DENGUE fever and dengue hemorrhagic fever (DHF) are at epidemic levels in Costa Rica. Only malaria surpasses dengue as a worldwide tropical infectious disease. Citing the Journal of Clinical Microbiology Reviews global statistics, approximately 100 million cases of dengue fever occur annually, with 500,000 cases of dengue hemorrhagic fever and 25,000 dengue-attributed deaths.Dengue fever is a very old disease. Around A.D. 300, Chinese medical texts reported a dengue-like illness called “water poison” that was related to flying insects associated with water. In the late 1700s, apparent dengue epidemics occurred in Asia, Africa and North America. The first known epidemic of dengue hemorrhagic fever occurred in the Philippines in 1954. In 1981, the world’s largest epidemic of DHF to date took place in Cuba.The global pandemic of dengue has its roots in the ecologic disruption of Southeast Asia and the Pacific during and following World War II. Present-day resurgence of dengue and DHF is thought to be related to unprecedented global population growth; unplanned and uncontrolled urbanization, especially in tropical regions; insufficient home-based environmental-hygiene mosquito control (the only method shown to be effective); increased air travel; and decay of public health infrastructures. THE dengue virus produces mild to severe flu-like symptoms and is spread by the bite of infected mosquitoes. Symptoms include abrupt high fever, frontal headache and pain behind the eyes, body aches, bone pain, rash, altered sense of taste, mild sore throat, nausea, vomiting and loss of appetite. The disease is also known as breakbone fever and the African ki denga pepo, a term found in English literature during the 1827-1828 Caribbean outbreak.Dengue fever is generally self-limiting, but recovery may take weeks. Young children generally experience milder symptoms then older children and adults. Dengue hemorrhagic fever can be a severe, potentially fatal, bleeding complication of dengue that may show with bruising of skin and bleeding of gums, nose and other orifices. People who have previously had a dengue infection are at greater risk for DHF if it recurs. Fatalities from DHF are more common in children and young adults. Risk factors include a person’s age, immune status and which one or combination of the four dengue virus strains a person contracts.While found in rural areas, dengue is more common in city environments. Aedes aegypti, the mosquito that transmits dengue, is a homebody. It likes to rest indoors, is unobtrusive and prefers to feed on humans during daylight hours. For dengue mosquitoes to breed, any standing water in or near dwellings will do: plant containers, plastic bottles, old tires or buckets. Infected female mosquitoes transmit dengue when probing human skin for a blood meal. These somewhat skittish insects don’t have to draw blood to transmit the virus – probing alone will do.THERE is no vaccine to prevent dengue. Prevention entails avoidance of mosquito bites where dengue occurs or might occur, and eliminating breeding sites – any standing water lasting longer than one day. Oral supplements of vitamin B1 (thiamine), 50-100 milligrams daily, can help repel mosquitoes, while many perfume products will attract them. Seek medical care immediately if you suspect you may have dengue fever. There is no specific treatment for the dengue virus; however, there are supportive, lifesaving medical interventions for DHF. People suffering from dengue fever need rest and plenty of fluids to prevent dehydration. Frequent small amounts are better then infrequent large amounts to avoid vomiting. Do not rely on soda or sport drinks if diarrhea is present, as the high sugar content may worsen the condition.Liquid used to steam vegetables provides a good source of electrolytes, and any pharmacy should have electrolyte replacement drinks. This is especially important for children and infants if vomiting or diarrhea is present. Symptoms of inadequate fluid intake, such as dry, sticky mouth, low or no urine output, no tears, lethargy or sunken eyes, require medical attention.TO prevent the spread of the disease, infected individuals need to be kept away from mosquitoes for at least six days. Use acetaminophen, not aspirin for aches and pains. Aspirin may aggravate bleeding ten- dencies associated with DHF, and in children can be associated with the development of Reye’s syndrome, a rare disease that can lead to brain and liver damage.Fever is the body’s attempt to kill a virus, so a little temperature may be acceptable. Hypericum or Saint-John’swort possesses antiviral properties against the dengue virus family and is an herb to consider for dengue treatment. Check with your doctor before using hypericum if you are taking any prescription medications.Avoid herbal and fungal (mushroom) immune-system stimulants such as Echinacea and shiitake. They may exacerbate the immune irregularities of DHF.Milk thistle, taken as directed by health stores, helps protect the liver from possible dengue damage. If you haven’t lost your appetite, artichokes, radishes and beets all aid in liver function. Ginger powder (1/4-1/2 teaspoon) in hot water, taken as needed, is a safe, time-tested anti-nausea therapy. DON’T forget about homeopathic medicine to ease the illness. In the absence of a qualified homeopathic practitioner, consider the following preparations, based on the dominant symptom profile, from a homeopathic pharmacy or retailer: belladonna, for intense pain and high temperature; baptisia or gelsemium, for confusion; Eupatorium perfoliatum, for severe bone pain; and bryonia, for dryness, thirst, severe headache and aches that grow worse with movement.Homeopathic remedies come in different strengths or potencies and have several numerical systems to quantify the strength. Strengths such as 12X, 24X or 30C are generally considered low dosages applicable for home use. Typically a sick person would take a few pellets of belladonna, for example, either 12X, 24X or 30C depending on what’s available, or a few drops in water if liquid homeopathic, and see if improvement occurs in the next one to three hours. If feeling better, take no more of the remedy unless relapse occurs. In the case of no improvement, try a different remedy. I usually advise no more than three or four doses of a remedy without consulting a practitioner, and no more than three different remedies during the course of an illness without professional guidance.Weakness, exhaustion and a slow recovery may be mitigated with the following regimen for adults: 500 mg vitamin C twice daily, to repair tissue and aid in immune system recovery; fish oil supplements, about 1,200 mg twice daily (taken in the middle of your meal to avoid burping), to reduce inflammation; and milk thistle as above, to help remove toxic waste products accumulated during the fever.Jon Dunn is a naturopathic physician living in Nosara, on the northern Pacific coast. E-mail questions or comments to email@example.com, or visit www.drjondunn.com.