Dengue fever is a viral disease spread by the bite of infected mosquitoes, Aedes aegypti.

There are four types of viruses that cause dengue fever.

Infection with one of these types of viruses provides protection to only that type for life, so persons living in a dengue-endemic area can have more than one dengue infection during their lifetime.

The disease is now found in more than 100 countries in South and South-East Asia , Africa, the Americas, the Eastern Mediterranean, and the Western Pacific.

Symptoms and signs

• Dengue fever may occur from 3 to 14 days after the bite of an infected mosquito, commonly within 4 to 7 days.
• It usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. Rash that does not blanch on pressure may also be present especially on the extremities.
• The fever can be as high as 40-41 ‘C, and usually continues for 2-7 days. It may be accompanied by fits in children less than 6 years old. The severity of the joint pain has given dengue the name “breakbone fever”.
• The rash usually appears 3 to 4 days after the start of the fever.
• Vomiting and loss of appetite are common.

Diagnosis

Antibody detection in blood (Dengue IgM) (Antibodies are substances made by the body’s immune system to fight a specific infection).

PCR test ( method of detecting genetic contents in the virus ) can detect dengue virus in the blood available in some lab.

NSI antigen: Another test that detect dengue infection early during febrile phase.

Treatment

• Please consult your doctor. Please consult treatment early with h/o fever and living in at dengue prone area. There is no specific medication.
• Rest and drink plenty of fluids. Paracetamol can be taken for fever and pain relief.
• Avoid aspirin NSAID analgesic in children less than 12 years.
• Tepid sponging.
• Antibiotics are not necessary.

Dengue Haemorrhagic Fever (DHF)

• It’s a more severe form of dengue and is caused by infection with the same viruses that cause dengue.
• The initial complaints are the same as dengue fever. However, as the fever starts to subside, the individual becomes acutely unwell as a result of inflammation of small blood vessels. Symptoms include vomiting, giddiness, abdominal pain.
• These small blood vessels become very leaky, and this may lead to fluid imbalance in the body, leading to shock and even death.
• There is no specific medication. Hospitalization is required for dengue haemorrhagic fever and it can be treated by effective and timely fluids given intravenously. With early treatment, the death rate can be less than 1%.
• Even though the name DHF implies hemorrhage (bleeding): it is NOT THE BLEEDING is a problem but the ‘leaky blood vessels’ causing fluid loss/imbalance.

Resurgance of Dengue Fever

Contributing factors:

• Rapid growth of cities in tropical countries leading to overcrowding.
• Increase in plastic packaging and discarded tyres is creating new breeding sites for mosquitoes.
• Movement of people from one place to another cause outbreak of rapidly.

Prevention

There is presently there is vaccine to prevent dengue fever. However, in Malaysia still not in recommendation as the safety profile still clinical. Avoid mosquito bites by:

• Using mosquito repellents on skin and clothing.
• Avoiding heavily populated residential areas.
• Staying in air-conditioned or screened areas.
• Use bed nets if sleeping areas are not screened or air-conditioned.

Eliminate mosquito breeding sites:

• Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially buckets, old tyres, vases, plastic containers, drums.
• Regularly change the water in pet containers, bath tubs, pails and jars.

If your child issuspected to have dengue and being monitored as outpatient, bring your child back to hospital/clinic ASAP (as soon as possible), if your child is having:

• Frequent/persistent vomiting.
• Abdominal pain.
• Drowsiness/fits.
• Difficulty in breathing.
• Pale, cold or clammy hands/feet.
• Bleeding: vomiting blood, passing black coloured stools, bleeding from nose/gum, red spots or patches on the skin.
• Infant
• Children with diabetes, renal failure, low immune status, thalassemia, obesity

For More Information

• See your paediatrician.
• Local Public Health Department.
• Local Health Clinics.
• Center for Disease Control and Prevention website, www.dph.gov.my or at tel : 03-88833888.

References

• Paediatric Protoco;s 4th Edition 2018