Reappearance of Chikungunya, Formerly Called Dengue, in the Americas

Scott B. Halstead


Emerging Infectious Diseases. 2015;21(4):557-561. 

In This Article

History of Disease Caused by Dengue Viruses

The first clinical description of a syndrome likely to have been caused by a dengue virus was one by Benjamin Rush, who in 1789 described an epidemic of a disease he called bilious remitting fever.[25] The epidemic occurred from mid-August through September 1780 in Philadelphia, principally among residents living along the Delaware River waterfront. According to Rush:[25]

"The fever generally came on with rigor… In some persons it was introduced by a slight sore throat…. The pains which accompanied this fever were exquisitely severe in the head, back and limbs. The pains in the head were sometimes in the back parts of it and sometime occupied only the eyeballs…. A few complained of their flesh being sore to touch… the disease was sometimes believed to be a rheumatism. But, its more general name among all classes of people was breakbone fever…. A nausea universally, and in some instances, vomiting, accompanied by a disagreeable taste in the mouth, accompanied this fever…. A rash often appeared on the third and fourth days."

Rush's description of bilious remitting fever was well known to physicians who attended to patients during the 1828 outbreak in the Caribbean. However, at the same time, George Stedman, a former president of the Royal Medical Society of Scotland, who practiced medicine on St. Croix, felt that the 1828 dengue was quite different from bilious remitting fever. He observed, "I think that it will be evident to everyone who pays the least attention to the symptoms, that the diseases, though somewhat alike in a few symptoms, are essentially different".[9] The principal distinctions made by Stedman were in the suddenness of the onset and the nature and duration of the after-pains of dengue (present-day chikungunya).[9] Christie also recognized the existence of 2 distinct febrile exanthems, 1 with and 1 without post-illness arthritis. He cited a description of dengue "with an almost entire absence of the articular pains"; this description of illness during an 1853–1854 epidemic in Calcutta was from The Science and Practice of Medicine,[26] an authoritative text authored by William Aitken.[4,27]