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Dengue fever

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in
the tropics, with a geographical spread similar to malaria. Caused by one of four
closely related virus serotypes of the genus Flavivirus, family Flaviviridae, each
serotype is sufficiently different that there is no cross-protection and epidemics
caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to
humans by the Aedes aegypti (rarely Aedes albopictus) mosquito.This mosquito
tends to bite just after dawn and just before sunset.

Signs and symptoms

Fever, with severe headache, muscle and joint pains (myalgias and arthralgias
severe pain gives it the name break-bone fever or bonecrusher disease) and rashes
The dengue rash is characteristically bright red petechia and usually appears first
on the lower limbs and the chest - in some patients, it spreads to cover most of the
body. Some cases develop much milder symptoms, which can, when no rash is
present, be misdiagnosed as a flu or other viral infection.

There may also be gastritis with some combination of associated abdominal pain,
nausea, vomiting or diarrhea.

The classic dengue fever lasts about six to seven days, with a smaller peak of
fever at the trailing end of the fever (the so-called "biphasic pattern"). Clinically,
the platelet count will drop until the patient's temperature is normal.

Cases of DHF also show higher fever, haemorrhagic phenomena, thrombocytopenia and
haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS)
which has a high mortality rate.

Diagnosis
The diagnosis of dengue is usually made clinically. The classic picture is high fever with
no localising source of infection, a petechial rash with thrombocytopenia and relative
leukopenia.
There exists a WHO definition of dengue haemorrhagic fever that has been in use since
1975; all four criteria must be fulfilled:
1. Fever
2. Haemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding
from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
3. Thrombocytopaenia (<100,000 platelets per mm or estimated as less than 3
platelets per high power field)

4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or
drop in haematocrit of 20% or more from baseline following IV fluid, pleural
effusion, ascites, hypoproteinaemia)
Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

Weak rapid pulse,


Narrow pulse pressure (less than 20 mm Hg)

Hypotension for age;


Cold, clammy skin and restlessness.

or,

Serology and PCR (polymerase chain reaction) studies are available to confirm the
diagnosis of dengue if clinically indicated.

Prevention
Primary prevention of dengue mainly resides in eliminating or reducing the mosquito
vector for dengue. Public spraying for mosquitoes is the most important aspect of this
vector. Application of larvicides such as Abate to standing water is more effective in the
long term control of mosquitoes. Initiatives to eradicate pools of standing water (such as
in flowerpots) have proven useful in controlling mosquito-borne diseases.
Personal prevention consists of the use of mosquito nets, repellents, cover exposed skin,
use DEET-impregnated bednets, and avoiding endemic areas. This is also important for
malaria prevention.

Infirmary 2007

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