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OVERVIEW OF DENGUE SYNDROME AND ITS PREVENTION Introduction: Dengue fever (DF) and dengue hemorrhagic fever (DHF) are acute febrile diseases, caused by a family of viruses that are transmitted by mosquitoes. It is transmitted by the bite of an Aedes aegypti (rarely Aedes albopictus) mosquito that has been infected with any one of the four dengue viruses. Dengue is also known as "breakbone" or "dandy fever." The name breakbone fever was given because of the contortions caused due to the intense joint and muscle pain. The name dandy fever was given because of the postures and gait of West Indian slaves who contracted dengue. Dengue hemorrhagic fever is a more severe form of the viral illness and can be life-threatening or even fatal. Geographical Spread: This disease is predominant in the tropical and subtropical areas of the world. In India it has been noted since 1812. In Calcutta there has been epidemics several times in 1960,1963,1964 and 1970.There has been explosive outbreak in Delhi 1982 and 1996. When 72247 cases were reported out of which 297 died . It is due to growing urban population , poor housing condition, overcrowding and inadequate sanitation. Causes of Dengue As said before dengue fever (DF) and dengue hemorrhagic fever (DHF) is caused by dengue virus which belongs to genus Flavivirus family Flaviviridae. This virus is transmitted by Aedes aegypti mosquito that has previously bitten an infected person. Aedies mosquito is also known as Tiger Mosquito as it has got black and white stripes on his back.It is a day time biting mosquito and breeds in clean stagnated water. This species of mosquito flourishes during rainy seasons. However, they can breed all round the year in water-filled flower pots, plastic bags, and cans. One mosquito bite is strong enough to inflict the disease. However, the virus is not contagious and does not spread from person to person. It requires the mosquito as a medium and a person-to-mosquito-toanother-person pathway. Symptoms of Dengue : The incubation period of dengue fever is usually 5 – 6 days. However, this period at times may vary between 3 to 10 days. Dengue fever affects one and all, starting from infants to young children and adults. But it is seldom fatal in nature. The symptoms manifested by dengue vary according to the age of the patient. Infants and young children usually have a non-specific febrile illness which is characterised by the appearance of rash. On the other hand, the symptoms manifested by older children and adults are: Abrupt onset of high fever (up to 105 degrees Fahrenheit) Severe headache Severe muscle and joint pain (break bone fever) Rash and other haemorrhagic manifestation Leucopenia However, dengue hemorrhagic fever (DHF) is a potentially deadly complication and the symptoms manifested are: High fever Headache Anorexia Vomiting and abdominal pain Haemorrhagic diathesis, commonly demonstrated by scattered fine petechiae on the extremities, face, trunk, and in the axillae Bleeding nose, gums, and gastrointestinal tract Hematuria (though a rare symptom) Enlargement of the liver The alarming signs in Dengue are Bleeding nose and gums, hemetemesis Refusal to food or drink Difficulty in breathing Reduced urination Minute spots on the skin signifying bleeding within the skin Abnormal behaviour Drowsiness Diagnosis of Dengue Isolation of virus in serum Serological diagnosis: IgM antibodies and IgG antibodies Chemistry panel Guaiac test Complete blood count Liver Hemoconcentration (hematocrit increased by 20%) Thrombocytopenia (platelet count <100 x 109/L) Leukopenia function tests Imaging Studies Chest radiography Head CT scan without contrast Treatment for dengue Dengue is caused by a virus. There is no specific treatment or antibiotic for it. The treatment provided to a patient during dengue infection is mainly supportive in nature which is purely concerned with the relief of the symptoms (symptomatic). The patient is advised to take complete rest and increase the intake of fluids in order to prevent dehydration and significant hemo-concentration. However, if the patient is unable to maintain oral intake, supplementation with intravenous fluids may be necessary. In case if the platelet level drops significantly, a platelet transfusion becomes necessary. Mortality/Morbidity Treated DHF/DSS is associated with a 3% mortality rate. Untreated DHF/DSS is associated with a 50% mortality rate. Prevention The best precaution for Dengue is the prevention of mosquito bites. Some important tips: Use insect repellent containing DEET, Picaridin, oil of lemon eucalyptus, or IR3535 on exposed skin. Wear long sleeves and pants. Treat the clothes with permethrin or other repellents. Use secure screens on windows and doors to keep mosquitoes out. Get rid of mosquito sources in and around the house by emptying standing water from flower pots, buckets and barrels. Also, change the water in pet dishes and replace the water in bird baths once every week. In order to drain out water, drill holes in tire swings. Moreover, keep children's wading pools empty while not at use Since the infection of dengue essentially requires a mosquito, the transmission of the virus to mosquitoes must be interrupted in order to prevent the illness. To achieve this, infected patients should limit his exposure to mosquito bites and remain confined under mosquito netting until the second bout of fever is over. Thereafter, the infection is no longer contagious. Vaccination Currently, no vaccine is available for the prevention of dengue infection. However, immunogenic, safe tetravalent vaccines have been developed and are undergoing clinical trials. By Dr. Bhavna Singh