TOP

Dengue Fever

Dengue Fever is an acute febrile disease transmitted through a mosquito bite. It can be a threat to life. Dengue fever is caused by the four genus Flavivirus from the Flaviviridae family, a virus serotype. It was also called breakbone fever because it is extremely painful. It is transmitted by the mosquito, Aedes aegypti and sometimes by Aedes albopictus mosquito. The mosquitoes usually bites at dawn but it may also bite any time of the day especially in indoors, when it’s cloudy or in shady areas. The estimated dengue cases every year is 50 million worldwide. It is now endemic in 100 countries or more.

Signs and Symptoms

Dengue FeverDengue fever manifest a sudden onset of fever associated with joint and muscle pains also called as arthralgias and myalgias which gives the name breakbone because of severe pain, headache, and rash and retro-orbital pain.

The dengue rash presents a maculopapular rash that is generalized. The characteristics of hemorrhagic rash include bright red pinpoint spots called as petechiae which may occur later with illness accompanied with thrombocytopenia. The chest and lower limbs are the parts where symptoms first appear and spread covering almost the entire body. Severe pain in the retro-orbital area may be present, a pain behind the eyes. Gastritis is also felt accompanied by nausea and vomiting, abdominal pain, coffee-ground blood and severe diarrhea.

In some mild cases, it is misdiagnosed as influenza or other viral infection if no retro-orbital pain or rash is present. Travellers with fever may transmit dengue to dengue free countries.

The fever lasts for about 2 to 7 days. The platelet count drops until the temperature is normal.

There is such case as Dengue Hemorrhagic fever with signs and symptoms of bleeding from the nose, eyes, ear, mouth, gut and blood oozing from skin pores, hemoconcentration and thrombocytopenia. Severe DHF causes blood vessel fluids leak in the skin and in the spaces of abdomen and lungs causing too much fluid loss which eventually causes falling of blood pressure termed as Dengue shock syndrome with high chances of mortality rate.

Diagnosis

Dengue is diagnosed through clinical features upon examination which include headaches, fever, severe dizziness, eye pain and loss of appetite, positive tourniquet test, bruising, bleeding from mucosa or gingiva and in injection sites. Thrombocytopenia is distinctive with the platelet count falls to less than 100,000. There is also plasma leakage with hematocrit rising to more than 20%.

Treatment

The treatment is supportive therapy to stop bleeding and prevent circulatory shock. Accurate monitoring of vital signs is a must. It is more critical if the fever subsides. To prevent dehydration, oral rehydration therapy and administration of intravenous fluids is rendered for moderate and severe cases. If the platelet drops below 20,000 or if there is bleeding, a platelet transfusion is indicated. Melena indicates bleeding in the gastrointestinal tract which requires transfusion of platelets and red blood cells.

Non-steroidal anti-inflammatory drug and aspirin are to be avoided because it worsens the bleeding tendency. Also, intramuscular injections are also contraindicated. Acetaminophen and paracetamol may be given instead.

Read More