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DENGUE FEVER

  • Introduction

    Dengue Hemorrhagic Fever is a mosquito-borne viral infection endemic in the tropical and sub-tropical regions. The female mosquito Ae.aegypti most is semi-domesticated, preferring to lay its eggs in man-made water containers, resting indoors and feeding in the early morning or late afternoon. Dengue usually occurs as epidemics in Sri Lanka following monsoon seasons.
    According to data from epidemiology unit of Sri Lanka, the number of total cases recorded for year 2009 is 32713. Most affected district was Kandy. Colombo, Gampaha and Kaluthara districts which have been susceptible in the past have also recorded a high rate of infection and deaths.
    Causative agents
    Dengue virus; There are 4 serotypes of the single-stranded RNA virus (flaviviridae).
    Types of Dengue
    Dengue fever, Dengue haemorrhagic fever ,Dengue shock syndrome.

     
     
  • Symptoms and signs (features of disease)

    Disease varies in severity
    bullet Incubation period is 2-7 days.
    bullet All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5–41ºC) and myalgia.
    bullet Fever is often biphasic with two peaks.
    bullet Fever is associated with frontal or retro-orbital headache lasting 1–7 days, accompanied by    generalised macular, blanching rash.
    bullet Initial rash usually fades after 1–2 days.
    bullet Symptoms regress for a day or two then rash reappears in (maculopapular, morbilliform pattern),    sparing palms and soles of feet. Fever recurs but not as high. There may be desquamation.
    bullet DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last    for weeks (hence breakbone fever).
    bullet Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.
    bullet Abdominal pain may occur and if severe suggests DHF pattern.
    IF you notice these symptoms please consult a doctor immediately

     
     
  • Complications

    bullet Dengue can cause severe complications like Hepatic failure – ( failure of the liver) Myocarditis –(    Inflammation of heart muscles) ,Encephalopathy (Means damage to the brain causing fits, loss of    consciousness and confusion ,Disseminated intravascular coagulation) ,Damage to blood vessels    and blood cells causing problematic bleeding and clotting, or death.

     
     
  • Investigations

    bullet FBC - low platelets and high packed cell volume if haemoconcentrated. Usually white cell count    will fall
    bullet Infection may be confirmed by isolation of virus in serum and detection of IgM and IgG antibodies    for Dengue by ELISA,
    bullet Molecular diagnostic methods such as reverse-transcriptase-PCR

     
     
  • Management

    bullet Bed rest
    bullet Nutritious diet and lot of liquids, But avoid red and brown foods and drinks like coffee, as it may    misinterpret vomiting as blood stained .
    bullet Fever control with paracetamol, tepid sponging and fans. Aspirin should be avoided.
    bullet Hospital management includes intravenous fluid resuscitation with close monitoring, Intensive    management may be required in severe DHF/DSS cases.

     
     
  • Prevention of Dengue fever

    bullet Anti-mosquito public health measures such as reducing breeding sites ( flower pots, fish    tanks, tires, coconut shells,tins, water collecting plants, gutters which can collect water)    and good sewage management
    bullet Insecticides to destroy the larvae.
    bullet Mosquito nets can be used during day and night time as the Aedes mosquitoes is day-    biting.
    bullet Mosquito repellants