Dengue: Symptoms, Causes, Treatment, and Prevention

Dengue fever, a mosquito-borne illness, is widespread in tropical and subtropical regions across the globe. The less severe manifestation of dengue, characterized by elevated fever and flu-like symptoms, necessitates proper treatment of dengue fever in India. Meanwhile, its severe counterpart, referred to as dengue hemorrhagic fever, can lead to profound bleeding, abrupt blood pressure decline (shock), and even fatality.

Each year, millions of individuals contract dengue infections, emphasizing the importance of early and effective treatment of dengue fever in India. This prevalence is especially notable in Southeast Asia, the Western Pacific, Latin America, and Africa. Notably, the disease is progressively extending its reach to novel territories, including localized outbreaks in certain regions of Europe and the southern United States. It's vital to prioritize preventive measures and timely treatment of dengue fever in India to curtail its impact and enhance public health.

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Understanding the Symptoms of Dengue Fever

Dengue infections may not always show symptoms, but when they do, they can be similar to other illnesses. These symptoms typically appear within four to 10 days after a mosquito bite. Dengue fever symptoms include:

• High fever (104°F or 40°C)

• Headache

• Muscle, bone, or joint pain

• Nausea and vomiting

• Pain behind the eyes

• Swollen glands

• Rash

At times, dengue fever symptoms might be mild, resembling those of the flu or another viral infection. Younger children and individuals who haven't encountered the infection before typically experience milder cases compared to older children and adults.

However, the situation can turn severe. This includes dengue hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, liver enlargement, and circulatory system failure. Symptoms might progress to extensive bleeding, shock, and even death, known as dengue shock syndrome (DSS).

People with weakened immune systems, along with those facing a second or subsequent dengue infection, are believed to face a higher risk of developing dengue hemorrhagic fever.
 

Staying Alert to Severe Dengue

Severe dengue arises when blood vessels are damaged and leak, causing a drop in clot-forming platelets. This can result in shock, internal bleeding, organ failure, and even fatality.

Warning signs for severe dengue appear quickly, often after the fever subsides, and include:

• Intense stomach pain

• Persistent vomiting

• Bleeding from gums or nose

• Blood in urine, stools, or vomit

• Skin bleeding resembling bruising

• Difficulty or rapid breathing

• Fatigue, irritability, or restlessness
   

Dengue Hemorrhagic Fever: A severe and often fatal condition occurring in individuals with dengue fever. Symptoms include abdominal pain, persistent vomiting, fluctuation in body temperature from fever to hypothermia, irritability, confusion, and bleeding manifestations. Early signs of shock may appear, such as weak pulse, restlessness, and cold, clammy skin.

What causes dengue fever that becomes hemorrhagic lies in abnormal blood clotting and plasma leakage. The latter is due to an increase in vascular permeability mediated by cytokines. Vascular permeability refers to blood vessels' ability to control the flow of molecules and immune cells of specific sizes, preventing larger molecules from escaping. During diseases like inflammation or allergies, molecules as large as 2,000 kDa can leak, leading to plasma leakage.

Dengue Hemorrhagic Fever often affects children and infants, typically resulting from secondary infection with a different dengue virus serotype than their initial infection. Pregnant women are also susceptible due to pregnancy-induced physiological changes.

Criteria for Dengue Hemorrhagic Fever according to WHO:

• Presence of hemorrhagic manifestation

• Thrombocytopenia (platelet count <100,000 cells/mm3)

• Increased body temperature or recent fever history (2–7 days)

• Evidence of increased vascular permeability

Dengue Hemorrhagic Fever in Pregnancy: Pregnant women are more vulnerable to dengue's severe complications, especially in the third trimester. Increased vascular permeability during dengue hemorrhagic fever can lead to placental injury and viral transmission.

Dengue Shock Syndrome: A grave consequence of dengue infection, often fatal, occurring upon secondary infection with a different serotype. The exact cause is under study, but it involves abnormal immune responses and antibody-dependent enhancement, leading to severe infection, shock, and multiorgan failure.

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Test for Diagnosis of Dengue Fever

Doctors use blood tests to diagnose dengue infection by detecting the virus or antibodies against it. If you fall ill after being around people with dengue, especially if you've traveled, inform your doctor. This helps them consider dengue as the possible cause of your symptoms.

The diagnosis of dengue fever involves a combination of blood and imaging tests, as the body's immune response to the virus is intricate. Due to initial symptoms overlapping with other diseases, such as malaria, lab and radiology tests are essential. These may encompass:

• Complete Blood Count (CBC) - To track platelet levels in later illness stages and detect reduced hematocrit, hemoglobin, and red blood cell count indicating anemia due to severe dengue-associated blood loss.

• Dengue Serology Test (Dengue IgG & IgM) - Detects immune system-produced antibodies after virus exposure. Effective around 4 days post-exposure, useful for both primary and secondary infections.

• Dengue Virus Antigen Detection (NS1) - Confirms Dengue viral infection, useful for early detection within 1-2 days post-infection.

In severe cases, in order to provide best treatment for dengue fever additional tests may be suggested to determine the extent of infection spread:

• Liver Function Tests (LFT) - Reveals hepatic effects of Aedes mosquito virus, leading to elevated bilirubin, transaminases, and serum albumin anomalies that can result in liver failure.

• Renal Function Test (RFT) - Monitors serum creatinine levels, helping diagnose potential renal issues like acute renal failure, hemolytic uremic syndrome, and more.

• ECG - Checks heart's electrical rhythm; abnormalities occur due to electrolyte imbalances induced by dengue infection.

• Ultrasound Abdomen (USG) - Identifies conditions like serositis, gallbladder edema, and ascites caused by dengue infection.

• Chest X-ray - Detects pleural and pericardial effusion caused by dengue fever.

• D-dimer Test - Measures blood clot dissolution, crucial as increased levels can result from dengue infection and cause pain, fever, breathing difficulties, and skin color changes.

• 2D Echocardiography (2D Echo) - Assesses heart muscle damage caused by severe dengue.

• Fibrinogen Test - Monitors fibrinogen levels crucial for blood clotting; low levels can lead to excessive bleeding.

• Fibrin Degradation Products Test - Detects substances left behind as clots dissolve, indicating fibrinolysis due to dengue hemorrhagic fever.

The above-mentioned tests can help diagnose the severity clearly and provide the best treatment for Dengue fever.

Cause of Dengue Fever: Dengue Transmission Insights

• Transmission through Mosquito Bites: The virus spreads through bites from infected female mosquitoes, primarily Aedes aegypti. Other Aedes species can also transmit, but Aedes aegypti is the primary vector. After feeding on an infected person, the virus multiplies in the mosquito before reaching salivary glands. The time between ingesting the virus and transmission to a new host is the extrinsic incubation period (EIP). EIP is around 8–12 days at temperatures of 25–28°C. Various factors like temperature fluctuations, virus type, and initial viral concentration influence the transmission time. Once infected, mosquitoes can transmit the virus for life.

• Human-to-Mosquito Transmission: Mosquitoes can contract DENV from viremic people, whether symptomatic, pre-symptomatic, or asymptomatic. Transmission can occur up to 2 days before symptoms appear and up to 2 days after fever subsides. The risk is higher with high viremia and rage, while DENV-specific antibodies decrease mosquito infection risk. Viremia lasts about 4–5 days but can extend up to 12 days.

• Maternal Transmission: DENV transmission mainly occurs via mosquitoes, yet limited maternal information (pregnant mother to baby) has been observed. Vertical transmission rates appear low and relate to infection timing during pregnancy. Babies born to infected mothers might experience preterm birth, low birth weight, and fetal distress.

• Other Transmission Modes: Rare cases involve transmission through blood products, organ donations, and transfusions. Transovarial transmission within mosquitoes has also been noted.
   

Treatment of Dengue Fever:

Addressing dengue involves symptom management. Treatment of dengue fever, for milder cases, comprises:

When focusing on the treatment of dengue fever at home, keep in mind the following:

• Staying Hydrated: Ensuring adequate water intake to prevent dehydration is crucial during the home treatment of dengue fever.

• Resting: Prioritize giving your body ample rest to facilitate a smoother recovery process.

• Pain Relief: Utilize pain relievers such as Tylenol or paracetamol to alleviate discomfort and help lower fever levels when using it as a treatment of dengue fever at home.

• Avoiding Specific Medications: Be cautious about using nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen as treatment of dengue fever at home, as they can increase the risk of internal bleeding.

Remember, while treatment of dengue fever at home can help alleviate symptoms, it's essential to be aware that severe cases might require medical intervention. Always consult a healthcare professional for proper guidance and management, particularly if symptoms worsen or complications arise.

Medical treatment of Dengue fever

In more severe instances, a doctor might advise hospitalization and:

• Administering IV fluids to replenish hydration.

• Considering blood transfusion if necessary.

Platelet transfusion is typically considered when the platelet count falls below 20,000 to 30,000 cells per microliter. This helps prevent bleeding complications and supports the body's ability to form clots. For severe cases, hospitalization is often necessary. Untreated, severe cases can be fatal in 10–20% of instances. However, proper medical treatment of dengue fever  in India reduces this rate significantly to just 1%.

It's worth noting that a vaccine called Dengvaxia is available as a medical treatment of dengue fever in India for individuals who have had dengue at least once and reside in areas where the disease is prevalent.

Factors Influencing Dengue Risk: A Comprehensive Perspective

Certain factors significantly contribute to an individual's susceptibility to dengue and the transmission of the disease within communities. Here's an in-depth exploration:

• Previous Infection: Individuals previously infected with DENV are at an elevated risk of developing severe dengue when exposed to the virus again.

• Urbanization Impact: Urbanization, especially in an unplanned manner, plays a pivotal role in dengue transmission due to a multitude of social and environmental dynamics. These include population density, patterns of human mobility, access to reliable water sources, and water storage practices.

• Community Dynamics: The risk of dengue within a community is closely tied to various factors, including the knowledge, attitudes, and practices of its population towards dengue. Additionally, the effective implementation of routine and sustainable vector control activities within the community is crucial in mitigating the disease's spread.

• Climate Change and Vectors: Disease risks exhibit potential changes and shifts with the advent of climate change, particularly in tropical and subtropical regions. Vectors responsible for transmitting dengue, such as mosquitoes, might adapt to new environments and climate conditions, further influencing the transmission dynamics of the disease.

In summary, a comprehensive understanding of these multifaceted factors is essential for effectively managing and curbing the impact of dengue fever in India. By addressing these interconnected aspects, public health strategies can be refined to better control and prevent dengue outbreaks and improve the medical treatment of dengue fever in India.

Prevention of Dengue Fever

While a dengue vaccine is recommended for kids and teens aged 9–16 who've previously experienced dengue fever and reside in endemic U.S. territories, it isn't advised for travelers to these regions. Mosquito bite prevention remains crucial. Follow these steps for effective protection:

• Install screens on doors and windows, promptly repairing any damage. Keep unscreened openings closed.

• Dress kids in long-sleeved shirts, long pants, shoes, and socks when outdoors. Utilize mosquito netting over beds at night.

• Apply insect repellent correctly on children. Opt for DEET or oil of lemon eucalyptus formulas.

• Minimize outdoor exposure during daytime hours, especially around dawn and dusk when mosquitoes are most active.

• Eliminate mosquito breeding grounds. Remove standing water from containers, discarded tires, and change the water in birdbaths, dog bowls, and vases weekly. By adhering to these measures and avoiding regions with dengue fever outbreaks, the risk of contracting the disease remains low for international travelers.
   

Duration of Dengue Fever: Understanding Symptoms and Progression

The onset of dengue fever symptoms occurs within a range of 4 days to 2 weeks after a mosquito bite from an infected vector. These symptoms generally persist for a span of 2 to 7 days. Following the subsiding of the initial fever, certain symptoms can intensify, potentially leading to more severe complications.

These complications include increased bleeding tendencies, gastrointestinal issues such as nausea, vomiting, and intense abdominal pain, as well as respiratory difficulties like labored breathing. If Dengue Hemorrhagic Fever (DHF) is left untreated, it can lead to critical outcomes such as dehydration, significant bleeding, and a rapid decline in blood pressure, resulting in shock. 

These severe symptoms necessitate immediate medical attention, highlighting the importance of seeking the best treatment for dengue fever to prevent life-threatening consequences. Notably, having experienced dengue once imparts immunity against that specific viral strain. However, it's crucial to acknowledge that immunity to one strain does not provide protection against the other three types of the virus, making continued preventive measures essential.

Remaining vigilant about dengue symptoms, seeking timely medical assistance, and adopting measures to prevent mosquito bites remain paramount for safeguarding health and minimizing the impact of dengue fever. It is recommended to stay informed about the medical treatment of dengue fever for the best possible outcomes.

Conclusion

Dengue fever is a significant health concern, particularly in tropical and subtropical regions. Its symptoms range from mild flu-like discomfort to severe complications like dengue hemorrhagic fever, which can be life-threatening if not treated promptly. Effective treatment of dengue fever involves recognizing the symptoms, seeking medical attention, and following recommended protocols. Felix Hospital, a trusted healthcare institution reachable at +91 9667064100, is committed to providing comprehensive care for dengue fever and other medical conditions.

Alongside medical intervention, prevention through mosquito bite avoidance, adequate hydration, and rest play a crucial role in minimizing the impact of dengue fever. By staying informed, taking preventive measures, and seeking medical assistance when needed, we can collectively contribute to managing and reducing the prevalence of dengue fever.