Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses.

This disease used to be called break-bone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years. INTRODUCTION Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of  Africa  Southeast Asia and China  India  Middle East  Caribbean and Central and South America  Australia and the South and Central Pacific An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide, more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases reported annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have recently traveled abroad. Many more cases likely go unreported because some health care providers do not recognize the disease. During the last part of the 20th century, many tropical regions of the world saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In addition to typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased in many parts of the world. Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two, if not all four types at different times during your lifetime, but only once by the same type. You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person. Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito and include  High fever, up to 105 degrees Fahrenheit  Severe headache  Retro-orbital (behind the eye) pain  Severe joint and muscle pain  Nausea and vomiting  Rash The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus  Marked damage to blood and lymph vessels  Bleeding from the nose, gums, or under the skin, causing purplish bruises This form of dengue disease can cause death. Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus  Fluids leaking outside of blood vessels  Massive bleeding  Shock (very low blood pressure) This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

Pathophysiology

Dengue infection is caused by 1 of 4 related, but antigenically distinct, viral serotypes: dengue virus 1 (DENV-1), dengue virus 2 (DENV-2), dengue virus 3 (DENV-3), and dengue virus 4 (DENV-4). Genetic studies of sylvatic strains suggest that the 4 viruses evolved from a common ancestor in primate populations approximately 1000 years ago and that all 4 viruses separately emerged into a human urban transmission cycle 500 years ago in either Asia or Africa.[1, 8] Albert Sabin speciated these viruses in 1944. Each serotype is known to have several different genotypes. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity, but each individual can eventually be infected by all 4 serotypes. Several serotypes can be in circulation during an epidemic. Dengue viruses are transmitted by the bite of an infected Aedes (subgenusStegomyia) mosquito. Globally, A aegypti is the predominant highly efficient mosquito vector for dengue infection, but A albopictus and other Aedesspecies can also transmit dengue with varying degrees of efficiency. Aedes mosquito species have adapted well to human habitation, often breeding around dwellings in small amounts of stagnant water found in old tires or other small containers discarded by humans. Female Aedesmosquitoes are daytime feeders. They inflict an innocuous bite and are easily disturbed during a blood meal, causing them to move on to finish a meal on another individual, making them efficient vectors. Entire families who develop infection within a 24- to 36-hour period, presumably from the bites of a single infected vector, are not unusual. Humans serve as the primary reservoir for dengue; however, certain nonhuman primates in Africa and Asia also serve as hosts but do not develop dengue hemorrhagic fever. Mosquitoes acquire the virus when they feed on a carrier of the virus. The mosquito can transmit dengue if it immediately bites another host. In addition, transmission occurs after 8-12 days of viral replication in the mosquito's salivary glands (extrinsic incubation period). The mosquito remains infected for the remainder of its 15- to 65-day lifespan. Vertical transmission of dengue virus in mosquitoes has been documented.[9]The eggs of Aedes mosquitoes withstand long periods of desiccation, reportedly as long as 1 year, but are killed by temperatures of less than 10C. Once inoculated into a human host, dengue has an incubation period of 3-14 days (average 4-7 d) while viral replication takes place in target dendritic cells. Infection of target cells, primarily those of the reticuloendothelial system, such as dendritic cells, hepatocytes, and endothelial cells,[10, 11, 12, 13] result in the production of immune mediators that serve to shape the quantity, type, and duration of cellular and humoral immune response to both the initial and subsequent virus infections.[14, 15, 10, 16, 17, 18, 19] Following incubation, a 5- to 7-day acute febrile illness ensues. Recovery is usually complete by 7-10 days. Dengue hemorrhagic fever or dengue shock syndrome usually develops around the third to seventh day of illness, approximately at the time of defervescence. The major pathophysiological abnormalities caused by dengue hemorrhagic fever and dengue shock syndrome include the rapid onset of plasma leakage, altered hemostasis, and damage to the liver, resulting in severe fluid losses and bleeding. Plasma leakage is caused by increased capillary permeability and may manifest as hemoconcentration, as well as pleural effusion and ascites. Bleeding is caused by capillary fragility and thrombocytopenia and may manifest in various forms, ranging from petechial skin hemorrhages to life-threatening gastrointestinal bleeding. Liver damage manifests as increases in levels of alanine aminotransferase and aspartate aminotransferase, low albumin levels, and deranged coagulationparameters(PT,PTT).[20, 21] In persons with fatal dengue hepatitis, infection was demonstrated in more than 90% of hepatocytes and Kupffer cells with minimal cytokine response (tumor necrosis factor [TNF]alpha, interleukin [IL]2). This is similar to that seen with fatal yellow fever and Ebola infections.[20] Most patients who develop dengue hemorrhagic fever or dengue shock syndrome have had prior infection with one or more dengue serotypes. In individuals with low levels of neutralizing antibodies, nonneutralizing antibodies to one dengue serotype, when bound by macrophage and monocyte Fc receptors, have been proposed to result in increased viral entry and replication and increased cytokine production and complement activation. This phenomenon is called antibody-dependent enhancement.

Some researchers suggest T-cell immunopathology may play a role, with increased T-cell activation and apoptosis. Increased concentrations of interferon have been recorded 1-2 days following fever onset during symptomatic secondary dengue infections.[22] The activation of cytokines, including TNF-alpha, TNF receptors, soluble CD8, and soluble IL-2 receptors, has been correlated with disease severity.[10] Cuban studies have shown that stored serum sample analysis demonstrated progressive loss of cross-reactive neutralizing antibodies to DENV-2 as the interval since DENV-1 infection increased.[17] In addition, certain dengue strains, particularly those of DENV-2, have been proposed to be more virulent, in part because more epidemics of dengue hemorrhagic fever have been associated with DENV-2 than with the other serotypes.

Aedes Aegypti
Bite of the Female Aedes Aegypti (day biting, low flying, breeds in stagnant water, in urban areas). Why female? It is because that they use the blood obtained for laying of eggs. It is the primary vector for the transmission ofdengue. Sources: 1. 2. Infected Persons virus is present in the blood of patients during the acute phase of the disease and will

become a reservoir of the virus Standing water will serve as a breeding place for the mosquitoes

Mode of transmission
By the bit of an infective Aedes Aegypti mosquito

Incubation Period
4-6 days (minimum: 3 days; maximum: 10days)

Pathophysiology     
1. Each of the 4 types of Dengue virus can cause either classical or dengue hemorrhagic fever. Virus enters the blood stream Neutralizing antibodies are produced principally against the virus type Because of the production of antibodies, and the response of the immune system to the initial attack, constitutional signs and symptoms are manifested Because of the increasing antigen-antibody complex Increased capillary fragility brought about by a strong immune complex reaction the produce toxic substance like histamine, serotonin and bradykinin which damages the capillary wall in an attempt to repair lesions, clotting occurs DISSEMINATED INTRAVASCULAR COAGULATION 2. 3. 4. Increased capillary permeability Thrombocytopenia loss of plasma from intravascular space initiated by lesions in the capillary wall acute excessive consumption of platelets due to generalized intravascular clotting

Decreased blood coagulation factors

For Dengue Fever Syndrome

a. Oral fluid and electrolyte replacement

- encouraged to prevent and correct dehydration which results from fever

b. For fever

antipyretics like Acetaminophen but not aspirin

c. Hematocrit Determination

 

useful guide in therapy as this reflects the degree of plasma leakage and the need for IV fluid test is recommended daily until the 3rd until patient is afebrile for 1-2 days. continuous monitoring of BP/Hct/Platelet

d. Close surveillance

Dengue fever is a virus-based disease spread by mosquitoes. See also: Dengue hemorrhagic fever

Causes of Dengue fever

Dengue fever is caused by one of four different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti, which is found in tropic and subtropic regions. This includes parts of:
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Indonesian archipelago into northeastern Australia South and Central America Southeast Asia Sub-Saharan Africa Dengue fever is being seen more in world travelers. Dengue fever should not be confused with Dengue hemorrhagic fever, which is a separate disease that is caused by the same type of virus but has much more severe symptoms.

Dengue fever Symptoms

Dengue fever begins with a sudden high fever, often as high as 104 - 105 degrees Fahrenheit.

A flat, red rash may appear over most of the body 2 - 5 days after the fever starts. A second rash, which looks like the measles, appears later in the disease. Infected people may have increased skin sensitivity and are very uncomfortable. Other symptoms include:
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Headache (especially behind the eyes) Fatigue Joint aches Muscle aches Nausea Swollen lymph nodes Vomiting

Tests and Exams

Tests that may be done to diagnose this condition include:
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Antibody titer for dengue virus types Complete blood count (CBC) Serology studies to look for antibodies to dengue viruses

Treatment of Dengue fever

There is no specific treatment for dengue fever. You will need fluids if there are signs ofdehydration. Acetaminophen (Tylenol) is used to treat a high fever. Avoid taking aspirin.

Prognosis (Outlook)
The condition generally lasts a week or more. Although uncomfortable, dengue fever is not deadly. People with the condition should fully recover.

Potential Complications
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Febrile convulsions Severe dehydration

When to Contact a Health Professional

Call your health care provider if you have traveled in an area where dengue fever is known to occur and have developed symptoms of the disease.

Prevention of Dengue fever

Clothing, mosquito repellent, and netting can help reduce exposure to mosquitoes. Traveling during periods of minimal mosquito activity can also be helpful. Mosquito abatement programs may reduce the risk of infection.

reatments and drugs

By Mayo Clinic staff No specific treatment for dengue fever exists. For a mild form of the disease, your doctor may recommend: Drinking plenty of fluids to avoid dehydration from vomiting and high fever. Taking acetaminophen (Tylenol, others) to alleviate pain and reduce fever. Don't take aspirin or other nonsteroidal antiinflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others). These can increase the risk of bleeding complications. For a more severe form of the disease, treatment consists of: Supportive care in a hospital Intravenous (IV) fluid and electrolyte replacement Blood pressure monitoring Transfusion to replace blood loss If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

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A. Patient's Name: > C.J.S a thirteen year-old male patient, who was diagnosed with Dengue Hemorrhagic Fever. B. Diet:> Encourage nutritious foods like vegetables, meat and fruits. C. Medications:

> Give acetaminophen in case the temperatures increases. > Give oresol to replace fluid in the body. D. Treatment: > Increased oral fluid intake. E. Health Teaching: > D- discuss the possible source of infection of the disease. > E- educate the family/patient on how to eliminate those vectors. > N- Never stocked water in a container without cover. > G- Gallon, container and tires must have proper way of disposal. > U- Use insecticides at home to kill or reduce mosquito. > E- Encourage the family of the patient to clean the surroundings to destroy the breeding places of mosquito.