c






 

    
Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases which occur in the tropics, can be
life-threatening, and are caused by four closely related virus serotypes of the genus O
, family Flaviviridae. It
is also known as breakbone fever, since it can be extremely painful. Unlike malaria, dengue is just as prevalent in
the urban districts of its range as in rural areas. 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  
 


  or more rarely the  

  mosquito, both of which feed
exclusively during daylight hours.



°| fever of sudden onset associated with headache,

°| muscle and joint pains

°
| distinctive retro-orbital pain
°
| rash.

The classic dengue rash is a generalised maculopapular rash with islands of sparing. A hemorrhagic rash of
characteristically bright red pinpoint spots, known as petechiaecan occur later during the illness and is associated
with thrombocytopenia. It usually appears first on the lower limbs and the chest; There may also be severe retro-
orbital pain, (a pain from behind the eyes that is distinctive to Dengue infections), and gastritis with some
combination of associated abdominal pain, nausea, vomiting coffee-grounds-like congealed blood, ordiarrhea.
Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when
no rash or retro-orbital pain is present. Febrile travelers from tropical areas may transmit dengue inadvertently to
previously Dengue free populations of  
 

  mosquitoes, having not been properly diagnosed
for Dengue. Clinically, the platelet count will drop until after the patient's temperature is normal. Cases of DHF also
show higher fever, variable hemorrhagic phenomena including bleeding from the eyes,nose,mouth and ear into
the gut, and oozing blood from skin pores, thrombocytopenia, and hemoconcentration. When Dengue infections
proceed to DHF symptoms, DHF causes vascular leak syndrome which includes fluid in the blood vessels leaking
through the skin and into spaces around the lungs and belly. This fluid loss and severe bleeding can cause blood
pressure to fall, then Dengue Shock Syndrome(DSS) sets in, which has a high mortality rate.



1.| Fever, headaches, eye pain, severe dizziness and loss of appetite.
2.| Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva,
injection sites, etc.; vomiting blood, or bloody diarrhea)
3.| Thrombocytopenia (<100,000 platelets per mm³ 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 hematocrit of
20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinemia)
5.| Encephalitic occurrences.

u
 
The mainstay of treatment is timely supportive therapy to tackle circulatory shock due
to hemoconcentration and bleeding.

°| Close monitoring of vital signs

°| Increased oral fluid intake (is recommended to prevent dehydration.)

°| A platelet transfusion may be indicated (if the platelet level drops significantly (below 20,000) or if there is
significant bleeding.)

°| The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red
blood cell transfusion.

°| Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the
bleeding tendency associated with some of these infections.

°| Îatients may receive paracetamol, acetaminophen, preparations to deal with these symptoms if dengue is
suspected.

°| Vecent investigation in India revealed that juice of green portion of papaya leaves in pure form is found to
be of great help.

°| The method recommended to take the juice is, take two big leaves fresh from the tree and clean them.
Then squeeze them after pounding to fine mash, using clean white linen. Collect the juice and
immediately use it. It tastes very bitter. Dose recommended for adults, every day two tablespoon juice
early morning preferably. The treatment has shown results within 24 hours.


  

°| Dengue is transmitted by Aedes mosquitoes, particularly 

  and 

 .

°| ›lood transfusion Dengue may also be transmitted via infected blood products (blood transfusions,
plasma, and platelets),



     
!  


 ||
|
 |


|  || | ||
|| | |  ||


| 
| |  ||
|
| |
 
|
|
||
 |  |
  |
||
|
|  | | || 
|
|
||
 
| |
|
 |
 |

|
|
 |
 
|  
|
 |  ||
|| |  |   || |
|
| | |
|
| | 
|
 |  | |

|
|| |
|
 |


|
|
| ||  | | ||  | 
||
|  |
| |
|

||
||
| |  |
 
|   ||  ||
|
|


| ||

 | |
 ||  |
||

|   | 
|  | |
 ||
 |
| 
||
|
 
| || ||
| |
|  |
|  |
 |

 
|
 ||
|