Acute febrile illness with headache, retro-orbital pain, myalgias, arthralgias ?Break-bone fever? High fever 5-7 days Second fever for 1-2 days in 5% patients Followed by marked fatigue days to weeks Classic dengue 15-60% of infections Nausea, vomiting, diarrhea (30%) Macular or maculopapular confluent rash (50%) Respiratory symptoms: cough, sore throat (30%) Dengue replication and transmission Mosquitoes transmit dengue to human dendritic Cells (specialized cells found in most tissues) Dengue targets liver, spleen, lymph nodes, bone marrow, and glands. Dengue invades organs successfully. Dengue enters blood circulation People contract dengue from mosquitoes, as has been established. Once dengue enters one?s body, it enters the dendritic cells (specialized cells found in most tissues) which migrate to the lymphatic system. Once in the lymphatic system, where white blood cells are produced, they target all areas where there is an abundance of WBCs, including the spleen, liver, and glands. Entering the white blood cells and lymphatic tissue gives dengue access to the circulatory system and therefore the entire body). The transmission cycle of dengue virus by the mosquito Aedes aegypti begins with a dengue-infected person. This person will have virus circulating in the blood?a viremia that lasts for about five days. During the viremic period, an uninfected female Aedes aegypti mosquito bites the person and ingests blood that contains dengue virus. Although there is some evidence of transovarial transmission of dengue virus in Aedes aegypti, usually mosquitoes are only infected by biting a viremic person. Then, within the mosquito, the virus replicates during an extrinsic incubation period of eight to twelve days. The mosquito then bites a susceptible person and transmits the virus to him or her, as well as to every other susceptible person the mosquito bites for the rest of its lifetime. The virus then replicates in the second person and produces symptoms. The symptoms begin to appear an average of four to seven days after the mosquito bite?this is the intrinsic incubation period, within humans. While the intrinsic incubation period averages from four to seven days, it can range from three to 14 days. The viremia begins slightly before the onset of symptoms. Symptoms caused by dengue infection may last three to 10 days, with an average of five days, after the onset of symptoms?so the illness persists several days after the viremia has ended.
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