Jump to: Introduction | Sign & Symptoms | Lab Tests | Treatment | Prevention
Introduction:
Dengue fever (other names dengue, breakbone fever, water poison) is a viral disease caused by dengue virus (DENV-1,2,3,4), transmitted by the infective bite of a particular mosquito known as Aedes Aegypti (daytime feeder & breed in areas of stagnant water). Human being develops disease after 5 – 6 days of being bitten by an infective mosquito.
Classification of Dengue:
- Non-severe dengue without warning signs (Treat at home)
- Non-severe dengue with warning signs (Needs hospital care)
- Severe Dengue (Needs emergency care)
Signs & symptoms: 3 – Phases Febrile, critical & recovery phases in dengue
1 Febrile phase: Initial 1-3 days
Non severe dengue without warning signs:
- Sudden-onset high grade fever
- Headache (typically located behind the eyes)
- Muscle and joint pain
- Rashes
- Chills (shivering)
- Facial flushing
- Nausea and vomiting
- Loss of appetite
- Sore throat
- Abnormal bleeding such as nosebleeds, bleeding gums and/or blood in your urine.
2 Critical phase – 3–7 days
- Body temperature drops (no fever)
Patient with these signs & symptoms comes under non-severe dengue with warning signs. A patient may have 2 or more symptoms (warning signs):
- Abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation in the abdomen or pleural cavity of lungs.
- Oral or nasal bleeding
- Lethargy and restlessness
- Liver size increases >2 cm, gall bladder edema
- Laboratory: Rapid decrease in ↓ platelet counts, ↓WBC, increase ↑ PCV/hematocrit.
A patient with these complications in dengue comes under severe dengue.
- Shock (BP<90/60 mmHg)
- Massive bleeding evaluated by a doctor
- Organ dysfunction eg: liver AST or ALT › 1 000, loss of consciousness
- Shortness of breath (decrease in sp02) due to fluid collection.
3 Recovery phase – 7-10 days
- General well-being improves, appetite returns, platelets increases, PCV stabilizes
- Some patients may have a rash of “isles of white in the sea of red”.
- Some may experience generalized itching
Lab tests:
- CBC with peripheral smear
- NS1 Antigen
- Dengue-specific IgM, IgG antibody
- Ultrasound, Chest X-ray to evaluate dengue with warning signs
Treatment:
No specific medication for the treatment of dengue infection.
For non-severe dengue without warning signs: (Treat at home)
- Adequate bed rest
- Adequate fluid intake (>5 glasses for average-sized adults or accordingly in children) -Milk, fruit juice (caution with diabetes patient), and isotonic electrolyte solution (ORS) OR barley/rice water.
- Plain water alone may cause electrolyte imbalance.
- Take only paracetamol (not more than 4 grams per day for adults and accordingly in children).
- No pain killers, steroids.
- Tepid sponging
- May take multivitamins
- No antibiotics are needed
For non-severe dengue with warning signs and severe dengue: (Needs hospital care)
- IV fluids for eg: NS, RL, colloids
- Platelet transfusion only when counts are less than 10,000 or in case of any bleeding even with 50,000 counts.
Prevention:
- Use insect repellents and mosquito nets to avoid being bitten.
- Wear long-sleeved clothes and long trousers while going outdoors.
- Avoid collection of water.