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Dengue fever also named as breakbone fever, is a contagious disease transmitted by mosquitoes and triggered by anyone of four related dengue viruses. With nearly 50–100 million people infected annually dengue is becoming a serious threat to life in tropical areas of the world. Dengue is spread by several species of mosquito within the genus Aedes, principally A. aegypti. There are four different, but closely related, viruses that onset dengue namely D-1, D-2, D-3 and D-4. Since this fever is trigged by four different serotypes of virus, it is likely to acquiredengue fever several times in one’s life. Nevertheless, an infection of dengue creates immunity in that person for the lifetime for specific serotype with which the patient was infected. The patients of dengue frequently suffer from contortions because of the severe joint and muscle pain; hence this disease is also referred to as breakbone fever. Dengue has been known to health experts for more than 200 years but still there is no solid and effective treatment available against this disease. Dengue raised its neck worldwide since the Second World War and is now widespread in more than 110 countries. However, work is being done to make vaccine as well as medication targeted precisely at the virus to cure dengue. Cause and Transmission The dengue virus is caused by the bite of Aedes aegypti mosquito that has earlier bitten an individual infected with dengue virus. Because of this reason human beings are the said to be the major carriers of this virus by acting as a source of virus for uninfected mosquitoes. After viral incubation for 8 to 10 days, the infected mosquito becomes capable of passing on the virus to human beings and to its offspring throughout its life. This mosquito grows in damp and rainy times of the year but also can reproduce in water-filled tubs, plastic jars, and cans throughout the year. A person can acquire the disease in single bite of mosquito. However, the dengue virus is not contagious and it can’t spread the disease directly from one person to the other. There ought to be a person-to-mosquito-to-another-person trail for it to spread the disease. Symptoms Dengue (pronounced DENG-gay) can affect anybody but it is more brutal in individuals with weak immune systems. The symptoms of dengue fever occur in stages and are as follows: In the initial phase the patients suffer from coldness, headache, pain in the eyes while moving them around and backache in the lower part of body. Sore aching in the legs and joints are also exhibited by patient in the early stages of infection. Then the temperature of the person goes up rapidly as high as 104 F (40 C). Redness occurs in the eyes followed by a pale pink rash over whole face and then it fades away. The above symptoms continue for two to four days followed by a sudden fall in body temperature with prolific sweating. This leads to a phase with average temperature and a feeling of comfort that continues for about a day. A second brisk climb in temperature follows. Specific rashes develop together with the fever and extend from the boundaries to cover up the whole body apart from face. So the typical patient at any stage of infection exhibits following symptoms: High fever and at least two of the following: Severe headache Acute eye pain (behind eyes) Pain in joints Intense muscle pain Rash Mild bleeding symptom Low count of white blood cells Mechanism of Dengue Action: The mechanism of dengue action is segregated into three phases named as: febrile, critical, and recovery phase. Febrile Phase: This is the initial phase which involves high fever, usually above 40 C and is accompanied with general pain and headache. It lasts for about two to seven days. In this phase, a rash arises throughout the body along with approximately 50–80% of other symptoms.The rash starts in the first or second day along with the fever which is itself biphasic in nature, breaks and then returns for one or two days. Critical Phase: If the patient’s immune system is weak and cannot combat with this infection then it enters into a critical phase in which high fever progresses to its peak and lasts from one to two days. Inthis phase there may be large fluid buildup in the chest and abdomen because of intense capillary permeability and leakage. This results in lessening of fluid and blood from the circulation which ultimately reduces supply of blood to vital organs of the body. In this phase, organ dysfunction and serious bleeding may take place from the gastrointestinal tract. Recovery Phase: The recovery phase proceeds after critical phase in which resorption of the seeped out fluid into the bloodstream occurs.This phase generally lasts two to three days. The recovery is often signaled, but there may possibly be intense itching and low blood pressure. This phase may involve damage to brain because of fluid overload which can result in reduced level of consciousness. Diagnosis Dengue fever becomes hard to spot because its signs tend to overlap with many other viral diseases. The first factor which indicates the presence of dengue fever is the low white blood cell count, which leads to low platelets count. In most of the cases the victims of dengue fever are usually diagnosed on the basis of fever plus two of the following symptoms: headache, vomiting, rash, pains in whole body, low white blood cell count, eye pain, severe muscle aches, positive tourniquet test, or any of the other symptoms associated with dengue fever. Treatment Since dengue fever is a viral infection, there is no particular medicine available to cure it. For typical dengue fever case, the medication is solely involved with liberation of the symptoms. Early on and proactive approach towards treatment with fluid intake and electrolyte replacement can be very beneficial. Moreover the victims of dengue are advised to use analgesics (pain relievers) with acetaminophen and keep away from medicine that contain ibuprofen, Naproxen, aspirin or aspirin containing drugs. Dengue is a painful disease but with proper care and guidance most people recover within 2 weeks. To help with recovery, healthcare specialist suggest to: Get complete bed rest Drink lots of fluids Taking medicine to reduce fever Helpful Diet The diet used for treatment for dengue primarily consist of juices rich in ingredients that aid to enhance the performance of immune system. Although there is no clinically proved diet plan for dengue patients but following foods have been found helpful in treating dengue fever: Papaya juice can be very beneficial to improve the performance of immune system by enhancing platelets count which ultimately cures dengue. Rice gruel has been shown to be excellent remedy for dengue patients. Biscuits with tea can be had in morning and evening can be helpful. The tea must be herbal rich in fever reducing ingredients like ginger, cardamom etc. Baked toats along with the tea are also helpful as breakfast. The patients suffering from dengue should avoid any kind of spices in their diet. Porridge can be given to the patients during the times of hunger. Prevention and Control There is no specific and effective vaccine available to control dengue which makes prevention the most vital step, and prevention means to evade the bite of mosquito. This can be done by reducing habitats where it mosquito lays her eggs. Stagnant water pots, outdoors, clean water containers; flower planter dishes should be emptied to restrict the growth of mosquito. Governmental programs to reduce mosquitoes also facilitate to keep dengue fever in check but have been weakly successful. The Aedes aegypti mosquito is a daylight biter with high time of biting around dawn and dusk. It usually slyly resides in homes in curtains and behind the doors and can bite anytime. In order to protect yourself from the bit of mosquito do the following: Use mosquito repellant sprays that include DEET as the major component Try to wear long sleeved shirts and pants along with socks and shoes for additional protection. Ensure that the home windows and door screens are safe and without openings. Try to sleep in air conditioners if possible. Use mosquito bed net while asleep which can act as a barrier between you and mosquito. Don’t stand near stagnant water for around 2 hours near to sunrise and sunset. If someone in your house is a victim of dengue then, take extra safety measures to stop mosquitoes from biting other members of the family. -- Dr.Arun Kumar Singh B.Sc,MBBS(KEMC),MD Paediatics Medicine(KEMU) Fellowship-Paediatric Endocrinology and Diabetes Nihon University,Japan ------------------------------------------------------------- Assistant Professor Department of Paedatrics Medicine B.P.Koirala Institute of Health Sciences Dharan,Nepal Mobile;+977-9803551879 ,+977-9844241397 http://www.arunsinghnepal.com.np/

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