Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Typical symptoms include fever, headache, a characteristic morbilliform skin rash, and muscle and joint pains; in a small proportion the disease progresses to life-threatening complications such as dengue hemorrhagic fever (which may lead to severe bleeding) and dengue shock syndrome (where inadequate perfusion of tissues can cause organ dysfunction or failure and even death).
Dengue is transmitted by several species of mosquito within the Aedes genus, particularly A. aegypti. The virus exists in four different types, and an infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. There is currently no available vaccine, but measures to reduce the habitat and the number of mosquitoes, and limiting exposure to bites, are used to decrease the incidence of dengue.
Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. The incidence of dengue fever has increased dramatically over the last 50 years, with around 50–100 million people being infected yearly. Dengue is currently endemic in more than 110 countries. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a worldwide problem since the Second World War.
Clinical course
The characteristic symptoms of dengue are: a sudden-onset fever, headache (typically behind the eyes), muscle and joint pains, and a rash; the alternative name for dengue, "break-bone fever", comes from the associated muscle and joints pains. The course of infection is divided into three phases: febrile, critical, and recovery.
The febrile phase involves high fevers, frequently over 40 °C (104 °F) and associated with generalized pain and a headache; this usually lasts 2–7 days. Flushed skin and some small red spots called petechiae, which are caused by broken capillaries, may occur at this point, as may some mild bleeding from mucous membranes of the mouth and nose.
The critical phase, if it occurs, follows the resolution of the high fever and typically lasts one to two days. During this phase there may be significant fluid accumulation in the chest and abdominal cavity due to increased capillary permeability and leakage. This leads to depletion of fluid from the circulation and decreased blood supply to vital organs. During this phase, organ dysfunction and severe bleeding (typically from the gastrointestinal tract) may occur. Shock and hemorrhage occur in less than 5% of all cases of dengue but those who have previously been infected with other serotypes of dengue virus ("secondary infection") have an increased risk of this.
The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream. This usually occurs over a period of two to three days. The improvement is often striking, but there may be severe itching and a slow heart rate. It is during this stage that a fluid overload state may occur, which if it affects the brain may reduce the level of consciousness or cause seizures.
Management
There are no specific treatments for the dengue fever virus. Treatment depends on the symptoms, varying from oral rehydration therapy at home with close follow-up, to hospital admission with administration of intravenous fluids and/or blood transfusion. A decision for hospital admission is typically based on the presence of the "warning signs" listed in the table above, especially in those with preexisting health conditions.
Intravenous hydration is usually only needed for one or two days. The rate of fluid administration is titrated to a urinary output of 0.5–1 mL/kg/hr, stable vital signs and normalization of hematocrit. Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial punctures are avoided, in view of the bleeding risk. Acetaminophen may be used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding. Blood transfusion is initiated early in patients presenting with unstable vital signs in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined "transfusion trigger" level. Packed red blood cells or whole blood are recommended, while platelets and fresh frozen plasma are usually not.
During the recovery phase intravenous fluids are discontinued to prevent a state of fluid overload. If fluid overload occurs and vital signs are stable, stopping further fluid may be all that is needed. If a person is outside of the critical phase, a loop diuretic such as furosemide may be used to eliminate excess fluid from the circulation.
Prevention of Dengue Fever
To prevent dengue, mosquito transmission (Aedes aegypti) must be eliminated, because vacsin for prevention are not yet available
1) Proper way to eradicate Aedes aegypti mosquito-larvae is to eradicate the breeding grounds.
2) Therefore there breeding grounds in homes and public places, then every family should regularly carry out environmental hygiene at least once a week
3) Bathtub drain at least 1 week
4) Seal water reservoirs
5) Replace vase water / water plants once a week
6) Changing the drinking water of birds
7) Hoarding used goods that can hold water
8) Sowing Abete powder or altosid in places that are difficult drained water reservoirs or in areas with clean water scarce, so we need rainwater
Abate dose: 1 tablespoon pressed (+ 10 grams) to 100 liters of water
Altosid dose: 1 / 4 teaspoon pressed (+ 2.5 grams) to 100 liters
9) Keeping fish in places where water reservoirs
10) fogging with mosquito killer drug in mosquito breeding. required to kill adult mosquitoes
