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Dengue Fever

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

  • Incubation period is 2-7 days.
  • All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5–41ºC) and myalgia.
  • Fever is often biphasic with two peaks.
  • Fever is associated with frontal or retro-orbital headache lasting 1–7 days, accompanied by generalised macular, blanching rash.
  • Initial rash usually fades after 1–2 days.
  • 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.
  • DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last for weeks (hence breakbone fever).
  • Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.
  • Abdominal pain may occur and if severe suggests DHF pattern.
  • IF you notice these symptoms please consult a doctor immediately

    Complications

    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

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

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

  • 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
  • Insecticides to destroy the larvae.
  • Mosquito nets can be used during day and night time as the Aedes mosquitoes is day- biting.
  • Mosquito repellants
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