Dengue has been on the nightly news in Paraguay every day for weeks now. 22 people have died this year, and thousands have been sick (although much fewer than the epidemics of 2006-2007). They don’t have enough hospital beds for all the people sick with dengue, and now flu season is starting up. Dengue is caused by four related viruses and spread by Aedes aegypti mosquitoes. A lot of the focus in the news has been on government and public responsibility to clean up the environmental reservoirs for the mosquitoes: any containers that hold open water.
If you’re bit by an infected mosquito you have an incubation period of 3-14 days before symptoms show up. No cases of dengue have been previously reported in the part of the Chaco where I’m doing my research, so it’s most likely I picked it up in Asunción – which has had a lot of dengue this year – and it was incubating until I got out there.
Dengue fever is sometimes called “break-bone fever” for the severe joint and muscle pain that its victims experience. It starts off with a high fever that lasts for a few days, and usually also a severe headache, pain behind the eyes, and the aforementioned joint and muscle pain. I was feverish for 3-4 days and tried to stay under my mosquito net and rest for most of the day. The joint and muscle pain made that tough, because I couldn’t find a position that I was comfortable in. The first night I had a really high fever I didn’t sleep until the sun rose because I was so achy all over.
When the fever goes away you get a couple of days of respite, but this is actually the more worrisome stage when your blood vessels become weak and you need to watch carefully for signs that the dengue will become Dengue Hemorrhagic Fever (e.g. severe bruising, going into shock). Most people develop some kind of rash after the brief break. I have a light rash on my hands, arms, and feet. My legs, especially my calves, developed a really nasty red rash that looked like tons of really tiny bruises:
And then a new form of torture sets in with the rash: it itches!! Especially my hands and feet are itchy, although they don’t appear to have as much of a rash on them. It feels like ants are crawling all over my hands and feet and biting me. It’s not an itch that you can ignore and eventually it will pass; the more I ignore it the more it physically hurts. I had two nights without sleep because of the itchiness. I’m told in the final stage of the disease the skin on my hands and feet is probably going to peel off, like from a sunburn. Ugh, something to look forward too.
There’s no vaccine for dengue and no specific treatment. Taking acetaminophen helped a lot with the muscle pain (do not take ibuprofen or aspirin – these pain killers can cause complications if you have the hemorrhagic form of dengue!). And I try to drink as many fluids as I can, which helped with the fever and is also supposed to be good for the rash and itchiness. I used hydro-cortisone on the rash for a few days, and talcum powder also helped soothe the itching. If you have hemorrhagic dengue you need to get to a hospital quickly so they can give you fluid replacement therapy and keep an eye on you.
I’ve acquired lots of different gut bugs during my travels, but I think this bout of dengue counts as my first truly tropical disease. And probably not my last! That’s one of the hazards of being really enthusiastic about infectious diseases. I do the best I can to protect myself: I wear long-sleeved shirts and pants as much as I can, I use bug spray (I am not a fan of DEET, so I use All Terrain Herbal Armor – and have found it very effective), and I sleep underneath a mosquito net, fan, or in an air-conditioned room.
So how did I still come away with dengue? I love walking around in bare feet. The mosquitoes in the Chaco are painful when they bite you, so you notice and cover up or put on bug spray. In Asunción the mosquitoes are sneaky little buggers, and I didn’t notice they were chewing up my feet until I was super itchy the following day.
I have forbidden myself to go barefoot now. After your first bout with dengue you’re pretty resistant to getting infected with that strain again, but if you are infected with a different strain you have a higher risk of developing hemorrhagic dengue. Best to avoid multiple rounds of dengue! I think I had one of the milder strains of dengue this round, and I’ve had enough!