Introduction

Dengue: Overview
Dengue virus is an acute fiery infectious disease caused by dengue virus. It is also
known as breakbone fever Dengue is usually transmitted by the mosquito Ades aegypti
and often by Aedes albopictus. There are four different serotypes of this virues i.e.
(DEN1, DEN2, DEN3 and DEN4) and an infection with life long immunity to it and
short-term immunity to others. Each serotype is inadequately different that there is no
cross-protection, where all the four types of serotypes have the potential to cause either
classical dengue fever (DF) or the more serious form of the disease, dengue haemorrhagic
fever (DHF).

Fig.1Ades mosquito
Global epidemiology
Dengue has been reported since 18th century but major outbreak occurred at interval 10 to
40 years in Asia, Africa and North America. Its outbreak has been observed in the areas
near to the seaports. After world war II the epidemiology of denude was changed, due to
the increasing economic growth and the urbanization of the South East Asia in particular,
where millions of people moved towards the cities. Due to which they faced the problems
of having inadequate water and sewage systems, thus providing environment for the
Aedes mosquito to breed. As, a result of which dengue virus spread rapidly.

Fig 2 Outbreak of dengue world wide

The principle areas affected by the dengue are Caribbean, south and central America,
Africa, Pacific Islands, South East Asia, India sub-continent Hawaii and Australia. The
world’s health organization has predicted that some the 2.5 billion people, two fifths of
the world's population, are now at the risk of dengue and it is estimated that there may be
50 million cases of dengue infection worldwide every year. [1]

Fig3 World wide distribution of dengue

Dengue in Pakistan:

Dengue fever outbreak in 6 provinces:

Dengue fever outbreak in Pakistan largely centered in Sindh province, but with the cases
through out the country. The outbreak was considered as the second spike of an epidemic
in 2005. The total no of suspected cases of dengue fever has increased by 912, mostly in
Sindh according to the survey done by WHO in 2005.The no of death has increased from
35 to 37.

Table: 1 Summary of dengue fever reported in 2006

Province Area Suspected cases Laboratory Deaths
Confirmed
cases
Islamabad Islamabad 279 97 0
Punjab Rawalpindi 280 100 0
Chakwal 74 20 0
Khushab
Lahore
Sindh Karachi 3023 1179 35
Hyderabad
Larkana,Umar
kot,Sukkur
NWFP Peshawar 17 10 2
Abbottabad
Khyber Agency
AJK Kotli 25 4 0
total 3698 1410 37

Transmission:
The dengue transmission cycle usually involves only two hosts – humans and
mosquitoes. The virus is transmitted to humans through the bite of an infected female
mosquito, primarily the Aedes aegypti mosquito.

Fig 5 Aedes aegypti

Life cycle of Ades aegypti Mosquito:

Female Mosquito become infected with the virus when she bites a person. The viraemic
period in human typically last for five days. Once the virus has entered a mosquito, it
replicates within the midgut, nerve tissue, ovaries and body fat. The virus then moves to
the mosquito’s salivary glands where it continues to replicate. The incubation period
usually last for eight to ten days. It may be affected by external environment, especially
temperature.
Infected mosquito then bites a healthy individual, transmitting the virus through its saliva.
Once the virus enters the human body it is carried to certain organs such as the liver,
spleen, lymph nodes and thymus. Within these organs the virus replicates, the incubation
period lasting between seven to ten days. The virus is then released into the blood at
which point symptoms will begin.
Note that the infection cycle is only complete once an uninfected mosquito feeds on a
dengue infected person, itself becoming infected with the virus. [3]

Fig 4 Life cycle of dengue virus

Sign and Symptoms:

The symptoms of dengue fever can closely resemble symptoms of influenza. They
include fever, joint and bone pain, nausea, vomiting, headache, and fatigue. A rash may
also occur about three to four days after onset of the fever.

Symptoms may vary in character and severity between individuals. Symptoms can be
extremely severe and include high fever up to 105 degrees F and severe join and bone
pain.

In some people dengue fever can lead to a life-threatening complication called dengue
hemorrhagic fever. Symptoms that the dengue fever is progressing into this complication
include bleeding from the gums, nose, or under the skin and the development of purple
bruises. Dengue hemorrhagic fever can result in dengue shock syndrome. Symptoms of
this syndrome include uncontrolled bleeding or hemorrhage, hypotension, and a change
in consciousness. If not treated quickly with intensive life-saving measures, this
complication can be fatal.

Diagnostic test:

Following tests are done in order to diagnose whether a person is suffering from dengue
fever. They are as follows:

• Blood tests
• Dengue virus lood test
• Dengue antibodies blood test [4]

Treatment:

The first step in treating dengue fever is prevention. Prevention measures include
controlling mosquito populations in warm sub-tropical and tropical areas of the world.
This includes draining areas and objects that can hold standing water and become a
breeding ground for mosquitoes, such as old tires, puddles, and bird baths. Wearing
insect repellent that contains DEET, picaridin, or oil of lemon eucalyptus and wearing
protective clothing that covers the whole body are also important preventive measures.

There is no definite treatment for or vaccine to prevent dengue fever. Most people who
get dengue fever will recover in about 2 weeks to a month by getting plenty of rest,
increasing fluid intake and taking acetaminophen (Tylenol) for fever and body aches.
People with dengue fever should not take aspirin or medications that contain aspirin
because it increases the risk for severe bleeding.

Hospitalization and intensive care is required for people who develop the life-threatening
complications of dengue hemorrhagic fever and dengue shock syndrome these
complications can occur in anyone but happen most often in children.
Treatment List for Dengue fever:

The list of treatments mentioned in various sources for Dengue fever includes the
following list. Always seek professional medical advice about any treatment or change in
treatment plans.

• Symptomatic and supportive

• Bed rest
• Fluids
• Fever medications - though aspirin is not advisable according to some sources
• Aspirin - some sources recommend aspirin (ask your doctor for current advice)
• Pain relief medications
o Acetaminophen
o Codeine
o Pethidine - in severe cases
• Calamine lotion - for rash

Prevention:

The best way to prevent dengue fever is to take special precautions to avoid contact with
mosquitoes. Several dengue vaccines are being developed, but none is likely to be
licensed by the U.S. Food and Drug Administration in the next few years.

When outdoors in an area where dengue fever has been found,

• Use a mosquito repellant containing DEET.

• Dress in protective clothing—long-sleeved shirts, long pants, socks, and shoes.
Because Aedes mosquitoes usually bite during the day, be sure to use precautions
especially during early morning hours before daybreak and in the late afternoon before
dark.

Other precautions include

• Keep unscreened windows and doors closed.

• Keep window and door screens repaired.
• Get rid of areas where mosquitoes breed, such as standing water in flower pots or
discarded tires. [4]

Objectives:
• Effects of dengue on human health.
• How to control it from spreading.
• How to prevent it.
• Available vaccine/ possible cures.

Method and materials:

Discussion:

Effects of dengue on human health:

Following are the effects of Dengue on human health:-

Splenomegaly:
Splenomegaly, an enlargement of the spleen, which usually lies in the left upper quadrant
of the human abdomen

Splenomegaly

Purpura:
Purpura, an appearance of red or purple discolorations on the skin that do not blanch on
applying pressure
 Purpura

Neutropenia:
Neutropenia (a deficiency in the number of granulocytes, a type of white blood cell)

Neutropenia

Viral hemorrhagic fever:

Viral haemorrhagic fever (a group of viral diseases of diverse etiology but having many
similar clinical characteristics; increased capillary permeability, leukopenia, and
thrombocytopenia are common to all)
 Viral hemorrhagic fever

Hemoglobinuria
Haematuria (a laboratory test result which indicates free hemoglobin in the urine)

Hemoglobinuria

Haemoptysis
Haemoptysis or haemoptysis, an expectoration of blood or of blood-stained sputum from
the bronchi, larynx, trachea, or lungs
 Hemoptysis

Thrombocytopenia:
Thrombocytopenia (a decrease in the number of platelets in the blood that may result in
easy bruising and excessive bleeding from wounds or bleeding in mucous membranes
and other tissues)

Thrombocytopenia (a)

Lymphadenopathy:
Lymphadenopathy (disease or swelling of the lymph nodes)
 Lymphadenopathy (b)

Hepatocellular jaundice:
Hepatocellular jaundice (inflammation of the liver and liver disease involving
degenerative or necrotic alterations of hepatocytes)

Hepatocellular jaundice (c)

Hyperthermia:
Pyrexia (the elevation of the body's temperature above the upper limit of normal, usually
taken as 37.7 degrees C)
 Hyperthermia (d)

Clotting factor dysfunction or deficiency:

Clotting factor dysfunction or deficiency (condition in which there is a deviation from or
interruption of the normal coagulation properties of the blood)

Clotting factor dysfunction or deficiency ( e)

Maculopapular rash:
Maculopapular rash, the Phenomenon and medical concept with Diseases DB code
"7691"[obj]
 Maculopapular rash(f)

1 http://www.nathnac.org/pro/factsheets/dengue.htm
2 http://khup.com/view/13_keyword-dengue-fever-in-pakistan/wmmr-pakistan.html

3 http://www.panbiodengue.com/page/transmission-dengue
4 http://www.wrongdiagnosis.com/d/dengue_fever/symptoms.htm

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