ARBOVIRUS

These are group of virus transmitted to humans indecently and spread among humans by
arthropods
E,g dengue virus , Yellow fever virus, Kyasanur Forest disease,

DENGUE
Dengue fever used to be called "break-bone fever" because it can entail excruciating
joint and muscle pain.

Etiopathogenesis
Dengue has been found mainly in Asia and Africa
Dengue fever is caused by any of four closely related dengue viruses (dengue 1
4).
Dengue viruses are transmitted to humans by the bite of an infected mosquito,
most commonly daytime-biting Aedes aegypti(also vector of yellow fever and
chikungunya viruses)
Breeds in relatively fresh water from sources
The incubation period is from 5 to 6 days and immunity after the illness is
serospecific.
A subsequent infection with a different serotype of dengue virus leads causes
Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS)

Clinical features
Two forms of the disease are recognized
a) Uncomplicated (classic) dengue
Characterised by abrupt onset of fever, malaise, headache, retrobulbar pain,
conjunctival suffusion and severe backache, which is a prominent symptom.
The rash is morbiliform and is first seen on the limbs and then spreads to involve
the trunk.
The fever subsides after 3-4 days, the patient remains afebrile for a couple of days,
and then the fever returns, together with the features mentioned above, but milder.
This biphasic or saddleback pattern is considered characteristic.

b) Dengue hemorrhagic fever

It is a severe form of dengue fever and is believed to be the result of sequential
infection with two different dengue serotypes
Fever is high grade
Distinguished from uncomplicated dengue fever by
Hemorrhagic manifestations (e.g., spontaneous GI bleeding without
preexisting lesions)
Increased vascular permeability -Ascites, pleural effusions,
hemoconcentration
Usually occurs 37 days after onset of illness
Dengue shock syndrome-
It is due to vascular leakage of fluid.
Dengue shock syndrome has all features of DHF with additional hypotension.

Differential diagnosis
Leptospirosis
Malaria

Laboratory Tests
The diagnosis usually is made on clinical grounds.
Nonspecific laboratory findings
Complete blood count -Leukopenia ,Thrombocytopenia ,Hemoconcentration.
Platelets can be <10,000 in dengue hemorrhagic fever.
Liver biochemical panel -Modest (25 times upper limit of normal) to marked
(515 times) elevations in aminotransferase levels.
Elvated CK and abnormal renal functions are occationaly features

Specific diagnostic studies

IgM ELISA for dengue-usually positive after 1 week
Virus isolation

Treatment
There is no specific treatment for classic dengue fever.
It is important to exclude other treatable diagnoses
Treatment is symptomatic.
Immediate replacement of plasma loss with isotonic salt solution, plasma or
plasma expanders is required in cases of profound shock.
Electrolyte and acid-base balance must be maintained.
Blood loss must be replaced.

* Read yellow fever, Japanese encephalitis