Authors

Discussion

Introduction   It is not rare to find in literature at its highest level the powerful representation of human disease. It is the case in the novel Paradise by Abdulrazak Gurnah, which contains a description of a likely  Dengue outbreak .

Aims  and methods  We have analysed the paragraph from the novel emphasizing details that could suggest a Dengue aetiology for the outbreak described among members of the caravan protagonists of the novel.

  Early the following day, they set off for Chatu's country. […] They travelled on narrow country paths, beating uphill through lush vegetation. […] Clouds of insects circled their heads. When they stopped to rest, the insects alighted on them and sought out orifices and tender flesh. At the end of their first day in Marungu several of them had fallen ill. They were tormented by mosquitoes in such numbers that in the morning their faces were bloodied and scarred with bites. […]  By the third day, the afflicted men were desperately ill and others were showing signs of decline. The worst ones could neither eat nor prevent their bodies from evacuating. Their fellows carried their stinking bodies in turn, ignoring their delirious groans as much as was possible and trying to evade the black blood that oozed out of them. On the steep inclines the men could only move a few feet at a time, dragging their burdens on hands and knees. On the fourth day two of the men died. They buried them quickly and waited an hour while the merchant silently read a sura from the Koran. All of them were now tormented by festering sores, which the insects dug deep into to lay their eggs and draw fresh blood. […]  When two more men were found dead on the fifth morning …”

Discussion Dengue  was reported in Tanzania since the fifteenth Century and during the nineteenth century on the Islands of Zanzibar and was endemic at the time and geographic setting where the novel Paradise takes place (the actual Republic of Tanzania, during times of colonial invasion). Mosquito vectors are described as “Clouds of insects circled their heads” through the lush vegetation, encountered “early the following day”, likely the  day-time beating Aedes mosquito,  responsible for disease transmission.

The members of the caravan initially exposed to the endemic serotype in coastal regions, could have been infected with a different serotype when traveling into mainland, explaining the rapid onset of symptoms due to antibody dependent enhancement. Accordingly, the incubation period for Dengue virus is 4–7 days, followed by a febrile phase and  constitutional symptoms, well described in a clear temporal sequence, from “the end of the first day” to the “fifth morning” as  asthenia, anorexia and “black blood that oozed out of them”, or haemorrhagic manifestations typical of severe disease. The short incubation period, the intensity of symptoms reported by the majority of cases and the fatality rate  favours the hypothesis of ADE in diagnosis of Dengue reinfection during the journey in a region endemic for a different viral serotype, and exclude malaria from differential diagnosis, for which premunition in endemic regions would favour asymptomatic infection.   

Conclusions Notwithstanding the public health  burden of  Aedes invasive species and of its  transmitted arboviruses in Tanzania, there is still nowadays insufficient   information on vector dynamics and transmission risk in most parts of the Country.  The powerful pictorial view of this endemic condition provided by Gurnah could inspire, through the beauty of art, further research.