severe in the head, back and limbs. The pains in the head were sometimes in the back parts of it, and at other times they occupied only the eyeballs. in some people, the pains ere so acute in their backs and hips, that they could not lie in bed … A few complained of their flesh being sore to the touch, in every art of the body. From these circumstances, the disease was sometimes believed to be a rheumatism, but its more general name among all classes of people was the breakbone fever.”[1]

A description of it in the American Journal of Ophthalmology of 1919 stated:

“It may occur so suddenly and with such complete prostration as to strike down the sufferer at his business, pleasure or devotions. The intense and excruciating myalgia and joint pains are the most typical symptoms. Here may be mentioned the only ocular complaints occurring as a rule, namely the intense retroorbital and supraorbital pain, and often great pain on an attempted ocular movement. The disease lasts from 10 to 14 days, during which time the temperature is usually highest on the 4th or 5th day, varying between 103-106ºF. There is then often a remission in symptoms followed by a return of symptoms and by a rash.[2]

After a week of suffering, many patients found themselves on the road to recovery as mortality was low. However, a severe form of dengue, known as hemorrhagic fever, affected children and was fatal about 30% of the time. It has the similar symptoms as classic dengue but worsened until the body went into shock, which caused the circulatory system to fail and resulted in hemorrhaging.

One of the first published descriptions of dengue fever came from Rush. He described an outbreak in the summer of 1780 in Philadelphia, Pennsylvania, saying, patients suffered pains that were “exquisitely severe in the head, back and limbs.”[3] Rush also listed diarrhea, nausea, and a rash. He noted the disease seemed to coincide with extremely warm weather, as “the mercury stood on the 6th of August at 94 1/2º, and for several days after at 90º.”[4] In addition, Rush reported noxious odors blowing in the wind and that “moschetoes [sic] were uncommonly numerous.”[5]

Although Rush was a hearty proponent of bloodletting, he recommended little bloodletting in this case. Rush treated his patients by providing purgative cleansers for their bowels and having them swallow a poisonous crystalline salt known as “tartar emetic” to empty their stomachs. He also recommended patients survive on a liquid diet and get plenty of bed rest, which are recommendations that are still given today as modern medicine has found no better aid for victims.

Although there were numerous reports of epidemics of dengue fever throughout the 1600s, it seems the most likely cases of dengue occurred between 1779 and 1780 in North America, Asia, and Africa. Interestingly, today, dengue fever remains the second most popular reason why people are hospitalized after having visited a foreign land.

References:

• [1] Kiple, Kenneth F., Plague, Pox, & Pestilence, London, 1997, p. 93-94.
• [2] American Journal of Ophthalmology, 1919, p. 651.
• [3] Osler, Sir William, The Principles and Practice of Medicine, 1905, p. 156.
• [4] Kiple, Kenneth F., p. 93.
• [5] Ibid.