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Dengue fever?
- Sajeeb Sarker
Dengue, again, is the issue; we suffer a lot and we forget about then. This
happens 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 by
knowing a little more about its types and diagnosis systems, we can increase the
chance of preventing being misdiagnosed. Here are some information about
Dengue that can be a lot helpful for both purposes, and for all people:
Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile
diseases 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 by
multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans
by the Aedes aegypti (rarely Aedes albopictus) mosquito, which feeds during the
day.
Virus Classification
Group: Group IV {(+) ssRNA}
Family: Flaviviridae
Genus: Flavivirus
Species: Dengue Virus
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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 the
body. Petechiae (small red or purple blisters under the skin), bleeding in the nose
or gums, black stools, or easy bruising are all possible signs of hemorrhage. This
form of dengue fever can be life-threatening or even fatal.
The virus is contracted from the bite of a striped Aedes aegypti mosquito
that has previously bitten an infected person. The mosquito flourishes during rainy
seasons but can breed in water-filled flower pots, plastic bags, and cans year-
round. One mosquito bite can inflict the disease.
The virus is not contagious and cannot be spread directly from person to
person. There must be a person-to-mosquito-to-another-person pathway.
After being bitten by a mosquito carrying the virus, the incubation period
ranges from three to 15 (usually five to eight) days before the signs and symptoms
of 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 first
hours of illness. The temperature rises quickly as high as 104° F (40° C), with
relative low heart rate (bradycardia) and low blood pressure (hypotension). The
eyes become reddened. A flushing or pale pink rash comes over the face and then
disappears. 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 rapid
drop in temperature (defervescence) with profuse sweating. This precedes a period
with normal temperature and a sense of well-being that lasts about a day. A second
rapid 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.
Yet, we can have another look over the signs and symptoms of dengue for a
little more information:
• 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 is
present, be misdiagnosed as influenza or other viral infection. Thus travelers from
tropical areas may inadvertently pass on dengue in their home countries, having
not been properly diagnosed at the height of their illness. Patients with dengue can
pass on the infection only through mosquitoes or blood products and only while
they 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.
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Dengue shock syndrome is defined as dengue hemorrhagic fever plus:
Here, we’ve spoken of dengue hemorrhagic fever several times; let’s take a
little close look at this:
The WHO definition of dengue haemorrhagic fever has been in use since
1975; all four criteria must be fulfilled:
DHF starts abruptly with high continuous fever and headache. There are
respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and
abdominal pain. Shock occurs two to six days after the start of symptoms with
sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse,
and blueness around the mouth (circumoral cyanosis).
In DHF, there is bleeding with easy bruising, blood spots in the skin
(petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding
gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the
heart (myocarditis) may be present.
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Patients with DHF must be monitored closely for the first few days since shock
may occur or recur precipitously. Cyanotic (bluish) patients are given oxygen.
Vascular collapse (shock) requires immediate fluid replacement. Blood
transfusions may be needed to control bleeding.
The mortality, or death rate, with DHF is significant. It ranges from 6%-30%.
Most deaths occur in children. Infants under a year of age are especially at risk of
dying from DHF.
Diagnosis
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Emerging treatments
Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue
replication. Initial experiments showed a fivefold increase in defective viral RNA
production by cells treated with each drug. In vivo studies, however, have not yet
been done.
Vaccine development
Mosquito control
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Ministry of Health introduced a scheme that encouraged children to place a water
bug, the crustacean Mesocyclops, in water tanks and discarded containers where
the Aedes aegypti mosquito was known to thrive. This method is viewed as being
more cost-effective and more environmentally friendly than pesticides, though not
as effective, and requires the ongoing participation of the community.
Personal protection
Wear long pants and long sleeves. For personal protection, use mosquito
repellant sprays that contain DEET when visiting places where dengue is endemic.
Limiting exposure to mosquitoes by avoiding standing water and staying indoors
two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is
a daytime biter with peak periods of biting around sunrise and sunset. It may bite
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at any time of the day and is often hidden inside homes or other dwellings,
especially in urban areas.
Typical dengue does not result in death. It is fatal in less than 1% of cases.
The acute phase of the illness with fever and myalgias lasts about one to two
weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and
full recovery often takes several weeks.
The origins of the word dengue are not clear, but one theory is that it is
derived from the Swahili phrase "Ka-dinga pepo", which describes the disease as
being caused by an evil spirit. The Swahili word "dinga" may possibly have its
origin in the Spanish word "dengue" (fastidious or careful), describing the gait of a
person suffering dengue fever or, alternatively, the Spanish word may derive from
the Swahili. It may also be attributed to the phrase meaning "Break bone fever",
referencing the fact that pain in the bones is a common symptom.
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areas with widespread dengue, including Tahiti, the South Pacific, Southeast Asia,
the West Indies, India, and the Middle East.
Though not that much epidemic as other places, yet, Bangladesh is not even
a fresher for dengue. A lot people have suffered and have been suffering, and a
considerable number of people have already died. In this circumstance, we should
treat the issue of dengue as a highly priorative, and knowing about dengue as
much as possible is a must to make prevention against it.
Sources:
1. http://www.medicinenet.com/dengue_fever/page4.htm
2. http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070823_e.html
3. http://www.who.int/tdr/publications/publications/pdf/planning_dengue.pdf
4. http://www.cdc.gov/ncidod/dvbid/dengue/
5. http:/www.who.int/topics/dengue/en/
6. http:www.en.wikipedia.org
7. Acosta, Dalia (2006-09-12). "War on Mosquitoes Continues During Global Summit", Inter Press Service.
8. Manson's Tropical Diseases
9. Mandell's Principles and Practices of Infection Diseases
10. Cecil Textbook of Medicine
11. The Oxford Textbook of Medicine
12. Harrison's Principles of Internal Medicine
13. Theiler, Max and Downs, W. G. 1973. The Arthropod-Borne Viruses of Vertebrates: An Account
of The Rockefeller Foundation Virus Program 1951-1970. Yale University Press.
14. Downs, Wilbur H., et al. 1965. Virus diseases in the West Indies. Special edition of the Caribbean
Medical Journal, Vol. XXVI, Nos. 1-4, 1965.
15. Earle, k. Vigors. 1965. "Notes on the Dengue epidemic at Point Fortin." The Caribbean Medical
Journal, Vol. XXVI, Nos. 1-4, pp. 157-164.
16. Hill, A. Edward. 1965. "Isolation of Dengue Virus from a Human Being in Trinidad." Virus
diseases in the West Indies. The Caribbean Medical Journal, Vol. XXVI, Nos. 1-4, pp. 83-84;
"Dengue and Related Fevers in Trinidad and Tobago." Ibid, pp. 91-96.
• Courtesy: Centers for Disease Control and Prevention, Public Health Image Library.
- SAJEEB SARKER
e-mail: sajib.0205@yahoo.com
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