Dengue (DENG-gee) fever, also known as “Breakbone fever” is a viral fever caused by dengue virus transmitted by the bite of mosquito named Aedes aegypti (A.aegypti) in the tropical and subtropical areas. Open water sources are the main breeding places for mosquitos (A.aegypti), the main culprit of the dengue fever.

1. Dengue Fever
Dengue (DENG-gee) fever, also known as “Breakbone fever” is a viral fever caused
by dengue virus transmitted by the bite of mosquito named Aedes aegypti
(A.aegypti) in the tropical and subtropical areas. Open water sources are the main
breeding places for mosquitos (A.aegypti), the main culprit of the dengue fever.
Introduction & Background
Dengue fever, also known as “Breakbone fever” is a viral infection caused by
dengue virus transmitted by the bite of mosquito named Aedes aegypti
(A.aegypti) in the tropical and subtropical areas. Typical symptoms of the dengue
fever include fever, headache, characteristic skin rash, generalized muscle and
joint pain and pain behind the eyes. Dengue fever may be in mild form or may be
in severe form depending upon the infection. The dengue fever is wide spread in
its distribution throughout the world but it is especially notorious in tropical as
well as in subtropical areas, such as
 South east Asia
 India
 Pakistan
 Sri Lanka
 Mexico
 China
 Taiwan

2.  Central and South America
 Caribbean Islands
 Africa
 Pacific lands
Millions of cases of dengue fever occur worldwide every year. Dengue fever is
most common in Asia (mainly Pakistan, Sri Lanka & India) and Pacific islands, but
its incidence is increasing in America and Africa as well.

3. Dengue virus is a single stranded RNA virus that belongs to family Flavivridae,
genus Flavivirus. Dengue has 5 serotypes and all the 5 serotypes can cause
dengue fever. The genome of dengue virus consists of 11000 bases that code for
structural as well as non-structural proteins. There are three basic structural
proteins of dengue virus, capsid protein C, membrane protein M and envelope
protein E. There are also 7 other main non-structural proteins such as NS1, NS2a,
NS2b, NS3, NS4a, NS4b, NS5. Short coding regions are present on both 3’ and 5’
end of the genome.
What is Dengue Fever
Dengue fever is a viral infection caused by dengue virus that is transmitted by the
mosquito (A.aegypti). Dengue fever may be of mild form or may be severe form in
terms of its severity depending upon the infection. The symptoms of the mild
form of dengue fever include sudden onset of fever, headache, generalized body
rash, joint and muscle pain throughout the body and pain behind the eyes. In
small proportion of people the dengue fever may become life threatening and is
known as dengue hemorrhagic fever. Dengue hemorrhagic fever is the sever form
of the dengue fever. Dengue hemorrhagic fever has some additional signs and
symptoms in addition to the typical symptoms of mild form of dengue fever, such
as bleeding from the nose and mouth, significant fall in blood pressure which
results in shock and this this condition is known as “dengue shock syndrome”.
Signs & Symptoms of Dengue Fever
Most of the people (80%) affected with dengue virus are asymptomatic i.e., they
do not show the typical symptoms of dengue fever. The incubation period of the
dengue fever ranges from 3-14 days but may be of short duration (4-7 days). Signs
and symptoms of dengue fever may vary depending upon the severity of the
disease. The dengue fever may be in mild form or may appear in severe form
which is also known as “Dengue hemorrhagic fever”. Children may show signs and
symptoms that may be quite similar to that of common cold and gastroenteritis

4. i.e., vomiting and diarrhea etc. The characteristic signs and symptoms of dengue
fever are fever which is of sudden onset form, rash, headache and joint pain etc.
The signs and symptoms of dengue fever are following,
 Headache
 Malaise
 Fever (106 °F or 41 °C)
 Pain behind the eyes
 Joint pain
 Bleeding from nose or gums
 Rash all over the body
 Nausea
 Vomiting

5. The fever present in dengue fever is characteristically biphasic in nature i.e.,
breaking and then again returning within one or two days.
Most of the people show mild form of dengue fever and recover within a week or
sometimes more. In some cases, the symptoms persist and worsen and may
become life-threatening for the patient. The platelet count is decreased which
results in bleeding from nose and mouth due to leaky blood vessels. Other sign

6. and symptoms in “Dengue hemorrhagic fever” form of dengue fever are
following,
 Bleeding from mouth and nose
 Continuous vomiting
 Abdominal pain
 Petechial hemorrhages under the skin (Minor bleeding under the skin)
 There may be complications of the heart, liver and lungs
When to See Your Doctor
Headache need not concern much if you are generally healthy and got signs and
symptoms of joint pain, generalized body rash and pain behind the eyes, and then
visit your doctor because it may be life threatening for you if you ignore these
symptoms. International or national travel history is very important for the
diagnosis.
How Dengue Fever is diagnosed?
The dengue fever is diagnosed clinically on the basis of clinical signs and
symptoms as well as on the basis of physical examination. Early symptoms of
dengue fever are difficult to differentiate from other viral infections. A probable
diagnosis is made on the symptoms of fever, nausea, vomiting, rash, malaise, joint
pain and low platelet count.

7. Diagnosis is made in the persons who were being in the subtropical or tropical
areas representing with fever within a week or so. Dengue fever is difficult to
differentiate from Chikungunya. For this clinical investigations are done to
differentiate between these two conditions. Similarly, laboratory investigations
are required to exclude other similar conditions such as,
 Malaria
 Influenza
 Typhoid fever
 Measles
 Viral hemorrhagic fever
 Leptospirosis
 Meningococcal disease
The initial detectable change on laboratory investigation is the fall in white blood
cells (WBCs) count. Elevated levels of aminotransferases (AST & ALT) are also
associated with fall in platelet count and plasma leakage. While plasma leakage in
return is associated with pleural effusion or ascites.
The diagnosis of dengue fever is confirmed by laboratory investigations.
Following laboratory investigations are performed to diagnose dengue fever,
 Cell cultures
 PCR for nucleic acid detection

8.  Specific antigens detection
 Specific antibody detection
For first 7 days, specific antigens and PCR are most accurate tests for the
diagnosis of the acute dengue fever. Laboratory investigations for dengue specific
antibodies are also helpful. IgM and IgG are also helpful in the diagnosis. A rise in
titer of IgM is associated with primary infection with dengue virus.
Risk Factors
The factors which can predispose a person to dengue fever are following,
1. Travelling to subtropical or tropical areas of the world
2. Previous infection with dengue virus
3. Compromised immune system
4. Female sex
5. High body mass index (BMI)
6. Diabetes
7. Asthma
Complications
In the severe form of dengue fever, the dengue virus can affect heart, liver and
lungs. The blood pressure may fall to a dangerous level, the condition known as
dengue shock syndrome. There is a risk of inflammation of brain by dengue virus.
Other rare complications associated with dengue fever are following,
 Guillain-Barŕe syndrome
 Transverse myelitis
 Acute liver failure
 Infection of the heart

9. Treatment
There is no specific medication for the treatment of dengue fever except
maintaining fluid level of the body. Over the counter (OTC) pain killers are advised
to relieve the joint pain, headache and pain behind the eyes but those painkillers
are contraindicated in dengue fever which increase the bleeding tendency such as
aspirin, naproxen and ibuprofen. Paracetamol (acetaminophen) is used for the
treatment of fever.
The patients with severe dengue fever are admitted to intensive care unit (ICU)
and then following interventions are required,
 Blood pressure monitoring and maintenance
 Supportive care
 Maintaining body fluid level
Preventions
 Do not come outside wearing half sleeves shirt.
 Ensure that public health bodies and communities are strengthened.
 There should be adequate collaboration between the health and other
sectors (public and private).

10.  Maximize use of health resources to control disease with an integrated
approach.
 Decisions should be made to ensure that all interventions are targeted
appropriately.
 Provide an adequate response to the local situation.
 Open water sources are the breeding places of the mosquitoes.
Eliminate the breeding places of mosquitoes.
 Spraying with organophosphorus insecticides.
 The main method of controlling A. aegypti, main cause of dengue
fever, is by eliminating its natural breeding places. This is mainly done by
eliminating open sources of water.
 Always wear long sleeves shirts and long pants in the areas of
mosquitoes.
 Stay in well screened rooms in order to avoid mosquitoes.
 Always use mosquito repellents.
Lifestyle modifications & Home Remedies
 The juice of papaya leaf has been seen to inhibit the destruction of
platelets.
 The main method of controlling A. aegypti, main cause of dengue fever, is
by eliminating its natural breeding places of mosquitos. This is mainly done
by eliminating open sources of water.
 Always wear long sleeves shirts and long pants in the areas of mosquitos.

11.  Stay in well screened rooms in order to avoid mosquitos.
 Use mosquito repellents.
 Open water sources are the breeding places of the mosquitos. Eliminate
the breeding places of mosquitos.
 Spraying with organophosphorus insecticides.
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