American Medical Association Family Medical Guide - American Medical Association [658]
Dengue
Dengue is an infection caused by a virus that is transmitted through the bites of Aedes mosquitoes. Dengue infections occur in Central and South America, the Caribbean, the South and Central Pacific islands, Southeast Asia, China, India, the Middle East, and Africa.
Symptoms
The symptoms of dengue, which develop 8 to 10 days after the infecting mosquito bite, occur suddenly and resemble those of other viral infections, such as high fever, headache, nausea and vomiting, and joint and muscle pain. The joint and muscle pain is so severe that dengue is often called breakbone fever. A rash may appear 3 to 4 days after a fever develops. Dengue can last up to 10 days, but complete recovery can take 2 weeks to a month. In severe cases, dengue progresses to a life-threatening complication called dengue hemorrhage, which is characterized by severe bleeding that can be fatal.
Diagnosis and Treatment
To diagnose dengue, a doctor takes a detailed health history and orders blood tests to check for antibodies (infection-fighting proteins the body produces to fight the virus) or for the virus itself. If you have recently traveled to any area where dengue is prevalent and have symptoms, tell your doctor.
To treat dengue, doctors usually recommend bed rest, plenty of fluids, and a pain reliever such as acetaminophen. People with dengue should not take aspirin because aspirin interferes with blood clotting and can increase the risk of bleeding.
Leishmaniasis
Leishmaniaisis is a potentially life-threatening disease caused by a parasite that is transmitted through the bites of infected sand flies. In very rare cases, leishmaniasis can be transmitted through blood transfusions, and from a pregnant woman to the fetus. The most common types of leishmaniasis are cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis. The majority of cases occur in countries in South America, South Asia, and Africa. Leishmaniasis is also found in some parts of Central America, Mexico, and the Middle East. Although very rare in the United States, cutaneous leishmaniasis infections have occurred in rural areas of southern Texas.
Symptoms
The symptoms of cutaneous leishmaniasis—skin sores that begin as small red or purple bumps—can appear weeks or months after a person has been bitten by an infected sand fly. The sores increase in size and develop a raised edge and central crater. The sores can cause scabs that may leave disfiguring scars. In some cases, untreated cutaneous leishmaniasis can spread, causing sores in the nose or mouth (mucosal leishmaniasis).
Symptoms of visceral leishmaniasis can include fever, swollen glands, weight loss, darkening of the skin, and an enlarged spleen or liver. Visceral leishmaniasis can destroy red blood cells (which deliver oxygen to tissues) and white blood cells (which fight infection) in the spleen, liver, and bone marrow, potentially causing anemia (see page 610).
Diagnosis
To diagnose cutaneous leishmaniasis, a doctor takes a detailed health history and examines the skin for the characteristic sores. If you have sores that have not healed, the doctor will take samples from the sores for examination in the laboratory. For all forms of leishmaniasis, blood tests are used to evaluate the levels of red cells, white cells, and platelets (cell fragments that enable blood to clot). You may have a blood test to look for antibodies (specific infection-fighting proteins the body produces to fight the parasite) or a test to detect the parasite itself in a tissue sample from a sore or from the bone marrow or lymph nodes.
Treatment
The skin sores of cutaneous leishmaniasis usually heal without treatment. However, a doctor may prescribe an antiparasitic or antifungal medication to treat cutaneous leishmaniasis or to prevent it from spreading to the nose and mouth. These drugs also are used to treat