Dengue fever

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Dengue virus

A TEM micrograph showing

Dengue virus virions (the cluster
of dark dots near the center).

Virus classification
Group: Group IV ((+)ssRNA)
Family: Flaviviridae
Genus: Flavivirus
Species: Dengue virus

Dengue fever
Classification and external resources
ICD-10

A90.

ICD-9

061

DiseasesDB

3564

MedlinePlus

001374

eMedicine

med/528

MeSH

C02.782.417.214

Dengue fever (pronounced UK: /de/, US: /di/) 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 Flavivirus, family Flaviviridae.[1] It
is also known as breakbone fever. It occurs widely in the tropics, including northern
Argentina, northern Australia, the entirety of Bangladesh, Barbados, Bolivia[2], Brazil,
Cambodia, Costa Rica, Dominican Republic, Guatemala, Guyana, Honduras, India, Indonesia,

Jamaica, Laos, Malaysia, Mexico, Pakistan, Panama, Paraguay[3], Philippines, Puerto Rico,
Samoa[4], Singapore, Sri Lanka, Suriname, Taiwan, Thailand, Trinidad, Venezuela and
Vietnam, and increasingly in southern China[5]. 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 Aedes aegypti or more rarely the Aedes
albopictus mosquito, which feed during the day.[6]
The WHO says some 2.5 billion people, two fifths of the world's population, are now at risk
from dengue and estimates that there may be 50 million cases of dengue infection worldwide
every year. The disease is now endemic in more than 100 countries.[7]

Contents
[hide]

1 Signs and symptoms

2 Diagnosis

3 Cause

4 Prevention
o 4.1 Vaccine development
o 4.2 Mosquito control

4.2.1 Mesocyclops

4.2.2 Wolbachia

4.2.3 Mosquito mapping

o 4.3 Potential antiviral approaches

5 Treatment
o 5.1 Research
o 5.2 Alternative medicine

6 Epidemiology
o 6.1 Blood transfusion

7 History
o 7.1 Etymology
o 7.2 History of the literature

8 Society and Culture

o 8.1 Use as a biological weapon

9 See also

10 References

11 External links

[edit] Signs and symptoms

The disease manifests as a sudden onset of severe headache, muscle and joint pains (myalgias
and arthralgiassevere pain that gives it the nickname break-bone fever or bonecrusher
disease), fever, and rash.[8] The dengue rash is characteristically bright red petechiae and
usually appears first on the lower limbs and the chest; in some patients, it spreads to cover
most of the body. There may also be gastritis with some combination of associated abdominal
pain, nausea, vomiting, or diarrhea.
Some cases develop much milder symptoms which can be misdiagnosed as influenza or other
viral infection when no rash is present. Thus travelers from tropical areas may pass on dengue
inadvertently, having not been properly diagnosed at the height of their illness. Patients with
dengue can pass on the infection only through mosquitoes or blood products and only while
they are still febrile. The classic dengue fever lasts about two to seven days, with a smaller
peak of fever at the trailing end of the disease (the so-called "biphasic pattern"). Clinically, the
platelet count will drop until the patient's temperature is normal. Cases of DHF also show
higher fever, variable hemorrhagic phenomena, thrombocytopenia, and hemoconcentration. A
small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality
rate. DHF combined with a cirrhotic liver has been suspected in rapid development of
hepatocellular carcinoma (HCC). Given that the dengue virus (DEN) is related to the
Hepatitis C virus, this is an avenue for further research as HCC is among the top five
cancerous causes of death outside Europe and North America. Normally HCC does not occur
in a cirrhotic liver for ten or more years after the cessation of the poisoning agent. DHF
patients can develop HCC within one year of cessation of poisoning agent.

[edit] Diagnosis
The diagnosis of dengue is usually made clinically. The classic picture is high fever with no
localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia

- low platelet and white blood cell count. Care has to be taken as diagnosis of DHF can mask
end stage liver disease and vice versa.
1. Fever, bladder problem, constant 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 mm 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 occurrence
Dengue shock syndrome is defined as dengue hemorrhagic fever plus:

Weak rapid pulse,

Narrow pulse pressure (less than 20 mm Hg)

Cold, clammy skin and restlessness.

Dependable, immediate diagnosis of dengue can be performed in rural areas by the use of
Rapid Diagnostic Test kits, which also differentiate between primary and secondary dengue
infections.[9] Serology and polymerase chain reaction (PCR) studies are available to confirm
the diagnosis of dengue if clinically indicated. Dengue can be a life threatening fever.

[edit] Cause
Dengue fever is caused by Dengue virus (DENV), a mosquito-borne flavivirus. DENV is an
ssRNA positive-strand virus of the family Flaviviridae; genus Flavivirus. There are four
serotypes of DENV. The virus has a genome of about 11000 bases that codes for three
structural proteins, C, prM, E; seven nonstructural proteins, NS1, NS2a, NS2b, NS3, NS4a,
NS4b, NS5; and short non-coding regions on both the 5' and 3' ends.[10]

[edit] Prevention
[edit] Vaccine development
There is no tested and approved vaccine for the dengue flavivirus. There are many ongoing
vaccine development programs. Among them is the Pediatric Dengue Vaccine Initiative set up
in 2003 with the aim of accelerating the development and introduction of dengue vaccine(s)
that are affordable and accessible to poor children in endemic countries.[11] Thai researchers
are testing a dengue fever vaccine on 3,0005,000 human volunteers after having successfully

conducted tests on animals and a small group of human volunteers.[12] A number of other
vaccine candidates are entering phase I or II testing.[13]

[edit] Mosquito control

A field technician looking for larvae in standing water containers during the 1965 Aedes
aegypti eradication program in Miami, Florida. In the 1960s, a major effort was made to
eradicate the principal urban vector mosquito of dengue and yellow fever viruses, Aedes
aegypti, from southeast United States.
Primary prevention of dengue mainly resides in mosquito control. There are two primary
methods: larval control and adult mosquito control.[citation needed] In urban areas, Aedes mosquitos
breed on water collections in artificial containers such as plastic cups, used tires, broken
bottles, flower pots, etc. Periodic draining or removal of containers is the most effective way
of reducing the breeding grounds for mosquitos.[citation needed] Larvicide treatment is another
effective way to control the vector larvae, but the larvicide chosen should be long-lasting and
preferably have World Health Organization clearance for use in drinking water. There are
some very effective insect growth regulators (IGRs) available which are both safe and longlasting (e.g., pyriproxyfen). For reducing the adult mosquito load, fogging with insecticide is
somewhat effective.[citation needed]
Prevention of mosquito bites is another way of preventing disease. This can be achieved by
using insect repellent, mosquito traps or mosquito nets.
[edit] Mesocyclops
In 1998, scientists from the Queensland Institute of Medical Research (QIMR) in Australia
and Vietnam's Ministry of Health introduced a scheme that encouraged children to place a
water bug, the crustacean Mesocyclops, in water tanks and discarded containers where the
Aedes aegypti mosquito was known to thrive.[14] This method is viewed as being more costeffective and more environmentally friendly than pesticides, though not as effective, and
requires the continuing participation of the community.[15]
Even though this method of mosquito control was successful in rural provinces, not much is
known about how effective it could be if applied to cities and urban areas. The Mesocyclops
can survive and breed in large water containers but would not be able to do so in small
containers that most urban dwellers have in their homes. Also, Mesocyclops are hosts for the
guinea worm, a pathogen that causes a parasite infection, and so this method of mosquito
control cannot be used in countries that are still susceptible to the guinea worm. The biggest
dilemma with Mesocyclops is that its success depends on the participation of the community.
This idea of a possible parasite-bearing creature in household water containers dissuades

people from continuing the process of inoculation and, without the support and work of
everyone living in the city, this method will not be successful.[16]
[edit] Wolbachia
In 2009, scientists from the School of Integrative Biology at The University of Queensland
revealed that by infecting Aedes mosquitos with the bacterium Wolbachia, the adult lifespan
was reduced by half.[17] In the study, super-fine needles were used to inject 10,000 mosquito
embryos with the bacterium. Once an insect was infected, the bacterium would spread via its
eggs to the next generation. A pilot release of infected mosquitoes could begin in Vietnam
within three years. If no problems are discovered, a full-scale biological attack against the
insects could be launched within five years.[18]
[edit] Mosquito mapping
In 2004, scientists from the Federal University of Minas Gerais, Brazil, discovered a fast way
to find and count mosquito population inside urban areas. The technology, named Intelligent
Monitoring of Dengue (in Portuguese), uses traps with kairomones that capture Aedes gravid
females, and upload insect counts with a combination of cell phone, GPS and internet
technology. The result is a complete map of the mosquitoes in urban areas, updated in real
time and accessible remotely, that can inform control methodologies.[19] The technology was
recognized with a Tech Museum Award in 2006.[20]

[edit] Potential antiviral approaches

Dengue virus belongs to the family Flaviviridae, which includes the hepatitis C virus, West
Nile and Yellow fever viruses among others. Possible laboratory modification of the yellow
fever vaccine YF-17D to target the dengue virus via chimeric replacement has been discussed
extensively in scientific literature,[21] but as of 2009 no full scale studies have been conducted.
[22]

In 2006 a group of Argentine scientists discovered the molecular replication mechanism of the
virus, which could be specifically attacked by disrupting the viral RNA polymerase.[23] In cell
culture[24] and murine experiments[25][26] morpholino antisense oligomers have shown specific
activity against Dengue virus.
In 2007 virus replication was attenuated in the laboratory by interfering with activity of the
dengue viral protease, and a project to identify drug leads with broad spectrum activity against
the related dengue, hepatitis C, West Nile, and yellow fever viruses was launched[27][28].

[edit] Treatment
The mainstay of treatment is timely supportive therapy to tackle shock due to
hemoconcentration and bleeding. Close monitoring of vital signs in critical period (between
day 2 to day 7 of fever) is critical. Increased oral fluid intake is recommended to prevent
dehydration. Supplementation with intravenous fluids may be necessary to prevent
dehydration and significant concentration of the blood if the patient is unable to maintain oral
intake. A platelet transfusion is indicated in rare cases 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. Patients may receive
paracetamol preparations to deal with these symptoms if dengue is suspected.[29]

[edit] Research
Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication.
Initial experiments showed a fivefold increase in defective viral RNA production by cells
treated with each drug.[30] In vivo studies, however, have not yet been done. Unlike HIV
therapy, lack of adequate global interest and funding greatly hampers the development of a
treatment regime.

[edit] Alternative medicine

In Brazilian traditional medicine, cat's claw herb is used to treat patients with dengue.[31] In
Philippines, the tawa-tawa herb is used to treat patients with dengue.[32]

[edit] Epidemiology

Disability-adjusted life year for dengue fever per 100,000 inhabitants in 2002.
no data
120-135

less than 15
15-30
135-150
150-250

30-45
45-60
more than 250

60-75

75-90

90-105

105-120

Worldwide dengue distribution, 2006. Red: Epidemic dengue. Blue: Aedes aegypti.

Worldwide dengue distribution, 2000.

Dengue is transmitted by Aedes mosquitoes, particularly A. aegypti and A. albopictus.

The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and
North America in the 1780s, shortly after the identification and naming of the disease in 1779.
A pandemic began in Southeast Asia in the 1950s, and by 1975 DHF had become a leading
cause of death among children in the region. Epidemic dengue has become more common
since the 1980s. By the late 1990s, dengue was the most important mosquito-borne disease
affecting humans after malaria, with around 40 million cases of dengue fever and several
hundred thousand cases of dengue hemorrhagic fever each year. Significant outbreaks of
dengue fever tend to occur every five or six months. The cyclical rise and fall in numbers of
dengue cases is thought to be the result of seasonal cycles interacting with a short-lived crossimmunity[clarification needed] for all four strains in people who have had dengue. When the crossimmunity wears off the population is more susceptible to transmission whenever the next
seasonal peak occurs. Thus over time there remain large numbers of susceptible people in
affected populations despite previous outbreaks due to the four different serotypes of dengue
virus and the presence of unexposed individuals from childbirth or immigration.
There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue
hemorrhagic fever is more likely to occur in patients who have secondary infections by
another one of dengue fever's four serotypes. One model to explain this process is known as
antibody-dependent enhancement (ADE), which allows for increased uptake and virion
replication during a secondary infection with a different strain. Through an immunological
phenomenon, known as original antigenic sin, the immune system is not able to adequately
respond to the stronger infection, and the secondary infection becomes far more serious.[33]
This process is also known as superinfection.[34][35]
Reported cases of dengue are an under-representation of all cases when accounting for
subclinical cases and cases where the patient did not present for medical treatment.
There was a serious outbreak in Rio de Janeiro in February 2002 affecting around one million
people and killing sixteen. On March 20, 2008, the secretary of health of the state of Rio de
Janeiro, Srgio Crtes, announced that 23,555 cases of dengue, including 30 deaths, had been
recorded in the state in less than three months. Crtes said, "I am treating this as an epidemic
because the number of cases is extremely high." Federal Minister of Health, Jos Gomes
Temporo also announced that he was forming a panel to respond to the situation. Cesar Maia,
mayor of the city of Rio de Janeiro, denied that there was serious cause for concern, saying
that the incidence of cases was in fact declining from a peak at the beginning of February.[36]
By April 3, 2008, the number of cases reported rose to 55,000 [37]
In Singapore, there are 4,0005,000 reported cases of dengue fever or dengue haemorrhagic
fever every year. In the year 2004, there were seven deaths from dengue shock syndrome[38].
An epidemic broke out in Bolivia in early 2009, in which 18 people have died and 31,000
infected.
An outbreak of dengue fever was declared in Cairns, located in the tropical north of
Queensland, Australia on 1 December 2008. As at 3 March 2009 there were 503 confirmed
cases of dengue fever, in a residential population of 152,137. Outbreaks were subsequently
declared the neighbouring cities and towns of Townsville (outbreak declared 5 January 2009),
Port Douglas (6 February 2009), Yarrabah (19 February 2009), Injinoo (24 February 2009),
Innisfail (27 February 2009) and Rockhampton (10 March 2009). There have been
occurrences of dengue types one, two, three and four in the region. March 4, 2009,

Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns, in
the first fatality since the epidemic began last year. The statement said that although the
woman had other health problems, she tested positive for dengue and the disease probably
contributed to her death.
In 2009, in Argentina, a dengue outbreak was declared the northern provinces of Chaco,
Catamarca, Salta, Jujuy, and Corrientes, with over 9673 cases reported as of April 11, 2009 by
the Health Ministry [1]. Some travelers from the affected zones have spread the fever as far
south as Buenos Aires [2]. Major efforts to control the epidemic in Argentina are focused on
preventing its vector (the Aedes mosquitoes) from reproducing. This is addressed by asking
people to dry out all possible water reservoirs from where mosquitoes could proliferate
(which is, in other countries, known as "descacharrado"). There have also been information
campaigns concerning prevention of the dengue fever; and the government is fumigating with
insecticide in order to control the mosquito population.[39]
The first cases of dengue fever have recently been reported on the island of Mauritius, in the
Indian Ocean. One of the South Asian countries still suffering highly from this problem is Sri
Lanka.[40]

[edit] Blood transfusion

Dengue may also be transmitted via infected blood products (blood transfusions, plasma, and
platelets),[41][42] and in countries such as Singapore, where dengue is endemic, the risk was
estimated to be between 1.6 and 6 per 10,000 blood transfusions.[43]

[edit] History
[edit] Etymology
The origins of the word dengue are not clear, but one theory is that it is derived from the
Swahili phrase "Ka-dinga pepo", which describes the disease as being caused by an evil spirit.
[44]
The Swahili word "dinga" may possibly have its origin in the Spanish word "dengue"
meaning fastidious or careful, which would describe the gait of a person suffering the bone
pain of dengue fever.[45] Alternatively, the use of the Spanish word may derive from the
similar-sounding Swahili.[46]

[edit] History of the literature

Slaves in the West Indies who contracted dengue were said to have the posture and gait of a
dandy, and the disease was known as "Dandy Fever".[47] The first record of a case of probable
dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (265420 AD) which
referred to a water poison associated with flying insects.[46] The first confirmed case report
dates from 1789 and is by Benjamin Rush, who coined the term "breakbone fever" because of
the symptoms of myalgia and arthralgia.[48] The viral etiology and the transmission by
mosquitoes were discovered in the 20th century by Sir John Burton Cleland.
Population movements during World War II spread the disease globally. A pandemic of
dengue began in Southeast Asia after World War II and has spread around the globe since
then.[49]

[edit] Society and Culture

[edit] Use as a biological weapon
Dengue fever was one of more than a dozen agents that the United States researched as
potential biological weapons before the nation suspended its biological weapons program.[5

Dengue Fever
Swine Flu Alert

What is Dengue fever?

Dengue fever (pronounced Den-gay) is a viral infection caused by the female
mosquito (Aedes aegypti and Aedes albopictus). Dengue fever occurs in tropical and
sub-tropical regions and usually increases in the hot and humid months. Dengue
fever is not a new disease. It was discovered several hundred years ago. In recent

years, dengue fever has become a major international public health concern.
Dengue fever nicknamed "breakbone fever" because dengue patients usually
express contorted movements due to intense joint and muscle pain. Benjamin Rush
from Philadelphia, US, first described "breakbone fever" in 1780. Slaves who
developed dengue fever in the West Indies were said to have "dandy fever" because
of their posture and gait.
Dengue fever lasts for approximately 7 days, despite its sudden and acute onset.
However, extra precautions should be taken after the recovery period. These
precautions will help prevent severe illness from occurring in some people, such as
dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). These
illnesses are potentially lethal and are today the leading cause of childhood mortality
in several Asian countries.

Aedes Mosquito

How is Dengue fever transmitted?

Dengue viruses are transmitted to humans (host) through the bites of the female
striped Aedes aegypti mosquito (vector). This variety of mosquito breeds easily
during the rainy seasons but can flourish in peridomestic fresh water, e.g. water that
is stored in plastic bags, cans, flowerpots and old tires. The dengue virus is
transmitted to its host during probing and blood feeding. The mosquito may carry the
virus from one host to another host and the mosquito is most active in the early
morning and later afternoon. A mosquito bite can cause the disease. Incubation
period occurs when the viruses has been transmitted to the human host. The period
ranges from 3 to 15 days (usually lasting for 5-8 days) before the characteristics of
dengue appear. During incubation time, the dengue viruses multiply.
What are the characteristics of Dengue fever?
The Dengue virus travels to various glands in the body where it multiples. It then
travels to the bloodstream, affecting some changes to these blood vessels. The virus
may cause the blood vessels to swell and leak. The spleen and lymph nodes may
also become swollen. Patches of liver tissue may die. Furthermore, a process known
as disseminated intravascular coagulation (DIC) occurs. During this process,
chemicals used to clot blood are used up, and thus severe bleeding (hemorrhage)
occurs internally as well as the skin.
The signs and symptoms of Dengue fever are as follows:
- High fever (104 F, 40C)
- Chills

- Headache
- Red eyes, pain in the eyes
- Enlarged lymph nodes
- Deep muscle and joint pains (during first hours of illness)
- Loss of appetite
- Nausea and vomiting
- Low blood pressure and heart rate
- Extreme fatigue
Basically, dengue commences with high fever and other signs as listed above for 2 to
4 days. Then, the temperature drops rapidly and intense sweating takes place. After
about a day with normal temperature and a feeling of well-being, the temperature
rises abruptly again. Rashes (small red bumps) show up on the arms, legs and the
entire body simultaneously along with fever. However, rashes rarely occur on the
face. The palms of the hands and soles of the feet may be swollen and bright red.
Although the patient may feel exhausted for several weeks, most cases of dengue
take approximately one week to recover. Once a person recovers from dengue, he or
she will have antibodies in their bloodstream which will prevent them from having a
relapse for about a year.
Treatment
There is no specific treatment to shorten the course of dengue fever. Medications are
given to alleviate the signs and symptoms. Aspirin should not be given to patients. It
will cause severe bleeding. Hence, it is advisable to take paracetamol to relieve
muscle and joint aches, fever and headache. The patient may be required to be
sponged down with water at room temperature using a wet, squeezed out towel for
about 20 minutes at a time. This will help to help lower the high temperature. Ice
water should not be used for this purpose. However, bed rest is essential to a speedy
recovery and the patient should consume plenty of water which will help to alleviate
the illness. Patients should be kept in a room that has screens to prevent mosquitoes
from entering or else under mosquito netting until the second period of fever has
subsided. Hence, mosquitoes cannot bite them. If the patient is bitten then the
dengue virus may be transmitted to the mosquito and then to another host.
What is Dengue Hemorrhagic Fever (DHF)?
Dengue hemorrhagic fever occurs when the dengue virus re-infects a person who
previously has experienced dengue fever. In this case, the previous infection teaches
the immune system to recognize the virus, resulting in the immune system over
reacting. DHF is also known as dengue shock syndrome (DSS) and the symptoms in
this case are severe. It is a potential fatal immunological reaction and tends to affect
children under 15 years old.
The signs and symptoms of DHF are as follows:
- Abdominal pain
- Hemorrhage (severe bleeding)
- Circulatory collapse (shock)
- Nausea and vomiting

- Bleeding of the nose and gums

- Sore throat and cough
- Pneumonia
- Inflammation of the heart
- Blood in the stool
- High fever (40 -41 C)
The initial symptoms of DHF are high fever and severe headache. Small purplish
spots (petechiae) can be seen on the skin. This is because blood is leaking out of the
vessels. Large bruised areas appear due to severe bleeding. Sometimes, patients
may begin to vomit a substance that appears as coffee grounds. This is actually a
sign of bleeding in the stomach. The severe hemorrhage results in a decrease of
blood in the body. The low blood flow will unable to maintain adequate supply of
blood to meet the metabolic requests of the cells in the body. This state of low blood
flow is the defined as Dengue shock syndrome (DSS).
Patients with DHF must be closely monitored for the first few days until their condition
is stabilized. The patient's condition may suddenly worsen after few days if the fever
has not subsided. The temperature will then suddenly drop and the patient shows
signs of circulatory failure. The patient may rapidly go into a critical state of shock
(DSS) and die within 12 to 24 hours. However, he or she may recover quickly after
appropriate volume replacement therapy. Fluids are infused to patients to avoid
dehydration. Sometimes, blood transfusions may be necessary if severe bleeding
occurs. In addition, oxygen is given to cyanotic (bluish) patients.
Prevention and Control
At present, the only method of preventing and controlling dengue fever is to eradicate
the mosquito population. They are a number of ways to combat the vector
mosquitoes:
- Improved water storage practices. Cover all containers to prevent egg laying female
mosquitoes access to it.
- Implement proper solid waste disposal.
- Eliminate any sources that may collect water such as tins, bottles, plastic food
containers and old tires. Mosquitoes breed easily in any source of standing water.
- Appropriate insecticides, such as larvicide's can be added to water containers and
man-made ponds. The insecticides can prevent mosquitoes breeding for several
weeks. However, they must be re-applied as per directions.
- Always clean and check drains to ensure they are not blocked especially during the
rainy season.
- Breed small mosquito-eating fishes in an artificial pond to eradicate the mosquito
larvae.
In addition to the above, there are a number of factors to help prevent the mosquito

being attracted to human prey.

- Avoid wearing dark and tight clothing because mosquitoes are attracted to dark
colours. Wear loose, white and long clothes, which cover the whole body. Mosquitoes
find it difficult to bite through loose clothes than tight fitting clothes.
- Environmental conditions. It is suggested to sleep under mosquito netting or in a
room which has mosquito screens on the windows. Mosquitoes are unlikely to bite in
an air-conditioned room and under strong fans. Mosquito coils are also useful to help
prevent mosquitoes from entering the room.
- Apply mosquito repellants.
- Avoid reduce outdoor activities during morning and late afternoon because Aedes
mosquitoes are daytime feeders.

Dengue

Introduction
What is dengue?
Dengue is a viral infection caused by any one of the 4 types of dengue virus. The viruses are
spread by the bite of infected aedes mosquitoes. It is estimated that there are over 100 million
cases of dengue worldwide each year.

Signs and Symptoms

How do I know if I have dengue?
A person usually becomes symptomatic 5-6 days after the infecting bite. The common
symptoms of dengue fever are

High fever

Severe headache

Backache

Joint pains

Nausea and vomiting

Eye pain

Rash

Complication
What will happen if I do not seek treatment for dengue?
Dengue can present either as Dengue Fever or Dengue Haemorrhagic Fever (DHF) which is
the more severe form of the disease.
For DHF, the above symptoms can be followed by haemmorrhagic manifestations:

tendency to bruise easily or

other types of skin haemorrhages such as bleeding nose or gums.

This may lead to generalised bleeding tendency and followed by death if left
untreated.

[Top]

Treatment
What is the treatment for dengue?
There is no specific treatment for dengue infection. If you think you have dengue fever should
consult your doctor immediately. Analgesic is given for the fever and pain and patients are
you advised to take adequate rest and plenty of fluids. If a person has DHF, hospitalisation is
frequently required in order to be adequately managed.

Prevention
What can I do to prevent dengue infection?
There are many ways to prevent dengue infection :
1. To eliminate potential breeding sites for mosquitoes.
o Properly dispose or discard items that collect rainwater or are used to store
water eg. plastic containers, tin can buckets or used old tyres.
o Cover and seal septic tanks, rainwater tanks or other large water storage
containers
o Empty and scour watering containers and vases at least once a week.
o Ensure roof gutters drain freely.
o To keep fish pond with fish

2. Use mosquito spray inside the house where mosquitoes are observed to congregate to
kill adult mosquitoes.

3. Use protective measures to prevent mosquito bite

o Ensure windows or doors in the house are screened
o Apply mosquito repellents on exposed skin
o Wear loose light coloured clothing with long sleeves, trousers and socks when
outside the house
o Mosquito coils and electric vapour mats in enclosed areas

Community Medic Malaysia (BETA)

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Dengue Fever
tags: aedes, dengue
by admin

Nyamuk Aedes and Dengue

Definition
Dengue fever is a disease caused by one of a number of viruses that are carried by
mosquitoes. These mosquitoes then transmit the virus to humans.

Description

The virus that causes dengue fever is called an arbovirus, which stands for arthropod-borne
virus. Mosquitoes are a type of arthropod. In a number of regions, mosquitoes carry this virus
and are responsible for passing it along to humans. These regions include the Middle East, the
far East, Africa, and the Caribbean Islands. In these locations, the dengue fever arbovirus is
endemic, meaning that the virus naturally and consistently lives in that location. The disease
only shows up in the United States sporadically.
In order to understand how dengue fever is transmitted, several terms need to be defined. The
word host means an animal (including a human) that can be infected with a particular
disease. The word vector means an organism that can carry a particular disease-causing
agent (like a virus or bacteria) without actually developing the disease. The vector can then
pass the virus or bacteria on to a new host.
Many of the common illnesses in the United States (including the common cold, many viral
causes of diarrhea, and influenza or flu) are spread because the viruses that cause these
illness can be passed directly from person to person. However, dengue fever cannot be passed
directly from one infected person to another. Instead, the virus responsible for dengue fever
requires an intermediate vector, a mosquito, that carries the virus from one host to another.
The mosquito that carries the arbovirus responsible for dengue fever is the same type of
mosquito that can transmit other diseases, including yellow fever. This mosquito is called
Aedes egypti. The most common victims are children younger than 10 years of age.

Causes and symptoms

Dengue fever can occur when a mosquito carrying the arbovirus bites a human, passing the
virus on to the new host. Once in the body, the virus travels to various glands where it
multiplies. The virus can then enter the bloodstream. The presence of the virus within the
blood vessels, especially those feeding the skin, causes changes to these blood vessels. The
vessels swell and leak. The spleen and lymph nodes become enlarged, and patches of liver
tissue die. A process called disseminated intravascular coagulation (DIC) occurs, where
chemicals responsible for clotting are used up and lead to a risk of severe bleeding
(hemorrhage).
After the virus has been transmitted to the human host, a period of incubation occurs. During
this time (lasting about five to eight days) the virus multiplies. Symptoms of the disease
appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph
nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs
and joints.
This initial period of illness lasts about two or three days. After this time, the fever drops
rapidly and the patient sweats heavily. After about a day of feeling relatively well, the
patients temperature increases again, although not as much as the first time. A rash of small
red bumps begins on the arms and legs, spreading to the chest, abdomen, and back. It rarely
affects the face. The palms of the hands and the soles of the feet become swollen and turn
bright red. The characteristic combination of fever, rash, and headache are called the dengue
triad. Most people recover fully from dengue fever, although weakness and fatigue may last
for several weeks. Once a person has been infected with dengue fever, his or her immune
system keeps producing cells that prevent reinfection for about a year.
More severe illness may occur in some people. These people may be experiencing dengue
fever for the first time. However, in some cases a person may have already had dengue fever
at one time, recovered, and then is reinfected with the virus. In these cases, the first infectio n
teaches the immune system to recognize the presence of the arbovirus. When the immune
cells encounter the virus during later infections, the immune system over-reacts. These types
of illnesses, called dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS),

involve more severe symptoms. Fever and headache are the first symptoms, but the other
initial symptoms of dengue fever are absent. The patient develops a cough, followed by the
appearance of small purplish spots (petechiae) on the skin. These petechiae are areas where
blood is leaking out of the vessels. Large bruised areas appear as the bleeding worsens and
abdominal pain may be severe. The patient may begin to vomit a substance that looks like
coffee grounds. This is actually a sign of bleeding into the stomach. As the blood vessels
become more damaged, they leak more and continue to increase in diameter (dilate), causing
a decrease in blood flow to all tissues of the body. This state of low blood flow is called
shock. Shock can result in damage to the bodys organs (especially the heart and kidneys)
because low blood flow deprives them of oxygen.

Diagnosis
Diagnosis should be suspected in endemic areas whenever a high fever goes on for two to
seven days, especially if accompanied by a bleeding tendency. Symptoms of shock should
suggest the progression of the disease to DSS.
The arbovirus causing dengue fever is one of the few types of arbovirus that can be isolated
from the serum of the blood. The serum is the fluid in which blood cells are suspended. Serum
can be tested because the phase in which the virus travels throughout the bloodstream is
longer in dengue fever than in other arboviral infections. A number of tests are used to look
for reactions between the patients serum and laboratory-produced antibodies. Antibodies are
special cells that recognize the markers (or antigens) presen t on invading organisms. During
these tests, antibodies are added to a sample of the patients serum. Healthcare workers then
look for reactions that would only occur if viral antigens were present in that serum.

Treatment
There is no treatment available to shorten the course of dengue fever, DHF, or DSS.
Medications can be given to lower the fever and to decrease the pain of muscle aches and
headaches. Fluids are given through a needle in a vein to prevent dehydration. Blood
transfusions may be necessary if severe hemorrhaging occurs. Oxygen should be administered
to patients in shock.

Prognosis
The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients
fully recover. However, as many as 6-30% of all patients die when DHF occurs. The death
rate is especially high among the youngest patients (under one year old). In places where
excellent medical care is available, very close monitoring and immediate treatment of
complications lowers the death rate among DHF and DSS patients to about 1%.

Prevention
Preve ntion of dengue fever means decreasing the mosquito population. Any sources of
standing water (buckets, vases, etc.) where the m osq uitoes can breed must be eliminated.
Mosquito repellant is recommended for those areas where dengue fever is endemic. To help
break the cycle of transmission, sick patients should be placed in bed nets so that mosquitoes
cannot bite them and become a rboviral vectors.