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Symptoms include fever, headache, muscle andjoint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting inbleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs. Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunityto that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.
coldand gastroenteritis (vomiting and diarrhea),  but are more susceptible to the severe complications. Clinical
The characteristic symptoms of dengue are suddenonset fever, headache (typically located behind the eyes), muscle and joint pains, and a rash. The alternative name for dengue, "break-bone fever", comes from the associated muscle and joint pains.  The course of infection is divided into three phases: febrile, critical, and recovery.
The febrile phase involves high fever, often over 40 °C (104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days.  At this stage, a rash occurs in approximately 50–80% of those with symptoms. It occurs in the first or second day of symptoms as flushed skin, or later in the course of illness (days 4–7), as ameasles-like rash. Some petechiae (small red Treatment of acute dengue is supportive, using either spots that do not disappear when the skin is pressed, oral or intravenous rehydration for mild or moderate which are caused by brokencapillaries) can appear at this point, as may some mild bleeding from disease, and intravenous fluids and blood transfusion for more severe cases. Theincidence of the mucous membranes of the mouth and nose.  The fever itself is classically biphasic in nature, dengue fever has increased dramatically since the breaking and then returning for one or two days, 1960s, with around 50–100 million people infected yearly. Early descriptions of the condition date from although there is wide variation in how often this 1779, and its viral cause and the transmission were pattern actually happens. elucidated in the early 20th century. Dengue has In some people, the disease proceeds to a critical become a worldwide problem since the Second World phase, which follows the resolution of the high fever War and is endemic in more than 110 countries. and typically lasts one to two days.During this Apart from eliminating the mosquitoes, work is phase there may be significant fluid accumulation in ongoing on a vaccine, as well as medication targeted the chest and abdominal cavity due to directly at the virus. increased capillary permeability and leakage. This leads to depletion of fluid from the circulation and decreased blood supply to vital organs. During this phase, organ dysfunction and Signs and symptoms severe bleeding, typically from the gastrointestinal Typically, people infected with dengue virus tract, may occur. Shock (dengue shock are asymptomatic (80%) or only have mild symptoms syndrome) and hemorrhage (dengue hemorrhagic such as an uncomplicated fever. Others have fever) occur in less than 5% of all cases of dengue, more severe illness (5%), and in a small proportion it  however those who have previously been infected is life-threatening. The incubation period(time with otherserotypes of dengue virus ("secondary between exposure and onset of symptoms) ranges infection") are at an increased risk. from 3–14 days, but most often it is 4–7 days.  Therefore, travelers returning from endemic areas The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream. This usually are unlikely to have dengue if fever or other lasts two to three days. The improvement is often symptoms start more than 14 days after arriving striking, but there may be severe itching and a slow home. Children often experience symptoms heart rate. During this stage, a fluid similar to those of the common
 . andOmsk hemorrhagic fever virus. Other members of the same family include yellow fever virus. and these are referred to as DENV-1. for example.Infection of have no detrimental effect on the mosquito. the risk is estimated to be between 1. Transmission Dengue virus is primarily transmitted by Aedes mosquitoes. and to feed off people rather than other vertebrates. Louis encephalitis virus.6 and 6 per 10. Kyasanur forest disease virus. DC-SIGN. Other Aedes species that transmit the Dengue can occasionally affect several other body disease include A. genus Flavivirus. NS2a. cells lining its gut. TGFβ. called serotypes.   CTLA4. The dengue virus genome (genetic material) contains about Predisposition 11. proteins known as TNFα. to live in close proximity to humans. In countries such as Singapore. particularly A.overload state may occur.300 ft). A.000 metres (3. NS5) that are only found in  Women are more at risk than men. They bite primarily during the day. aegypti. NS3. it may cause a reduced level of consciousness or seizures. mannan-binding lectin. the liver. Dengue can also be transmitted via infected blood products and through organ donation. There are four strains of the virus. About 8–10 days later. These mosquitoes usually live between the latitudes of 35° North and 35° South below Associated problems an elevation of 1. Polymorphisms in the genes for the vitamin D 3. A female by the virus or indirectly as a result of impairment of mosquito that takes a blood meal from a person infected with dengue fever becomes itself infected with the virus in the vital organs. common in children that are relatively well nourished. NS4b. Other personto-person modes of transmission have also been reported. which remains the heart and acute liver failure are among the rarer infected for life. Infection with one been linked with an increased risk of severe dengue serotype is believed to produce lifelong immunity to that complications. the virus spreads Other neurological disorders have been reported in to other tissues including the mosquito's salivary glands and the context of dengue. All four serotypes can Polymorphisms (normal variations) in particular genes have cause the full spectrum of disease. artificial water containers. either in isolation or along with the scutellaris. DENV-3 and DENV-4. prM and E) that form the virus children. appears to increase DENV-1 then contracts serotype DENV-2 or serotype DENVthe risk. A decreased level of  but it also circulates in nonhuman primates. Aedes aegypti prefers to lay its eggs in complications. which codefor the three different Severe disease is more common in babies and young types of protein molecules (C. Examples include the genes coding for the serotype but only short term protection against the others. tickborne encephalitis virus. such as transverse is subsequently released into its saliva. albopictus. if it affects the brain. Humans are the primaryhost of the virus. Dengue can be infected host cells and are required for replication of the life-threatening in people with chronic diseases such virus. An consciousness occurs in 0. classic dengue symptoms. and particular forms ofhuman leukocyte antigen. and are therefore also referred to as arboviruses (arthropod-borne viruses). and in contrast to many other infections it is more particle and seven other types of protein molecules (NS1. Cause  Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae. disease in secondary dengue infection.5–6% of severe cases. Japanese encephalitis virus. polynesiensis and A. systems. The virus seems to myelitis and Guillain-Barré syndrome. Most are transmitted by arthropods (mosquitoes or ticks). A common The severe complications on secondary infection occurs genetic abnormality in Africans.  Vertical transmission (from mother to child) during pregnancy or at birth has been reported. known as glucose-6particularly if someone previously exposed to serotype phosphate dehydrogenase deficiency. St. DENV-2. where dengue is endemic. but are very unusual. West Nile virus.000 nucleotide bases.000 transfusions. which are asdiabetes and asthma. which is attributable either to infection of the brain infection can be acquired via a single bite. NS4a. or if someone previously exposed to type DENV-3 then receptor and FcγR seem to offer protection against severe acquires DENV-2. NS2b.
enhancement (ADE). a for the bleeding complications. and fluid from the bloodstream leaks through the widely accepted hypothesis is that of antibody-dependent wall of small blood vessels into body cavities.Mechanism well as T cells that directly attack any cell infected with the virus. some bind When a mosquito carrying dengue virus bites a person. but some bind the virus less well and appear the cells while they move throughout the body. which infections. on the the production of a large group of proteins mediated by basis of reported symptoms and physical examination. Meanwhile. leading to the genome is replicated in membrane-bound vesicles on the release of cytokines and activation of both coagulation cell's endoplasmic reticulum. and the clot degradation).Endothelial dysfunction leads to between viral proteins and membrane proteins on the the leakage of fluid from the blood vessels into the chest and Langerhans cell. In severe infection. where the cell's protein and fibrinolysis (the opposing systems of blood clotting and synthesis apparatus produces new viral proteins. and various lines of research have implied  a role for T cells and soluble factors such as cytokines and Viral reproduction thecomplement system. mannose receptor and CLEC5A. and the blood unclear. Cells in the affected organs die. It for phagocytosis (ingestion by specialized cells and binds to and enterswhite blood cells. such Liver enlargement as monocytes and macrophages. Higher viral load in the blood non-specific receptor for foreign material on dendritic cells. rash. the virus disease. Some serotypes of dengue virus applies especially in endemic areas. proteins. which are virus for destruction. and reproduces inside destruction). Immature virus particles are transported endothelial dysfunction and coagulation disorder. and many strain of dengue virus places people at risk of dengue more organs (such as the liver and thebone marrow) can be hemorrhagic fever and dengue shock syndrome. As a result. this increases the risk not the only mechanism underlying severe dengue-related of bleeding. the other major complication of dengue fever. the flu-like symptoms Severe disease and the severe pains. to the Golgi apparatus. . The exact mechanism behind ADE is less blood circulates in the blood vessels. the part of the cell where some of the Diagnosis proteins receive necessary sugar chains (glycoproteins). disease can be difficult to differentiate from other viral Interferon also activates the adaptive immune system. They are then able to Ongoing vomiting enter other white blood cells. These alterations together lead to both viral RNA is copied. Once inside the skin. early appear to have mechanisms to slow down this process. However. The white instead to deliver the virus into a part of the phagocytes blood cells respond by producing a number of signaling where it is not destroyed but is able to replicate further. Furthermore. It may be caused by poor binding of nonpressure becomes so low that it cannot supply sufficient neutralizing antibodies and delivery into the wrong blood to vital organs. High hematocrit with low platelets a cytokine that raises a number of defenses against viral Lethargy infection through theinnate immune system by augmenting The diagnosis of dengue is typically made clinically. specifically the C-type lectinscalled DCabdominal cavities. complications. and involvement of other organs (such as the bone seems to be the main point of entry. this the JAK-STAT pathway. There is a suspicion that ADE is necessary for effective blood clotting. The Warning signs now mature new viruses bud on the surface of the infected Abdominal pain cell and are released by exocytosis. which are responsible for many of the symptoms. dengue virus binds to Langerhans Severe disease is marked by two problems: dysfunction cells (a population of dendritic cells in the skin that identifies of endothelium (the cells that line blood vessels) and pathogens). A probable diagnosis is based on the findings leads to the generation of antibodies against the virus as of fever plus two of the following: nausea and vomiting. DC-SIGN. Various antibodies are generated. The most affected. the closely to the viral proteins and target them virus enters the skin together with the mosquito's saliva. the virus It is not entirely clear why secondary infection with a different production inside the body is greatly increased. The dendritic cell marrow and theliver) are associated with more severe moves to the nearest lymph node. The virus enters the cells through binding disordered blood clotting. such as the fever. such as interferon. Mucosal bleeding The initial reaction of infected cells is to produce interferon. dysfunction of the bone compartment of white blood cells that have ingested the marrow leads to reduced numbers of platelets. while coagulation disorder is responsible SIGN.
restrictive. such as yellow fever effusions or ascites can be detected by physical examination virus. IgG. although spraying with organophosphate or pyrethroid insecticides is not .generalized pains. Grade I is the presence (1) Advocacy. In subsequent re-infections. Classification Prevention The World Health Organization's 2009 classification divides dengue fever into two groups: uncomplicated and severe. (4) evidence-based pressure and pulse cannot be detected. grade III is the clinical evidence (public and private). and dengue World Health Organization recommends an Integrated hemorrhagic fever. which may then be followed earlier and the titres are usually higher. or any warning sign (see table) in widely available due to their greater cost. provide protective immunity to the infecting serotype of the plasma leakage results in hemoconcentration (as indicated virus. but IgM is also a similar viral infection that shares many symptoms and produced in secondary and tertiary infections. This is done by emptying containers of water or by adding insecticides or biological control agents to these areas. is a useful indicator of past infection. but these tests are not positivetourniquet test. becomes undetectable 30–90 days after a primary infection. with fever. and grade IV is shock so severe that blood control to maximize use of resources. by contrast. The highest levels (titres) of IgM can be difficult to distinguish dengue fever andchikungunya. viral antigen detection or specific antibodies (serology). primary infection the IgG reaches peak levels in the blood The earliest change detectable on laboratory investigations after 14–21 days. can be useful in confirming a diagnosis followed by the counting of any petechial hemorrhages. In the laboratory test the IgG and the IgM antibodies by a rising hematocrit) andhypoalbuminemia. a in the later stages of the infection. typhoid fever. Often. and meningococcal symptoms. Pleural can cross-react with other flaviviruses. In a person with symptoms. which is particularly useful in settings where the acute phase of the illness with the exception of serology. though the older classification is still widely used. types IgG and IgM. grade II is the presence of spontaneous bleeding (2) collaboration between the health and other sectors into the skin and elsewhere. After a disease. Warning signs be negative in the early stages of the disease. which can make the interpretation of the serology when large. which thus decrease mosquito populations needed to be simplified as it had been found to be too There are no approved vaccines for the dengue virus. in the absence of as malaria. Dengue fever may be diagnosed by microbiological laboratory testing. leptospirosis. Grades III and decision making to ensure any interventions are targeted IV are referred to as "dengue shock syndrome". It produced after 5–7 days. The use of ultrasound is limited by days apart and a greater than fourfold increase in levels of lack of availability in many settings. specific IgG is detected.  Prevention thus depends on control of and protection  The 1997 classification divided dengue into from the bites of the mosquito that transmits it. The undifferentiated fever. are detected following a primary infection. the detection of IgM is considered diagnostic. appropriately and (5) capacity-building to ensure an Laboratory tests adequate response to the local situation. involves Tests for dengue virus-specific antibodies. The detection of IgG alone is not onultrasound may assist in the early identification of dengue considered diagnostic unless blood samples are collected 14 shock syndrome. dengue fever. aegypti is by eliminating its habitats. social mobilization and legislation to ensure only of easy bruising or a positive tourniquet test in someone that public health bodies and communities are strengthened.  Virus isolation and nucleic acid detection are more The primary method of controlling A. (3) an integrated approach to disease of shock. The These laboratory tests are only of diagnostic value during tourniquet test. Both IgG and IgM by low platelets andmetabolic acidosis. no laboratory investigations are readily available. Dengue hemorrhagic fever was Vector Control program consisting of five elements: subdivided further into grades I–IV. remains cause similar symptoms. such detectable for over 60 years and. accurate than antigen detection. A 1920s photograph of efforts to disperse standing water and  This replaces the 1997 WHO classification. the application of ablood pressure cuff for five minutes. Both IgG and IgM are higher number makes a diagnosis of dengue more likely. low white blood cell count. This can be done by virus isolation in cell cultures. All tests may someone who lives in an endemic area. typically occur before the onset of severe dengue. In severe disease. nucleic acid detection by PCR. investigations are performed to exclude other conditions that but earlier following re-infections. levels peak is a low white blood cell count. but the demonstration of fluid difficult. The IgM occurs in similar parts of the world to dengue.
to hospital admission with administration of intravenous fluids and/or blood transfusion. and Asia." Victims of dengue often have contortions due to the intense joint and muscle pain. This form of such as nasogastric intubation. it is possible to get dengue fever clothing that fully covers the skin. What areas are at high risk for contracting  Blood transfusion is initiated early in patients presenting dengue fever? with unstable vital signs in the face of a decreasing Dengue is prevalent throughout the tropics and hematocrit. A decision for hospital admission is typically based on the presence of the "warning signs" listed in the table above.thought to be effective.S. and the Middle discontinued to prevent a state of fluid overload. varying from oral rehydration therapy at home with close follow-up. black stools. The presence (the "dengue triad") of fever. Fla. and through environmental modification is the preferred method red palms and soles. rash. Petechiae (small red or purple blisters under the a urinary output of 0. fever. andheadache (and other pains) is particularly characteristic of dengue. an attack of dengue produces netting while resting. If a person is outside of harbormalaria and yellow fever). stopping further East (similar in distribution to the areas of the world that fluid may be all that is needed. hence the name breakbone fever. India. intramuscular injections and dengue fever can be life-threatening and can progress to arterial punctures are avoided. However. travelers used to eliminate excess fluid from the circulation. If fluid overload occurs and vital signs are stable. 17 individuals have been identified that acquired dengue in Key West in 2010. Dengue goes by other names. Virgin Islands. Subsequent testing of the population of Key West has shown that up to 55 of the people living in the area have antibodies to dengue. Singapore. Intravenous hydration is usually only needed for one or two and evidence of hemorrhage in the days. contracted the virus. bleeding in the nose or gums.S. a loop diuretic such as furosemide may be leading cause of acute febrile illness in U. The rate of fluid administration is titrated to body. the U. Packed red blood Caribbean. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait. Cuba. exhaustion. . or easy normalization of hematocrit. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache. stable vital signs and skin). especially in those with preexisting health conditions. and rash. 2010. Manifestations include headache. fever. During the recovery phase intravenous fluids are Southeast Asia. including Puerto Rico. showed that three patients who did not travel outside of the U. including Tahiti. severe pain behind the eyes. the patient was exposed. Outbreaks have occurred recently in the "transfusion trigger" level. the most severe form of the illness. the West Indies. discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding. dengue shock  Paracetamol (acetaminophen) is used for fever and syndrome. Dengue is now the the critical phase. Cases have also been while platelets andfresh frozen plasma are usually not. South America. and Central America. given the concerns of negative health effect from Dengue (pronounced DENG-gay) strikes people with low insecticides and greater logistical difficulties with control agents. Because it is caused by one of four serotypes of virus.  Treatment depends on the symptoms. cells or whole blood are recommended. Reducing open collections of waterinclude bleeding gums. including "breakbone" or "dandy fever. Invasive medical procedures bruisingare all possible signs of hemorrhage.. Dengue hemorrhagic fever is a more severe form of the viral illness. People can prevent mosquito bites by wearing levels of immunity.S.5–1 mL/kg/hr. using mosquito multiple times. severe muscle andjoint pain. imported via tourists returning from areas with widespread dengue. swollen glands(lymphadenopathy). As of July 17. the South Pacific. Other signs of dengue fever A 2009 outbreak of dengue fever in Key West. rather than waiting for the hemoglobin concentration to decrease to some predetermined subtropics. rash. Management There are no specific treatments for dengue fever. returning from the Caribbean. of control. Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. in view of the bleeding risk. and/or the application of insect immunity for a lifetime to that particular serotype to which repellent (DEET being the most effective).
fever. disease. the treatment is purely concerned with relief of and Prevention (CDC). hemorrhage disappears. For typical cases. rash. Nearly 40% of the world's doctor's supervision because of the possibility of population lives in an area endemic with dengue. swollen glands (lymphadenopathy). and low backache. headache. legs and joints occurs during the first hours of illness. The glands (lymph nodes) in the neck and (bleeding). aegypti mosquito that has previously bitten an infected person. Virgin After being bitten by a mosquito carrying the virus. groin are often swollen. worsening hemorrhagic How is dengue fever contracted? complications. The palms and soles may be bright red humans through the bites of infective and swollen. and Central America. The presence (the The virus is not contagious and cannot be spread directly "dengue triad") of fever. Centers for Disease Control dengue. • Dengue is prevalent throughout the tropics and What are dengue fever symptoms and signs? subtropics. with lasts about one to two weeks. severe joint and muscle pain. relative low heart rate (bradycardia) and low blood • Dengue hemorrhagic fever (DHF) is a specific pressure(hypotension). that lasts about a day. One mosquito bite can inflict the • Symptoms such as headache. Acetaminophen (Tylenol) andcodeine may be given for severe headache and for the joint and The virus is contracted from the bite of a striped Aedes muscle pain (myalgia). It causes abdominal pain. Aspirin and nonsteroidal cases of dengue hemorrhagic fever requiring anti-inflammatory drugsshould only be taken under a hospitalization each year. According to the U. and circulatory collapse (shock). (defervescence) with profuse sweating. the treatment is purely concerned with moving the eyes. and viruses that are transmitted by mosquitoes. there is eight) days before the signs and symptoms of dengue no specific medicine or antibiotic to treat it. Vietnam. A syndrome that tends to affect children under 10 years flushing or pale pink rash comes over the face and then of age.S.Dengue fever is common. The • The acute phase of the illness with fever and myalgias temperature rises quickly as high as 104 F (40 C). and Malaysia have all reported an increase in specific medicine or antibiotic to treat it. Thailand. the U. including Puerto Rico. there are an estimated 100 million the symptoms (symptomatic). The mosquito flourishes during rainy seasons but • Dengue fever is a disease caused by a family of can breed in water-filled flower pots. female Aedesmosquit oes.S. Because dengue fever is caused by a virus. plastic bags. there is no Singapore. The eyes become reddened. Painful aching in the relief of the symptoms (symptomatic). fever. This precedes a • There is currently no vaccine available for dengue period with normal temperature and a sense of well-being fever. and headache (and from person to person. Mosquitoes generally acquire the WHO/TDR/Stammers . the Islands. For typical appear. A second rapid rise in temperature Transmission follows. incubation period ranges from three to 15 (usually five to • Because dengue fever is caused by a virus. • The prevention of dengue fever requires control or Fever and other signs of dengue last for two to four days. eradication of the mosquitoes carrying the virus that followed by a rapid drop in body temperature causes dengue. cans year-round. and statistics show it may be What is the treatment for dengue fever? increasing in Southeast Asia. exhaustion. Cuba. There must be a person-toother pains) is particularly characteristic of dengue mosquito-to-another-person pathway. pain upon dengue fever. Outbreaks have occurred recently in the Caribbean. A characteristic rash appears along with the fever Dengue viruses are and spreads from the extremities to cover the entire body transmitted to except the face. Dengue starts with chills. Rest and fluid intake for cases of dengue fever with several hundred thousand adequate hydration is important. and rash.
Dengue is transmitted to a fever. followed Halstead in the 1970s. A global pandemic began in . The illness often five or six years. Infants and young children common since the 1980s – by the late 1990s. infection. Maintenance of the patient's person. There was a serious muscle and joint pains. and in Significant outbreaks of dengue fever tend to occur every severe cases circulatory failure. flu-like illness that affects Southeast Asia in the 1950s and by 1975 DHF had become infants. and rash. which feeds during the day. The virus circulates serotype is sufficiently different that there is no crossin the blood of infected humans for two to seven protection and epidemics caused by multiple serotypes days. In severe cases. during probing and care. but seldom a leading cause of death among children in many countries causes death. The fever usually continues for two to outbreaks because there are four different strains of the seven days and can be as high as 41°C. Aedes mosquitoes may acquire the virus humans by the Aedes aegypti(rarely Aedes albopictus) when they feed on an individual during this period. increased uptake and virion replication during a secondary For DHF. dengue hemorrhagic fever each year.B.decreasing mortality rates from more than identified and named in 1779. and North America in the 1780s. There tend to remain large numbers of begins with a sudden rise in temperature accompanied by facial flush and other flu-like susceptible people in the population despite previous symptoms. The first epidemics occurred almost simultaneously in Asia. an circulating fluid volume is the central feature of DHF infected mosquito is capable. that dengue hemorrhagic fever is by signs of circulatory failure. but the role of this in sustaining transmission of the virus to humans has not yet been Dengue fever (IPA: /ˈdɛŋgeɪ/) and dengue hemorrhagic fever (DHF) are acute febrile diseases. the temperature drops. originally suggested by S. possibly with dengue virus and because of new susceptible individuals convulsions and other complications. Some studies have shown that monkeys in some parts of the world play a similar role in transmission. the immune complicating haemorrhagic fever can frequently save system is not able to adequately respond to the stronger lives . deadly complication that is characterized by high fever. of transmitting the virus for the rest of its life. few days of fever. each multipliers of the virus. dengue was may have a fever with rash. medical care by physicians and nurses infection with a different strain. there being around 40 million cases incapacitating disease with abrupt onset and high of dengue fever and several hundred thousand cases of fever. either through childbirth or In moderate DHF cases. Infected female mosquitoes may also transmit Pathophysiology the virus to their offspring by transovarial (via the eggs) transmission. entering the target population. 2002 affecting Dengue haemorrhagic fever (DHF) is a potentially around one million people and killing sixteen. tropics. serving as a source of the virus for uninfected mosquitoes. the patient's condition may suddenly deteriorate after a There is significant evidence. Older children and adultsthe most important mosquito-borne disease affecting may have either a mild fever or the classical humans after malaria. Caused by one of four closely related virus Infected humans are the main carriers and serotypes of the genus Flavivirus. mosquito. One model to explain this process is known as Treatment antibody-dependent enhancement (ADE). pain behind the eyes. After virus incubation for eight to 10 days. often with enlargement of the liver. The disease was Characteristics Dengue fever is a severe. all signs and symptoms immigration. known as original antigenic sin. and the patient may rapidly go into a critical state of shock and die within more likely to occur in patients who have secondary 12 to 24 hours. outbreak in Rio de Janeiro in February. Through an immunological experienced with the effects and progression of the phenomena. abate after the fever subsides. at approximately the same time that they have (hyperendemicity) can occur. young children and adults. Africa. Epidemic dengue has become more to the age of the patient. severe headache. blood feeding.virus while feeding on the blood of an infected 20% to less than 1%. that occurs in the defined. family Flaviviridae. The clinical features of dengue fever vary according in that region. which allows for There is no specific treatment for dengue fever. or quickly recover following infections by serotypes different from the primary appropriate medical treatment (see below).
muscle and joint pains 5. nausea. muscle and joint pains break-bone fever or bonecrusher disease) and rashes. The classic dengue fever lasts about six to seven days. clammy skin and restlessness Dependable. The classic dengue fever lasts about six to seven days. or drop in hematocrit of 20% or more from baseline following IV fluid. Thrombocytopenia (<100. Cases of DHF also show higher fever. when no rash is present. pleural effusion. infection. hypoproteinemia) MOT: This infectious disease is manifested by a sudden onset of fever. it spreads to cover most of the body. spontaneous bruising. when no rash is present. and hemoconcentration. Encephalitic occurrences (myalgias and arthralgias – severe pain gives it the name Dengue shock syndrome is defined as dengue hemorrhagic break-bone fever or bonecrusher disease) and rashes. a petechial rash with thrombocytopenia and illness. through mosquitoes or blood products while they are still febrile. the platelet S/sx: fever. be misdiagnosed as influenza or other viral infection. the platelet count will drop until the patient’s temperature is normal. Some cases develop much milder symptoms which can. immediate diagnosis of dengue can be performed in rural areas by the use of Rapid Diagnostic Test kits. with a smaller peak of fever at the trailing end of the fever (the so-called “biphasic pattern”). hemorrhagic usually appears first on the lower limbs and the chest – in phenomena. Fever 2. Clinically. Thus travelers from tropical areas having not been properly diagnosed at the height of their through mosquitoes or blood products while they are still febrile. vomiting or diarrhea. and the secondary infection becomes far more serious. vomiting or diarrhea. nausea. There small proportion of cases lead todengue shock may also be gastritis with some combination of associated syndrome (DSS) which has a high mortality rate.thrombocytopenia. bleeding from mucosa. Hemorrhagic tendency (positive tourniquet test. be misdiagnosed as influenza or other viral infection. The classic picture is high fever with no localizing source of relative leukopenia. it spreads to cover most of the body. abdominal pain. may inadvertently pass on dengue in their home countries. Patients with dengue can only pass on the infection • • • Weak rapid pulse Narrow pulse pressure (less than 20 mm Hg) Cold. all four criteria must be fulfilled: 1. Patients with dengue can only pass on the infection There exists a WHO definition of dengue hemorrhagic fever 4. Serology and polymerase diagnosis of dengue if clinically indicated. Thus travelers from tropical areas having not been properly diagnosed at the height of their illness.000 platelets per mm³ or estimated as less than 3 platelets per high power field) may inadvertently pass on dengue in their home countries. This process is also known as superinfection. (the so-called “biphasic pattern”). ascites. gingiva. Clinically.. the fever plus: dengue rash is characteristically bright red petechia and usually appears first on the lower limbs and the chest – in some patients. A some patients. which also differentiate between primary and secondary dengue infections. the dengue rash is characteristically bright red petechia and This infectious disease is manifested by a sudden onset of with a smaller peak of fever at the trailing end of the fever (myalgias and arthralgias – severe pain gives it the name count will drop until the patient’s temperature is normal. Cases of DHF also show higher fever.thrombocytopenia. vomiting blood. that has been in use since 1975. etc. chain reaction (PCR) studies are available to confirm the .infection. Some cases develop much milder symptoms which can. A small proportion of cases lead todengue shock syndrome (DSS) which has a high mortality rate. hemorrhagic phenomena. DX: The diagnosis of dengue is usually made clinically. with severe headache. Evidence of plasma leakage (hematocrit more than 20% higher than expected. or bloody diarrhea) 3. injection sites. and hemoconcentration. There may also be gastritis with some combination of associated abdominal pain. with severe headache.
is not unusual. Vertical transmission of dengue virus in mosquitoes has been documented. dengue has an incubation period of 3-14 days (average 4-7 d). however. approximately at the time of defervescence. certain nonhuman primates in Africa and Asia also serve as hosts. nonneutralizing macrophage and monocyte Fc receptors.Incu period: approx.to 7-day acute febrile illness ensues. These drugs are often used to . It is very important to avoid aspirin and non-steroidal antiinflammatory medications. but each individual can eventually circulation during an epidemic. They inflict an innocuous have been associated with DEN-2 than with the other bite and are easily disturbed during a blood meal. Albert Sabin speciated these in 1944. a 5. In addition. Bleeding is caused by capillary fragility and thrombocytopenia and may present various ways. and dengue virus 4 (DENV-4). DHF or DSS usually develops around the third to seventh day of illness. The mosquito can transmit dengue if it immediately bites another host. Increased oral fluid intake is recommended to prevent dehydration.to 65-day lifespan. ranging from petechial skin hemorrhages to life- be infected by all 4 serotypes. 4 days Pplogy: Dengue infection is caused by 1 of 4 related. a aegypti is the predominant albopictus and other Aedes species can also transmit dengue with varying degrees of efficiency. but antigenically distinct. The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion. Recovery is usually complete by 7-10 days. and increased cytokine production and complement activation. dengue virus 2 (DENV-2). The mosquito remains infected for the remainder of its 15. but A antibodies to one dengue serotype. The major pathophysiological abnormalities that occur in DHF and DSS are plasma leakage and bleeding. spherical. Mosquitoes acquire the virus when they feed on a carrier of the virus. Globally. A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20. certain dengue strains. In individuals with low levels of neutralizing antibodies. Dengue viruses are small. Entire families who develop infection within a 24. Plasma leakage is caused by increased capillary permeability and may be manifested by hemoconcentration. as well as pleural effusion and ascites. in part because more epidemics of DHF highly efficient mosquito vector for dengue infection. Supplementation with intravenous fluids may be necessary to prevent dehydration and significant hemoconcentration if the patient is unable to maintain oral intake.000) or if there is significant bleeding. but are killed by temperatures of less than 10°C. when bound by amounts of stagnant water found in old tires or other small particularly those of DEN-2. them to move on to finish a meal on another individual. Most patients who develop DHF or DSS have had prior Dengue viruses are transmitted by the bite of an infected Aedes mosquito.to 36-hour period. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity. The eggs of Aedes mosquitoes withstand long TX: The mainstay of treatment is supportive therapy. viral serotypes: dengue virus 1 (DENV-1). Following incubation. Aedes mosquito species have adapted well to human habitation. presumably from the bites of a single infected vector. Each serotype is known to have several different genotypes. single-stranded enveloped RNA viruses of the family Flaviviridae. genus Flavivirus. transmission occurs after 8-12 days of viral replication in the mosquito’s salivary glands (extrinsic incubation period). Humans serve as the primary reservoir for dengue. In addition. have been proposed to result in increased viral entry and replication. have been proposed to be mosquitoes are daytime feeders. often breeding around dwellings in small containers discarded by humans. Once inoculated into a human host. making them efficient vectors. This phenomenon is called antibody-dependent enhancement. dengue virus 3 (DENV-3). Several serotypes can be in threatening gastrointestinal bleeding. reportedly as long as 1 year. more virulent. periods of desiccation. causing serotypes. Female Aedes infection with one or more dengue serotypes.
Having a strong immune system also benefits recovery from dengue. Patients should instead receive acetaminophen preparations to deal with these symptoms if dengue is suspected.treat pain and fever though in this case they may actually aggravate the bleeding tendency associated with some of these infections. .
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