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Dengue Fever- Questions And Answers

Dengue fever is a term that is commonly used to refer to clinically moderate dengue virus infections.

Introduction

<a href="https://merisehat.pk/disease/dengue-hemorrhagic-fever-dengue-shock-syndrome">Dengue fever</a> is the fastest-growing vector-borne ailment in humans that has persistently placed a significant strain on healthcare systems around the globe in general and in tropical and subtropical areas in particular<a href="#accordion">[1]</a>.

According to the WHO, around 100-400 million people are infected every year, with roughly 80% of them categorised as mild and asymptomatic. That&rsquo;s nearly half of the world&rsquo;s population at risk of contracting dengue<a href="#accordion">[6]</a>. 
&nbsp;

Understanding Commonly Asked Questions About Dengue Fever

There are 4 serotypes (groups of microbes within a single species, for example, bacteria or viruses, that share particular surface structures) of the dengue virus:

<ol>
	<li>DENV-1</li>
	<li>DENV-2</li>
	<li>DENV-3</li>
	<li>DENV-4</li>
</ol>

Each of the 4 serotypes is capable of causing dengue fever.

Dengue fever is a term that is commonly used to refer to clinically moderate dengue virus infections, whereas dengue haemorrhagic fever (DHF) is used in more serious instances. 
&nbsp;

<h5>Symptoms Of Moderate Dengue</h5>

Moderate dengue is often mistaken for other diseases since a lot of them cause similar fever, pain, discomfort, and rashes.

However, one of the most frequent signs of dengue is fever presenting along with the following symptoms:

<ul>
	<li>Nausea or vomiting</li>
	<li>Rashes</li>
	<li>Pain and discomfort (e.g., eye pain, muscular pain, joint pain).</li>
</ul>

These symptoms usually last 2-7 days and a majority of individuals get better within a week. 
&nbsp;

<h5>Symptoms Of Severe Dengue</h5>

It&rsquo;s crucial to keep an eye out for signs and symptoms of DHF because it can be life-threatening. The warning signs usually appear 24-48 hours after the fever has subsided:

<ul>
	<li>Belly aches and tenderness</li>
	<li>Vomiting at least thrice a day</li>
	<li>Nose or gum bleeding</li>
	<li>Puking blood or passing blood in the faeces</li>
	<li>Feeling tired, agitated, or restless 
	&nbsp;</li>
</ul>

Note: If any individual or their loved one experiences any of the symptoms, consult a doctor or visit an emergency room immediately. 
&nbsp;

<h5>How Long Does Dengue Fever Last?</h5>

Mostly, dengue resolves within a week or two and has no long-term consequences. It&rsquo;s important to immediately consult a doctor if the illness is serious, or if the symptoms have worsened during the first two days following the dengue fever; DHF is a medical emergency. 
&nbsp;

The Aedes mosquito can carry the dengue virus without becoming ill. These mosquitoes themselves become infected after they bite an infected person. When an infected mosquito bites an otherwise healthy individual, it passes the virus into the person&#39;s bloodstream. As a result, people and mosquitos are continuously exchanging dengue viruses. The dengue virus is present as long as Aedes mosquitos are present in the environment.

It can be transmitted from the mother to the foetus during pregnancy or at the time of birth<a href="#accordion">[7]</a>. 
&nbsp;

<ol>
	<li>
	<h5>&nbsp;Dengue Virus Antigen NS1 Detection </h5>
	</li>
</ol>

<ul>
	<li>NS1 tests detect the dengue virus&#39;s nonstructural protein NS1. This protein is secreted into the bloodstream during the infection.</li>
	<li>NS1 can be detected throughout the acute stage of dengue virus infections. NS1 tests can be as sensitive as molecular tests if conducted on the first seven days of symptoms. These tests are not suggested after the 7th day. 
	&nbsp;</li>
</ul>

<ol start="2">
	<li>
	<h5>&nbsp;IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA)</h5>
	</li>
</ol>

<ul>
	<li>The dengue MAC-ELISA is used to qualitatively detect dengue virus IgM antibodies.</li>
	<li>Once the individual gets dengue, their immune system will start combating it. IgM antibodies against the dengue virus can be detected 4-5 days after the onset of signs and symptoms. They are fairly noticeable for up to 12 weeks.</li>
	<li>Positive dengue IgM antibodies are typically used to confirm a recent dengue virus infection; however, these presumed positive IgM antibody test results should be further confirmed through PRNT. 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>
	<h5>&nbsp;Plaque Reduction Neutralization Test (PRNT)</h5>
	</li>
</ol>

<ul>
	<li>PRNT detects particular antibodies that neutralise dengue virus and other flaviviruses.</li>
	<li>It is used to detect the source of infection more accurately in IgM-positive individuals for whom a particular detection is clinically or epidemiologically necessary (e.g., to exclude additional flaviviruses, for example, Zika or yellow fever).</li>
	<li>PRNT is employed in an attempt to verify the virus in dengue or Zika virus IgM-positive samples. In a few instances, it can detect the infecting serotype of the dengue virus.</li>
	<li>PRNT carried out on a dengue IgM-positive sample demonstrating neutralising antibodies to just one dengue virus serotype verifies infection with that serotype<a href="#accordion">[8]</a>. 
	&nbsp;</li>
</ul>

During the febrile phase (2-7 days), individuals with dengue infection are prone to dehydration due to diarrhoea, nausea, throwing up, anorexia, and high fever<a href="#accordion">[1]</a>.

Doctors must assess the severity of dehydration in patients to provide proper care and management. Urine colour correlates directly with the overall hydration status so that can be used as an indicator. According to a study, consuming more than 5 glasses of fluid in the 24 hours right before the clinical evaluation reduced the risk of dengue fever patients getting hospitalised<a href="#accordion">[2]</a>. 
&nbsp;

<h5>Why Does Dengue Fever Cause Low Platelet Count?</h5>

Thrombocytopenia during dengue can result from either reduced bone marrow cell production or increased platelet destruction and clearance from peripheral blood. A high mean platelet volume (MPV) in patients means increased platelet destruction. MPV levels in dengue patients are typically high; thus, excessive platelet destruction can be the primary cause of thrombocytopenia in dengue patients. According to a number of studies, platelet count decreases significantly on the fourth day of the infection<a href="#accordion">[3]</a>. 
&nbsp;

<h5>When Do Patients Need A Platelet Transfusion?</h5>

As specified by clinical guidelines, platelet transfusions should be given to individuals presenting with a severe haemorrhagic exhibition, with platelet counts dropping less than 10&ndash;20 &times; 109 /L.<a href="#accordion">[3]</a>. 
&nbsp;

The WHO considers thrombocytopenia to be a criterion for determining the severity of the ailment. Thrombocytopenia is a rapid drop in platelet count or a platelet count of less than 150,000/mm<a href="#accordion">[3]</a>&nbsp;(&lt; 150 G/L)<a href="#accordion">[9]</a>.

A serious dengue patient with a decreased platelet count will have bleeding spots on the skin in different body parts. Severe dengue affects the lungs, liver, and heart. If the blood pressure falls to dangerously low levels, it can result in shock and, in some instances, death. 
&nbsp;

<ul>
	<li>
	There is no particular medication to treat dengue. Viruses always complete their cycle of either 5 or 7 or 14 days.
	</li>
	<li>Consult a doctor always. Meanwhile, symptomatic treatment can help alleviate the symptoms of dengue fever. 
	&nbsp;</li>
</ul>

<h5>Symptomatic Treatment</h5>

<ul>
	<li>Rest as much as you can.</li>
	<li>Take Panadol to control fever and alleviate pain and discomfort. 
	&nbsp;</li>
</ul>

Avoid aspirin and ibuprofen as they cause more bleeding <a href="#accordion">[10]</a>.

<ul>
	<li>Stay hydrated by drinking plenty of fluids. Drink water or electrolyte-enriched beverages.</li>
	<li>Care for a sick baby, child, or family member at home only if the signs are moderate. 
	&nbsp;</li>
</ul>

<h5>Food That Helps To Boost Platelet Count</h5>

One of the symptoms that incidentally also help with its diagnosis is that dengue affects the platelet count in the body. Especially in case of severe dengue; symptoms usually become life-threatening because the number of platelets in the bloodstream drastically drops.

Treatment recommendations are normally attempts to boost this platelet count to ensure the individual has a greater chance of combating the infection. 
&nbsp;

Hence, it&rsquo;s advised to consume a diet that&rsquo;s rich in

<ul>
	<li>Omega-3</li>
	<li>Iron</li>
	<li>Vitamins</li>
	<li>Other minerals 
	&nbsp;</li>
</ul>

<h5>How To Take Care Of Your Sick Baby At Home</h5>

<ul>
	<li>Paracetamol can help reduce fever<a href="#accordion">[11]</a>.</li>
	<li>Give sponge baths with cool water in summer and with normal water in winter.</li>
	<li>Make sure they drink plenty of liquids. Dehydration occurs when an individual loses excessive body fluid due to fever, vomiting, or not drinking the required amount of liquids.</li>
	<li>Keep an eye out for symptoms of dehydration and seek medical attention right away if the baby exhibits any of them. 
	&nbsp;</li>
</ul>

<ul>
	<li>
	Extreme skin bleeding with blood specks on the skin (petechiae) and huge blotches of blood under the skin (ecchymoses)
	</li>
	<li>
	Black faeces
	</li>
	<li>
	Urine containing blood (hematuria)
	</li>
	<li>
	Leakage
	</li>
	<li>
	Severe plasma respiratory failure
	</li>
	<li>
	Liver failure
	</li>
	<li>
	Heart failure
	</li>
	<li>
	Mental health changes associated with impaired consciousness
	</li>
	<li>
	Patients exhibit warning indications (specifically inactivity and continuous puking)
	</li>
	<li>People with low platelet counts and high haematocrit (high red blood cell counts) have a high likelihood of organ failure problems or even death 
	&nbsp;</li>
</ul>

From Mosquito Bite

<ul>
	<li>Use mosquito repellent</li>
	<li>Keeping the body covered</li>
	<li>Discard any standing water 
	&nbsp;</li>
</ul>

Dengue Virus Vaccine&nbsp;

Dengvaxia is the only dengue vaccine that&rsquo;s been approved by the FDA and suggested for regular use by the Advisory Committee on Immunization Practices. It protects against all 4 dengue virus serotypes<a href="#accordion">[12]</a>.

By the end of 2022, Dengvaxia will be accessible for use in youngsters (aged 9-16) who have previously been infected with dengue virus and who currently reside in a region where dengue is endemic, i.e., takes place commonly or constantly. 
&nbsp;

Can Malaria And Dengue Occur Concurrently?

While there is no denying that malaria and dengue are highly prevalent in tropical countries, it is rare to have both dengue fever and malaria at the same time. Appropriate lab tests should be conducted to confirm the disease condition because the treatment of both diseases is different. Repeated blood smears are a credible test to avoid incorrect negative results and successive malaria misdiagnosis<a href="#accordion">[5].</a>&nbsp;Malaria and dengue fever should be presumed in pyretic patients residing in or returning from areas where malaria and dengue is prevalent<a href="#accordion">[4]</a>. 
&nbsp;

Conclusion

Annually, hundreds of millions of people become infected with dengue. Even if the majority of cases are mild or asymptomatic, the prospect of severe dengue can be frightening.

Fortunately, it can be prevented. Precautions like keeping the skin covered at all times reduce the risk of mosquito bites. While travelling to endemic regions, find out beforehand where emergency medical attention is being provided for the dengue. Recovery is possible if the patient receives proper treatment on time. 
&nbsp;

Key Takeaways

<ul>
	<li>The dengue virus causes dengue fever, which can be transmitted through mosquito bites.</li>
	<li>Dengue fever is frequent in many areas of the world, so individuals travelling to the endemic regions should take precautions against mosquito bites. This includes keeping the body well covered, using mosquito netting, and applying mosquito repellent.</li>
	<li>Dengue fever can be fatal. Make sure to get medical attention right away to avoid symptoms from worsening. 
	&nbsp;</li>
</ul>

[1] Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176(2):313–21.

[2] Harris E, Pérez L, Phares CR, de los Angeles Pérez M, Idiaquez W, Rocha J, et al. Fluid intake and decreased risk for hospitalization for dengue fever, Nicaragua. Emerg Infect Dis. 2003;9(8):1003.

[3] Das S, Abreu C, Harris M, Shrader J, Sarvepalli S. Severe Thrombocytopenia Associated with Dengue Fever: An Evidence-Based Approach to Management of Thrombocytopenia. Case Rep Hematol. 2022;2022.

[4] Carme B, Matheus S, Donutil G, Raulin O, Nacher M, Morvan J. Concurrent dengue and malaria in Cayenne hospital, French Guiana. Emerg Infect Dis. 2009;15(4):668.

[5] Bhagat M, Kanhere S, Phadke V, George R. Concurrent malaria and dengue fever: a need for rapid diagnostic methods. J Fam Med Prim Care. 2014;3(4):446.

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