Dengue is a type of viral fever. The usual, seasonal viral fever (seasonal flu) spreads through air. However, dengue virus spreads via mosquitoes which harbor the virus. The type of mosquito which harbours the virus is Aedes aegypti and it is the bite of infected female of Aedes aegypti mosquito which transmits the infection.
Dengue fever, in majority of cases, presents as sudden onset of high grade fever 101-103° F (occasionally 104-105°F) with headache and body ache. Classically, patient with dengue fever complains of pain behind eyes (retro bulbar pain), muscle aches, joint pains, decrease appetite, occasionally vomiting and abdominal discomfort. This lasts for 2-7days and recovery occurs in one to two weeks. In some it may pass of like a mild flu with slight fever and throat congestion for a couple of days. There is feeling of extreme exhaustion and weakness in recovery phase.
In some individuals, dengue infection may lead to complications like pain upper part of abdomen, severe vomiting, and appearance of red coloured pin point spots under the skin due to bleeding (known as petechiae). This is dangerous because in such individuals the viral infection destroys blood cells known as platelets in blood. Platelets are responsible for maintaining integrity of blood in the circulation. Decreasing platelets leads to bleeding tendencies in the body. The first sign is appearance of red spots or rash under the skin, known as petechiae, which further may be associated with bleeding gums and blood in vomit. This is termed as dengue haemorrhagic fever and it can be life threatening. There may be internal bleeding leading to low blood pressure and collapse of patient and death can occur within 24-48 hours of the appearance of rash. Mortality varies from 2-10% depending on age of patient , any associated illness in patient and the standard of care available.
Diagnosis of dengue fever is initially clinical and is made when a patient exhibits the typical clinical symptoms of headache, fever, eye pain, severe muscle aches and petechial rash and has a history of being in an area where dengue fever is endemic. Dengue fever may however be difficult to diagnose just by history and examination because its symptoms overlap with those of many other viral illnesses, such as chikungunya fever. A blood test is often done to confirm diagnosis in addition to testing for platelet counts. Platelet counts may be repeated daily in acute phase of infection if they are low or if patient has rash. Once recovery starts there is no need to do further platelet count to check if they are increasing.
Treatment of dengue is primarily providing support for management of symptoms. It is actually a self limiting fever and subsides on its own. There are no antibiotics for dengue fever. Fever is treated by paracetamol and sponging. It is advisable to avoid any other pain killer like brufen (combiflam, flexon) or voveran as they can worsen the condition leading to bleeding. To bring down fever sponging of entire body with cool water is ideal. The patient is advised to rest, have normal diet and take plenty of fluids. Admission to hospital is required in high risk patients like, children below 5 years, elderly, patients with diabetes, asthma or any other long term illnesses and in patients where platelet counts are decreasing.
Dengue fever is dangerous as it can lead to life threatening complications in some. Hence, prevention of dengue infection is very important. There is no vaccine for dengue as yet. The only method to control spread of infection is to prevent breeding of the rogue mosquitoes. These Aedes aegypti mosquitoes breed in fresh water collections. Hence, it is important especially in summers and monsoons to prevent collection of water in broken pots, water coolers, open overhead tanks and ensuring that they are cleaned regularly. It is important to prevent water collecting in open drains and pits surrounding houses. The community along with help of government civic agencies should ensure proper disposal of solid waste, spraying of anti-mosquito chemicals like DDT sprays at regular intervals especially in overcrowded areas and where breeding is detected, drains should be covered or kerosene oil can be spilled on the surface of collected water in open drains to prevent breeding and kill the larva of these mosquitoes. A regular survey should be undertaken by various civic bodies of locality to check breeding of mosquitoes. At an individual and family level each on of us should ensure cleanliness in house and surroundings, use mosquito nets and mosquito repellents when required.
