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Dengue, Zika virus and chikungunya are transmitted by the same mosquito, but cause different symptoms and complications.

Dengue, Zika virus and chikungunya are transmitted by the same mosquito, but cause different symptoms and complications.

In the year 2015 alone, there were 2,975 suspected cases of microcephaly, according to the latest epidemiological bulletin issued by the Ministry of Health that year, and one of the main suspects is that the outbreak is related to infection by the Zika virus during pregnancy. To get an idea of ​​the size of the problem, between 2010 and 2014 a total of 781 cases were registered nationwide. By 2016 this number continues to rise, with the risk of spreading, even, to other countries. In relation to contamination by dengue, the numbers are also alarming. According to the Ministry of Health, Brazil presented a record index of 1.6 million people infected by the disease in 2015. The number is the largest since the 1990s.

The high Aedes aegypti contamination statistics occur, among many factors, because it is a domestic mosquito that lodges in or near homes, especially in urban areas and places with high population density. Contamination outbreaks usually occur in the summer, due to the elevation of temperature and intensity of rainfall - which makes it possible and proliferation of the mosquito. In view of the dangerous nature of the mosquito, several Brazilian cities have declared a state of alert against Aedes aegypti.

Aedes aegypti transmission cycle

The transmission of the virus is done by the female. The cycle begins the moment it deposits its eggs in containers with water, when they leave the eggs, the larvae live in the water for about a week. After this period, they become adult mosquitoes, ready to sting people. The Aedes aegypti procreates at prodigious speed and the adult dengue mosquito lives on average 45 days.

Aedes aegypti becomes a vector of contamination after stinging someone who has already been infected with the dengue virus (DEN-1, DEN-2, DEN-3 or DEN-4), zika (ZIKV) or chikungunya (CHIKV). It is important to note that the mosquito can carry the virus throughout its life. It is therefore of great importance that the person who is in the period of treatment of dengue, zika and chikungunya protects themselves from contact with the mosquito again.

After the person is bitten by the mosquito that carries the virus, it takes between three to 15 days to manifest the symptoms, being more common between the fifth and sixth day. In the case of chikungunya of two to 12 days (more common of five to six days) after the bite, and in the Zika of three to 12 days.

Symptoms

In common, besides being transmitted by the bite of the same mosquito , the diseases appear in acute phases, they can give malaise, pains for the body and of head, and fever. "Among the differences, headache tends to be more intense in dengue, while joint pain is more intense in chikungunya and Zika rarely presents with fever or other more characteristic symptoms," says Esper Kallas, hospital infectious disease coordinator Syrian-Lebanese. "The Zika infection also usually has a picture of conjunctivitis in about half of the people, the redness in the body usually scratches and it can cause an enlargement of the ganglia, signs that are not present in the other two."Although all diseases cause fatigue and pain in the body, in the case of chikungunya, joint pain is disabling and can also cause swelling. Therefore, the person can not do his daily activities. See the comparison between the symptoms of dengue, zika and chikungunya in the table below:

Dengue

Zika Virus

ChikungunyaHigh feverLow fever
Disabling joint painPain headachePain in the joints
FeverPain behind the eyesMuscle pain
Back painLoss of appetiteHeadache
RashSkin blemishes and rashes (especially in the region of the thorax and upper limbs)Pain behind the eyes
FatigueNausea and vomitingConjunctivitis
NauseaDizzinessRashes reddish which may scratch
VomitingSmoothness and extreme tirednessAbdominal pain (uncommon)
HeadacheBody painDiarrhea (uncommon)
Muscle pain (myalgias )Pain in bones and jointsConstipation (uncommon)
Pain in the abdomenSmall ulcers in the oral mucosa (uncommon)
Diagnosis and treatmentTo establish if op Zinc, dengue or chikungunya, in addition to analyzing the symptoms, the doctor may request tests to confirm the diagnosis. "Dengue can lead to a decrease in the number of platelets, which is detected in a blood count, but the diagnosis is made by serology, in which the antibody is searched for the disease In the case of chikungunya, it is also possible to test for serology in search of the antibody, but Zika does not have a serology test available. Private laboratories are seeking genetic material (PCR) tests for Zika and chikungunya, "says Kallas. However, these tests can only be applied until the fifth day after the manifestation of the symptoms for the Zika virus and up to the tenth day for chikungunya, since after that the virus is no longer in the body then it is not detected by the test of genetic material (PCR).

The Ministry of Health announced in the second half of January that it is acquiring 500,000 PCR tests to also diagnose the Zika virus in public laboratories, and that the first 250,000 units will be delivered in February and the second half will be available in the second half.

In addition to this, the Ministry also announced that another 500,000 tests, called Kit NAT, will be purchased by the Oswaldo Cruz Foundation (Fiocruz) for diagnosis of dengue fever, Zika and chikungunya. A similar type of this same test has been used since January 2014 for the detection of HIV and hepatitis C in Brazilian blood banks. According to the Ministry's official note, "the NAT Kit discriminatory for dengue, Zika and chikungunya, allows simultaneous identification of the genetic material for the three viruses, avoiding the need for three separate tests", which will ensure greater agility in diagnosis.

Zika, dengue and chikungunya do not have a specific medication that will fight the virus, so the treatment of all is based on the symptoms that the person presents. "Our aim in the treatment is to make the clinical support to control the symptoms and monitor the appearance of possible complications, keeping the patient in the best possible state while the cycle of the virus ends naturally," explains Carolina Lázari, an infectious disease specialist at Fleury Medicina e Saúde.

In the case of dengue, the responsible doctor will request the monitoring of the patient's blood count, since this disease can cause serious complications and even death. "People who have a change in the blood count are kept at a minimum with intravenous hydration, which is also very important, and simple cases can be treated at home, while the most serious cases remain hospitalized. for the other two viruses, so we are learning now, because the clinical manifestations of them are milder and it is rare that there is death in these cases, unlike dengue, "explains the infectologist.Although the Zika virus is the mildest from a clinical standpoint, which means that the symptoms last for a shorter time, it is what demands greater attention in the case of pregnant women, once their relationship has been confirmed with fetal developmental problems - microcephaly. "Unfortunately, there is still no specific way to treat this mother and protect the fetus. Unlike syphilis and toxoplasmosis, for example, we have medicines that, treating the mother early in prenatal care, prevent the problem from going through the a placental barrier that brings about sequelae or complications when the baby is born, "says Carolina.

Chikungunya, which has the most striking symptoms among the three infections, may take the longest time to come to an end. "It may be necessary to use a greater amount of analgesic, anti-inflammatory and even corticosteroid medications to contain the inflammatory activity and pain, and in addition, it is reported that the same infection, once the symptoms are resolved, can return to normal. reactivate, causing the same symptoms again, which does not happen for dengue and Zika, "says the doctor. See the possible complications of Zika virus, dengue and chikungunya in the following table:

Dengue

Zika virus

Chikungunya

Complications

The main complications of dengue fever are circulatory shock, hemorrhages, visceral complications such as hepatitis and encephalitis, among others. The complications of Zika in an adult are neurological, such as the Guillain-Barré Syndrome. In general, the complications of Zika in an adult are neurological, such as Guillain-Barré Syndrome. In the case of the chikungunya, the main complications are the delay in the resolution of the symptoms, especially the joint pains. In the case of the chikungunya, there is a risk of fetal development, resulting in the birth of the baby with microcephaly and other malformations. , which can cause the person to take several weeks to resume their daily activities, as well as the possibility of reactivation of the disease after a period of improvement.Viruses have the capacity to modify to some extent and also to reach different populations in different ways that end up contracting them over time. It is precisely for this reason that it is not possible to say whether the dengue virus, Zika and chikungunya may be related to other complications besides these. Several researches are being carried out in Brazil and the world on this subject, but it is still very new and requires more time for confirmation and registration in the medical and scientific literature of its effects.


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