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An Undescribed Idiopathic Fever on the Isthmus of Panama

Two hundred and fifty cases of a syndrome of tropical fever occurring in the general population from 1945 to 1947 on the Isthmus of Panama and the reports of dengue and dengue-like fevers in this region during the last 50 years are reviewed.

Although specific etiology was not determined for this syndrome, there was a characteristic clinical pattern which included an acute onset with shaking chills, fever of varying severity and duration, usually persisting for six days, prominent grippe-like symptoms such as severe frontal headaches, pains in muscles and joints, nausea and vomiting, and a prolonged period of convalescence with extreme asthenia and moderate mental depression.

A seasonal increase in incidence and the history of repeated exposure to insect bites in many cases suggested an insect vector.

¹ Formerly Staff Member of Department of Internal Medicine, Gorgas Hospital, Ancon, Canal Zone.

² Present Address—Research Fellow, Evans Memorial, Massachusetts Memorial Hospitals; and Instructor in Medicine, Boston University School of Medicine, Boston, Mass.