#Dengue fever is a mosquito-borne disease that occurs in #tropical and #subtropical areas of the #world. Mild dengue fever causes high fever, #rash, and #muscle and #joint pain. A severe form of dengue #fever, also called dengue #hemorrhagic fever, can cause severe #bleeding, a sudden drop in #blood pressure (#shock) and #death. #Millions of cases of dengue infection occur #worldwide each year. Dengue fever is most common in #Southeast #Asia and the #western #Pacific #islands, but the #disease has been increasing rapidly in #Latin #America and the #Caribbean please comment thank you

1. Dengue fever
(medical information)
PREPARED BY
MARTIN SHAJI
PHARM D

2. #Dengue fever is a mosquito-borne disease that occurs in #tropical and
#subtropical areas of the #world. Mild dengue fever causes high fever, #rash,
and #muscle and #joint pain. A severe form of dengue #fever, also called
dengue #hemorrhagic fever, can cause severe #bleeding, a sudden drop in
#blood pressure (#shock) and #death.
#Millions of cases of dengue infection occur #worldwide each year. Dengue
fever is most common in #Southeast #Asia and the #western #Pacific #islands,
but the #disease has been increasing rapidly in #Latin #America and the
#Caribbean
Introduction

3. Summary
Introduction
Definition
Epidemiology
Etiology | causes
Signs and symptoms
When to see a doctor
Pathophysiology
Lab investigations
Serology
Clinical manifestations
Diagnosis
Treatment
Complications
Mortality and morbidity

4. Definition
Dengue: Also known as Dengue fever, an acute mosquito-borne viral
illness of sudden onset that usually follows a benign course with
headache, fever, prostration, severe joint and muscle pain, swollen
glands (lymphadenopathy) and rash. ... Victims of dengue often have
contortions due to the intense joint and muscle pain.

5. Epidemiology
The actual numbers of dengue cases are underreported and many cases
are misclassified. One recent (2013) estimate indicates that 390 million
dengue infections occur every year (95% credible interval 284–528
million), of which 96 million (67–136 million) manifest clinically (with any
severity of disease)
disease is common in many popular tourist destinations in the Caribbean
(including Puerto Rico), Central and South America, Southeast Asia, and the
Pacific Islands. In the United States, local cases and limited spread of
dengue does occur periodically in some states with hot, humid climates
and Aedes mosquitoes.

7. Causes | etiology
Dengue fever is caused by any one of four dengue viruses spread by
mosquitoes that thrive in and near human lodgings.
When a mosquito bites a person infected with a dengue virus, the virus ente
the mosquito. When the infected mosquito then bites another person, the
virus enters that person's bloodstream.
After you've recovered from dengue fever, you have immunity to the virus
that infected you — but not to the other three dengue fever viruses. The risk
of developing severe dengue fever, also known as dengue hemorrhagic fever
actually increases if you're infected a second, third or fourth time.

8. Symptoms
Many people, especially children and teens, may experience no signs
or symptoms during a mild case of dengue fever. When symptoms do
occur, they usually begin four to 10 days after you are bitten by an
infected mosquito. Signs and symptoms of dengue fever most
commonly include:
Fever, as high as 106 F (41 C)
Headaches
Muscle, bone and joint pain
Pain behind your eyes

9. You might also experience:
Widespread rash
Nausea and vomiting
Rarely, minor bleeding from your gums or nose

10. Most people recover within a week or so. In some cases, symptoms
worsen and can become life-threatening. Blood vessels often become
damaged and leaky. And the number of clot-forming cells (platelets) in
your bloodstream drops. This can cause:
Bleeding from your nose and mouth
Severe abdominal pain
Persistent vomiting
Bleeding under the skin, which might look like bruising
Problems with your lungs, liver and heart

11. When to see a doctor
If you've recently visited a region in which dengue fever is known to
occur and you suddenly develop a fever, see your doctor.

12. Tests And Diagnosis
Diagnosing dengue fever can be difficult, because its signs and
symptoms can be easily confused with those of other diseases — such
as malaria, leptospirosis and typhoid fever.
Your doctor will likely ask about your medical and travel history. Be sure
to describe international trips in detail, including the countries you
visited and the dates, as well as any contact you may have had with
mosquitoes.
Certain laboratory tests can detect evidence of the dengue viruses, but
test results usually come back too late to help direct treatment
decisions.

13. Laboratory Findings
Leukoenia
Thrombocytopenia (<100,000)
Modest liver enzyme elevation (2-5x nml)

14. Serology:
Acute phase serum 1gM (+6-90 days) ELISA
Acute and convalescent lgG (99% sens, 96%spec)
Hemagglutination inhibition assay (HI) is gold standard.
Paired acute and convalescent Hlassay, positive if >4 fold titer rise

15. Transmitted by the bite of Aedes mosquito (Aedesaegypti).
Incubation 3-14 days.
Acute illness and viremia 3-7 days.
Recovery or progression to leakage phase
Pathophysiology

16. The transmission cycle of dengue virus by the mosquito Aedes aegypti
begins with a dengue-infected person.
This person will have virus circulating in the blood—a viremia that lasts
for about five days. During the viremic period, an uninfected female
Aedes aegypti mosquito bites the person and ingests blood that
contains dengue virus.
Then, within the mosquito, the virus replicates during an extrinsic
incubation period of eight to twelve days.
Pathophysiology (cont..)

17. Dengue virus enters and replicates within monocytes, mast cells, fibroblasts
Innate and adaptive immune response
Cytokine release: TNF-a, IL-2, IL-6, IL-8
Compliment activation
Antibody dependent enhancement (ADE)thought to contribute to severe
infections
T-cell activation: CD4 and CD8 cells cytokine production
Pathophysiology ( cont ….)

18. Dengue Infection
Infected monocyte
Vasoactive mediators
Increased vascular permeability
Plasma leaking & hemoconcentration

19. Treatments And Drugs
No specific treatment for dengue fever exists. Your doctor may recommend
that you drink plenty of fluids to avoid dehydration from vomiting and high
fever. Acetaminophen (Tylenol, others) can alleviate pain and reduce fever.
Avoid pain relievers that can increase bleeding complications — such as
aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve,
others).
If you have severe dengue fever, you may need:

20. Supportive care in a hospital
Intravenous (IV) fluid and electrolyte replacement
Blood pressure monitoring
Transfusion to replace blood loss

21. Risk Factors
Factors that put you at greater risk of developing dengue fever or a
more severe form of the disease include:
Living or traveling in tropical areas. Being in tropical and subtropical
areas increases your risk of exposure to the virus that causes dengue
fever. Especially high-risk areas are Southeast Asia, the western Pacific
islands, Latin America and the Caribbean.
Prior infection with a dengue fever virus. Previous infection with a
dengue fever virus increases your risk of having severe symptoms if
you're infected again.

22. Complications
If severe, dengue fever can damage the lungs, liver or heart. Blood
pressure can drop to dangerous levels, causing shock and, in some cases,
death.

23. Mortality &
Morbidity
Treated DHF/DSS is associated with
a 3%mortality rate.
Untreated DHF/DSS is associated
with a50% mortality rate.

24. lifestyle and home remedies
Six dengue fever vaccines are in development, but not yet available. The
vaccine that's furthest in development is a three-dose vaccine for
children. The results of a phase III trial were published in July 2014. This
study showed that the vaccine appears to be safe, and it prevented
dengue infections slightly more than half the time.
Those who had the vaccine but still became infected with dengue had a
milder course of the disease than did those who weren't vaccinated.
Although the vaccine is not as effective as doctors would like, it is safe.
The company that makes this vaccine hasn't yet announced any plans to
seek approval to market the vaccine.

25. So for now, if you're living or traveling in an area where dengue fever is
known to be, the best way to avoid dengue fever is to avoid being bitten
by mosquitoes that carry the disease.
If you are living or traveling in tropical areas where dengue fever is
common, these tips may help reduce your risk of mosquito bites:
Stay in air-conditioned or well-screened housing. It's particularly
important to keep mosquitoes out at night.
Prevention

26. Reschedule outdoor activities. Avoid being outdoors at dawn, dusk and
early evening, when more mosquitoes are out.
Wear protective clothing. When you go into mosquito-infested areas,
wear a long-sleeved shirt, long pants, socks and shoes.
Use mosquito repellent. Permethrin can be applied to your clothing,
shoes, camping gear and bed netting. You can also buy clothing made
with permethrin already in it. For your skin, use a repellent containing
at least a 10 percent concentration of DEET.

27. Reduce mosquito habitat. The mosquitoes that carry the dengue
virus typically live in and around houses, breeding in standing
water that can collect in such things as used automobile tires.
Reduce the breeding habitat to lower mosquito populations.

28. “Mosquitoes take
about 7 days to
complete lifecycle.
The first three Stages:
eggs larva and pupa
are aquatic.
Therefore, the best
way to prevent
mosquito breeding
into remove :stagnant
water”