Dengue

OVERVIEW

Dengue is a mosquito-borne viral illness caused by the dengue virus (DENV), transmitted to humans through the bite of infected Aedes mosquitoes, especially during the daytime. 

The symptoms usually begin about 4-10 days after infection and last 2-7 days. Mild dengue fever causes a high fever, severe headache, skin rash, and severe muscle and joint pains. Severe dengue fever, also called dengue hemorrhagic fever, can cause severe bleeding, a sudden drop in blood pressure (shock) and can be fatal.

To prevent Dengue, take all necessary measures to reduce mosquito population and water stagnation. Patients suffering from Dengue should rest and drink plenty of fluids. Closely monitor blood pressure and blood platelet count.

IMPORTANT INFORMATION

Usually seen in - All age groups

Gender affected - Both men and women

Body parts involved – Liver, Lungs, Brain, Spleen

Prevalence - Worldwide: Over 6 million (2023)

      India: 94, 198 (2023)

Mimicking Conditions – Malaria, Zika, Chikungunya, Influenza (flu), Measles

Necessary health tests/imaging - Dengue antigen test

Dengue antibody IgM test

Dengue antibody IgG test

Dengue RNA PCR test

Complete Blood Count

Treatment - Paracetamol

      Fluid replacement (hydration)

      Platelet transfusion

Specialists to consult - General Physician, Internal medicine specialist

Related NGOs - Welltech Foundation

SYMPTOMS

Most dengue patients have minimal or no symptoms and recover in 1-2 weeks.

If symptoms occur, they usually begin 4–10 days after infection and last for 2–7 days. Symptoms may include:

• high fever (40°C/104°F)
• severe headache
• muscle and joint pains
• pain behind the eyes
• vomiting
• nausea
• swollen glands
• rash

People who come into contact with the dengue virus for the second time are more likely to experience severe symptoms.

Severe symptoms often come after the fever has gone away:

• persistent vomiting
• severe stomach pain
• rapid breathing
• bleeding gums or nose 
• fatigue
• restlessness
• being very thirsty
• rapid, weak pulse
• blood in vomit or stool
• pale and cold skin
• feeling weak

People with these severe symptoms should get care right away. 

After recovery, people with Dengue may feel tired for several weeks.

CAUSES

Dengue is caused by any one of four different types of dengue viruses. Dengue fever does not spread from person to person. It is spread through the mosquito bite of an infected Aedes species (Ae. aegypti or Ae. albopictus).

A mosquito contracts the dengue virus when it bites an infected person. The virus then enters the bloodstream of the person bitten by the infected mosquito, resulting in an infection. Dengue mosquitoes have characteristic black and white markings on their legs and bodies.

RISK FACTORS

You may be at greater risk of getting dengue fever or a more severe case of the illness if:

• In your area, there are multiple dengue cases.
• You work on construction sites or in an area with standing water, as these are high-risk regions for mosquito breeding.
• You visit or reside in tropical regions. Living in tropical and subtropical areas increases your chance of contracting dengue fever. Southeast Asia, the western Pacific islands, Latin America, and Africa are particularly dangerous regions.
• You have previously had dengue fever. If you contract the dengue fever virus again, your chances of experiencing severe symptoms increase.

POSSIBLE COMPLICATIONS

Some patients with dengue fever develop dengue hemorrhagic fever (DHF), a severe and sometimes fatal form of the disease. Around the time the fever begins to subside (usually 3–7 days after symptom onset), the patient may develop warning signs of severe disease. 

Dengue hemorrhagic fever (DHF) is currently defined by the following four World Health Organization (WHO) criteria:

• Fever or recent history of fever lasting 2–7 days.  
• Any hemorrhagic manifestation (internal bleeding).
• Thrombocytopenia (platelet count of <100,000/mm3). 
• Evidence of increased vascular permeability.

PREVENTION

The two most effective ways to stop Dengue from spreading are still avoiding mosquito bites and managing the mosquito population.

If you reside in or visit a region where dengue fever is prevalent, the following advice may help lower your chance of getting bitten by mosquitoes:

• Stay in a well-screened or air-conditioned room: Though they can bite at any time of day, dengue-carrying mosquitoes are most active from dawn until sunset.
• Wear protective clothing: Wear long sleeves, long pants, socks, and shoes when you are in an area where mosquitoes are a problem.
• Reduce mosquito habitat: Dengue-carrying mosquitoes are usually found in and around homes, breed in standing water, and can gather in objects like old vehicle tires. By removing habitats, you can contribute to a decrease in mosquito populations.
• Use insect repellent: You can treat your clothes, shoes, camping equipment, and bed nets with permethrin. Additionally, clothes pre-treated with permethrin can be purchased. Use a repellent with at least 10% DEET concentration on your skin.

DIAGNOSIS/TESTS

Generally, if your doctor suspects Dengue, a complete blood count (including platelet count) is recommended. However, to confirm the presence of the Dengue virus, you need to take definitive tests, which include:

1. Dengue NS1 antigen test

This blood test helps to detect the non-structural protein NS1 of the dengue virus during the early phase of infection. This test is sensitive within the first seven days of symptoms. After seven days, this test is not recommended as NS1 antigen is rarely detectable.

2. Dengue antibody IgM test

This test detects dengue virus IgM antibodies in the blood, which appear in the early course of the disease (acute infection). This test also helps to differentiate between primary (first-time infection) and secondary (second-time infection with the other kinds of dengue viruses) infection. 

3. Dengue IgG-ELISA test

The IgG-ELISA test or Dengue Immunoglobulin G test is used to detect dengue virus IgG antibodies. It is used to detect recent or past dengue infections. IgG levels in the blood increase throughout seven days, peaking during the second week. It remains in the blood for 90 days. But in some people, these antibodies may stay for the rest of their life. A positive IgG and a negative IgM result indicate that the person was infected with Dengue in the past.

4. Dengue RNA PCR test

This test is used to diagnose Dengue fever during the initial stage of infection. It helps to detect the viral RNA of the Dengue virus. Also, it helps to identify the different serotypes of the dengue virus. 

TREATMENT & THERAPIES

There is no specific treatment for Dengue. The focus is on treating pain symptoms. 

1. Bed rest: 

• Let your sick child or family member rest as much as possible. 

2. Control high fever:

• Avoid Ibuprofen, aspirin or aspirin-containing drugs as they can increase the risk of bleeding.
• Give Paracetamol (acetaminophen) every 6 hours if needed for high fever (maximum four doses per day).
• Sponge the patient's skin with cool water if the fever remains high. 

3. Prevent dehydration:

Give plenty of fluids, and watch for signs of dehydration, which occurs when a person loses too much body fluid from fever or vomiting or does not drink enough fluids. Bring your child or sick family member to a clinic or emergency room if any of the following signs appear:

• Decrease in urination (check the number of wet diapers or trips to the bathroom)
• Few or no tears when a child cries
• Feeling overtired, overly agitated, or confused
• Dry mouth, tongue, or lips 
• Rapid heartbeat (more than 100 beats per minute) 
• Cold or clammy fingers and toes
• Sunken eyes
• Sunken soft spot (fontanel) in an infant's head

4. Prevent the spread of Dengue inside your house:

Mosquitoes that bite the affected family member can go on to bite and infect others.

• Allow the sick child or family member to rest and sleep under a bed net or use insect repellent while feverish.
• Kill all mosquitoes in the house and empty containers that carry water on patios.
• Place screens on windows and doors to prevent mosquitoes from entering the house.

Severe Dengue is a medical emergency and can result in internal bleeding, shock and even death. Dengue can become severe when the fever disappears between the third and seventh day of illness. Watch for signs and symptoms of severe Dengue. Immediately go to a local clinic or emergency room if you or a family member has severe dengue symptoms.

LIFESTYLE & HOME REMEDIES

1. Papaya leaf juice: Papaya leaf juice is an excellent remedy to increase platelet count. Also, it improves immunity, which helps treat Dengue. Take some papaya leaves and crush them to extract juice out of them. You can consume a small quantity of papaya leaf juice twice daily for better results.
2. Giloy juice: It is a well-known remedy for dengue fever. Giloy juice increases immunity and speeds up your metabolism. Strong immunity helps in fighting dengue fever effectively. It helps in increasing the platelet count and gives relief to the patient. Boil two short stems of the giloy plant in a glass of water. Drink this water while it's still a little warm. Additionally, you can drink a cup of boiling water with a few drops of Giloy juice added twice daily. But make sure that you don't drink too much giloy juice.
3. Fenugreek seeds: Fenugreek seeds are also rich in multiple nutrients which help control dengue fever. Soak some fenugreek seeds in a cup of hot water. Allow the water to cool down, and drink it twice a day. Fenugreek water will reduce fever and boost immunity.