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Dengue fever

Dengue Fever, previously known as break-bone fever due to the remarkable muscle and joint pain that comes with it, is a virus that is transmitted to humans via the female Aedes Aegypti mosquito. (The same family of mosquitos responsible for transmitting the Zika and Chikungunya viruses.) There are four serotypes of the dengue virus, making an individual susceptible to acquiring the virus four times in a lifetime. Secondary infection entails a more pronounced manifestation of the symptoms, predisposed to more bleeding, more susceptible to shock.

Typical symptoms include high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding. All symptoms appear after an incubation period of 4-10 days. The course of the infection is divided into three phases: Febrile phase – lasts two to seven days, where persistent high grade fever and other typical flulike symptoms manifest. Rashes of different kinds tend to appear on this stage. Rashes which can be described as “islands of white in a sea of red”, petechial (small red to pink dots that are caused by bursting capillaries or small blood vessels) also tend to appear during the middle part or the latter part of this phase. Critical phase – the first two days without fever, when the drastic drop on platelets or remarkable changes in the blood happen. Severe bleeding may happen at this time, which would include nose bleeding, gum bleeding, or internal bleeding. Convalescence – days after the critical phase where platelets and blood parameters are back to normal, where symptoms dramatically disappear.

Early treatment and identification of infection are very crucial. Signs and symptoms that include bleeding, restlessness, cold and clammy extremities, faint pulses, narrow pulse pressures (i.e. blood pressure of 120/110 or 90/80mmHg), pronounced tachycardia (heart rate of more than 100 beats per minute), and hypotension (blood pressure of less than 90/60mmHg) are key indicators of impending shock, which would require close monitoring and early intervention, as shock may eventually lead to death, with a mortality rate of as high as 20% if left untreated or unidentified.

Treatment of dengue is primarily supportive in nature – no antivirals or any other specific medicine are required. Most important thing to take note of in dengue is the level of hydration of the individual. Hence, any symptoms of fluid restriction brought about by nausea, vomiting, or abdominal pain, are called “warning signs” as they may predispose the patient to dehydration. Fever and pain are treated with Paracetamol or Acetaminophen, and NOT non-steroidal anti-inflammatory drugs such as Aspirin as they increase the risk of bleeding.

Prevention entails conscious effort to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water. Items that collect rainwater or to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and cleaned (to remove eggs) at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.




BSM Nurses

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