WEBVTT - Ep 42 Dandy Dengue Fever 0:00:00.920 --> 0:00:03.560 My name is Alex Trio and I am an assistant 0:00:03.560 --> 0:00:07.000 professor at Gettysburg College. I'm an professor of animal behavior 0:00:07.240 --> 0:00:12.440 and tropical biology. I got diagnosed with denge in the 0:00:12.480 --> 0:00:15.480 summer of twenty and sixty. I do a lot of 0:00:15.480 --> 0:00:18.560 field work and I work in Panama Dismissed On and 0:00:18.600 --> 0:00:22.720 Tropical Research Institute, and our work is to set up 0:00:23.079 --> 0:00:29.160 speakers and playbacks that have frog calls to attract predators 0:00:29.200 --> 0:00:32.040 and parasites of these frog So we attract bats and 0:00:32.159 --> 0:00:36.239 we attract these very small midges, and so most of 0:00:36.280 --> 0:00:39.200 our work during the summer at least is in the field, 0:00:39.640 --> 0:00:42.560 all across different field sites in Pana. I was doing 0:00:42.560 --> 0:00:44.920 this work with some of my students in twenty sixty. 0:00:45.520 --> 0:00:49.199 I first started feeling very tired, but I thought that 0:00:49.479 --> 0:00:52.640 it was just because I wasn't sleeping well, because you know, 0:00:52.800 --> 0:00:55.240 I had a young baby and I was working at 0:00:55.320 --> 0:00:58.440 me And one of the days I was so tired 0:00:58.520 --> 0:01:03.320 that my husband recalled me just like kind of collapsing 0:01:03.360 --> 0:01:06.520 on the on the trail going to one of the 0:01:06.560 --> 0:01:10.319 sites where we had our speakers, and he noticed that 0:01:10.560 --> 0:01:12.720 I just felt, well, you know, one of those days 0:01:12.760 --> 0:01:15.200 where I just am tired, and we kind of let 0:01:15.240 --> 0:01:18.240 that go, and then a couple of days later, I 0:01:18.319 --> 0:01:23.479 started feeling much more sick. I got a very small fever. 0:01:24.120 --> 0:01:26.360 I don't really get fevers, and I think that that 0:01:26.480 --> 0:01:28.679 was one of the reasons why it took me so 0:01:28.880 --> 0:01:31.919 long to realize I had them, or I had something 0:01:31.959 --> 0:01:34.800 else than a cold. I was in an actual moment 0:01:34.840 --> 0:01:37.920 where I was really stressed out because not only that 0:01:37.959 --> 0:01:40.000 they had to finish old or they need to do 0:01:40.040 --> 0:01:42.479 all the field work. I had to leave a lot 0:01:42.480 --> 0:01:44.880 of things set up during the field work for my 0:01:44.920 --> 0:01:47.680 students because I was traveling to a conference, and so 0:01:47.800 --> 0:01:52.880 I wasn't really hoping and or expecting and or wanting 0:01:53.000 --> 0:01:57.040 to be sick. I was just you know, trying really 0:01:57.040 --> 0:02:01.480 hard to power through. My cold still went on on 0:02:01.520 --> 0:02:05.480 the plane, and I remember arriving to the US and 0:02:05.560 --> 0:02:08.400 I had to walk to my next gate, and I 0:02:08.480 --> 0:02:11.600 just remember like sitting, you know, on the floor next 0:02:11.639 --> 0:02:14.600 to the chairs and just being like calling my husband 0:02:14.680 --> 0:02:17.440 and saying, I just don't know if I can make 0:02:17.520 --> 0:02:21.880 it to the gate to the connection, like I'm that tired. 0:02:22.320 --> 0:02:24.840 So at this point, what I was feeling mostly was 0:02:24.960 --> 0:02:30.240 extreme my lace like super super tired, and what I 0:02:30.320 --> 0:02:36.280 had was like really strong joint pain. I remember very 0:02:36.320 --> 0:02:40.919 little about the conference. My talk was second or the 0:02:40.960 --> 0:02:43.280 third day of the conference, so I just worked really 0:02:43.320 --> 0:02:46.600 hard and the day I gave my talk. That day 0:02:46.840 --> 0:02:50.360 I started with the fevers. After I finished the talk, 0:02:50.960 --> 0:02:55.160 I came back to my room and I passed out 0:02:55.160 --> 0:02:58.640 for like almost twenty four hours. I was fine, but 0:02:58.800 --> 0:03:01.640 I was in like a lot of pain. When I 0:03:01.680 --> 0:03:06.760 came back, I got this horrible headaches. It just feels 0:03:06.760 --> 0:03:10.040 that you have pressure on top of your nose and 0:03:10.080 --> 0:03:11.960 on the sides of your head like like but the 0:03:12.000 --> 0:03:14.000 pressure is from the inside. It is like if someone's 0:03:14.040 --> 0:03:16.600 like put a hand inside your brain and trying to 0:03:16.639 --> 0:03:18.680 pull it from the inside. That's kind of what it 0:03:18.680 --> 0:03:21.680 feels like. But on the second day of this really 0:03:21.760 --> 0:03:24.400 terrible headaches, we just I just said, we have to go. 0:03:24.600 --> 0:03:26.640 I something has to stop. I don't know what it is, 0:03:26.680 --> 0:03:28.520 but we're going to the emergency room because like I 0:03:28.600 --> 0:03:32.840 want to literally like pull my brain out. The doctor 0:03:33.240 --> 0:03:36.000 saw me and he at first said, oh, it must 0:03:36.080 --> 0:03:41.360 be a really bad sineside as infection, and I was like, 0:03:41.520 --> 0:03:44.440 I have signed as infections before and this is not 0:03:44.600 --> 0:03:47.200 it there's something else that's beaker. And it was actually 0:03:47.200 --> 0:03:49.200 my husband who was like, we're not leaving this place 0:03:49.280 --> 0:03:52.280 until you test for the like you have to test for. 0:03:53.280 --> 0:03:55.840 And so they went ahead and they tested, and then 0:03:55.880 --> 0:03:58.840 we were waiting at the waiting room. So I just 0:03:58.880 --> 0:04:01.680 remember being asleep and then wake up and then the 0:04:01.720 --> 0:04:04.000 doctor being there and said like, yes, you know, you 0:04:04.080 --> 0:04:08.120 were tested positive for denge And I just remember both 0:04:08.200 --> 0:04:11.320 Michael and I actually being happy about it because we 0:04:11.440 --> 0:04:14.440 finally figured out there was like a reason why. I 0:04:14.560 --> 0:04:15.920 was like, I was like, Okay, now we know what 0:04:16.000 --> 0:04:19.599 to do, right, Like we have a diagnosis and we 0:04:19.760 --> 0:04:21.520 know what to do about it, but I mean, there's 0:04:21.520 --> 0:04:24.039 not much you can do, right. I slowly started like 0:04:24.360 --> 0:04:28.039 getting a little bit better. I was weak and tired 0:04:28.200 --> 0:04:30.520 and feeling my laise for like at least two months 0:04:30.600 --> 0:04:34.240 after that. A lot of people thought that I probably 0:04:34.320 --> 0:04:38.520 had it from working in Gamboa in the forest, but 0:04:38.600 --> 0:04:42.120 I do remember about ten days a week to ten 0:04:42.200 --> 0:04:46.159 days before I started feeling sick. I was actually with 0:04:46.279 --> 0:04:49.400 a friend of mine, you guys know here we were 0:04:49.440 --> 0:04:54.000 sitting at a at a restaurant outside in the city 0:04:54.080 --> 0:04:57.120 of Panama. So I honest I think that I got 0:04:57.120 --> 0:04:59.280 it in the city. And so from then on, I 0:04:59.320 --> 0:05:02.039 told my student and I we all like whenever we 0:05:02.279 --> 0:05:05.160 never were, like nobody were skirts or shorts or or 0:05:05.200 --> 0:05:09.480 shorts leaves. We all like get lungs leaves and pants 0:05:09.480 --> 0:05:12.479 and shoes every time we go to town because we're like 0:05:13.120 --> 0:05:16.400 a little bit nervous about that. So yeah, so no 0:05:16.480 --> 0:05:59.760 more skirts in the city. 0:06:00.680 --> 0:06:04.080 You just heard from doctor Alex Trio, who was nice 0:06:04.160 --> 0:06:07.760 enough to share her experiences with dangay with us, and 0:06:07.960 --> 0:06:11.000 if you want to learn more about the awesome research 0:06:11.080 --> 0:06:13.840 that she does, you can check out her website at 0:06:13.960 --> 0:06:17.919 www dot Alextrio dot com. That's a l e X 0:06:18.000 --> 0:06:20.920 t r I l l O and you can also 0:06:21.040 --> 0:06:24.080 follow her on Twitter at t R I l l 0:06:24.200 --> 0:06:28.440 O underscore PA. Thanks again, Alex. Hi. 0:06:28.640 --> 0:06:31.320 I'm erin Welsh and I'm erin omen Updake and. 0:06:31.240 --> 0:06:33.039 This is this podcast will kill you. 0:06:33.800 --> 0:06:36.760 Yeah. Today we're talking about do you say dangy or dangay? 0:06:37.240 --> 0:06:38.400 I think I say both. 0:06:38.680 --> 0:06:42.040 I think we've done this before, right, we have discussed this. 0:06:42.200 --> 0:06:44.800 We have discussed this and we didn't come to a conclusion. 0:06:45.279 --> 0:06:48.280 Yeah, well I'll say dangy, you say dangay perfect. 0:06:48.400 --> 0:06:50.680 That sounds excellent. Okay, great, cover all our faces. 0:06:50.760 --> 0:06:52.320 We can irritate everyone that. 0:06:52.320 --> 0:06:55.919 Way, exactly our favorite thing to do. 0:06:56.400 --> 0:06:59.320 Yes, So, as you might have guessed, we are talking 0:06:59.320 --> 0:07:06.000 about or Dan Gay today, which is a very fascinating 0:07:06.120 --> 0:07:11.400 mosquito born virus. Yes, and it is actually an episode 0:07:11.560 --> 0:07:14.720 or a topic that we have covered once before. We have, 0:07:15.120 --> 0:07:17.800 although only a few of you may have heard it. 0:07:18.200 --> 0:07:22.840 Yeah, So in October we got invited shout out Nick 0:07:22.880 --> 0:07:26.800 Kaiser to University of Florida to give a little talk 0:07:26.920 --> 0:07:30.440 and we talked about Dan Gay, so we technically have 0:07:30.480 --> 0:07:34.680 heard each other talk about Dan Gay before. However, I 0:07:34.720 --> 0:07:37.040 don't remember anything you said, Erin, because I was really 0:07:37.040 --> 0:07:39.520 nervous during this talk, so I was like not actually 0:07:39.520 --> 0:07:40.200 paying attention. 0:07:40.920 --> 0:07:44.920 Well, thank you and same. Also my memory is terrible, 0:07:45.040 --> 0:07:47.040 so but it'll be great. 0:07:48.880 --> 0:07:50.119 I'll still learn new things. 0:07:51.520 --> 0:07:54.960 Apologies to anyone who was in the audience in Florida, 0:07:55.040 --> 0:07:58.200 because if you remember anything, then some of this or 0:07:58.240 --> 0:08:00.640 all of this will be a repeat, but add a 0:08:00.640 --> 0:08:03.680 little bit more to kind of fill in the edges. 0:08:03.960 --> 0:08:06.680 We definitely have some new things and some answers to 0:08:06.760 --> 0:08:11.240 some questions that people asked during that event. Ooh, stay tuned. 0:08:12.000 --> 0:08:14.640 Well is it Quarantini? 0:08:14.720 --> 0:08:14.800 Da? 0:08:15.200 --> 0:08:16.280 I think it is. 0:08:16.600 --> 0:08:17.480 I think it is too. 0:08:18.040 --> 0:08:19.680 What are we drinking this week? 0:08:19.800 --> 0:08:21.520 We're drinking the bone Breaker? 0:08:21.920 --> 0:08:24.160 M what's in the bone Breaker? 0:08:24.520 --> 0:08:27.960 It is mes call. Preferably you could use tequila if 0:08:28.000 --> 0:08:32.240 it's all you've got, passion fruit simple syrup. Oh yeah, 0:08:32.800 --> 0:08:37.000 pin juice, pineapple juice, and you rim it with taheen, 0:08:37.080 --> 0:08:38.840 which is one of our little favorite things. 0:08:39.240 --> 0:08:42.960 It is and it's really refreshing and delicious, so tasty 0:08:43.120 --> 0:08:45.640 and hopefully won't make your bones feel like they're breaking, 0:08:45.920 --> 0:08:48.120 let's hope not just your head the next day. If 0:08:48.120 --> 0:08:51.520 you have too many, don't do that, just have one. 0:08:52.320 --> 0:08:56.560 We will post the recipe for the alcoholic Quarantini and 0:08:56.559 --> 0:08:59.959 the non alcoholic plusy Berta on our website and also 0:09:00.000 --> 0:09:02.480 so on our social media which you can follow us 0:09:02.559 --> 0:09:07.040 at This podcast will Kill You on Instagram and TPWKY 0:09:07.120 --> 0:09:09.680 on Twitter, and you can also find us on Facebook. 0:09:10.440 --> 0:09:13.960 Yeah, any other business that we should discuss erin? 0:09:15.400 --> 0:09:16.120 I don't think so. 0:09:16.400 --> 0:09:18.320 I don't think so either. Should we jump right into 0:09:18.360 --> 0:09:18.960 this episode? 0:09:19.160 --> 0:09:19.720 Let's do it. 0:09:40.600 --> 0:09:45.079 Dangay virus. You already know a lot about it, it's 0:09:45.120 --> 0:09:48.760 a virus. This is a flava virus, so that's in 0:09:48.800 --> 0:09:52.880 the same group of viruses as yellow fever, West Nile Zeka, 0:09:53.600 --> 0:09:59.240 a bunch of different encephalitis viruses, etc. Okay, there are 0:09:59.520 --> 0:10:03.880 five zero types, so that means five different strains of 0:10:03.920 --> 0:10:06.480 this virus. It used to only be four, but in 0:10:06.520 --> 0:10:10.960 twenty thirteen they announced a new one. Ooh, and so 0:10:11.120 --> 0:10:14.240 this means that if you get infected with one strain 0:10:14.800 --> 0:10:20.200 of dngay, you're not protected against the other strains of dngay. Right, 0:10:20.559 --> 0:10:25.800 and as we'll talk about later, it's actually a lot worse. Yeah, spoilers. 0:10:25.960 --> 0:10:27.719 I already have a question about that. I'm going to 0:10:27.800 --> 0:10:33.440 write it down instead of okay. 0:10:32.920 --> 0:10:36.000 A question down and then ask me later. Yeah, okay, 0:10:36.120 --> 0:10:37.200 you don't want to ask it now. 0:10:37.440 --> 0:10:39.480 I mean, because it's kind of jumping ahead to. 0:10:39.720 --> 0:10:43.960 Okay, all right, yeah, okay, ask it later. Okay, Okay. 0:10:44.320 --> 0:10:47.640 So let's talk about how you get infected with danay. 0:10:48.640 --> 0:10:52.080 You already mentioned aaron. This is a mosquito born virus. 0:10:52.720 --> 0:10:56.000 So dangay is transmitted by eighties mosquitos, which we've talked 0:10:56.000 --> 0:11:01.080 about before. Because these little buggers transmit a whole number 0:11:01.160 --> 0:11:06.600 of different diseases, including yellow fever, Zeca et cetera, chicken gunyah, 0:11:06.600 --> 0:11:09.760 which we haven't talked about yet. One thing that's different 0:11:09.800 --> 0:11:13.480 though about dangay than some of these other viruses, although 0:11:13.480 --> 0:11:16.640 not all of them, is that dan gay is pretty 0:11:16.679 --> 0:11:20.240 specifically often a disease of more urban areas, where a 0:11:20.280 --> 0:11:23.960 lot of other viral hemorrhagic fevers tend to be diseases 0:11:24.000 --> 0:11:26.880 of more rural areas. And this is for a couple 0:11:26.920 --> 0:11:30.560 of different reasons. One is that these eighties mosquitoes that 0:11:30.600 --> 0:11:35.800 transmit dangay are very well adapted to urban environments. They 0:11:35.800 --> 0:11:39.640 breed in little, tiny containers of water, and so anytime 0:11:39.640 --> 0:11:43.319 you have like let's say, pots or tires or whatever 0:11:43.440 --> 0:11:46.559 in your yard that could collect water, eighties can breed 0:11:46.920 --> 0:11:51.120 in those small bodies of water. And dangay is a 0:11:51.200 --> 0:11:54.920 human specific disease, so unlike something like yellow fever that 0:11:54.960 --> 0:11:59.360 can spill over from animal populations into human populations, dangay 0:11:59.400 --> 0:12:02.680 is human spita. So where you have large populations of humans, 0:12:02.920 --> 0:12:05.000 you're more likely to get spread of dang gay in 0:12:05.040 --> 0:12:05.640 those areas. 0:12:05.920 --> 0:12:09.400 I forgot about that aspect of yellow fever. Yeah, Like, 0:12:09.559 --> 0:12:13.040 why do you think evolutionarily, there would be a difference 0:12:13.720 --> 0:12:16.600 between the two, you know, like why would dangay be 0:12:16.760 --> 0:12:20.080 so specific to humans and so interesting? 0:12:20.200 --> 0:12:22.000 Yeah, well, I was hoping you would tell me, like 0:12:22.080 --> 0:12:23.240 where dangay came from. 0:12:23.440 --> 0:12:26.320 I mean, I'll tell you that I don't. I won't 0:12:26.320 --> 0:12:30.160 be able to answer this question. Huh. 0:12:30.559 --> 0:12:30.800 Yeah. 0:12:30.800 --> 0:12:33.280 But yeah, there's no like sylvatic wild cycle like there 0:12:33.360 --> 0:12:38.640 is for yellow fever. It's really interesting interesting. So that also, 0:12:38.960 --> 0:12:42.040 I will say, contributes to some of the lack of 0:12:42.120 --> 0:12:45.120 understanding that we have about dangay fever. We don't fully 0:12:45.160 --> 0:12:50.120 understand dangay, and it's because when we have human specific diseases, 0:12:50.200 --> 0:12:52.960 it's often really difficult to find good animal models to 0:12:53.040 --> 0:12:56.560 study these diseases in. So in the case of dangay, 0:12:56.600 --> 0:13:00.600 there are some like modified mice that you can infect 0:13:00.600 --> 0:13:02.679 with dan gay and use. You can do it in 0:13:02.720 --> 0:13:05.520 monkeys in some cases, but we don't have really good 0:13:05.559 --> 0:13:07.320 animal models for studying dan gay. 0:13:07.600 --> 0:13:07.960 Okay. 0:13:08.920 --> 0:13:11.560 The other way that it is possible to get dan gay, 0:13:11.679 --> 0:13:15.200 although this is much more rare than mosquito transmission, is 0:13:15.320 --> 0:13:19.360 vertical transmission, so across the placenta. So it's possible for 0:13:19.400 --> 0:13:22.480 this virus to cross the placenta. So during pregnancy, if 0:13:22.480 --> 0:13:25.560 someone is infected, especially late in the pregnancy, then the 0:13:25.559 --> 0:13:29.240 fetus can potentially get infected as well, and this can 0:13:29.400 --> 0:13:33.120 have pretty bad outcomes once the baby is born. That 0:13:33.160 --> 0:13:35.680 we'll talk about a little bit more later, Okay, But 0:13:35.840 --> 0:13:39.360 it doesn't seem to cause birth defects the way that 0:13:39.400 --> 0:13:45.080 something like zeca virus does, which I think is very interesting. Yeah, huh, Yeah, 0:13:45.160 --> 0:13:48.280 it's not entirely clear if someone gets infected very early 0:13:48.320 --> 0:13:52.920 in their pregnancy, if they might have poor outcomes like 0:13:53.120 --> 0:13:57.120 maybe a miscarriage or something like that. It's not entirely 0:13:57.160 --> 0:13:59.800 clear if that happens if you get infected with dangay 0:13:59.880 --> 0:14:02.760 or in your pregnancy, Okay, but definitely if you get 0:14:02.800 --> 0:14:04.960 infected late, then the fetus can get infected and then 0:14:05.000 --> 0:14:08.600 basically when it's born, it can either have symptoms of 0:14:08.720 --> 0:14:12.280 dangay or it might just have antibodies, like it might 0:14:12.280 --> 0:14:14.760 be born having antibodies against dangae virus. 0:14:14.920 --> 0:14:17.840 Okay, like having already been infected and then. 0:14:18.200 --> 0:14:21.240 And survived the infection. Yeah, yes, Oh, put a pin 0:14:21.280 --> 0:14:28.720 in that. Okay, that oh is the perfect Oh okay, 0:14:28.840 --> 0:14:32.120 So that's how you get transmitted or how you get infected. Rather, 0:14:32.160 --> 0:14:36.800 that's the transmission cycle what basically happens. We've talked about 0:14:36.840 --> 0:14:40.760 a number of mosquito born diseases on this podcast by now, 0:14:41.200 --> 0:14:44.440 so what's important to remember about all mosquito born diseases 0:14:44.480 --> 0:14:47.800 is that there's the cycle of the virus in the 0:14:47.880 --> 0:14:50.240 human and then there's also the cycle of the virus 0:14:50.280 --> 0:14:54.440 in the mosquito mm hm. And so the mosquitoes get 0:14:54.480 --> 0:14:58.480 infected if they bite a person who's actively febrile. For 0:14:58.520 --> 0:15:01.120 the most part, it's all it's possible like a couple 0:15:01.200 --> 0:15:03.640 days before you show symptoms and a couple days after 0:15:03.680 --> 0:15:06.360 you recover. If a mosquito bites a person infected with 0:15:06.440 --> 0:15:10.800 dungay during that time period, then the mosquito sucks up 0:15:10.800 --> 0:15:14.000 a bunch of viral particles. Those will travel through the 0:15:14.040 --> 0:15:16.920 gut of the mosquito, and then they have to make 0:15:16.960 --> 0:15:19.119 it out of the gut and back to the salivary 0:15:19.160 --> 0:15:22.760 glands of the mosquito. Importantly, that whole process in the 0:15:22.800 --> 0:15:27.640 mosquito takes like eight to ten days. Wow, Yeah, it's 0:15:27.720 --> 0:15:31.240 kind of a long time, okay, And that means that 0:15:31.320 --> 0:15:35.080 if you can somehow stop that process in that eight 0:15:35.120 --> 0:15:38.480 to ten day window, then you could block the transmission 0:15:38.520 --> 0:15:43.920 of dengay, right right, So that's really important. We'll talk 0:15:44.000 --> 0:15:46.680 even more about that in the current events section, because. 0:15:46.480 --> 0:15:48.440 That's a lot of people are all these little hints. 0:15:48.480 --> 0:15:50.480 It's all I do. This whole bio section is just 0:15:50.480 --> 0:15:51.560 going to be hints for later. 0:15:51.760 --> 0:15:55.240 Oh my god. Also, I just need to have a 0:15:55.240 --> 0:15:59.920 little point out right now that I remember nothing excellent, 0:16:00.480 --> 0:16:02.920 Like I'm like, okay, yeah, I know that it's a flavivirus, 0:16:02.960 --> 0:16:04.720 I know that this and that, but like that was 0:16:04.760 --> 0:16:06.440 all pervictage. 0:16:06.640 --> 0:16:08.760 I'm so sorry. I think we must have been like 0:16:08.960 --> 0:16:11.240 nervous blackout when we were presenting. 0:16:11.400 --> 0:16:14.640 For sure, I remember nothing of that whole trip there. 0:16:16.880 --> 0:16:22.040 Okay. So then when if that does work properly in 0:16:22.040 --> 0:16:24.200 the mosquito, then you have a bunch of virus in 0:16:24.240 --> 0:16:27.040 the mosquito salivary glands. Then they're going to bite another 0:16:27.160 --> 0:16:32.080 human and spit all of that virus into you essentially, 0:16:33.520 --> 0:16:37.520 and then that virus will go into your usually your 0:16:37.600 --> 0:16:42.200 lymph system, and in the case of Dane virus, it'll 0:16:42.320 --> 0:16:45.040 enter your white blood cells, and that is where the 0:16:45.120 --> 0:16:50.840 virus replicates in human bodies. So then after about four 0:16:50.880 --> 0:16:55.080 to seven days usually after you get infected with this virus, 0:16:55.160 --> 0:16:59.360 that's when you'll start to show symptoms. Okay, cool, Okay, 0:17:00.160 --> 0:17:02.720 so now we know the transmission. We know that it's 0:17:02.840 --> 0:17:06.720 infecting your white blood cells, which, if you don't recall, 0:17:07.200 --> 0:17:11.480 are part of your immune system. So that's really important 0:17:11.480 --> 0:17:15.760 because it's directly sort of targeting your immune cells. Okay, 0:17:16.520 --> 0:17:18.840 so what kind of symptoms do we have if you 0:17:18.840 --> 0:17:23.000 get infected with dangay. If you get infected with dangay 0:17:23.000 --> 0:17:28.320 for the first time, most people will never have any symptoms. 0:17:28.520 --> 0:17:30.479 What's most eighty percent? 0:17:31.040 --> 0:17:31.840 Wow? 0:17:32.080 --> 0:17:35.000 Yeah, so, like eighty percent of people who are infected 0:17:35.000 --> 0:17:37.960 for the first time with dangay have either very very 0:17:38.000 --> 0:17:42.760 mild symptoms or are entirely asymptomatic, which you can imagine 0:17:42.760 --> 0:17:45.359 makes it even more difficult to understand how many people 0:17:45.400 --> 0:17:48.840 really do get infected every year and how to actually 0:17:48.880 --> 0:17:54.680 control this virus. Yeah, if you do get symptoms from 0:17:54.720 --> 0:17:58.440 a primary infection, it generally starts as all of our 0:17:58.440 --> 0:18:03.479 favorite diseases do. With a fever. You'll often get a 0:18:03.520 --> 0:18:08.800 headache and very classically you get severe muscle and joint pain. 0:18:08.920 --> 0:18:11.560 So that's how it got the name breakbone fever, right, 0:18:13.000 --> 0:18:16.160 and the symptoms can actually be broken down into three 0:18:16.240 --> 0:18:20.960 main phases, but the last two phases tend to only 0:18:21.080 --> 0:18:27.480 happen if you're getting infected with dange for the second time. Aha, okay, 0:18:28.000 --> 0:18:32.879 so here are the three main phases. Febrile, critical but 0:18:33.000 --> 0:18:39.720 oh not good, and recovery oh asterisk or death Okay, yeah, okay, 0:18:41.320 --> 0:18:44.720 So the febrile phase that we kind of already started 0:18:44.760 --> 0:18:46.920 talking about. If you get infected for the second time, 0:18:47.160 --> 0:18:49.800 it's much more likely to be symptomatic, and this phase 0:18:49.840 --> 0:18:53.679 will probably start out worse than the first infection. So 0:18:53.720 --> 0:18:56.320 it starts out with a super high fever. We're talking 0:18:56.359 --> 0:19:03.400 over one hundred and four fahrenheit, yes, forty celsius sting. Yeah, 0:19:03.720 --> 0:19:05.400 wait is that right? Yeah, I'm pretty sure it's right. 0:19:05.800 --> 0:19:06.840 That's high. 0:19:07.080 --> 0:19:10.720 It's very high. And this fever lasts usually between two 0:19:10.800 --> 0:19:13.520 and seven days. Oh my gosh, I know it's a 0:19:13.560 --> 0:19:15.560 long time. You're very, very sick. 0:19:16.359 --> 0:19:20.960 Does it does it respond to like anti piretics? 0:19:21.080 --> 0:19:26.800 Good question, probably, But it's also often bi phasic. So 0:19:27.000 --> 0:19:29.240 often you'll get a really high fever and then you'll 0:19:29.280 --> 0:19:31.480 start to get better, and then a couple days later 0:19:31.520 --> 0:19:32.760 it'll come back again. 0:19:33.080 --> 0:19:38.600 Does the fever intensity correspond to like circulating virus anything 0:19:38.680 --> 0:19:39.280 like that. 0:19:39.280 --> 0:19:41.119 That's a really good question that I don't fully know 0:19:41.200 --> 0:19:43.879 the answer to. We'll talk a little bit more about 0:19:43.920 --> 0:19:47.520 like viremia, how much virus you have in your body, uh, 0:19:47.560 --> 0:19:49.800 when we talk about some of the more severe symptoms 0:19:49.800 --> 0:19:53.000 of it. But definitely the higher the viral load, the 0:19:53.119 --> 0:19:56.160 more sick you'll probably get, right, and the more likely 0:19:56.200 --> 0:19:58.400 you are to like have symptoms and things like that. 0:19:58.640 --> 0:20:01.360 But is that why the bi phasic, Like, is that 0:20:01.480 --> 0:20:02.200 part of it? 0:20:02.320 --> 0:20:02.399 There? 0:20:02.520 --> 0:20:04.960 Definitely could be. I mean that's usually when we think 0:20:04.960 --> 0:20:07.600 of things like malaria and stuff like that. That's usually 0:20:07.640 --> 0:20:09.679 when you have those biphasic fevers. So it could be that, 0:20:09.760 --> 0:20:12.199 like you get an initial infection and maybe your immune 0:20:12.200 --> 0:20:14.360 system kicks in is able to knock it down a bit, 0:20:14.400 --> 0:20:17.520 but then the viruses just start replicating like crazy, and 0:20:17.560 --> 0:20:19.640 then you get a secondary second wave. 0:20:19.800 --> 0:20:23.040 Interesting. Yeah, And do we know whether the fever is 0:20:23.560 --> 0:20:27.680 a defense mechanism by your bucket, like an immunological response, 0:20:27.840 --> 0:20:29.680 or is it induced by the virus? 0:20:29.880 --> 0:20:34.040 Excellent question. Most of the symptoms of dengee are your 0:20:34.119 --> 0:20:38.760 immune system responding to the virus. Okay, great questions, Aaron as. 0:20:40.000 --> 0:20:43.520 Other symptoms that you'll see are severe headache, and for 0:20:43.560 --> 0:20:45.840 some reason, don't ask me why on this one because 0:20:45.840 --> 0:20:48.960 I won't have an answer. It's often behind like right 0:20:49.000 --> 0:20:52.760 behind your eyes where you get this severe headache. And then, 0:20:52.840 --> 0:20:55.840 like I mentioned already, muscle and joint pain, nausea and 0:20:55.960 --> 0:21:00.680 vomiting are really common, and then a rash can often 0:21:00.720 --> 0:21:04.800 happen after a few days. And the rash unlike other 0:21:04.960 --> 0:21:08.400 viral illnesses that are really common, like or that used 0:21:08.400 --> 0:21:10.960 to be really common, something like measles, where you also 0:21:11.000 --> 0:21:14.359 get a rash, this rash starts on the torso and 0:21:14.400 --> 0:21:17.439 then spreads to the limbs. Okay, so a lot of 0:21:17.480 --> 0:21:20.200 other rashes will start like on the head and go down. 0:21:20.600 --> 0:21:23.600 So where rashes start can kind of help you figure 0:21:23.640 --> 0:21:26.119 out what disease it might be. Isn't that weird? 0:21:26.359 --> 0:21:26.760 Why? 0:21:27.119 --> 0:21:31.480 I don't know? Viruses are just so cool? 0:21:32.600 --> 0:21:34.760 What did we talk about with the rash and the palms? 0:21:35.119 --> 0:21:38.679 Oh uh so ricketsia causes that, and syphilis causes that, 0:21:39.000 --> 0:21:40.480 and then hand foot in mouth disease. 0:21:40.600 --> 0:21:44.240 Yeah, okay, cool, Yeah, see I'm remembering thing. 0:21:44.359 --> 0:21:48.240 Good. So this one starts on the torsos, writes to 0:21:48.240 --> 0:21:50.560 the limbs. But what's really important is that it's often 0:21:50.680 --> 0:21:53.080 really really hard to see this rash. So it's not like, 0:21:54.280 --> 0:21:59.440 you know, this really huge, you know, scary looking rash 0:21:59.480 --> 0:22:02.800 or anything. It's a very light red, pink, kind of 0:22:02.920 --> 0:22:08.000 splotchy rash. So it's not very descriptive. So after those 0:22:08.080 --> 0:22:10.560 few days, a couple days, you know, two to seven 0:22:10.600 --> 0:22:14.200 days of fever, as the fever starts to fade out, 0:22:14.800 --> 0:22:19.720 especially with the secondary infection, dengay can become more severe. 0:22:19.840 --> 0:22:22.560 This is when we get into two different syndromes called 0:22:22.600 --> 0:22:29.159 dengay hemorrhagic fever and dengay shock syndrome. Overall across like 0:22:29.240 --> 0:22:33.360 all dengay infections, these two syndromes happen in less than 0:22:33.400 --> 0:22:36.280 five percent of cases, but the vast majority of those 0:22:36.359 --> 0:22:38.520 are when someone's been infected the second. 0:22:38.200 --> 0:22:41.960 Time, you mean the second time with a different strain. 0:22:41.800 --> 0:22:44.680 With a different strain exactly, okay. 0:22:44.200 --> 0:22:48.439 And so you cannot get sick again from the same strain, 0:22:49.040 --> 0:22:51.640 Do you have lifetime immunity or what's the deal? 0:22:51.800 --> 0:22:55.320 Pretty much, yeah, from that particular strain, Like maybe unless 0:22:55.320 --> 0:22:58.200 you got infected with a really really low viral load 0:22:58.400 --> 0:23:01.000 and you didn't mount a great immune response, then maybe 0:23:01.000 --> 0:23:03.520 you could be reinfected with the same strain. But for 0:23:03.600 --> 0:23:08.040 the most part, in areas where dengay circulates, multiple strains 0:23:08.080 --> 0:23:10.400 circulate at the same time, so you're much more likely 0:23:10.440 --> 0:23:13.000 to get infected with a different strain. And that's when 0:23:13.000 --> 0:23:15.760 you see Dangay hemorrhagic fever or dan gay shock syndrome. 0:23:16.560 --> 0:23:19.760 So what's happening in these two syndromes. Both of them 0:23:19.960 --> 0:23:25.479 are related to capillary leakage. So your capillaries are the 0:23:25.640 --> 0:23:29.960 tiny ends where your arteries and veins come together, right 0:23:30.000 --> 0:23:34.760 where like gas exchange is happening. And so what happens 0:23:34.880 --> 0:23:37.960 is the virus and your immune response to the virus 0:23:38.080 --> 0:23:42.280 both cause damage to these tiny blood vessels and it 0:23:42.320 --> 0:23:45.879 causes them to leak, and that is going to cause 0:23:45.960 --> 0:23:49.840