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DENGUE
FEVER AND DENGUE HAEMORRHAGIC FEVER
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Dengue fever and Dengue
Haemorrhagic fever (DF/DHF) is a viral
disease transmitted by Ae. aegypti mosquito.
There are four sero-types of dengue virus,
DEN-1; DEN-2; DEN-3; and DEN-4; all producing
similar manifestations, which may be asymptomatic,
undifferentiated fever, dengue fever (DF)
and dengue haemorrhagic fever (DHF) with
plasma leakage and shock(Dengue Shock
Syndrome-DSS).The global population at
risk is estimated to be 2.5-3.0 billion
in the urban areas of the tropical and
sub-tropical regions. In Bangladesh there
had been Dengue outbreaks in
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2000 (5,555 cases and 93
deaths);2001 (2,430 cases and 44 deaths) and
2002 (6,104 cases and 58 deaths). Cases were
reported from the metropolitan cities (Dhaka,
Chittagong, Khulna, Rajshahi) and as per the
sero-survey findings, 3 sero-types of the virus
circulating. No vaccine is available yet
and there is no specific treatment. Hence DF/DHF
control is primarily dependent on control of
Ae. aegypti mosquito
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Highlights
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No vaccine is available
yet and there is no specific treatment.
Hence DF/DHF control is primarily dependent
on control of Ae. aegypti mosquito
Dengue haemorrhagic fever
is most common in children less than 15
years of age, but it also occurs in adults.
DHF is characterised by the acute onset
of fever and associated non-specific constitutional
signs and symptoms
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This mosquito breeds in small
collection of clean water in domestic and peri-domestic
containers.
Clinical
Presentation
Undifferentiated fever: Infants, children
and some adults who have been infected with
dengue virus for the first time (i.e. primary
dengue infection) will develop a simple fever
indistinguishable from other viral infections
Dengue fever: It is generally an acute
biphasic fever (390 C to 400 C) with headache,
myalgia, arthralgias, rashes and leucopenia.
Although DF is commonly benign, it may be an
incapacitating disease with severe muscle and
joint pain (break-bone fever), particularly
in adults, and occasionally with unusual haemorrhage.
Dengue haemorrhagic fever: Dengue
haemorrhagic fever is most common in children
less than 15 years of age, but it also occurs
in adults. DHF is characterised by the acute
onset of fever and associated non-specific constitutional
signs and symptoms. There is a haemorrhagic
diathesis and a tendency to develop fatal shock
(dengue shock syndrome). Abnormal haemostasis
and plasma leakage are the main patho-physiological
changes, with thrombocytopenia and haemoconcentration.
Hemorrhage: It may occur from the beginning
with fever in case of Dengue Fever. But if this
is found after a few days during afebrile period
DHF is the possibility. DHF is a potentially
dangerous condition threatening life. Hemorrhage
may be of any description including prolongation
of menstrual bleeding in case of female. The
common sites are conjunctiva, skin, gum, nose
and GI tract usually evident in the form of
hematemesis, malena and hematokezia.
Incubation period is 4-6 days (range
3-14 days).
What
to do?
For prevention:
- Avoid mosquito bites, use long sleeve
shirts and protective clothing
- Sleep under mosquito nets (preferably
Insecticide treated nets)
- Destroy all domestic and peri-domestic
breeding sources of Ae. aegypti mosquito
(artificial containers, coconut shells,
canes, used tires, earthen pots, flower
vase, ant-traps etc.)
- Use of mats, coils, aerosol house spray,
vaporising mosquito repellents etc. may
be useful
- Use of Repellent: Essential oils from
plant extracts (neem oil, lemon grass, citronella
oil etc.) gives protection from mosquito
bites.
For Treatment
- Complete bed rest is essential and patient
should take sufficient fluid drinks (fruit
juice, ORS etc.). This will help correction
of dehydration due to fluid loss from vomiting
and high fever.
- Should consult the physician immediately
for appropriate management of the illness
and must be referred to the hospital if
needed.
- DO NOT use ASPIRIN or NSAID-these
drugs may trigger gastritis and provoke
bleeding.
- DO NOT give antibiotic as these
do not help
Standby Emergency Treatment
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