DENGUE THE BREAKBONE FEVER: PATHOPHYSIOLOGICAL AND PHARMACOTHERAPEUTIC UPDATE

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Gangwal et al. World Journal of Pharmacy and Pharmaceutical Sciences
DENGUE THE BREAKBONE FEVER: PATHOPHYSIOLOGICAL AND
PHARMACOTHERAPEUTIC UPDATE
Amit Gangwal*, Jacky Dumbwani, Virendra Sanoniya, Namrata Rathore,
Sanjay Jain
Smriti College of Pharmaceutical Education, Indore, India.
ABSTRACT
Dengue, also known as dengue hemorrhagic fever, is the most common
mosquito-borne viral disease of humans that in recent years has
become a major international public health concern and is becoming
fatal day by day as cases of dengue are surfacing in India. Although the
sciences has took long strides in many domain but it has yet to address
some mysteries. Globally, 2.5 billion people live in areas where
dengue viruses can be transmitted. The geographical spreads of both
the mosquito vectors and the viruses have led to the global resurgence
of dengue fever. All four types of the dengue viruses are re-emerging
worldwide and causing more frequent epidemics. In this review article
an attempt has been made to crawl highly relevant information
pertaining to pathophysiology and current option (though limited) to
manage and treat dengue.
Key words: Dengue, symptoms, papaya, mosquito, breakbone fever, virus.
INTRODUCTION
Dengue is a viral infection with potential fatal complications. The word “dengue” means
“cramp-like seizure” which is derived from the Swahili phrase Ka-dinga pepo. The first
clinically recognized dengue epidemics occurred almost simultaneously in Asia, Africa, and
North America in the 1780s. In 1789 the first clinical case was reported, and Benjamin Rush
of Philadelphia gave the term “break bone fever” because it may cause symptoms of myalgia
and arthralgia. After 1828 the term dengue fever came into the consideration1
. Every year, an
estimated 100 million cases of dengue fever surface worldwide. Most of these are in tropical
areas of the world, with the greatest risk occurring in The Indian subcontinent, Southeast
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Article Received on
12 September 2013,
Revised on 20 October 2013,
Accepted on 28 November
2013
*Correspondence for
Author:
*Dr. Amit Gangwal
Smriti College of
Pharmaceutical Education,
Indore, India.
gangwal.amit@gmail.com

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Gangwal et al. World Journal of Pharmacy and Pharmaceutical Sciences
Asia, Southern China, Taiwan, The Pacific Islands, The Caribbean (except Cuba and the
Cayman Islands), Mexico, Africa, Central and South America (except Chile, Paraguay, and
Argentina)2
. Dengue viruses are the most common cause of arboviral disease in the world.
They are found virtually throughout the tropics and sometimes causing dengue haemorrhagic
fever—a severe manifestation of dengue. More than two fifths of the world's population (2.5
billion) live in areas potentially at risk for dengue3
. Dengue scatters in urban poor areas,
suburbs and the countryside but also affects more affluent neighbourhoods in tropical and
subtropical countries4
.
Dengue virus
The four stereotypes of dengue viruses (DEN V1-V4) are the major challenges for various
research organizations5
. The dengue virus (DEN) has four serotypes (DEN-1, DEN-2, DEN-
3 and DEN-4) which belong to the genus Flavivirus, family Flaviviridae. Dissimilar
genotypes have been identified within each serotype, highlighting the extensive genetic
variability of the dengue serotypes. Among them, “Asian” genotypes of DEN-2 and DEN-3
are frequently associated with severe disease accompanying secondary dengue infections.
The Aedes aegypti mosquito is the main vector, transmitting, the viruses that cause dengue.
The viruses are passed on when an infective female Aedes mosquito bites humans4
.
Pathophysiology and symptoms
Dengue fever is a painful, debilitating mosquito-borne disease caused by any one of four
closely related dengue viruses. This infection is caused by the bite of an Aedes mosquito
infected with a dengue virus. The mosquito becomes infected when it bites a person with
dengue virus in their blood. It is not spread directly from person to person2
. Symptoms, which
are palpable usually four to six days after infection and last for up to 10 days of dengue,
include; sudden high fever, severe headaches, pain behind the eyes, severe joint and muscle
pain, enlargement of the liver, nausea, vomiting, skin rash, (which appears three to four days
after the onset of fever), mild bleeding. Sometimes symptoms are mild and can be mistaken
for those of the flu or another viral infection. Younger children and people who have never
had the infection before tend to have milder cases than older children and adults2
.
Pharmacotherapy of dengue
At present there is no cure or specific treatment (no specific medicine or antibiotic) available
for treating victim of dengue. Persons who believe that they may have dengue should consult
a physician. The pain symptoms associated with dengue can be treated with painkillers,

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Gangwal et al. World Journal of Pharmacy and Pharmaceutical Sciences
recommended by physician (because of the possibility of worsening bleeding complications).
In addition, dengue patients require bed rest and fluids (for adequate hydration). It is
important that patients with dengue be carefully monitored for signs of severe dengue so that
they can be treated with fluid replacement in a timely manner and make a full recovery6
. For
typical dengue, the treatment is purely symptomatic.
Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor's
supervision. Acetaminophen and codeine may be given for severe headache and for joint and
muscle pain7
. For severe dengue, medical care by physicians and nurses experienced with the
effects and progression of the disease can frequently save lives. Maintenance of the patient's
circulating fluid volume is very important. World health organization provides technical
advice and guidance to countries and private partners to support vaccine research and
evaluation. Several candidate vaccines are in various phases of trials4
.
Prevention and control
There is no vaccine to prevent dengue fever. The best way to prevent the disease is to prevent
bites by infected mosquitoes. Palpable symptoms of dengue must be reported to doctor
without delay. If someone in one’s vicinity becomes dengue victim, he should be especially
vigilant about efforts to protect himself and other family members from mosquitoes. At
present, the only method to control or prevent the transmission of dengue virus is to combat
vector mosquitoes through preventing mosquitoes from accessing egg-laying areas; disposing
of solid waste properly4
. The symptoms of dengue can vary widely, although some patients
have no symptoms at all. The classic symptoms of dengue include a high fever, severe pain in
the muscles, bones, and joints, pain behind the eyes, severe headaches, nausea and vomiting,
and a rash. Most patients recover from dengue infections with rest and fluids. Blood plasma
leaking through the capillaries constitutes a more serious condition. Severe dengue can lead
to internal bleeding, shock, and organ failure. When treated quickly with intravenous fluid
replacement, condition can be controlled6
DISCUSSION AND CONCLUSION
Dengue is more common than ever and its prevalence is expected to increase. Roughly half
the world’s population live in dengue-endemic countries, but no vaccine is available so far.
Frequently cases of dengue are being reported to civil hospitals in India like never before. As
mentioned earlier in absence of sure shot treatment, classical way of deterring mosquitoes
away is the only prevention. Time tested pain killers along with fluid replacement therapy are

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Gangwal et al. World Journal of Pharmacy and Pharmaceutical Sciences
the mostly recommended medications for this infectious disease. Scientists are working
across the world to find a remedy to address dengue. There is need of robust drug molecule
and vaccine which can combat the causative agent for a longer time and equally effective on
all the virulent strains.
REFERENCES
1. Nivedita G., Sakshi S., Jain A., Chaturvedi UC., Dengue in India, Indian J Med
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3. Robert VG., Dengue: an escalating problem, BMJ, 2002;324:1563
4. Dengue: Guidelines for diagnosis, treatment, prevention and control WHO, 2009
5. Sabchareon A., Wallace D., Sirivichayakul C., Limkittikul K., Chanthavanich P.,
Suvannadabba S., Jiwariyavej V., Dulyachai W., Pengsaa K., Wartel AT., Moureau A.,
Saville M., Bouckenooghe A., Viviani S., Tornieporth NG., Lang J., Protective efficacy
of the recombinant, live-attenuated, CYD tetravalent dengue vaccine in Thai
schoolchildren: a randomised, controlled phase 2b trial; Lancet. 2012 Nov
3;380(9853):1559-67
6. What Is Dengue Fever: www.nature.com/scitable/topicpage
7. www.medicinenet.com