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Dengue Fever - A endless disease


By Dr. Aye Min Htoo M.B.B. S (Dermatologist,Cosmetic Surgeon and Writer) on 2020-06-04 21:23:36

Dengue fever is caused by the dengue virus, due to the bite of Aedes aegypti mosquitoes. Cutaneous and mucosal findings like confluent erythema, morbilliform eruptions, and hemorrhagic lesions may be seen in the clinical features of dengue. 

 

Dengue virus 

  • Four serotypes of the dengue virus (DEN 1-4)
  • Single-stranded RNA virus
  • A flu-like illness that affects infants, children, adolescents, and adults

 

Dengue fever

  • Fever over 102F
  • Eyeball pain
  • Malaise
  • Headache 
  • Myalgia
  • Arthralgia
  • Face flash within 2 days (due to capillary dilation)
  • Rash (appear on day 5 of fever) from extremities to Tarso (within-day)
  • Exanthem- Resemble White Island within the Red Sea

Lab test 

  • Leukopenia + supportive serology

 

Dengue hemorrhagic fever 

  • Symptoms of Dengue fever + Mucosal bleeding
  • Petechiae, ecchymoses or purpura, hematemesis, and Malena
  • generalized rash characteristically starts on the dorsum of the hands and feet, then spreads to the arms, legs, and torso.

Lab test

  • Positive tourniquet test (when >20 petechiae/2.5 cm2 )
  • Thrombocytopenia (<100000 cells/mm3)
  • hematocrit ≥20% above (due to plasma leakage)
  • Pleural effusion or ascites (rare)

 

Dengue shock syndrome

  • Severe hemorrhage or organ failure 
  • cold and clammy extremities 
  • BP < 90mmHg, Weak pulse

 

Dengue diagnosis

  • NS 1 test (non-structural protein of dengue virus)- acute dengue infection
  • Dengue IgM (active disease)
  • Dengue IgG titer (previous infection)

 

Differential diagnosis

  • Chikungunya virus
  • Measles 
  • Rubella
  • Scarlet fever
  • Kawasaki disease
  • Roseola (HHV 6)
  • Infectious mononucleosis 

 

Treatment

Dengue fever needs just supportive treatment, such as antipyretic (paracetamol), enough fluid intake, and will recover on its own after 7 days. 

 

ORS (according to body weight)

  • <10 kg    - 100ml/kg/day 
  • 10-20kg - 75ml/kg/day
  • > 20kg   - 50ml/kg/day

 

Monitor every 8 hours

  • HR, capillary filling time, pulse volume, urine output, BP, and pulse pressure
  • Hb/platelet count Q24H.

 

For fluid replacement, Ringer lactate (or) sodium chloride 10-20ml/kg/hr infusion is the choice for dengue hemorrhagic fever. Then, reduced to 5ml/kg/hr, 3ml/kg/hr, 2ml/kg/hr every 2 hours if the symptoms have improved. Stop the IV fluid at 48 hours and change to ORS as required.

 

Home remedies 

  • Drinking papaya leaf juice

 

Dengue Vaccine

  • Dengvaxia is available in some countries (ages 9-45 years old) 0-6-12months

 

Outcome

 

Typical dengue fever is fatal in < 1% of cases.

Dengue hemorrhagic fever is fatal in 2.5% of cases. If DHF is not treated, mortality rates can be as high as 20%-50%.

 

How to avoid mosquito bite

  • Mosquito net
  • Mosquito repellent  - 10% diethyltoluamide (DEET)
  • Long sleeve cloth
  • Cover, Clean and good flow water around your environment

 

The Article is written by Dr. Aye Min Htoo. He is among the few renowned doctors in Myanmar and has gained rich experience in Dermatology and Aesthetic field. His overwhelming qualifications are M.B.B.S, PG. Dip Derm (UK), M.Sc Derm (UK), P. Dip Derm (Australia), Dip. Aesthetic Medicine (USA). He wrote the articles in various journals, magazines and newspapers, and also served as an editor in Dr. Ziwaka Magazine and Beauty Secrets Magazine. He is the pioneer doctor in Myanmar in contributing beauty tips SMS service via Telenor. Dr. Aye Min Htoo has been a prolific writer for nine years contributing towards the online community for sharing open medical information through various open-source knowledge platforms.

 
 

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