Case - On Christmas Eve, 2000, you were working as clerk in a Dallas emergency room. At 3 A.M., a man and two women arrived with a screaming 6 year old girl. The man tried to explain what was wrong, but he spoke only Spanish and you had a difficult time understanding him. The girl's mother was sobbing and you couldn't hear what she was saying. The other woman spoke a bit of English and explained to you and the nurse on duty that this was her sister's family, who had just arrived from El Salvador.  The aunt did not know what was wrong with her niece but told you that the father was repeating the words for "break bone".

The nurse examined the girl and found that she had a rash and fever of 104ºF. Although the girl seemed to be in severe pain, the nurse found no bone fractures. The father, shaking his head violently, said something urgently to his sister-in-law. She interpreted his frantic statement for you, "He said it's in her blood."

1. What is your diagnosis?

2. What connection does this disease have to broken bones?

3. This is a vector-borne disease.  What is the name of the most common vector?

4. What other infection is transmitted by the same vector?

5. The next night when you arrived at work the little girl seemed to be doing better.  The rash had subsided and her fever had lowered. But the on the third night you arrived to find that she had been transferred to intensive care after hemorrhaging internally.  Is this still consistent with your original diagnosis? Explain.

6. This all sound very bad, but you're somewhat comforted by the fact that this disease is not found in the United States. Right?