Disease Index Infectious Diseases

Dengue fever

Dengue fever is systemic disease caused by one of four sero-types of virus from the genus Flavivirus. After two to four days of headache, fever, and muscle aches, the disease eases for 12 to 48 hours before returning with a skin rash, chills, swollen and reddened eyes, and the severe joint pains that caused Rush to name it ‘break bone fever,’ an eponym that remains in use.

Dengue fever is systemic disease caused by one of four sero-types of virus from the genus Flavivirus, which also includes the pathogens responsible for yellow fever and Japanese encephalitis.

The first known cases of dengue fever occurred in Batavia in 1779, and Benjamin Rush, a prominent American Revolutionary War physician and signer of the Declaration of Independence gave the first detailed description of the disease when it caused an epidemic in Philadelphia in 1780.

Dengue most often manifests itself with the sudden onset of the fever five to eight days after a bite from one of several species of Aedes mosquito, including A. aegyptii, A. albopictus, and A. scutellaris.

After two to four days of headache, fever, and muscle aches, the disease eases for 12 to 48 hours before returning with a skin rash, chills, swollen and reddened eyes, and the severe joint pains that caused Rush to name it “break bone fever,” an eponym that remains in use. Dengue fever is usually benign and self limited, but a small number of cases will progress to the hemorrhagic form, in which bleeding from multiple organs and mucosal surfaces occurs and for which the mortality is about 5 percent. No vaccine is available for dengue, and there is no effective treatment. Because the mosquitoes that transmit the disease are day-biting, mosquito netting is of limited usefulness, and the only effective means of control has been to eliminate the Aedes vectors.

Symptoms and Signs of Dengue fever

Dengue fever is characterized by acute onset of high fever, frontal headache, retro-orbital pain, myalgia, arthralgias, nausea, vomiting, and often maculopapular rash and hemorrhagic manifestations.

Severity ranges from asymptomatic infections to fatal hypotensive and hemorrhagic disease. Hemorrhagic manifestations are usually skin hemorrhages (i.e., petechiae, Purpura, or ecchymoses), but may also include epistaxis bleeding gums, haematemesis, and melaena.

The acute phase of illness lasts approximately a week, whereas convalescence, characterized by weakness, malaise, and anorexia, may last 1-2 weeks. DHF may initially resemble dengue fever. As fever subsides, thrombocytopenia and hemoconcentration due to vascular plasma leakage may develop, resulting in circulatory failure and severe hemorrhage. Warning signs for Dengue Shock Syndrome include severe abdominal pain, protracted vomiting, marked temperature change (from fever to hypothermia), or change in mental status (irritability or obtundation). DSS, which can lead to profound shock and death, can develop rapidly. Early signs include cold clammy skin, restlessness, rapid weak pulse, narrowing of pulse pressure, or hypotension. DHF and DSS can occur in both children and adults.

Diagnosis of dengue fever

Dengue fever can be effectively ruled out if the patient has not been in a dengue endemic area, if symptoms have started more than 2 weeks after the patient left a dengue-endemic area, of if the fever lasts more than 2 weeks. Monitoring of blood pressure, hematocrit, platelet count, hemorrhagic manifestation, urinary output, and level of consciousness is crucial for early diagnosis and to guide treatment. The patient’s deterioration between 3 and 6 days of illness, and the relationship of de-fervescene in conjunction with thrombocytopenia and plasma leakage are highly suggestive of DHF/DSS. Only virus isolation or specific antibody detection can provide unequivocal dengue diagnosis.

Virus isolation is most often successful in serum specimens taken within 5 days after onset of symptoms and stored on dry ice, or, if to be delivered within 1 week, unfrozen in a refrigerator. For antibody detection, a serum sample taken 6 or more days after onset of symptoms is adequate (no refrigeration is required if the sample is delivered overnight).

Treatment of dengue fever

A major problem associated with dengue hemorrhagic fever and dengue shock syndrome is the severe increase of vascular permeability, resulting in the loss of up to 20% of plasma volume from the vascular compartments. This plasma leakage often leads to shock, and under some conditions, to death. Early detection of this state and quick replacement of body fluid with electrolyte solutions can reverse DSS quite effectively.

In the case of DHF, where high body temperature is also a concern, regulated doses of paracetamol (Tylenol) are a useful treatment.

Dengue shock syndrome patients need to be closely observed for the onset of shock. Determination of hematocrit (the percent of whole blood composed of red blood cells) is important. It should be determined daily from the third day of illness. If determination of hematocrit is not possible then hemoglobin levels should be determined accurately.

In DSS the state of shock is a medical emergency. The patient should be immediately given plasma replacement and then methodically checked. Because of the large volume of fluid replacement there might be a drop in hematocrit toward the later part of the treatment, but that should not be interpreted as sign of internal hemorrhage, particularly if the patient has a strong pulse and correct blood pressure.

Restlessness is often a major problem in children with DSS. Use of sedatives to help these children sleep can provide symptomatic relief. But long acting sedatives should be avoided.

Oxygen might be required to treat patients in shock but it should be managed carefully by competent nurses.

If there are patients with a significant amount of bleeding, blood transfusions might be required. Internal bleeding may be difficult to detect. A sharp drop of hematocrit with no signs of improvements in spite of adequate fluid replacement indicates significant internal bleeding.

Homeopathic treatment of dengue fever – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat dengue fever but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure dengue fever symptoms that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of dengue fever symptoms:

Rhus Tox, Bryonia, pulsatilla, Veratrum album, Nux vomica, Natrum Mur, Phosphorous, Ipecauc, Sanguinaria, Arsenic Album, Lobelia Inflate, Chamomilla  and many other medicines.

References:

Jack Edward McCallum- Military medicine: from ancient times to the 21 st century; 101 2008.

National Organization for Rare Disorders- NORD guide to rare disorders; 281; 2003

Tirtha Charkraborty- Dengue Fever and Other Hemorrhagic Viruses Page No; 61-62; 2008



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Ashish Sharma

Ashish Sharma

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