dengue

Know all about Dengue

Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash.

Fever is a very common problem from which almost all of us suffer whenever there is a change of season. Fever is not an illness; it’s a defense mechanism of the body to fight the infections. It’s the sign that our body is working against the infection which is caused by the viruses or bacteria. In fever the temperature of the body rises above the normal, the normal temperature of the body is 98.6 degree Fahrenheit. If the body will have fever then the temperature will rise higher than this.

As soon as our body get in contact with the toxins the white blood cells of the body raises the temperature. These toxins do not have a very good tolerance to the heat so fever helps to fight these infections and whenever we sweat we are eliminating the toxins from the body.

What is Dengue?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the “dengue triad”) of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever. Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and in Paraguay in South America, and Costa Rica in Central America. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic).

The acute phase of the illness with fever and myalgia’s lasts about one to two weeks. Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue. There is currently no vaccine available for dengue fever.

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedesaegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can cause the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the “dengue triad”) of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

Dengue goes by other names, including “break bone” or “dandy fever.” Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechial (small red or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.

What are dengue fever symptoms and signs?

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relatively low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.

Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

How is dengue fever diagnosed?

Patients with severe dengue illnesses can be treated successfully if they are diagnosed as early as possible. Scientists are working on improving dengue diagnostics so that patients infected with dengue can be treated quickly. What would the ideal diagnostic test for dengue do? The ideal diagnostic test would be able to distinguish dengue from other diseases with similar symptoms and distinguish one dengue serotype from another. An ideal diagnostic test would be highly sensitive during the acute stage of the infection, quick and easy to use, and affordable.

How is dengue diagnosed? A number of laboratory methods are used to diagnose dengue, including detection of the dengue virus, viral RNA, viral antigens, and antibodies against the virus in the patient’s blood or tissues (Figure 1). The virus can be detected in the blood for only four to five days after the onset of symptoms. During this early stage of the disease, isolation of the virus, viral RNA, and viral protein can be used to diagnose dengue.

The detection of antibodies (IgM and IgG) in the blood of an infected individual is an indirect method to diagnose dengue. This method is commonly used to diagnose dengue in the later stage of the disease, after the viral levels have decreased. Antibodies against dengue can be detected in most patients five days after the onset of symptoms, and IgG can be detected for many months and even years after an infection (Figure 2). During a primary (first) dengue infection, IgM levels are very high, but during a secondary infection, IgM levels are lower. The levels of IgG actually increase during a secondary infection.

Therefore, clinicians can measure the amounts of IgM and IgG to decide whether a patient has a primary or a secondary dengue infection. This test can be useful because patients with secondary infections are more likely to have severe dengue than those who have not had a previous infection. Because dengue can be mistaken for other diseases such as yellow fever, measles, and influenza, it is best to confirm a diagnosis of dengue by detecting the antibody response and testing for direct evidence of the virus.

What is the treatment for dengue fever?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms. Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor’s supervision because of the possibility of worsening bleeding complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for joint and muscle pain (myalgia).

What is the prognosis for typical dengue fever?

Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks.

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).

In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

The mortality (death) rate with DHF is significant. With proper treatment, the World Health Organization estimates a 2.5% mortality rate. However, without proper treatment, the mortality rate rises to 20%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.

How can dengue fever be prevented?

The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.

The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.

To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever, except living in or traveling to an area where the mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedesaegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

DO’S AND DON’TS FOR PATIENTS

If you or any family member is suffering from suspected dengue fever, it is important to carefullywatch yourself or relative for the next few days, since this disease can rapidly become very seriousand lead to a medical emergency.The complications associated with Dengue Fever/Dengue Haemorrhagic Fever usually appearbetween the third and fifth day of illness. You should therefore watch the patient for two days evenafter fever disappears.

WHAT TO DO:
  • Keep body temperature below 39oC. Give the patient paracetamol (not more than four times in 24hours) as per the dose prescribed below:
AGEDose (tablet 250 mg)Mg / dose
<1 year¼ tablet60
1-4 years½ tablet60-120
5 and above1 tablet240
  • Give large amounts of fluids (water, soup, milk, juice) along with the patient.s normal diet.
  • The patient should take complete rest.
  • Immediately consult a doctor if any of the following manifestations appear:
  1. Red spots or points on the skin.
  2. Bleeding from the nose or gums.
  3. Frequent vomiting.
  4. Vomiting with blood.
  5. Black stools.
  6. Sleepiness.
  7. Constant crying.
  8. Abdominal pain.
  9. Excessive thirst (dry mouth).
  10. Pale, cold or clammy skin.
  11. Difficulty in breathing.
WHAT NOT TO DO:
  • Do not wait in case the above symptoms appear. Immediately consult a doctor. It is crucialto quickly get treatment in case of these complications.
  • Do not take Aspirin or Brufen or Ibubrufen.

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