Dengue
Prevalence: Each year, an
estimated 100 million cases of dengue is reported through out the world.
The number of death recorded by these dengue viruses is on the rise
particularly in tropical countries like India, Southeast Asia, and Southern
China etc.
Dengue fever is transmitted by the bite of an Aedes mosquito infected
with a dengue virus. The mosquito becomes infected when it bites a person with
dengue virus in their blood. It can’t be spread directly from one person to
another person.
How to identify
dengue fever?
Dengue is an acute febrile illness of 2 -7 days duration with either
two or more of the following manifestations.
Head ache
Retro orbital pain (pain behind the eye)
Myalgia/arthralgia
Rash
Hemorrhagic manifestation
Leucopenia
Severe joint and muscle pain
Nausea
Vomiting
Skin rash which appears three to four days after the
onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy
bruising
In children dengue is usually mild. In few cases it may be associated
with severe bone pain and its recovery may be associated with prolong
depression and fatigue.
Dengue hemorrhagic fever: it is probable case where hemorrhagic is
evident by one or more of the following.
Positive tourniquet test
Petechiae, ecchymosis or
purpura
Bleeding from mucosa (mostly
epistaxis or bleeding from gums), injection sites or other sties
Haematemesis or melena
Thrombocytopaemia (platelets 100,000/cu.mm or less) and
Evidence of plasma leakage due to increased capillary permeability
manifested by one or more of the following:
1.
A > 20% rise in haemotocrit for age and sex
2.
A > 20% drop
in haemotocrit following treatment with fluids as compared to baseline
3.
Signs of plasma
leakage (pleural effusion, ascites or hypoproteinaemia)
Dengue Shock Syndrome (DSS)
All the above criteria of DHF plus signs of circulatory failure manifested by
rapid and weak pulse, narrow pulse pressure (< or equal to 20 mm Hg);
hypotension for age, cold and clammy skin and restlessness.
The above descriptions of
DF/DHF/DSS are adequate for guiding doctors to treat the disease. However, for
reporting of the disease, cases should be classified as suspected DF/DHF/DSS on
the basis of above the criteria. Added serological evidence would categorize
them into probable and confirmed cases.
How to prevent?
There is no vaccine to prevent
dengue fever. The best way to prevent the disease is to prevent bites by
infected mosquitoes, particularly if you are living in or traveling to a
tropical area. This involves protecting yourself and making efforts to keep the
mosquito population down.
To protect oneself
Stay away from heavily populated residential areas, if possible.
Use mosquito repellents, even indoors.
When outdoors, wear long-sleeved shirts and long pants tucked into
socks.
When indoors, use air conditioning if available.
Make sure window and door screens are secure and free of holes. If
sleeping areas are not screened or air conditioned, use mosquito nets.
If you have symptoms of dengue, speak to your doctor.
To reduce the mosquito population, get rid of places
where mosquitoes can breed. These include old tires, cans, or flower pots that
collect rain. Regularly change the water in outdoor bird baths and pets' water
dishes.
If someone in your home gets dengue fever, be especially vigilant
about efforts to protect yourself and other family members from mosquitoes.
Mosquitoes that bite the infected family member could spread the infection to
others in your home.
How to diagnose Dengue?
Doctors can
diagnose dengue infection with a blood test to check for the virus or
antibodies to it. If you become sick after traveling to a tropical area, let
your doctor know. This will allow your doctor to evaluate the possibility that
your symptoms were caused by a dengue infection.
Treatment for Dengue Fever?
There is no
specific medicine to treat dengue infection. If you think you may have dengue
fever, you should use pain relievers
with acetaminophen and
avoid medicines with asprin,
which could worsen bleeding. You should also rest, drink plenty of fluids, and
see your doctor. If you start to feel worse in the first 24 hours after your
fever goes down, you should get to a hospital immediately to be checked for
complications.
Do and don’ts for doctors
Cases of Dengue fever/Dengue Hemorrhagic Fever (DF/DHF) should be
observed every hour.
Serial platelet and
haematocrit determinations drop in platelets and rise in haematocrits are
essential for early diagnosis of DHF.
Timely intravenous therapy isotonic crystalloid solution can prevent
shock and/or lessen its severity.
If the patients condition
becomes worse despite giving 20ml/kg/hr for one hour, replace crystalloid
solution with colloid solution such as Dextran or plasma.
As soon as improvement occurs, replace with crystalloid.
If improvement occurs, reduce
the speed from 20 ml to 10 ml, then to 6 ml, and finally to 3 ml/kg.
If haematocrit falls, give
blood transfusion 10 ml/kg and then give crystalloid IV fluids at the rate of
10ml/kg/hr.
In case of severe bleeding,
give fresh blood transfusion about 20 ml/kg for two hours. Then give
crystalloid at 10 ml/kg/hr for a short time (30-60 minutes) and later reduce
the speed.
In case of shock, give oxygen.
For correction of acidosis (sign: deep breathing), use sodium
bicarbonate.
WHAT NOT TO DO:
Do not give Aspirin or Brufen
for treatment of fever.
Avoid giving intravenous
therapy before there is evidence of haemorrhage and bleeding.
Avoid giving blood transfusion unless indicated, reduction in
haematocrit or severe bleeding.
Avoid giving steroids. They do
not show any benefit.
Do not use antibiotics.
Do not changes the speed of fluid rapidly, i.e., avoid rapidly
increasing or rapidly slowing the speed of fluids.
Insertion of nasogastric tube
to determine concealed bleeding or to stop bleeding (by cold
lavage) is not recommended since it is hazardous.
SIGNS OF RECOVERY:
Stable pulse, blood pressure
and breathing rate
Normal temperature
No evidence of external or internal
bleeding
Return of appetite
No vomiting
Good urine output
Stable haematocrit
Convalescent confluent
petechiae rash
CRITERIA FOR DISCHARGING
PATIENTS:
Absence of fever for at least
24 hours without the use of anti-fever therapy
Return of appetite
Visible clinical improvement
Good urine output
Minimum of three days after
recovery from shock
No respiratory distress from pleural effusion and no ascites
Platelet count of more than
50,000/mm
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