Download the free patient handout PDF near the end of this article!
What is dengue fever?
Dengue fever is a globally important viral fever, caused by a group called Arbo-virus. The infection is transmitted by mosquitoes of the Aedes genus, commonly Aedes aegypti. The infection can range from very mild to a very serious one causing death.
Who gets dengue fever?
Those who are bitten by an infected mosquito get the disease. The incubation period is 3 to 14 days, with an average of 7 days. This means that the disease manifests after the incubation period, and during the incubation period, the person can spread the virus although he/she does not know that he/she is infected yet.
Can dengue infection be prevented?
The World Health Organization has given the guidelines for primary prevention. The Aedes mosquitoes are domesticated mosquitoes, and nearby stagnant water is their main breeding ground. Hence, it is important not to have such stagnant water. Appropriate mosquito repellants and clothing are necessary for prevention, and it is important to have the patient inside a mosquito net and have mosquito coils around.
A vaccine is being worked out, and recent news reported that the Indian vaccine might take about 5 years to be commercially available. At present, it is successful in animal trials. Genetically modified mosquitoes are also being tried, to prevent the spread.
What are the symptoms of dengue?
The first symptom to appear after the incubation period is the sudden onset of high-grade fever. Children can have convulsions (fits) because of this high fever. Pains and aches are common, and pain behind the eye is a classical symptom. Stomach upset and respiratory symptoms can also be present.
What are the signs that doctors look for?
The doctors look for the typical skin lesions and rashes. These are called maculopapular or rubelliform rashes. Signs of tiny bleeding can occur in serious patients and are petechiae, purpura, or a positive tourniquet test. Major bleeding can manifest as epistaxis, gingival bleeding, haematemesis, melaena, vaginal bleeding (in women of childbearing age), or bleeding from a venepuncture site. These are serious bleeding. When the pulse pressure is narrow and blood pressure drops, urine output drops, etc., then it means very serious disease.
What are the laboratory tests that are carried out?
Some of the tests that are necessary are commonly available. They include the hematocrit, total and differential white blood count, platelet count, serum albumin level and liver enzyme testing. The confirmatory tests might not be available in rural areas but are often not necessary to diagnose either the severe or non-severe forms of the disease.
How is dengue treated?
The World Health Organization has given the guidelines for treatment. It is important to triage the patients and find out to which of the following groups they belong, as quickly as possible.
You can print copies of this PDF handout for your patients, to reinforce what you have told them.
GROUP A
They have a mild infection and can be managed at home with lots of fluid, to make sure that they pass sufficient urine, at least once in six hours.
GROUP B
These patients are sicker. They have other co-existing disease like diabetes, obesity, renal failure or are just elderly or pregnant, etc., and they also have deranged blood reports with low platelet count or high hematocrit values.
GROUP C
These are very sick patients who are in shock and have severe bleeding.
The Group A patients are given adequate fluids (2.5 to 3 liters a day) and Paracetamol. Pain killers should be avoided. Oral rehydration products, fruit juices, and clear soups are better than water. Red or brown fluids should be avoided, as these may lead to confusion about haematemesis.
Patients of Group B should be admitted, and sufficient fluids (and blood, if necessary) should be given.
Patients of Group C require specialized treatment centers.
What is the treatment for specialized groups?
In pregnancy, the maternal mortality increases, and the antenatal outcome is poor. As pregnancy is associated with various physiological changes such as high pulse rate, low blood pressure, wider pulse pressure, decreased haemoglobin and haematocrit values, and decreased platelet count, baseline variables should be noted on the first day of infection, and subsequent results should be interpreted with caution. Children are more prone to shock.
Is prophylaxis with platelet transfusions helpful?
There is no evidence at present to suggest that these are helpful in preventing the progress of the disease. However, they are given when necessary.
Any other information that is necessary?
The mortality rate of severe dengue is about 2 to 2.5% and is higher in children. A second infection can occur with a different strain of the virus. There is no significant long term sequela. No successful antiviral drugs are available at present.
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Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries. |
References (click to show/hide)
- Available from: http://www.bmj.com/content/351/bmj.h4661 (accessed on September 19, 2015.)
indicates a Peer-Reviewed Article
What Should Rural Patients Know About Dengue Fever? – includes a free patient information PDF!
What is dengue fever?
Dengue fever is a globally important viral fever, caused by a group called Arbo-virus. The infection is transmitted by mosquitoes of the Aedes genus, commonly Aedes aegypti. The infection can range from very mild to a very serious one causing death.
Who gets dengue fever?
Those who are bitten by an infected mosquito get the disease. The incubation period is 3 to 14 days, with an average of 7 days. This means that the disease manifests after the incubation period, and during the incubation period, the person can spread the virus although he/she does not know that he/she is infected yet.
Can dengue infection be prevented?
The World Health Organization has given the guidelines for primary prevention. The Aedes mosquitoes are domesticated mosquitoes, and nearby stagnant water is their main breeding ground. Hence, it is important not to have such stagnant water. Appropriate mosquito repellants and clothing are necessary for prevention, and it is important to have the patient inside a mosquito net and have mosquito coils around.
A vaccine is being worked out, and recent news reported that the Indian vaccine might take about 5 years to be commercially available. At present, it is successful in animal trials. Genetically modified mosquitoes are also being tried, to prevent the spread.
What are the symptoms of dengue?
The first symptom to appear after the incubation period is the sudden onset of high-grade fever. Children can have convulsions (fits) because of this high fever. Pains and aches are common, and pain behind the eye is a classical symptom. Stomach upset and respiratory symptoms can also be present.
What are the signs that doctors look for?
The doctors look for the typical skin lesions and rashes. These are called maculopapular or rubelliform rashes. Signs of tiny bleeding can occur in serious patients and are petechiae, purpura, or a positive tourniquet test. Major bleeding can manifest as epistaxis, gingival bleeding, haematemesis, melaena, vaginal bleeding (in women of childbearing age), or bleeding from a venepuncture site. These are serious bleeding. When the pulse pressure is narrow and blood pressure drops, urine output drops, etc., then it means very serious disease.
What are the laboratory tests that are carried out?
Some of the tests that are necessary are commonly available. They include the hematocrit, total and differential white blood count, platelet count, serum albumin level and liver enzyme testing. The confirmatory tests might not be available in rural areas but are often not necessary to diagnose either the severe or non-severe forms of the disease.
How is dengue treated?
The World Health Organization has given the guidelines for treatment. It is important to triage the patients and find out to which of the following groups they belong, as quickly as possible.
GROUP A
They have a mild infection and can be managed at home with lots of fluid, to make sure that they pass sufficient urine, at least once in six hours.
GROUP B
These patients are sicker. They have other co-existing disease like diabetes, obesity, renal failure or are just elderly or pregnant, etc., and they also have deranged blood reports with low platelet count or high hematocrit values.
GROUP C
These are very sick patients who are in shock and have severe bleeding.
The Group A patients are given adequate fluids (2.5 to 3 liters a day) and Paracetamol. Pain killers should be avoided. Oral rehydration products, fruit juices, and clear soups are better than water. Red or brown fluids should be avoided, as these may lead to confusion about haematemesis.
Patients of Group B should be admitted, and sufficient fluids (and blood, if necessary) should be given.
Patients of Group C require specialized treatment centers.
What is the treatment for specialized groups?
In pregnancy, the maternal mortality increases, and the antenatal outcome is poor. As pregnancy is associated with various physiological changes such as high pulse rate, low blood pressure, wider pulse pressure, decreased haemoglobin and haematocrit values, and decreased platelet count, baseline variables should be noted on the first day of infection, and subsequent results should be interpreted with caution. Children are more prone to shock.
Is prophylaxis with platelet transfusions helpful?
There is no evidence at present to suggest that these are helpful in preventing the progress of the disease. However, they are given when necessary.
Any other information that is necessary?
The mortality rate of severe dengue is about 2 to 2.5% and is higher in children. A second infection can occur with a different strain of the virus. There is no significant long term sequela. No successful antiviral drugs are available at present.
References (click to show/hide)
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