PALM BEACH COUNTY, Fla. — The Palm Beach County Health Department is warning resisdents of a locally acquired case of the mosquito borne illness, Dengue Fever.

“we have been closely monitoring the county for the possibility of Dengue being reintroduced in our area since we have seen it in counties north and south of us,” said Health Director Alina Alonso, MD. “with today’s confirmation I am issuing a Mosquito Borne Illness Advisory.”

In 2009 locally acquired cases of Dengue were diagnosed in Key West and since then, others have been found in South Florida. this is the first locally acquired case in Palm Beach County although eight others have been reported this year and acquired out of the country.

Classic dengue fever is characterized by acute onset of high fever, 3-14 days after the bite of an infected mosquito. Patients develop high fevers, severe headache, muscle and bone aches, rash, severe pain behind the eyes and mild bleeding from the nose or gums. Acute symptoms, when present, usually last about 1 week, but weakness, malaise, and anorexia may persist for several weeks. Treatment emphasizes relief of symptoms, avoiding aspirin and other non steroidal anti-inflammatory medications and drinking plenty of fluids. Severe manifestations (e.g., dengue hemorrhagic fever and dengue shock syndrome) are rare but may be fatal.

Dengue is carried by the Aedes aegypti mosquito which is commonly known as the household mosquito but unlike others it is a day biter. The advisory encourages all to drain any standing water from around the home or business as these mosquitoes can leave their eggs in the smallest water reservoirs. all are also advised to cover their windows with screens in good condition, use air conditioning when possible and cover themselves with light weight long sleeve clothing and pants. Insect repellants containing DEET or picaridin are also effective in preventing the mosquito from biting.

Mosquito control has been notified and is stepping up its spraying efforts to reduce the Aedes mosquito population.

Persons experiencing symptoms should see their medical provider or if severe visit the nearest hospital or clinic.

What is dengue?

Dengue (pronounced den—gee) is a disease transmitted to humans by the bite of an infected mosquito. in the Western Hemisphere, the Aedes aegypti mosquito is the most important transmitter or vector of dengue viruses. it is estimated that there are over 100 million cases of dengue worldwide each year.

What is dengue hemorrhagic fever (DHF)?

DHF is a more severe form of dengue infection. it can be fatal if unrecognized and not properly treated in a timely manner. DHF is caused by infection with the same viruses that cause dengue fever. with good medical management, mortality due to DHF can be less than 1 percent.

How is dengue spread?

Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue virus in their blood. The person can either have symptoms of dengue fever or DHF, or they may have no symptoms. after about one week, the mosquito can then transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person.

What are the symptoms of dengue?

The principal symptoms of dengue are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash and mild bleeding (e.g., nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.

What is the treatment for dengue?

There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids and consult a physician. If they feel worse (e.g., develop vomiting and severe abdominal pain) in the first 24 hours after the fever declines, they should go immediately to the hospital for evaluation.

Where can outbreaks of dengue occur?

Outbreaks of dengue occur primarily in areas where Ae. aegypti (sometimes also Ae. albopictus) mosquitoes live. this includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists.

What can be done to reduce the risk of acquiring dengue?

There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Ae. aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water. Items that collect rainwater or to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and cleaned (to remove eggs) at least once a week. this will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas. Using air conditioning or window and door screens reduces the risk of mosquitoes coming indoors. Proper application of mosquito repellents containing 20-30 percent DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small. there is increased risk if an epidemic is in progress or visitors are in housing without air conditioning or screened windows and doors.

Tetanus is a severe illness characterized by intermittent tonic spasms of voluntary muscles. It is caused by Clostridium tetani, an anaerobic organism with drumstick appearance. The organism causes a disorder that has a very high mortality incidence. Tetanus infection is usually seen in persons above 50 years of age.

The organism enters the wound, multiplies there and produces powerful toxins (neurotoxin and haemolysin), which produce the disease. These toxins then enter the central nervous system through the peripheral nerves or through blood. Neurotoxin gets binded to the nerve cells and is responsible for tonic rigidity of the limbs, trunk, abdominal and neck muscles and causes reflex contraction due to minor stimuli.

Variety of Infection

Acute illness – The acute onset is sudden and severe. there is much restlessness and apprehension with pain in the neck, jaw and abdomen. other symptoms include lockjaw, dysphagia and dyspnoea. in the terminal stage, respiratory arrest causes cyanosis, tachycardia, fever and convulsions. Spasms are spontaneous but may also be induced by the slightest stimuli like touch, noise or any movement.

Chronic illness – in this, the onset is delayed with milder symptoms and muscle spasm may also not manifest itself fully.

Types of Infection

Generalized Tetanus – This is the commonest form in which the patient shows the symptoms but is mentally alert.

Localized Tetanus – in this variety, pain with stiffness is found at the site of the infection. Patients usually recover from this type.

Cephalic Tetanus – This is an uncommon type and is usually fatal. The portal of entry in such type is through the middle ear.

Routes of Infection

There are various routes of infection such as through umbilical cords in neonates, when the cord is treated with some septic material. Wound complication may also occur such as in road traffic accidents. Minor injuries with rusted nails, tattooing, injections and piercing of ear lobes may also cause the infection. Sometimes, the infection may also spread through septic abortion or some surgical operations.

Treatment

The circulating toxin cannot be neutralized. Wound dressing delayed for an hour or two is sufficient for absorption of the toxin. The patient should be put on absolute bed rest with sedation and nothing should be given through mouth until well. Anti-tetanus serum has to be administered at the time of wound excision.

Immunization through vaccines and proper wound debridement is necessary to prevent the illness.