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Symptoms of Dengue Fever

Symptoms, which usually begin four to six days after infection and last for up to 10
days, may include

Sudden, high fever


Severe headaches
Pain behind the eyes
Severe joint and muscle pain
Fatigue
Nausea
Vomiting

Skin rash, which appears two to five days after the onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

To protect yourself:

Stay away from heavily populated residential areas, if possible.


Use mosquito repellents, even indoors.
When outdoors, wear long-sleeved shirts and long pants tucked into socks.
When indoors, use air conditioning if available.
Make sure window and door screens are secure and free of holes. If sleeping
areas are not screened or air conditioned, use mosquito nets.
If you have symptoms of dengue, speak to your doctor.
To reduce the mosquito population, get rid of places where mosquitoes can breed.
These include old tires, cans, or flower pots that collect rain. Regularly change the water
in outdoor bird baths and pets' water dishes.
To protect yourself:

Stay away from heavily populated residential areas, if possible.


Use mosquito repellents, even indoors.
When outdoors, wear long-sleeved shirts and long pants tucked into socks.
When indoors, use air conditioning if available.
Make sure window and door screens are secure and free of holes. If sleeping
areas are not screened or air conditioned, use mosquito nets.
If you have symptoms of dengue, speak to your doctor.

To reduce the mosquito population, get rid of places where mosquitoes can breed.
These include old tires, cans, or flower pots that collect rain. Regularly change the water
in outdoor bird baths and pets' water dishes.
Dengue Fever
The disease manifests as a sudden onset of severe headache, chills, pain upon moving the eyes, and low backache.
Painful aching in the legs and joints (myalgias and arthralgiassevere pain that gives it the nick-name break-bone
fever or bonecrusher disease) occurs during the first hours of illness. The temperature rises quickly as high as 40 C,
with relative low heart rate (bradycardia) and low blood pressure (hypotension). The dengue rash is characteristically
bright red petechiae and usually appears first on the lower limbs and the chest (see figure 2). The glands (lymph
nodes) in the neck and groin are often swollen. In some patients, it spreads to cover most of the body. There may
also be gastritis with some combination of associated abdominal pain, nausea, vomiting, or diarrhea. Some cases
develop much milder symptoms which can be misdiagnosed as influenza, chikungunya, or other viral infection when
no rash is present. 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.
Recognition
Sudden
Severe
Pain
behind
Body
-

of

Dengue
onset

headache
the
eyes
aches
Nausea

of
(mostly
which

in
worsens
and
or

high
the
with

eye
joint

fever
fever
forehead)
movement
pains
vomiting

Figure 2: Typical dengue fever symptoms, patients with dengue fever rash
Dengue virus infections are sometimes confused with chikungunya viral infection, because both diseases can present
with high temperatures and myalgias (muscle pain) in people living in or returning from tropical areas (see figure 2,
and also diagnosis of Dengue and Chikungunya). Although these diseases share similar clinical features, prominent
and prolonged joint pains are more consistent with chikungunya, whereas haemorrhage is more common in cases of
dengue virus infection.

Figure 2: Comparisment of Dengue, Zika and Chikungunya symptoms. You can also downloadthe original image in
high resolution as jpg, tiff or powerpoint file.

Dengue Haemorrhagic Fever


Dengue hemorrhagic fever (DHF) is caused by the same viruses and is characterized by increased vascular
permeability, hypovolaemia and abnormal blood clotting mechanisms. DHF is a potentially deadly complication with
symptoms similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty.
The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms.
The fever usually continues for two to seven days and can be as high as 41C, possibly with convulsions and other
complications.
In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's
condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory
failure, and the patient may rapidly go into a critical state of shock. The Dengue Shock Syndrome (DSS) is
characterized by bleeding that may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood
under the skin (ecchymoses). Minor injuries may cause bleeding (see figure 4). Shock may cause death within 12 to
24 hours. Patients can recover following appropriate medical treatment.
The progress towards DHF or DSS occur after 3-5 days of fever (see figure 3). At this time, fever has often come
down. This may mislead many of us to believe that the patient is heading towards recovery. In fact, this is the most
dangerous period that requires high vigilance from care-givers.

Figure 3. Generalized time course of the events associated with DF, DHF and DSS. The incubation period before the
development
of
signs
of
infection
generally
ranges
from
4
to
7
days.

Recognition
of
Dengue
Haemorrhagic
Symptoms
similar
to
dengue
fever
plus,
any
one
Severe
and
continuous
pain
Bleeding
from
the
nose,
mouth
and
gums
Frequent
vomiting
with
or
Black
stools,
like
Excessive
thirst
(dry
Pale,
cold
- Restlessness, or sleepiness
Dengue
-

shock
Narrow
Cold,

syndrome
is
defined
Weak
pulse
pressure
clammy

as
(less
skin

dengue
rapid
than

Fever
of
the
in
or
skin
without
coal

hemorrhagic
20
and

(DHF)
following:
abdomen
bruising
blood
tar
mouth)
skin

fever

plus:
pulse
mm
Hg)
restlessness.

Figure 4: Patients with dengue hemorrhagic fever

Treatment of Dengue
Because dengue is caused by a virus, there is no specific medicine or antibiotic to treat it, the only treatment is to
treat the symptoms. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic).
Rest and fluid intake for adequate hydration is important.

Treatment
The mainstay of treatment is timely supportive therapy to tackle shock due to hemoconcentration and bleeding. Close
monitoring of vital signs in critical period (between day 2 to day 7 of fever) is critical. Increased oral fluid intake is
recommended to prevent dehydration. Supplementation with intravenous fluids may be necessary to prevent
dehydration and significant concentration of the blood if the patient is unable to maintain oral intake. A platelet
transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant
bleeding. The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood
cell transfusion.
People who suffer from dengue fever have no risk of death but some of them develop Dengue Haemorrhagic Fever
(DHF) or Dengue Shock Syndrome (DSS). In some of these cases death can occur. If a clinical diagnosis is made
early, a health care provider can effectively treat DHF using fluid replacement therapy. Adequately management of
DHF generally requires hospitalization.
Aspirin
Aspirin, Brufen and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding
tendency associated with some of these infections. Patients may receive paracetamol preparations to deal with these
symptoms if dengue is suspected. Doctors should be very careful when prescribing medicines. Any medicines that
decrease platelets should be avoided.
Traditional
treatment
In Brazilian traditional medicine, dengue is treated with cat's claw herb, which is for inflammation and does not
prevent dengue. In Malaysia, dengue is treated by some using natural medicine. The treatment is speculated to be
able to arrest and reverse the viral infection and prevent the disease from advancing into a critical stage, though no
evidence has yet shown effectiveness. In Philippines dengue patients use tawa-tawa herbs and sweet potato tops
juice to increase the platelets counts and revived the patients. These are traditional treatments nd are often not based
on scientific medicine research.