Dengue Fever

Dengue is a leading illness in many underdeveloped as well as developing countries mainly during rainy seasons.

Dengue fever occurs because of a viral infection due to the Dengue Virus (DENV). They are usually of 4 types : DEN 1-4. These belong to the species of virus called Flevivirus. Generally these virus enter the body of a person from a mosquito bite.

As we all know “Aedes aegypti” female mosquito is the leading cause of dengue. This mosquito contains the dengue virus in it’s saliva and transmits it to a person when sucking his/her blood. A dengue mosquito if noticed has typical white markings on the legs and a marking on the thorax. Females are larger than males, and can be distinguished by small sensing organs tipped with silver or white scales.

Do Dengue mosquitoes bite at night ? 

Aedes mosquito is usually most active during daytime but can bite even at night in well lighted areas.

Where do the Aedes mosquito bite ?

The spots this mosquito bites is below the elbow and the knee; neck bites are also seen sometimes.

Dengue virus when enters the body through the skin it infects mostly the immune cells in the body. For a period of 3-14 days the virus usually divides in the body and then the symptoms might appear when it enters the blood through these immune cells.

Can Dengue be transmitted from one person to another ?

Say a person, has been infected by Dengue fever, and Aedes mosquito bites that individual again , then the virus from the person blood will get into the mosquito and the same mosquito when biting another person can infect him. This is why Dengue is usually spread fast to all members of a family if one has it. The period till when  a person can spread the infection maximal is about 12 days.

  Dengue usually presents as these principal symptoms:

• Patient usually has headache, high fever usually rising and dropping 2 times (Bi-phasic) and , as we all take paracetamol for fever, one might complain of no effect of paracetamol on dengue fever.
• Severe joint pain to this degree that the person might say that he feels if he has been beaten with sticks.
• Pain behind eyes is also common
• A rash is usually seen during the illness.

Several other warning signs may also be present:

Virus usually effects the platelets and leucocytes so there is a decrease in infection fighting as well as clotting. So non stoppable bleeds are common.

1. Their might be decrease in blood supply to the brain and one may present with restlessness. In case of infants with dehydration and non opening eyes.
2. Bleeding usually frequently is common from the nose
3. Patient can also show frequent vomiting due to the infection.

Severe Dengue:

Most patients are usually cured on their own due to good nutrition. But in some after 2-7 days as the fever declines, critical period starts. They can develop Dengue shock syndrome / Dengue Hemmorhagic fever. A fall is usually seen in the BP of such individuals    

• Organ damage may also occur later.

Lungs: Fluid build up in the lungs can be seen as their is increase leakiness of capillaries in this disease.

Liver: Hepatomegaly can also be seen (2 cm below ribs)

• In severe cases their is severe distension of the stomach due to Ascites or fluid build up.

Such patients need immediate IV fluid treatment. But 1/2 normal saline should not be given. Platelet count  should be monitored and the platelet should only be given if the count is low and declining otherwise it can aggravate the fluid build up.

In some patients it might be possible that no warning signs appear, but joint pain may be common.

As such their is no perfect cure, fluid therapy and a less liver load diet is recommended. So prevention is the best cure.

1. Aedes mosquito usually dwells in water so proper drainage of water and not allowing water to accumulate is a must
2. In case of indoor plants water never to be allowed to accumulate in them too
3. Sanitation and cleaning of the house to be done in a proper scale
4. Also water from the coolers might need to be removed once a week.
5. Full sleeved T shirts to be worn so that the mosquito cannot penetrate.
6. Mosquito repellents like odomas can also be used but those containing permethrin chemical must be avoided directly application to the skin.
7. Asthmatics to avoid repellents. Rather they can use oils to the skin.
8. In case of epidemics fogging to be done of the affected areas.
9. In case of a family member with the symptom mosquito repellents and aerosols to be used in the house and plenty of fluids to be given to the person.
10. Aspirin, Ibuprofen not to be taken to reduce pain.

Food to be taken and avoided :

Avoided :

1. Non veg. , fatty food that provide load on liver.
2. Caffeine(coffee)
3. Carbonated drinks (Cold drinks), spicy food

Food to be taken :

1. Vegetables, fruits
2. Papaya leaves , Coconut water
3. Nuts
4. Aloe-vera
5. Yogurt(Dahi)

A certain vaccine was introduced by the name of CYD-TDV but it was observed that people with the vaccine if somehow contracted dengue, it was far more severe than the normal one so the vaccine is not used now.

Thus prevention and alertness are the key to the treatment of Dengue fever.

AKASH JOSHI,
MBBS (II-Year)
Himalayan Institute of Medical Sciences
JollyGrant, Dehradun
(Uttarakhand)