5000178 Dengue Fever

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What and How much we know aboutDengue fever?

-

Sajeeb Sarker

Dengue, again, is the issue; we suffer a lot and we forget about then. Thishappens just every single time. But, if we just try to know something about this –in as much details as possible, we can have a lot more chance to prevent it. And byknowing a little more about its types and diagnosis systems, we can increase thechance of preventing being misdiagnosed. Here are some information aboutDengue that can be a lot helpful for both purposes, and for all people:Dengue fever is a disease caused by a family of viruses that are transmittedby mosquitoes. It is an acute illness of sudden onset that usually follows a benigncourse with

headache

,

fever

, exhaustion, severe joint and

muscle pain

, swollenglands (

lymphadenopathy

), and

rash

. The presence (the "dengue triad") of fever,rash, and headache (and other pains) are particularly characteristics of dengue.

Dengue fever

and

dengue hemorrhagic fever

(DHF) are acute

febrilediseases

caused by four closely related

virus serotypes

of the genus

Flavivirus

,family

Flaviviridae

. The geographical spread is similar to malaria. Each

serotype

is sufficiently different that there is no cross-protection and epidemics caused bymultiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humansby the

Aedes aegypti

(rarely

Aedes albopictus

) mosquito, which feeds during theday.

Virus ClassificationGroup:

Group IV {(+) ssRNA}

Family:

Flaviviridae

Genus:

Flavivirus

Species:

Dengue Virus

Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible toget dengue fever multiple times. However, an attack of dengue produces immunityfor a lifetime to that particular serotype to which the patient was exposed.Dengue goes by other names, including "breakbone" 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 denguewere said to have dandy fever because of their postures and gait.

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Dengue hemorrhagic fever is a more severe form of the viral illness.Manifestations include headache, fever, rash, and evidence of hemorrhage in thebody.

Petechiae

(small red or purple blisters under the skin), bleeding in the noseor gums, black stools, or easy bruising are all possible signs of hemorrhage. Thisform of dengue fever can be life-threatening or even fatal.Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) isa potentially lethal complication, affecting mainly children. Early clinicaldiagnosis and careful clinical management by experienced physicians and nursesincrease survival of patients. Well, we’ll discuss it later.

How is dengue contracted?

The virus is contracted from the bite of a striped

Aedes aegypti

mosquitothat has previously bitten an infected person. The mosquito flourishes during rainyseasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.Again, dengue is transmitted by the bite of an

Aedes

mosquito infected withany one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3—14 days after the infective bite. Dengue fever is afebrile illness that affects infants, young children and adults.The virus is not contagious and cannot be spread directly from person toperson. There must be a

person-to-mosquito-to-another-person

pathway.

What are the signs and symptoms of dengue?

After being bitten by a mosquito carrying the virus, the incubation periodranges from three to 15 (usually five to eight) days before the signs and symptomsof dengue appear. Dengue starts with chills, headache, pain upon moving the eyes,and low backache. Painful aching in the legs and joints occurs during the firsthours of illness. The temperature rises quickly as high as 104° F (40° C), withrelative low heart rate (

bradycardia

) and

low blood pressure

(hypotension). Theeyes become reddened. A flushing or pale pink rash comes over the face and thendisappears. 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 rapiddrop in temperature (defervescence) with profuse sweating. This precedes a periodwith normal temperature and a sense of well-being that lasts about a day. A secondrapid rise in temperature follows. A characteristic rash appears along with the

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fever and spreads from the extremities to cover the entire body except the face.The palms and soles may be bright red and swollen.Symptoms range from a mild fever, to incapacitating high fever, withsevere headache, pain behind the eyes, muscle and joint pain, and rash. There areno specific antiviral medicines for dengue. It is important to maintain hydration.Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs(e.g. Ibuprofen) is not recommended.Yet, we can have another look over the signs and symptoms of dengue for alittle more information:This

infectious disease

is manifested by a sudden onset of

fever

, withsevere headache, muscle and joint pains (

myalgias

and

arthralgias

—severe paingives it the name

break-bone fever

or

bonecrusher disease

) and

rashes

. Thedengue rash is characteristically bright red

petechiae

and usually appears first onthe lower limbs and the chest; in some patients, it spreads to cover most of thebody. There may also be

gastritis

with some combination of associated

abdominal pain

,

nausea

,

vomiting

or

diarrhea

.

Other symptoms include:

•

fever;

•

chills;

•

constant headaches;

•

bleeding from nose, mouth or gums;

•

severe dizziness; and,

•

loss of appetite.Some cases develop much milder symptoms which can, when no rash ispresent, be misdiagnosed as

influenza

or other viral infection. Thus travelers fromtropical areas may inadvertently pass on dengue in their home countries, havingnot been properly diagnosed at the height of their illness. Patients with dengue canpass on the infection only through mosquitoes or blood products and only whilethey are still

febrile

.The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called "biphasic pattern"). Clinically,the

platelet

count will drop until the patient's temperature is normal.Cases of DHF also show higher fever,

haemorrhagic phenomena

,

thrombocytopenia

, and

haemoconcentration

. A small proportion of cases leadto

dengue shock syndrome

(DSS) which has a high mortality rate.

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dengue fever

reply02 / 07 / 2010