A CASE STUDY OF DENGUE FEVER

A REPORT
SUMITTED TO
Department of ZOOLOGY
KHWOPA COLLEGE
(Affiliated to Tribhuvan University)

In partial fulfillment of the requirement for the award of degree of B.Sc. in

Environmental Science

SUBMITTED BY:
Samesh Bajracharya
B.Sc. First year
Environmental Science
Date of Submission: 2076/12/
 ACKNOWLEDGEMENT

I would like to express my special thanks of gratitude to our incharge maam

Ms. Meera Prajapati who gave me a wonderful opportunity to compose a
report on the topic “A CASE STUDY OF DENGUE FEVER” that also had me doing
a lot of research and introduced so many new things that I wasn’t familiar
with. Furthermore, I would like to thank my parents as well as my friends who
contributed a lot in completion of this project within limited time. Also, to the
staff of Janaswastha who provided a lot of information to us. Also, my due
thanks, goes to Mr. Saroj Raj Gosai who made us realize that true knowledge
and precise information is not found on the pages of a book but on the actual
practical experimental grounds (terrace of mustard fields). I am extremely
thankful and pay my undying gratitude to Ms. Ashma Pakhrin for her valuable
guidance and support on fulfillment of this project.
I am making this project not only for marks but also to increase my knowledge.
I thank all who helped me during this project. THANK YOU ALL.

Thanking yours,

Samesh Bajracharya
BSc. First year
Environmental Science

ACKNOWLEDGEMENT
Table of contents
1. Introduction

 Background
 Sign and Symptoms
 Causes
 Transmission
 Diagnosis
 Prophylaxis
 Treatment

2. Objectives of the Study

3. Limitations of the Study

4. Study area

5. Methodology

6. Finding and Observation

 Table
 Graph

7. Result and Discussion

8. Conclusion

9. Recommendation

10.Reference

INTRODUCTION

Background:
Dengue fever is a mosquito borne tropical disease caused by dengue virus. It is
also known as break bone fever. According to WHO, Dengue fever is fast
emerging pandemic prone vital disease. In many parts of the world. In the
small proportion of cases, the disease develops into severe dengue, also
known as dengue hemorrhagic fever, resulting in bleeding, low level of blood
platelets and blood plasma leakage or into dengue shock syndrome, where
dangerously low blood pressure occur.

Dengue is viral infection caused by four types of viruses (DENV-1, DENV-2,

DENV-3, DENV-4) belonging to Flaviviridae family. It is spread by several
species of female mosquito of the Aedes types. The viruses are transmitted
through bite of infected Aedes aegypti and Aedes albopictus female mosquito
that feed indoor & outdoor during the daytime. The mosquito thrives in area
with standing water including puddles, Water tank, containers & old tires.

The majority of infected people are characterized by flu like symptoms which
include high fever, pain behind eyes and skin rash with red spots. A vaccine for
dengue fever has been approved and commercially available in a number of
countries but in case of Nepal, there is no antiviral treatment.

According to the Center for Disease Control & Prevention; it is estimated that
more than 400 million people are infected each year. In Nepal, 3900 people
were diagnosed with dengue fever and 800 of them were hospitalized.

Dengue has become a global problem since second world war and common in
more than 120 countries; mainly in Asia and South America. Dengue occurs in
urban and suburban setting with higher transmission rate during rainy season.

Sign and Symptoms:

 Typically, people infected with dengue virus are asymptomatic (80%) or have
only mild symptom such as an uncomplicated fever. Others have severe illness
(5%) which is life threatening. The incubation period ranges from 3 to 14 days
but most often 4 to 7 days. This infection is characterized by flu like symptom
which include a sudden high fever, muscle, joint and bone pain, severe
headache and skin rash with red spots. Children often experience symptoms
similar to those of common cold & gastroenteritis and have a greater risk of
severe complication.

The illness may progress to Dengue Hemorrhagic Fever symptoms include

severe abdominal pain, vomiting, diarrhea, convulsion, bruising and
uncontrolled bleeding. High fever can last from 2 to 7 days. Complication can
lead to circulatory system failure and shock and can fatal (also known as
Dengue Shock Syndrome). A pregnant woman who is infected with dengue is
at higher risk of miscarriage, premature birth and low weight birth. There is no
antiviral treatment available; however adequate amount of care can increase
patient’s mental condition so that he may muster the courage to fight against
it.

The symptoms of Dengue Hemorrhagic Fever in points are:

 Severe abdominal pain
 Persistent vomiting
 Bleeding from your gums or nose
 Blood in your urine, stools or vomit
 Bleeding under the skin, which might look like bruising
 Difficult or rapid breathing
 Cold or clammy skin (shock)
 Fatigue
 Irritability or restlessness

Causes:

Dengue fever is caused by any one of four types of Dengue virus

spread by mosquito that thrive in and near human lodging. Most
are transmitted by arthropods and are therefore referred to as
arboviruses. The mosquitoes inherit Dengue from an infected
person which then transfers to other uninfected people through a
Dengue hemorrhagic fever can occur when someone is bitten by a mosquito or
exposed to blood infected with the dengue virus. Infected mosquitoes are the most
common causes. There are four different types of the dengue virus. Once you are
infected with one of the viruses, you develop immunity to that virus for the rest of
your life. However, this immunity will not protect you from the other viruses. It is
possible to be infected with all four different types of the dengue virus in your
lifetime.

Transmission:
Dengue virus is primarily transmitted by Aedes mosquito, particularly. These
mosquitoes usually live between the latitudes of 35° N and 35° S below the
elevation of 1000m. They usually bite in the early morning and in the evening
but that doesn’t mean that the virus spreads only in these periods as they can
bite anytime. We humans are the primary host of the virus. However, the virus
also spreads in non-human primates. An infection can be acquired via a single
bite. A female mosquito; if intakes the blood from an infected person during
the initial 2 to 10 days period, becomes infected with Dengue itself which
causes the lining of guts in them. About 8 to 10 days later, the virus spreads to
the other tissues including the mosquito’s salivary gland and is subsequently
released into its saliva.

Dengue can also be transmitted via infected blood product through organ
donation. The generic variation in Dengue viruses is region specific; Suggestive
that establishment into new territories is relatively infrequent, despite dengue
emerging in new regions in recent decades.

Diagnosis:
The diagnosis of dengue is typically made clinically on the basis of reported
symptoms and physical examination, this applies especially in endemic area.
However, Early disease can be difficult to differentiate from viral infection. A
probable diagnosis is based on the realization of fever plus two of the
following:
 Headache
 Muscle, bone and joint pain
 Nausea
 Vomiting
 Pain behind the eyes
 Swollen glands
 Rash
Anyone who experiences such symptoms must be considered a probable
case of Dengue and must be given such diagnosis. Other diagnosis
includes Laboratory Test.

A female Aedes aegypti mosquito obtaining a blood-meal

Prophylaxis: from a human host through her proboscis, which
penetrates the host’s skin.
Prevention of infection is entirely a matter of hygiene i.e. both personal as
well as well as municipal. For personal hygiene, it is suggested to adopt the
following habits:
 Using personal mosquito repellent with long sleeved shirts and long
pants each time we step out of home
 Using household mosquito repellent in the morning, evening and at
night
 Staying away from mosquito contaminated food and drinks
The municipal hygiene includes the whole town, area or municipality or other
local bodies. The following preventive measures should be taken:
 Destroying mosquitoes reproducing areas
 Proper management of sewage and other wastages
 Pure drinking water facility must be accessible to all
 Proper protection of the environment

Treatment:

Treatment of dengue fever is very difficult as there is no specific medication

for it. However, Acetaminophen drug (Paracetamol) is considered effective
against it. If any of the mentioned symptoms are seen, a physician or a doctor
must be contacted immediately. Significant bed rest is suggested. Perhaps the
best remedy of the dengue fever is drinking plenty of pure water.

OBJECTIVES OF THE STUDY

 To know who is most affected among males and females.

 To find out the effects of Dengue Fever.

 To analyze the past and present data of patients.

LIMITATIONS OF THE STUDY
 The study area was limited only in a single health post of Bhaktapur.

 The time period for the field study was limited.

 The data stored in the health post was improper and scrambled.

Therefore, we had to arrange them while collecting.

STUDY AREA

The data was collected from Khwopa Polytechnic which is located in

Chyamasingh, Bhaktapur. The main purpose of the survey was to collect the
data on the number of males and females affected by dengue fever within a
year. The patients were mostly from Bhaktapur Municipality, Nala, Changu and
other areas.
METHODOLOGY
We have collected data from the annual report file of Khwopa Polytechnic
situated at Chyamasingh, Bhaktapur. The study was aimed to have the
Knowledge about the effect, cause, preventive measures of dengue fever along
with the comparison of present health post to the past. We had gone through
the questionnaire method and asked the staff of the health post about this
disease.
FINDINGS AND OBSERVATIONS
The following data was obtained during our case study. This is the data of
Dengue patients in the year 2076 on Bhadra, Aswin, Kartik and Mangsir.

Month Male(M) Female(F) 0-14yrs 15-59yrs 60+yrs Total

Bhadra 59 55 20 79 15 114

Aswin 160 194 17 308 29 354

Kartik 133 126 13 225 21 259

Mangsir 18 20 4 28 6 38

Record of Dengue Patients

 Record of Dengue Patients on the month of Bhadra

Date M F 0 - 14 15 - 59 60+ Total

5/21 12 19 2 23 6 31

5/25 12 18 4 24 2 30

5/28 10 8 - 18 - 18

5/29 9 3 - 10 2 12

5/30 7 2 2 4 3 9

5/31 9 5 12 - 2 14

Total no. of patients in Bhadra 114

Record of Dengue Patients on the month of Aswin

Date M F 0 - 14 15 – 59 60+ Total

6/01 4 6 2 7 1 10
6/02 4 6 2 7 1 10
6/03 8 7 2 13 - 15
6/04 6 5 9 2 11
6/05 10 9 - 16 3 19
6/06 4 5 1 7 1 9
6/07 4 12 1 13 2 16
6/08 9 8 - 16 1 17
6/09 7 13 - 19 1 20
6/10 5 7 - 11 1 12
6/11 6 7 1 12 - 13
6/12 7 10 - 16 1 17
6/13 7 4 - 11 - 11
6/14 3 5 - 6 2 8
6/15 7 7 - 12 2 14
6/16 5 7 - 12 - 12
6/17 7 10 1 16 - 17
6/18 6 2 - 7 1 8
6/19 - 8 1 7 - 8
6/20 2 2 - 4 - 4
6/21 2 1 1 2 - 3
6/23 5 3 - 7 1 8
6/24 2 4 - 5 1 6
6/26 8 12 4 15 1 20
6/27 7 14 - 19 2 21
6/28 12 8 1 16 3 20
6/29 7 10 - 15 2 17
6/30 6 2 - 8 - 8
Total no. of patients in Aswin 354

Record of Dengue Patients on the month of Kartik

Date M F 0 - 14 15 - 59 60+ Total
7/01 5 5 1 8 1 10
7/02 1 1 - 2 - 2
7/03 5 8 - 13 - 13
7/04 10 10 - 19 1 20
7/05 5 9 2 12 - 14
7/06 8 4 1 10 1 12
7/07 4 7 - 8 3 11
7/08 6 4 1 9 - 10
7/09 2 1 - 3 - 3
7/10 9 6 1 13 1 15
7/11 6 5 - 11 - 11
7/12 3 3 1 4 1 6
7/13 5 3 - 8 - 8
7/14 7 7 2 12 - 14
7/15 6 4 1 9 - 10
7/16 4 4 2 6 - 8
7/17 6 5 - 10 1 11
7/18 5 3 - 8 - 8
7/19 9 4 - 12 1 13
7/20 5 5 - 10 - 10
7/21 2 3 - 5 - 5
7/22 4 2 - 5 1 6
7/23 1 1 - 2 - 2
7/24 4 6 - 8 2 10
7/25 5 3 1 5 2 8
7/26 - 4 - 2 2 4
7/27 - 4 - 3 1 4
7/28 1 3 - 3 1 4
7/29 3 2 - 3 2 5
7/30 2 - - 2 - 2
Total no. of patients in Kartik 259
 Record of Dengue Patients on the month of Mangsir

Date M F 0 - 14 15 - 59 60+ Total

8/01 4 2 - 5 1 6
8/02 2 2 - 3 1 4
8/03 5 2 1 6 - 7
8/04 1 1 - 2 - 2
8/05 2 5 - 7 - 7
8/06 1 1 1 - 1 2
8/09 1 2 - 3 - 3
8/13 - 2 1 - 1 2
8/14 1 2 1 - 2 3
8/19 1 - - 1 - 1
8/21 - 1 - 1 - 1
Total no. of patients in Kartik 38