Dengue Fever

What is it?
Dengue fever is a type of arbovirus, which is short for arthropod-borne virus. The virus that causes
dengue fever is carried by Aedes egypti mosquitoes, and is transmitted to humans through their bite. An
organism that carries a disease, without actually developing the disease, is called a vector.

Who gets it?

The risk for being bitten by a mosquito that is carrying dengue fever is higher in Africa, Southeast Asia
and China, the Indian subcontinent, the Middle East, South and Central America, the Caribbean
Islands, Australia, and the South and Central Pacific. Dengue fever is considered "endemic" to certain
regions, which means it is native to, or naturally occurring, in these areas. Dengue fever is more likely
to occur during or shortly after the rainy season, when the mosquito population is larger. It also most
commonly affects children under the age of 10. Dengue fever is rarely seen in the United States.

What causes it?

When a mosquito that is carrying dengue fever bites a person, the virus travels through the body's
glands. Once in the glands, it multiplies and can enter the bloodstream. Dengue fever is not contagious,
which means one person cannot pass it directly to another.

What are the symptoms?

It takes around five to eight days after being bitten by an infected mosquito for the virus to multiply.
Then, symptoms including high fever, headache, chills, swollen lymph nodes, red eyes and eye pain,
severe joint and muscle pain, flushed face, lower back pain, and general weakness appear suddenly.
These symptoms last for two to three days. Afterward, the fever drops and the patient experiences
heavy sweats, but feels better for around one day. This is followed by an increase in temperature, a
rash, and a headache. The rash consists of small red bumps that begin on the arms and legs, but then
spread to the back, abdomen, and chest. The soles of the feet and palms of the hands also turn red and
swell. Symptoms usually last for up to 10 days, but the patient is weak and extremely tired for up to a
month afterward. In more severe cases, patients have fever and headache, then develop a cough.
The dengue virus causes the blood vessels to swell and leak, creating small purple colored spots on the
skin, called petechiae. The skin may appear bruised in areas where the bleeding is worse. Bleeding into
the stomach causes severe abdominal pains and vomiting of a black, grainy substance that looks like
coffee grounds. This severe bleeding, called hemorrhaging, occurs when the blood runs out of clotting
factors. The damaged blood vessels eventually become so large that they are unable to supply the
needed blood flow and the oxygen it carries to the body's tissues. This causes the body to go into shock,
and can damage major organs such as the heart and kidneys.
Severe cases of dengue fever are called dengue hemorrhagic fever (DHF) or dengue shock syndrome
(DSS). The body produces antibodies, which are disease-fighting cells, that protect the patient who has
had dengue fever from being reinfected for around one year. However, more severe cases of dengue
fever often occur in patients who have already had the virus, then are reinfected at a later time. Because
the immune system recognizes the virus, it overreacts, causing more severe symptoms. Most people
who have had dengue fever are more likely to have recurring similar viral infections over the years.

How is it diagnosed?
The arbovirus that causes dengue fever can be diagnosed by a blood test.

What is the treatment?

Dengue fever, like other arbovirus infections, must run its course. Treatment is focused on medications
to lower fever and reduce pain, fluids to prevent dehydration, and bed rest. Blood transfusions are
given in cases of severe blood loss, and oxygen must be given to patients with dengue shock syndrome
(DSS). Almost all patients with dengue fever have a complete recovery. Those with DSS have a good
prognosis if they receive immediate medical treatment.

Self-care tips
There are ways to protect yourself if you are traveling to a country that is known to have a high
population of dengue fever-carrying mosquitoes. You can avoid mosquito bites by using a mosquito
repellent spray or lotion on your body and clothes and staying in well-screened areas. Your sleeping
area should have mosquito netting over the bed. Avoid leaving any containers of standing water outside
where mosquitoes can breed. See a healthcare professional immediately if you have been in an area
endemic to dengue fever and you have any illness with fever that lasts for more than two days.

This information has been designed as a comprehensive and quick reference guide written by our
health care reviewers. The health information written by our authors is intended to be a supplement to
the care provided by your physician. It is not intended nor implied to be a substitute for professional
medical advice.
Dengue fever and how to avoid it

Vijay Singh in Mumbai | October 10, 2003 | 18:53 IST

Dengue fever is a self-limiting disease, which is transmitted by the bite of an infected female Aedes
aegypti mosquito.
These mosquitoes gather around stagnant water. Hence, it is common for a surge in reports of dengue
infections just after the monsoon.
Four persons reportedly died of dengue and 160 cases of infection were registered in various hospitals
in Mumbai from June to September 2003. Most of the cases were reported from the suburbs of Malad
and Borivali.
The Brihanmumbai Municipal Corporation is not sure how many of the people who died or those
admitted in hospitals were actually infected by dengue.
BMC's Deputy Executive Health Officer Dr J G Thanekar said, "The four people may have died of
dengue, but this could not be confirmed as none of them underwent the second (confirmatory) test.
Rarely do people go in for a second blood test (as they are alerted by the first one and begin
medication)."
In view of the dengue scare in the city, The BMC is organising a campaign to create awareness about
the disease and the necessary precautions to prevent infection.
There are two types of dengue:
1) Classical Dengue Fever: Infected person complains of high fever, intense headache, muscle�and
joint pain, bitter taste, insomnia, anorexia, retro orbital pain and photophobia. Instances of it proving
fatal are extremely low.
2) Dengue Haemorrhagic Fever or Dengue Shock Syndrome: Infected person complains of high fever,
bleeding from nose, gums, ears, skin. May go into shock due to blood loss.
The fever comes within eight days of the mosquito bite.
How to detect if you are infected:
1) Serological test to detect IgM, IgG antibodies: IgM antibodies appear in blood at the end of eight
days and persist for 1-3 months. It indicates acute infection. This is the test that most people undergo. It
has an accuracy of 80-90% and is referred to as the preliminary test.
2) Isolation of virus in blood: This is a sophisticated test, conducted only by the Pune-based National
Institute of Virology. Can be undertaken 10 days after the first blood test. Quite expensive, but it can
confirm if the person is infected by dengue.
3) Polymerized Chain Reaction: This test involves amplification of the DNA (Deoxyribo Nucleic
Acid). Very expensive and hence, undertaken only in rare cases.
The last two are undertaken to confirm infection.
How to avoid it:
1. Water from flower pots should be changed at least once a week
2. All containers storing water should be covered with a tight lid
3. Water stored in barrels, drums etc should be replaced by fresh stock (at least) once a week
4. All large water tanks, like those in buildings, should have single piece cast iron, tight fitting cover. A
suitable ladder should be provided to enable civic staff to climb and examine the tanks at frequent
intervals. The overflow pipe should be protected by a net that can keep away mosquitoes.
5. Discarded container-like objects like tyres, coconut shells, bottles, etc should be disposed off or
destroyed.
6. Water fountains should be kept dry once a week
7. Surface wells should be well-maintained so that mosquitoes do not breed in the vicinity
8. Rain water collected on terraces/roofs should be cleared (at least) once a week
Dengue is also known as Break Bone Fever. If the infection is treated on time, the mortality rate is less
then 15%.

URL for this article:

http://www.rediff.com//news/2003/oct/10deng.htm

What is Dengue Fever?:

Dengue fever and dengue hemorrhagic fever (DHF) are viral diseases transmitted by Aedes mosquitoes,
usually Ae. aegypti. More than 2.5 billion persons now live in areas at risk of infection, and an
estimated 50 million–100 million cases of dengue fever occur each year throughout the world.
How Can I Get Infected With Dengue Fever?:
Dengue fever is transmitted by mosquitoes which carry the virus from one infected person to another
(very similar to malaria). If you get bitten by a mosquito carying the virus, you will get dengue fever.
The mosquito carrying the virus prefers to feed on humans during the daytime and is found in or near
human habitations. Breeding sites include artificial water containers such as discarded tires, uncovered
barrels, buckets, flower vases or pots, cans, and cisterns.
How Can I Avoid Getting Dengue Fever?:
The best way to avoid getting dengue fever is to avoid getting bitten by mosquitoes, especially during
the day when the Ae. aegypti is most active. Use insect repellent that contains DEET for maximum
effect and wear long-sleeved shirts and long pants. Staying in rooms which are air-conditioned or have
a good working fan will also help.
Symptoms of Dengue Fever:
Dengue fever is characterized by the sudden onset of a high fever, severe frontal headache, and joint
and muscle pain. These symptoms appear (usually) after an incubation period of 4-7 days. Many
patients will have nausea, vomiting, and develop a rash. The rash appears 3-5 days after the onset of the
fever and can spread from the torso to the arms, legs, and face. Dengue can also present as a severe,
sometimes fatal hemorrhagic disease called DHF.
Treatment of Dengue Fever:
There is no vaccination for dengue fever. Acetaminophen products are recommended for managing
fever (not aspirin or ibuprofen). Patients should be encouraged to rest and take abundant fluids. In
severe cases, the prompt infusion of intravenous fluids is necessary to maintain adequate blood
pressure. Because shock may develop suddenly, vital signs must be monitored frequently. Hypotension
is a more frequent complication of DHF than severe hemorrhage.
Dengue
• Dengue [DEN-ghee] is a flu-like viral disease spread by the bite of infected mosquitoes.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue.
• Dengue occurs in most tropical areas of the world. Most U.S. cases occur in travelers returning
from abroad, but the dengue risk is increasing for persons living along the Texas-Mexico border
and in other parts of the southern United States.
• There is no specific treatment for dengue.
• Prevention centers on avoiding mosquito bites in areas where dengue occurs or might occur and
eliminating breeding sites.

What is dengue fever? What is dengue hemorrhagic fever?

Dengue fever is a flu-like illness spread by the bite of an infected mosquito.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.

What is the infectious agent that causes dengue?

Dengue and dengue hemorrhagic fever are caused by any of the dengue family of viruses. Infection
with one virus does not protect a person against infection with another.

How is dengue spread?

Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an
infected person and then biting someone else.

Where is dengue found?

Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the
Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most common
in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old
oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause
malaria, dengue mosquitoes bite during the day.

What are the signs and symptoms of dengue fever and dengue hemorrhagic fever?
Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes,
and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever."
Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of
the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older
children and adults are usually sicker than young children.
Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic
fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose,
mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the
blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal
in about 5 percent of cases, mostly among children and young adults.

How soon after exposure do symptoms appear?

The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to
6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons but
can be a source of dengue virus for mosquitoes for about 6 days.

How is dengue diagnosed?

Dengue is diagnosed by a blood test.

Who is at risk for dengue?

Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue
hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus.
Persons who were previously infected with one or more types of dengue virus are thought to be at
greater risk for developing dengue hemorrhagic fever if infected again.

What is the treatment for dengue and dengue hemorrhagic fever?

There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of
fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic
fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.

How common is dengue?

In tropical countries around the world, dengue is one of the most common viral diseases spread to
humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of thousands of
cases of dengue hemorrhagic fever occur each year.
In the United States, approximately 100 cases of dengue are reported each year in travelers returning
from tropical areas. Many more cases probably go unreported. A few persons have become infected
with dengue while living in the United States. Aedes mosquitoes are found in Texas, Florida, and other
southern states, and locally acquired dengue has been reported three times since 1980 in southern
Texas.

Is dengue an emerging infectious disease?

Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent
epidemics, especially in cities in the tropics. The emergence of dengue as a major public health
problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic levels
in Central America and is threatening the United States.
Several factors are contributing to the resurgence of dengue fever:
• No effective mosquito control efforts are underway in most countries with dengue.
• Public health systems to detect and control epidemics are deteriorating around the world.
• Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and
substandard sanitation, allowing more mosquitoes to live closer to more people.
• The increase in non-biodegradable plastic packaging and discarded tires is creating new
breeding sites for mosquitoes.
• Increased jet air travel is helping people infected with dengue viruses to move easily from city
to city.
Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more forms
of dengue virus are at greater risk for the more severe disease. With the increase in all types of virus,
the occurrence of dengue hemorrhagic fever becomes more likely.

How can dengue be prevented?

There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to
areas where dengue occurs and when in U.S. areas, especially along the Texas-Mexico border, where
dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention
measure.
Avoid mosquito bites when traveling in tropical areas:
• Use mosquito repellents on skin and clothing.
• When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants
tucked into socks.
• Avoid heavily populated residential areas.
• When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not
screened or air-conditioned.
• If you have symptoms of dengue, report your travel history to your doctor.
Eliminate mosquito breeding sites in areas where dengue might occur:
• Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off
water, especially old tires.
• Regularly change the water in outdoor bird baths and pet and animal water containers.

Preventive Measures to avoid Dengue Fever

Few easy-to-remember Tips to avoid Dengue Fever.
- Use mosquito repellents.
- discard all unwanted items getting gathered around the living area to avoid the breeding of
mosquitoes.
- Keep the water stores CLEAN and CLOSED.
- keep yourself well covered when outside.
- Take prompt medical advice once fever starts.
Dengue Fever on the Rise:

Cases of dengue fever are on the rise in many parts of the world, including Central and South America,
as well as many parts of Asia. Mexico has also seen a rise in cases of dengue, and the government has
taken steps to reduce the spread of the disease, but tourists should also take their own precautions.
What is Dengue Fever?:
Dengue fever is a flu-like illness which is caused by being bitten by an infected mosquito.
Symptoms of Dengue:
The symptoms of dengue may appear from any time between three days and two weeks from being
infected. If you become ill after returning from a trip, be sure to tell your doctor where you were
traveling.
• Sudden onset of fever
• Severe headache, muscle and joint pain
• Rash
• Gastrointestinal problems
Dengue Fever Treatment:
Dengue fever is treated with rest, and acetaminophen to bring down the fever. It is recommended to
take in plenty of fluids to avoid dehydration. Usually symptoms clear up in about two weeks but some
people may feel tired and sluggish for several weeks.
How to Avoid Dengue Fever:
There is no vaccine against dengue fever. The illness is avoided by taking preventive measures:
• wear clothing that covers your skin
• use an insect repellent containing DEET (Compare prices)
• stay in areas with air-conditioning and/or screens and mosquito nets
Dengue Hemorrhagic Fever:
Hemorrhagic Fever is a complication of dengue. Persons who have been infected with one or more
forms of dengue virus are at greater risk for this more severe form of the disease.
Dengue fever

Introduction
Dengue fever is a disease — ranging from a mild to severe — caused by four related viruses spread by
a particular species of mosquito. Mild dengue fever causes high fever, rash, and muscle and joint pain.
More severe forms of the disease — dengue hemorrhagic fever and dengue shock syndrome — can
additionally cause severe bleeding, a sudden drop in blood pressure (shock) and death.

Related Articles
• Dengue Fever
• Viral hemorrhagic fevers
» More overview Articles
No specific treatment for dengue fever exists, and most people recover. But if you have a severe form
of the disease, you need hospital care.
Fifty million to 100 million cases of dengue infection occur worldwide each year. Most cases of dengue
fever occur in urban areas of tropical and subtropical regions. A few cases have been reported in the
United States — particularly in Texas, along the border with Mexico, and in Hawaii.

Signs and symptoms

Signs and symptoms of dengue fever usually begin four to seven days after you've been bitten by a
mosquito carrying a dengue virus. These signs and symptoms can vary, depending on the form of the
disease. More severe forms of the disease usually begin the same way as the mild form (dengue fever),
then become worse after several days.
Dengue fever signs and symptoms typically include:
• High fever, up to 105 F
• A rash over most of your body, which may subside after a couple of days and then reappear
• Severe headache, backache or both
• Pain behind your eyes
• Severe joint and muscle pain
• Nausea and vomiting
Dengue fever rarely causes death, and symptoms usually get better after five to seven days.
Dengue hemorrhagic fever — a more severe form of the disease — can also cause:
• Significant damage to your blood and lymph vessels
• A decrease in the number blood cells that help your blood clot (platelets)
• Bleeding from the nose, mouth and under the skin, creating the appearance of bruising
• Death
Dengue shock syndrome — the most severe form of the disease — may also cause:
 • Blood vessel fluid (plasma) leakage
• Heavy bleeding
• A sudden drop in blood pressure (shock)
• Death
These signs and symptoms usually appear between the third and seventh day of illness, after fever has
improved. They may be preceded by severe abdominal pain, frequent vomiting and disorientation. Two
percent to 5 percent of those with a severe form of the disease die. Modern supportive hospital care
decreases this risk.
Recovery from dengue fever may include a long period of listlessness, fatigue and even depression.

Causes
Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti mosquito. These
mosquitoes thrive in and near human habitations where they breed in even the cleanest water.
Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a person
infected with a dengue virus, the virus enters the mosquito's bloodstream. It then circulates before
settling in the salivary glands. When the infected mosquito then bites another person, the virus enters
that person's bloodstream, where it may cause the serious illness.
You can become infected with dengue fever more than once. This happens when you're exposed to a
different one of the four dengue viruses than one to which you were previously exposed. Infection a
second time is typically what causes the more severe form of the disease — dengue hemorrhagic fever.

Risk factors
If you live or travel in tropical areas
Living in or traveling to an area where dengue fever viruses are present puts you at risk of the disease.
These areas include many tropical and subtropical areas around the world, for example:
• Central and South America
• Southeast Asia
• The Caribbean
• Africa
• India
• The Middle East
• The South and Central Pacific
Particularly high-risk areas include tropical Asia, Central and South America and the Caribbean.
Dengue virus transmission may occur year-round, although the risk is highest during a recognized
dengue fever outbreak.
If you've had dengue fever before
If you've had dengue fever before, you can get it again if you become infected with another one of the
four dengue viruses. Having antibodies to a virus in your blood from a previous infection usually helps
protect you. But in the case of dengue fever, it actually increases your risk of severe disease — dengue
hemorrhagic fever — if you're infected again. So previous infection with a dengue fever virus increases
your risk of a more severe form of the disease. This most often occurs in children.
If you're young, white or female
If you are younger than age 12, female or white, you are also at greater risk of the severe form of the
disease — dengue hemorrhagic fever.

When to seek medical advice

If you have any signs or symptoms of dengue fever, see your doctor, and explain that you've recently
traveled to a region in which the disease is known to occur.

Screening and diagnosis

Diagnosing dengue fever can be difficult. That's because its signs and symptoms can be easily confused
with those of other diseases, such as malaria, leptospirosis and typhoid fever. Still, diagnosis of dengue
fever is typically done by evaluating your signs and symptoms along with your medical and travel
history. To diagnose your condition, your doctor will likely ask about these. In addition, your blood
may be tested for evidence of a dengue virus.
Medical history
Your doctor will likely ask about your medical and travel history and any exposure to mosquitoes. Be
sure to describe international trips in detail, including the countries you visited and the dates, as well as
any contact you may have had with mosquitoes.
Blood tests
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of dengue
fever. If you have dengue fever, your blood may reveal the virus itself. If not, blood tests known as
hemagglutination inhibition (HI) assay, enzyme-linked immunosorbent assay (ELISA) and reverse
transcriptase-polymerase chain reaction (RT-PCR) also can detect antigens, antibodies or nucleic acids
specific to the viruses. These tests may take several days.

Complications
Most people with dengue fever recover within five to 14 days.  Some, particularly adults, may
feel listless, tired and even depressed for several weeks to months after being infected.
If severe, dengue fever can lead to dengue hemorrhagic fever and dengue shock syndrome, which can
cause heavy bleeding, shock and — in about 2 percent to 5 percent of those with these conditions —
death. Those who survive may experience liver, blood vessel and brain damage, as well as seizures.

Treatment
No specific treatment for dengue fever exists.
If you have a mild form of the disease, your doctor will recommend making sure to drink enough
fluids to avoid dehydration from vomiting and high fever. You can also take acetaminophen (Tylenol,
others) for pain and fever. Avoid aspirin or other nonsteroidal anti-inflammatory drugs, such as
ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These can increase the risk of bleeding
complications.
If you have a more severe form of the disease, treatment consists of supportive care in a hospital.
Such care includes intravenous fluids and electrolyte replacement, maintaining adequate blood pressure
and replacing blood loss.
If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid
transmitting the disease to others.
Prevention
No dengue fever vaccine exists. If you are living or traveling in an area where dengue fever is known to
be, the best way to avoid dengue fever is to avoid being bitten by mosquitoes that carry the disease.
To reduce your exposure to mosquitoes:
• Avoid unnecessary outdoor activity when mosquitoes are most prevalent, such as at dawn, dusk
and early evening.
• Wear long-sleeved shirts, long pants, socks and shoes when you go into mosquito-infested
areas.
• Stay in air-conditioned or well-screened housing. Patch screens if necessary, especially where
there will be night-time exposure.
• Use bed netting if available.
• Apply permethrin-containing mosquito repellent to your clothing, shoes, and camping gear and
bed netting. You can also buy clothing made with permethrin already in it. Use repellent with a
10 percent to 30 percent concentration of DEET to your skin. Choose the concentration based
on the hours of protection you need — a 10 percent concentration of DEET is effective for
about two hours, whereas higher concentrations last longer. Keep in mind that chemical
repellants can be toxic, and use only the amount needed for the time you'll be outdoors. Don't
use DEET on the hands of young children or on infants under 2 months of age. Instead, cover
your infant's stroller or playpen with mosquito netting when outside. According to the Centers
for Disease Control and Prevention, oil of lemon eucalyptus, a more natural product, offers the
same protection as DEET when used in similar concentrations.
Last Updated: 09/28/2007
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