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DENGUE FEVER EPIDEMIC IN INDIA -A REVIEW OF CLINICAL FEATURES,
DIAGNOSIS, PREVENTION & MEDICATIONS Debjit bhowmik,
K.K.Tripathi,Dipak Biswas, Karpagam University,Coimbatore
K.P.Sampath Kumar, Department of Pharmaceutical sciences,
Coimbatore medical college, Coimbatore,Tamilnadu
[email protected] ABSTRACT Dengue fever is an
infectious disease carried by mosquitoes. It is found mostly during
and shortly after the rainy season in tropical and subtropical
areas of: Africa ,Southeast Asia , China ,India ,Middle East
Caribbean , Central ,South America, Australia and the South and
Central Pacific .Dengue fever was previously 'break-bone fever'
because it sometimes causes severe joint and muscle pain Though
dengue is a very highly infectious disease, its mortality rate is
very low. Deaths usually occur due to ignorance of the methods of
treatment. In advanced countries, the mortality rates of dengue are
almost zero. However it is necessary to prevent the disease due to
the painful symptoms that it causes as long as it lasts. Dengue
fever can be caused by any one of four types of dengue virus:
DEN-1, DEN-2, DEN-3, and DEN-4. Infection with one virus does not
protect a person against infection with another. Dengue virus is
prevalent in the tropical and subtropical regions of the world and
each year infects about 50 million to100 million people. It
accounts for 25,000 deaths annually, most of them in children.
People contract dengue fever from the bite of an infected Aedes
mosquito. Mosquitoes become infected when they bite infected
humans, and later transmit infection to other people they bite. The
risk factors for dengue fever are as follows: traveling to or
living in endemic or outbreak areas, especially if no mosquito
control is attempted by the people or government; mosquito bites a
repeated infection with another serovar of dengue virus with
antibodies in the serum active against the first infecting serovar
and not taking precautions to avoid mosquito bites. The WHO says
some 2.5 billion people, two fifths of the world's population, are
now at risk from dengue and estimates that there may be 50 million
cases of dengue infection worldwide every year. The disease is now
endemic in more than 100 countries. There is no specific medication
for treatment of a dengue infection. Persons who think they have
dengue should use analgesics (pain relievers) with acetaminophen
and avoid those containing aspirin. They should also rest, drink
plenty of fluids, and consult a physician. After more than a decade
of development at the National Institutes of Health in U.S, a
vaccine to prevent infection by the mosquito-borne dengue virus has
begun human clinical testing INTRODUCTION Dengue fever is a disease
caused by viruses that are transmitted to people by mosquitoes.
Dengue fever usually causes fever (high, about 104 F-105 F), skin
rash (see Figure 1), and pain (headaches and often severe muscle
and joint pains). The disease has also been termed "breakbone" or
"dandy fever" because the unusually severe muscle and joint pains
can make people assume distorted body positions or exaggerated
walking movements in an effort to reduce their pain.Dengue is an
acute fever caused by a virus transmitted by the bite of an Aedes
Argypti mosquito. The mosquitoes are found indoors, in the closet
and other dark places. Outdoors they rest in cool and shaded areas.
Contrary to popular belief, it is not only a danger during the
rainy season (when eggs hatches faster), but the whole year
through. The World Health
Organization (WHO) says, "The female mosquitoes lay their eggs
in water containers in and around the homes, and other dwellings.
These eggs will develop, become larvae, and further develop into
adults in about 10 days."Incurring in tropical and sub-tropical
parts of the world, dengue fever is severe, flu-like illness that
affects infant, young children, and adults. It spreads rapidly, and
in the event of epidemic, it will affect a large number of people
and eventually cause the loss of lives. Another cause for alarm:
More than 2.5 billion people (or 40 percent of the world's
population), including 1 billion children lives in areas where
there is a risk of dengue transmission. The centers for disease
control and prevention in the United States says there is no
specific medication for treatment of a dengue infection. However,
proper and early treatment can relieve the symptoms,
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and prevent complications. If you suspect dengue: Give
analgesics (pain relievers) with paracetamol. Avoid close
containing aspirin, as well as ibuprofen, since these can increase
the risk of bleeding. Rest and plenty of fluids are also
recommended. Even if you're not sure that it's dengue, it's best to
consult a physician. A trip to the hospital is a must if vomiting
and severe abdominal pain develops in the first 24 hours after the
fever declines. For DHF, fluid replacement therapy is and option
for treatment if the condition is detected early. However, this
frequently requires hospitalization.
PATHOPHYSIOLOGY Dengue viral infections frequently are not
apparent. Classic dengue primarily occurs in nonimmune,
nonindigenous adults and children. Symptoms begin after a 5- to
10-day incubation period. DHF/DSS usually occurs during a second
dengue infection in persons with preexisting actively or
passively (maternally) acquired immunity to a heterologous
dengue virus serotype. Illness begins abruptly with a minor stage
of 2-4 days' duration followed by rapid deterioration. Increased
vascular permeability, bleeding, and possible DIC may be mediated
by circulating dengue antigen-antibody complexes, activation of
complement, and release of vasoactive amines. In the process of
immune elimination of infected cells, proteases and lymphokines may
be released and activate complement coagulation cascades and
vascular permeability factors.
TYPES OF DENGUE FEVER There are three different types of dengue
fever classified according to their symptoms. The following table
gives a comprehensible overview of these types of dengue fever and
the symptoms associate with them.
Types of Dengue Fever
Symptoms Features
1. Classic Dengue Fever
There is a high fever that can go up to 105 degrees Fahrenheit.
Headache is common, with a throbbing pain behind the eyes. Rash is
present all over the body, but mainly on the chest and limbs.
Nausea and vomiting is present. There is acute pain in the
joints.
This is the simple dengue fever, i.e. only dengue fever with no
complications attached. This type of dengue begins showing its
symptoms five or six days after the person has been infected by the
mosquito. In this type, the rash may get completely healed once,
but there may be an onset of a second rash episode.
2. Dengue Hemorrhagic Fever
High fever of up to 105 degrees Fahrenheit is caused. There is
headache and pain behind the eyes. There is acute pain in the
joints. Rash is developed on the chest and limbs. There is nausea
and vomiting. There is bleeding from the nose,
Dengue hemorrhagic fever is a usually fatal type of dengue. This
is dengue complicated by vascular problems. Due to these vascular
problems, there is bleeding from various parts of the body.
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gums and subcutaneous (i.e. under the skin). There is
malfunctioning of the blood and the lymph vessels.
3. Dengue Shock Fever
There is high fever, reaching up to 105 degrees Fahrenheit.
There is headache with pain behind the eyes.
There is acute pain in the joints.
Rash is developed. There is feeling of nausea and
actual vomiting. Low blood pressure is caused;
this is known as shock. There is internal leaking of
blood from the blood vessels.
This is a very fatal type of dengue fever. It is the type of
dengue that mostly affects children and young teenagers.
SYMPTOMS OF DENGUE FEVER Symptoms of typical dengue usually
start with fever and includes
High fever, up to 105 degrees Fahrenheit.
Severe headache. Retro-orbital (behind the eye) pain. Severe
joint and muscle pain. Nausea and vomiting. Rash - The rash may
appear over
most of your body 3 to 4 days after the fever begins. You may
get a second rash later in the disease. Symptoms of dengue
hemorrhagic fever include all of the symptoms of classic
dengue.
Marked damage to blood and lymph vessels.
Bleeding from the nose, gums or under the skin, causing purplish
bruises.
Exams and Tests A physical examination may reveal:
Enlarged liver (hepatomegaly)
Low blood pressure Rash Red eyes Red throat Swollen glands Weak,
rapid pulse
Tests may include: Arterial blood gases Coagulation studies
Electrolytes Hematocrit Liver enzymes Platelet count Serologic
studies (demonstrate
antibodies to Dengue viruses) Serum studies from samples
taken
during acute illness and convalescence (increase in titer to
Dengue antigen)
Tourniquet test (causes petechiae to form below the
tourniquet)
X-ray of the chest (may demonstrate pleural effusion)
DENGUE FEVER PROGNOSIS For the large majority of people infected
with dengue fever viruses, the prognosis is
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excellent, although they are likely to feel very ill during the
first one or two weeks of the acute illness and weak for about one
month. Patients with underlying illness or immune depression have a
fair to good prognosis because they are more likely to get
complications. Also, people who have been infected by one dengue
viral serovar are still able to be infected by the remaining three
serovars; a second infection increases the possibility that
complications will develop so patients with second-time dengue
fever have a less optimal prognosis. Patients who develop DHF or
DSS have a range of outcomes from good to poor, depending on their
underlying medical problems and how quickly supportive measures are
given. For example, DHF and DSS have about 50% fatality rate if
untreated but about a 3% rate if treated with supportive measures.
Overall, the fatality rate is about 1% of all dengue fever
infections. While this rate may seem low, worldwide it means that
about 500,000 to 1 million people die each year from dengue fever.
This is a concern since the worldwide case numbers and outbreaks
are increasing. DENGUE FEVER PREVENTION Dengue fever can be
prevented by stopping mosquitoes from biting because they are the
vectors the dengue viruses require for transfer to humans. The CDC
(2010) has supplied these general rules to prevent transfer of
viruses and other pathogens by mosquitoes and other biting vectors:
Avoid outbreaks: To the extent possible, travelers should avoid
known foci of epidemic disease transmission. The CDC Travelers'
Health web page provides alerts and information on regional disease
transmission patterns and outbreak alerts. Be aware of peak
exposure times and places: Exposure to arthropod bites may be
reduced if travelers modify their patterns of activity or behavior.
Although mosquitoes
may bite at any time of day, peak biting activity for vectors of
some diseases (for example, dengue, chikungunya) is during daylight
hours. Vectors of other diseases (for example, malaria) are most
active in twilight periods (for example, dawn and dusk) or in the
evening after dark. Avoiding the outdoors or focusing preventive
actions during peak hours may reduce risk. Place also matters;
ticks are often found in grasses and other vegetated areas. Local
health officials or guides may be able to point out areas with
greater arthropod activity. Wear appropriate clothing: Travelers
can minimize areas of exposed skin by wearing long-sleeved shirts,
long pants, boots, and hats. Tucking in shirts and wearing socks
and closed shoes instead of sandals may reduce risk. Repellents or
insecticides such as permethrin (Elimite) can be applied to
clothing and gear for added protection; this measure is discussed
in detail below. Check for ticks: Travelers should be advised to
inspect themselves and their clothing for ticks during outdoor
activity and at the end of the day. Prompt removal of attached
ticks can prevent some infections. Bed nets: When accommodations
are not adequately screened or air conditioned, bed nets are
essential to provide protection and to reduce discomfort caused by
biting insects. If bed nets do not reach the floor, they should be
tucked under mattresses. Bed nets are most effective when they are
treated with an insecticide or repellent such as permethrin.
Pretreated, long-lasting bed nets can be purchased prior to
traveling, or nets can be treated after purchase. The permethrin
will be effective for several months if the bed net is not washed.
(Long-lasting pretreated nets may be effective for much longer.)
Insecticides: Aerosol insecticides, vaporizing mats, and mosquito
coils can
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help to clear rooms or areas of mosquitoes; however, some
products available internationally may contain pesticides that are
not registered in the United States. Insecticides should always be
used with caution, avoiding direct inhalation of spray or
smoke.
Optimum protection can be provided by applying repellents. The
CDC recommends insect repellent should contain up to 50% DEET
(N,N-diethyl-m-toluamide) which is the most effective mosquito
repellent for adults and children over 2 months of age.There are no
vaccines currently available commercially for dengue virus
serovars. However, researchers are actively trying to produce
vaccines that will protect people from all dengue viral serovars.
DENGUE FEVER COMPLICATIONS The complications of dengue fever are
usually associated with the more severe forms of dengue fever,
hemorrhagic and shock syndrome. The most serious complications,
although infrequent, are as follows:dehydration;bleeding
(hemorrhage);low platelets;low blood pressure
(hypotension);bradycardia;liver damage;neurological damage
(seizures, encephalitis);and death. DENGUE HAEMORRHAGIC FEVER /
DENGUE SHOCK SYNDROME A rare complication of dengue fever, dengue
haemorrhagic fever, can occur, most often in small children and
elderly adults. This can sometimes be a serious illness. If DHF /
DSS occurs it will usually do so by day 3-5 of the fever. In
children, the progression of disease is not always characteristic.
A relatively mild first phase with an abrupt onset of fever,
malaise, vomiting, headache anorexia and cough is succeeded 2-5
days later by weakness and, sometimes, physical collapse.
Frequently, spots appear on the
forehead, arms and legs, along with spontaneous bruises and
bleeding from punctures where blood was taken. The more ill child
may breathe rapidly and often effortfully; the pulse may be weak,
rapid, and thready. Almost always patients have a positive
tourniquet test (where a tourniquet i.e. a blood pressure cuff is
applied and the skin demonstrates petechiae and / or bruising).The
WHO criteria for DHF are a platelet count of less than 100,000 and
a haematocrit 20% greater then normal. Such children need to be
hospitalized and watched for potential DSS. Such shock can be a
mortal illness and requires rapid and careful in-hospital
management with assiduous correction and replacement of fluid,
electrolytes, plasma and sometimes fresh blood / platelet
transfusions. The most useful laboratory test in suspected DHF is
estimation of thrombocytes (platelets) which will be very low. In
contrast to uncomplicated dengue fever the white cell count is more
often high. Mortality ranges from 5 - 30% (in untreated native
populations) and the highest risk is to infants under 1 year.
DENGUE FEVER MEDICATION Dengue fever is usually a self-limited
illness, and only supportive care is required. Acetaminophen may
be used to treat patients with symptomatic fever. Aspirin,
nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids
should be avoided.
Patients with known or suspected dengue fever should have their
platelet count and hematocrit measured daily from the third day of
illness until 1-2 days after defervescence. Patients with a rising
hematocrit level or falling platelet count should have
intravascular volume deficits replaced. Patients who improve can
continue to be monitored in an outpatient setting. Patients who do
not improve
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should be admitted to the hospital for continued hydration.
Patients who develop signs of dengue hemorrhagic fever warrant
closer observation. Patients who develop signs of dehydration, such
as tachycardia, prolonged capillary refill time, cool or mottled
skin, diminished pulse amplitude, altered mental status, decreased
urine output, rise in hematocrit levels, narrowed pulse pressure,
or hypotension, require admission for intravenous fluid
administration.
Successful management of severe dengue requires careful
attention to fluid management and proactive treatment of
hemorrhage. Intravascular volume deficits should be corrected with
isotonic fluids such as Ringers lactate solution. Boluses of 10-20
mL/kg should be given over 20 minutes and may be repeated. If this
fails to correct the deficit, the hematocrit value should be
determined, and, if it is rising, limited clinical information
suggests that a plasma expander may be administered. Starch,
dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One
recent study has suggested that starch may be preferable because of
hypersensitivity reactions to dextran.35 If the patient does not
improve after this, blood loss should be considered. Patients with
internal or gastrointestinal bleeding may require transfusion.
Patients with coagulopathy may require fresh frozen plasma.
After patients with dehydration are stabilized, they usually
require intravenous fluids for no more than 24-48 hours.
Intravenous fluids should be stopped when the hematocrit level
falls below 40% and adequate intravascular volume is present. At
this time, patients reabsorb extravasated fluid and are at risk for
volume overload if intravenous fluids are continued. Do not
interpret a falling
hematocrit value in a clinically improving patient as a sign of
internal bleeding.
Platelet and fresh frozen plasma transfusions may be required to
control severe bleeding. A recent case report demonstrated good
improvement following intravenous anti-D globulin administration in
two patients. The authors proposed that, similarly to nondengue
forms of immune thrombocytopenic purpura, intravenous anti-D
produces Fc receptor blockade to raise platelet counts.36
Patients who are resuscitated from shock rapidly recover.
Patients with dengue hemorrhagic fever or dengue shock syndrome may
be discharged from the hospital when they meet the following
criteria: o Afebrile for 24 hours without antipyretics o Good
appetite, clinically improved condition o Adequate urine output o
Stable hematocrit level o At least 48 hours since recovery from
shock o Absence of respiratory distress
NATURAL HOME REMEDIES FOR THE TREATMENT OF DENGUE FEVER
Traditional natural home remedy for dengue fever - Normal dengue
fever is not that dangerous. The symptom-based treatment should be
resorted to i.e., wet pads could be used if the temperature is
high. Antidotes could be administered as per the necessity.
Pain-killers should not be given to the patient of hemorrhagic
dengue. Pain-killers tend to increase hemorrhage. Maintaining the
water balance of the body and controlling the blood pressure of the
patient is also necessary. The standard conventional analgesic
treatment for dengue. Simple home remedy for dengue fever -
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Dhatura is the Ayurvedic version of the homeopathic belladonna.
Its leaves have potency in reducing the seriousness of the dengue
fevers. However, the dosage must not exceed 2 decigrams, or it will
lead to severe negative symptoms like dryness of the mouth and
dilation of the pupils. Good home remedy for dengue fever - The
orange juice helps with digestion, increased urinary output,
promotes antibodies for faster healing and recovery. It gives
energy and vitamins, over all a great source for fighting fevers.
Effective home remedy for dengue fever - The raw papaya leaves,
2pcs just cleaned and pound and squeeze with filter cloth. You will
only get one tablespoon per leaf. So two tablespoons per serving
once a day. Do not boil or cook or rinse with hot water, it will
loose its strength. This will prevent dengue fever. The affected
person is treated with Paracetamol to bring down the fever.
DIET TIPS FOR DENGUE FEVER Porridge and baked toasts (not fried)
can be had for allaying hungers in the course of the day. Biscuits
with tea can be had. The tea must be herbal, with tulsi, ginger,
cardamom and other such fever-reducing herbs in it. Learn how to
prepare simple recipes believed to be miracle cure for dengue
fever. There is no harm in trying as they are all the gift of
nature that can be used to ease the suffering of dengue patients
and probably could also save some lives. Dengue is an acute
infectious viral disease transmitted by the Aedes mosquitoes.
Common in tropical climates, the dengue fever is also known as
break-bone fever due to the severe joint and muscle pain suffered
by the patients. Other symptoms of dengue include severe headache,
fever, and intense joint pain, which will usually last about a
week. The fever will usually subside after 2 to 5 days and
thereafter will rise again followed by
rashes on the skin. The dengue hemorrhagic fever is another form
of the disease, which is more serious and can be fatal.
RECENT ADVANCES IN VACCINE DEVELOPMENT FOR THE TREATMENT OF
DENGUE Dengue virus belongs to the Flavivirus family characterized
by single stranded, positive sense RNA genome. Mutation rates in
RNA viruses are exponentially greater than agents with DNA genomes
due to the lack of proof reading mechanisms in the RNA dependant
RNA polymerases of the former. This leads to the development of
antigenic diversity because of varying levels of inter-virus
genetic recombination. Although no licensed vaccine is currently
available to combat dengue, a substantial amount of research has
been undertaken over many years and in several countries. As a
result, a number of conventional and novel vaccines are being
developed and several are undergoing clinical trials. In theory, an
effective vaccine against dengue is possible because it causes an
acute infection and the viral levels are effectively controlled in
a span of 3 to 7 days. Further, an individual exposed to a
particular type of dengue is immune against re-infection with that
subtype, thus leading to experiments in animal models, which have
shown that passive transfer of virus specific antibodies are
protective against subsequent challenge with that specific viral
subtype. The major obstacles relating to the development of an
effective dengue vaccine include a lack of complete understanding
regarding the pathogenesis of dengue hemorrhagic fever and the
absence of a representative animal model. Pre-existing heterotypic
dengue antibody is a risk factor for DHF; therefore, an effective
vaccine will have to be tetravalent and needs to prevent infection
with all four DV serotypes. Recent advances in molecular biology
and recombinant DNA
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technology have made it possible to create new strains that have
the non-structural proteins of a certain subtype flanked by
envelope antigens from a combination of different strains. This has
lead to the emergence of the chimeric dengue vaccine. Recent
studies have shown that by means of DNA shuffling and screening
techniques, an envelope antigen capable of inducing neutralizing
antibodies against all 4 types of dengue virus has been developed.
Another approach has been the introduction of antibody inducing
plasmid into DNA vaccines. This has also shown to produce
significant antibody response in animal trials. Some other areas of
interest include recombinant envelope vaccine, whole cell
inactivated dengue vaccine and the development of a tetravalent
live attenuated vaccine. Studies have shown that non-structural
proteins in comparison to envelope antigens do not elicit efficient
immune response on exposure. Novel approaches to find attenuated
strains that selectively identify infected dendritic cells are
underway. This increases the
effectiveness and the safety of the vaccine. The importance of
understanding the correlation between protection and mechanisms of
pathogenesis cannot be neglected. However, there is an escalating
need to provide a solution to the global threat of dengue infection
and the complications associated with the same. Better disease
management, vector control and improved public health measures will
help reduce the current disease burden, but a safe and effective
vaccine is probably the only long-term solution to this problem.
AYURVEDIC TREATMENT FOR DENGUE FEVER Dengue fever is a very serious
disease and self-medication should not be done. Medical attention
is extremely important. But in presence of continued symptoms,
there are several Ayurvedic herbs that can provide relief. The
following is a list of some herbs which are used for the treatment
of common fevers (not dengue fever in particular).
Ayurvedic Name of the Herb
Biological Name of the Herb
Common English Name of the Herb
Action on the Human Body
Amaltas Cassia fistula Cassia The root of the cassia tree is
used as a tonic for reducing dengue fever.
Chirayata Swertia chirata
Chirayata Chirayata has tremendous medicinal properties in the
reduction of fevers. It is used for remedying the convulsions that
accompany fevers in dengue.
Datura Datura stramonium
Dhatura Dhatura is the Ayurvedic version of the homeopathic
belladonna. Its leaves have potency in reducing the seriousness of
the dengue fevers. However, the dosage must not exceed 2 decigrams,
or it will lead to severe negative symptoms like dryness of the
mouth and dilation of the pupils.
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Hara dhania Coriandrum sativum
Coriander The leaves of the coriander can be taken in the form
of a tonic to reduce the fevers in dengue.
Hermal Peganum harmala
Hermal The seeds of hermal are powdered and taken as either an
infusion or as a decoction to treat intermittent and recurrent
fevers that are observed in dengue.
Kanghi Arbutilan indicum
Indian Mallow
An infusion of the Indian Mallow is used as an efficacious
treatment for reducing the dengue fevers.
Methi Trigonella foenum graecum
Fenugreek Fenugreek leaves are taken as herbal tea in order to
reduce fevers. This drink acts as a soothing and cleansing tea for
the human system. Fenugreek herbal tea has similar properties as
those of quinine.
Punarnava Boerhaavia diffusa
Hogweed Hogweed is used to bring down temperatures. Hogweed
produces plenty of perspiration which flushes the toxins and brings
the fever down.
Rojmari Achillea millefolium
Bloodwort Bloodwort is a traditionally used remedy for all types
of fevers in Ayurvedic medicine. Bloodwort when used in the form of
a hot infusion brings out sweat, which expels the toxins from the
body and reduces the fever.
Shaitan ka jhhad
Alstonia scholaris
Devils Tree Devils tree is used in Ayurveda for the treatment of
recurrent fevers as is seen in dengue. The herb is analogous in
function to cinchona and quinine. A hot infusion of the devils tree
can bring down high temperatures without making the person break
out into a sweat.
Tulsi Ocimum sanctum
Holy Basil Tender leaves of the holy basil boiled in water is a
very effective prophylactic (preventive) treatment for the rainy
season fevers, which include malaria and dengue. For better taste,
the tender tulsi leaves can be taken as a tea with a pinch of
cardamom powder in it. This is also a very popular recipe for
Indian herbal tea.
CONCLUSION Dengue is an infectious disease causing frequent
epidemics. There are various factors that contribute like lack of
effective mosquito control, lack of public health systems to
control the epidemic, the increase usage of plastic items which are
the
breeding sites of the mosquitoes.Most people infected with
dengue virus experience no symptoms at all or only a mild fever.
Others develop flu-like symptoms, headache, and joint and muscle
pain. A smaller portion of those infected
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experience the more severe dengue hemorrhagic fever/shock
syndrome (DHF/DSS), which can cause high fever, pain, bleeding, a
drop in blood pressure, and, in some cases, coma or death. As far
as the treatment is concerned there is no specific course, However
the affected person is treated with Paracetamol to bring down the
fever. The person is usually adviced to drink lots of fluids. The
infected person should be isolated until recovery from the rest of
the family to prevent further infections. Although there is no
vaccine to prevent this epidemic certain preventive measures as
specified below can be taken to control the epidemic. REFERENCE 1)
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hemorrhagic fever: A potential threat to public health in the
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Philadelphia, Pa: Saunders Elsevier; 2007:chap 405.
3) SS Whitehead, JE Blaney, AP Durbin, and BR Murphy. Prospects
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protection to interferon-deficient mice after dengue 2 virus
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PATHOPHYSIOLOGYDengue viral infections frequently are not
apparent. Classic dengue primarily occurs in nonimmune,
nonindigenous adults and children. Symptoms begin after a 5- to
10-day incubation period. DHF/DSS usually occurs during a second
dengue infection in per...SYMPTOMS OF DENGUE FEVER Symptoms of
typical dengue usually start with fever and includesExams and Tests
A physical examination may reveal:DENGUE FEVER PROGNOSISDENGUE
FEVER PREVENTIONDENGUE FEVER COMPLICATIONS
DENGUE HAEMORRHAGIC FEVER / DENGUE SHOCK SYNDROMENATURAL HOME
REMEDIES FOR THE TREATMENT OF DENGUE FEVER Traditional natural home
remedy for dengue fever - Normal dengue fever is not that
dangerous. The symptom-based treatment should be resorted to i.e.,
wet pads could be used if the temperature is ...DIET TIPS FOR
DENGUE FEVER Porridge and baked toasts (not fried) can be had for
allaying hungers in the course of the day. Biscuits with tea can be
had. The tea must be herbal, with tulsi, ginger, cardamom and other
such fever-reducing herbs in it. Le...RECENT ADVANCES IN VACCINE
DEVELOPMENT FOR THE TREATMENT OF DENGUE