Dengue is derived from African word “Denga” which means fever with haemorrhage. And what are those 9 things about dengue disease everyone should know?

Causes

Dengue is spread by Female mosquito AEDES AEGYPTI which sucks blood from infected body and during sucking her meal, she sucks DENGUE VIRUS. The disease is considered mostly in monsoon or rainy season when mosquito have easy supply of stagnant water to reproduce.

Mosquito- Aedes Aegypti, Virus- DENV (Dengue virus)

Aedes Egypti

Dengue virus or DENV is an RNA virus of five serotypes- DENV-1,DENV-2,DENV-3,DENV-4 and DENV-5 (DENV-5 announced in 2013).

Sign and Symptoms

Most dengue affected people are without any symptoms or mild fever. Children are most susceptible to dengue and develop life-threatening conditions. This is the most important part. The early you suspect you have dengue, better the result from treatment.

Dengue fever triad = Fever + Rash + Headache

Dengue should be immediately suspected if you have:-

Fever (40°C/104F) 

with any 2 of following:

  • Severe headache
  • Pain behind eyes
  • Muscle and joint pain
  • Vomiting
  • Tiredness
  • Black stool
  • Nose or gum bleeding 

These symptoms will start within few hours of mosquito bite and last for upto 14 days.

What not to do?

Dengue reduces your platelet count and causes dehydration. Following things should be AVOIDED in all cases:-

  • Taking Aspirin or Disprin
  • Taking any antibiotic
  • Taking any NSAID for pain and fever
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(These are contraindicated as these cause further platelet damage and worsen dengue.)

  • Getting dehydrated- As dengue fever warms up body and causes blood loss from body, there are chances of several dehydration. One should always try to keep him hydrated with drinks.
  • Ignoring symptoms and avoiding visit to physician- The earlier you know,the better you survive.

Clinical diagnosis

Once you reach the physician, he will immediately order the following tests:-

  • Complete blood test (CBC)
  • X-ray Chest (CXR)
  • Plasma thromboplastin time and prothrombin time

Why all these test? These tests reveal following to physician:-

>Complete blood test- Reveal marked reduction in platelet count (<100,00/cubic mm) called Thrombocytopenia. Also reveal Haemoconcentration.

>X-ray chest- This reveals pleural effusion in lung,mostly on right side. Bilateral (both sided) pleural effusion occurs in very severe cases of Dengue Shock Syndrome.

>Plasma thromboplastin time and prothrombin time- These are prolonged and thus mean prolonged bleeding time.

The lab diagnosis of dengue,though, differs from the clinical diagnosis.The approach is highly specific.

Lab diagnosis

The most specific tests for Dengue fever include:-

  • ELISA- MAC-ELISA is done
  • IgM/IgG ratio- It is increased
  • Haemagglutination inhibition test- it reveals 4 fold rise in antibody response
  • Other tests- Include Neutralization tests like serum dilution,virus constant,plaque-reduction test, Dot-blot immunoassay and Complement fixation test (CFT).

Treatment

Dengue is caused by a virus, hence, no specific management of dengue is available till now (not even anti-viral drugs). However, only symptomatic treatment is done.

The symptomatic treatment of dengue involves:-

Management of pain and fever

Paracetamol is the only drug of choice in dengue. However, doses guidelines as per WHO are as follows:-

1 year 60 mg/dose
1–3 years 60–120 mg/dose
3–6 years 120 mg/dose
6–12 years 240 mg/dose

A dose should be administered when body temperature is greater than 39°C, but no more than 6 doses should be administered in a 24-hour period.

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Maintaining Fluid levels

This is done by I.V fluids to prevent patient from going into shock stage.

A dose should be administered when body temperature is greater than 39°C, but no more than 6 doses should be administered in a 24-hour period.

Administration of I.V (intravenous fluid) is necessary as the patient has a >20% increase in haematocrit and early signs of circulatory disturbance (i.e. rapid pulse and worsening condition).

Hospitalization

It becomes only solution when-

  • Cool, mottled or pale skin
  • Reduced peripheral pulses
  • Changes in mental status
  • Increased heart beat (Tachycardia)
  • Increased capillary refill time (.2s)
  • Oliguria
  • Sudden rise in haematocrit or continuously elevated haematocrit despite administration of fluids
  • Narrowing of pulse pressure (<20 mmHg (2.7 kPa) )
  • Hypotension (a late finding representing uncorrected shock)

Stages

Dengue presents in three stages from the time of biting by mosquito,.i.e., entry of dengue virus into human body. These stages are:-

Symptomatic stage (Febrile stage)

This is where the fever and other symptoms start. It peaks and remains for 2-7 days.

Dengue hemorrhagic fever (Critical stage)

Fever comes down to normal body temperature. The plasma from blood capillaries starts leaking. This results in fluid accumulation in chest (pleural effusion) and abdominal cavity (ascites) while decreased blood supply to vitals. Cutaneous and intestinal hemorrhages are features of DHF.

Dengue shock syndrome (DSS)

This is the most serious manifestation of dengue and results in untreated patients or vulnerable children. This is the cause of death.

Noting point is, in most people,dengue is less serious as :-

  • Stage A can occur without symptoms (asymptomatic).
  • Stage B can occur as Dengue Fever (DF) Syndrome which is self-limiting febrile illness affecting muscles and joints with severe back pain due to myalgia (and hence the name ‘break-bone’ fever).
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Deaths

The cause of death is the end stage, Dengue Shock Syndrome (DSS) which is characterised by:

  • Bluish coloration of skin
  • Cold, clammy skin and restlessness
  • Rapid and weak pulse
  • Narrow pulse pressure
  • Hypotension

The patient starts feeling lethargy, which follows by shock and coma and finally, death in untreated patients.

Recurrence

The last and tricky question that comes is- CAN I HAVE DENGUE AGAIN?

The answer to question is YES. Since Dengue has 5 seroptypes, any other can affect you even if you have been affected. Moreover, the condition is more serious if this happens. This is called Secondary infection.

Dengue is always a hot topic during monsoon season, and you don’t want to miss out such an important endemic around you.  Hope we helped you. Feel free to share the page. Any doubts or suggestions or feedback is always welcome.

ANTI-DENGUE  DAY- 15th JUNE

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