Assignment

Dengue fever

Submitted By: Muhammad Anwar

ROLL NO.47657
BS 6TH

Submitted To: Ma’am, Nighat Sultana

Department of Biochemistry
Hazara University Mansehra

DEPARTMENT OF BIOCHEMISTRY
HAZARA UNIVERSITY MANSEHRA
2020
 TABLE OF CONTENTS
Dengue fever..................................................................................................................3
Introduction................................................................................................................3
Signs and symptoms...................................................................................................3
Clinical course............................................................................................................4
Associated problems...................................................................................................5
Cause..........................................................................................................................5
Virology......................................................................................................................5
Transmission...............................................................................................................5
Predisposition.............................................................................................................6
Controlling Dengue Outbreaks...................................................................................7
Environmental Management of Dengue Mosquito Populations................................7
Personal Actions to Reduce Contact with Mosquitoes...............................................7
Traps...........................................................................................................................7
Chemical Control of Dengue Mosquitoes..................................................................8
Bio insecticides...........................................................................................................8
Biological Control of Dengue Mosquitoes.................................................................8
References..................................................................................................................9
 Dengue fever
Introduction
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus.
Symptoms typically begin three to fourteen days after infection. These may include a
high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash.
Recovery generally takes two to seven days. In a small proportion of cases, the
disease develops into severe dengue, also known as dengue hemorrhagic fever,
resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into
dengue shock syndrome, where dangerously low blood pressure occurs.

Dengue is spread by several species of female mosquitoes of the Aedes genus,

principally Aedes aegypti. The virus has five serotypes; infection with one type
usually gives lifelong immunity to that type, but only short-term immunity to the
others. Subsequent infection with a different type increases the risk of severe
complications. A number of tests are available to confirm the diagnosis including
detecting antibodies to the virus or its RNA.

A vaccine for dengue fever has been approved and is commercially available in a
number of countries. As of 2018, the vaccine is only recommended in individuals who
have been previously infected, or in populations with a high rate of prior infection by
age nine. Other methods of prevention include reducing mosquito habitat and limiting
exposure to bites. This may be done by getting rid of or covering standing water and
wearing clothing that covers much of the body. Treatment of acute dengue is
supportive and includes giving fluid either by mouth or intravenously for mild or
moderate disease. For more severe cases, blood transfusion may be required. About
half a million people require hospital admission every year. Paracetamol
(acetaminophen) is recommended instead of nonsteroidal anti-inflammatory drugs
(NSAIDs) for fever reduction and pain relief in dengue due to an increased risk of
bleeding from NSAID use.

Signs and symptoms

Outline of a human torso with arrows indicating the organs affected in the various
stages of dengue fever Schematic depiction of the symptoms of dengue fever
Typically, people infected with dengue virus are asymptomatic (80%) or have only
mild symptoms such as an uncomplicated fever. Others have more severe illness
(5%), and in a small proportion it is life-threatening. The incubation period (time
between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it
is 4 to 7 days. Therefore, travelers returning from endemic areas are unlikely to have
dengue fever if symptoms start more than 14 days after arriving home. Children often
experience symptoms similar to those of the common cold and gastroenteritis
(vomiting and diarrhea) and have a greater risk of severe complications, though initial
symptoms are generally mild but include high fever.

Clinical course
The characteristic symptoms of dengue are sudden-onset fever, headache (typically
located behind the eyes), muscle and joint pains, and a rash. An alternative name for
dengue, "breakbone fever", comes from the associated muscle and joint pains. The
course of infection is divided into three phases: febrile, critical, and recovery.

The febrile phase involves high fever, potentially over 40 °C (104 °F), and is
associated with generalized pain and a headache; this usually lasts two to seven days.
Nausea and vomiting may also occur. A rash occurs in 50–80% of those with
symptoms in the first or second day of symptoms as flushed skin, or later in the
course of illness (days 4–7), as a measles-like rash. A rash described as "islands of
white in a sea of red" has also been observed. Some petechiae (small red spots that do
not disappear when the skin is pressed, which are caused by broken capillaries) can
appear at this point, as may some mild bleeding from the mucous membranes of the
mouth and nose. The fever itself is classically biphasic or saddleback in nature,
breaking and then returning for one or two days.

In some people, the disease proceeds to a critical phase as fever resolves. During this
period, there is leakage of plasma from the blood vessels, typically lasting one to two
days. This may result in fluid accumulation in the chest and abdominal cavity as well
as depletion of fluid from the circulation and decreased blood supply to vital organs.
There may also be organ dysfunction and severe bleeding, typically from the
gastrointestinal tract. Shock (dengue shock syndrome) and hemorrhage (dengue
hemorrhagic fever) occur in less than 5% of all cases of dengue; however, those who
have previously been infected with other serotypes of dengue virus ("secondary
infection") are at an increased risk. This critical phase, while rare, occurs relatively
more commonly in children and young adults.

Associated problems
Dengue can occasionally affect several other body systems, either in isolation or
along with the classic dengue symptoms. A decreased level of consciousness occurs
in 0.5–6% of severe cases, which is attributable either to inflammation of the brain by
the virus or indirectly as a result of impairment of vital organs, for example, the liver.
Other neurological disorders have been reported in the context of dengue, such as
transverse myelitis and Guillain–Barré syndrome. Infection of the heart and acute
liver failure are among the rarer complications.

Cause

Virology
Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus
Flavivirus. Other members of the same genus include yellow fever virus, West Nile
virus, Zika virus, St. Louis encephalitis virus, Japanese encephalitis virus, tick-borne
encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus.
Most are transmitted by arthropods (mosquitos or ticks), and are therefore also
referred to as arboviruses (arthropod-borne viruses).

The dengue virus genome (genetic material) contains about 11,000 nucleotide bases,
which code for the three different types of protein molecules (C, prM and E) that form
the virus particle and seven other non-structural protein molecules (NS1, NS2a, NS2b,
NS3, NS4a, NS4b, NS5) that are found in infected host cells only and are required for
replication of the virus. There are five strains of the virus, called serotypes, of which
the first four are referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The fifth
type was announced in 2013. The distinctions between the serotypes are based on
their antigenicity.

Transmission
Dengue virus is primarily transmitted by Aedes mosquitos, particularly A. aegypti.
These mosquitos usually live between the latitudes of 35° North and 35° South below
an elevation of 1,000 metres (3,300 ft). They typically bite during the early morning
and in the evening, but they may bite and thus spread infection at any time of day.
Other Aedes species that transmit the disease include A. albopictus, A. polynesiensis
and A. scutellaris. Humans are the primary host of the virus, but it also circulates in
nonhuman primates. An infection can be acquired via a single bite. A female
mosquito that takes a blood meal from a person infected with dengue fever, during the
initial 2- to 10-day febrile period, becomes itself infected with the virus in the cells
lining its gut. About 8–10 days later, the virus spreads to other tissues including the
mosquito's salivary glands and is subsequently released into its saliva. The virus
seems to have no detrimental effect on the mosquito, which remains infected for life.
Aedes aegypti is particularly involved, as it prefers to lay its eggs in artificial water
containers, to live in close proximity to humans, and to feed on people rather than
other vertebrates.

Dengue can also be transmitted via infected blood products and through organ
donation. In countries such as Singapore, where dengue is endemic, the risk is
estimated to be between 1.6 and 6 per 10,000 transfusions. Vertical transmission
(from mother to child) during pregnancy or at birth has been reported. Other person-
to-person modes of transmission, including sexual transmission, have also been
reported, but are very unusual. The genetic variation in dengue viruses is region
specific, suggestive that establishment into new territories is relatively infrequent,
despite dengue emerging in new regions in recent decades.

Predisposition
Severe disease is more common in babies and young children, and in contrast to many
other infections, it is more common in children who are relatively well nourished.
Other risk factors for severe disease include female sex, high body mass index, and
viral load. While each serotype can cause the full spectrum of disease, virus strain is a
risk factor. Infection with one serotype is thought to produce lifelong immunity to that
type, but only short-term protection against the other three. The risk of severe disease
from secondary infection increases if someone previously exposed to serotype
DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed
to DENV-3 acquires DENV-2. Dengue can be life-threatening in people with chronic
diseases such as diabetes and asthma.

Polymorphisms (normal variations) in particular genes have been linked with an

increased risk of severe dengue complications. Examples include the genes coding for
the proteins TNFα, mannan-binding lectin, CTLA4, TGFβ, DC-SIGN, PLCE1, and
particular forms of human leukocyte antigen from gene variations of HLA-B. A
common genetic abnormality, especially in Africans, known as glucose-6-phosphate
dehydrogenase deficiency, appears to increase the risk. Polymorphisms in the genes
for the vitamin D receptor and FcγR seem to offer protection against severe disease in
secondary dengue infection.

Controlling Dengue Outbreaks

Environmental Management of Dengue Mosquito Populations

The primary preventative measure to reduce dengue infections is the control of
mosquito populations. Because the transmission of dengue requires mosquitoes as
vectors, the spread of dengue can be limited by reducing mosquito populations. What
can people at risk of dengue infections do to reduce the size of mosquito populations?
One practical and recommended environmental management strategy is to eliminate
unnecessary container habitats that collect water.

Personal Actions to Reduce Contact with Mosquitoes

People can reduce the risk of mosquitoes entering their homes by using window and
door screens or by keeping their doors and windows closed and using air conditioning
to keep their homes cool. Aedes aegypti typically bite people during the day, so
wearing long pants and long-sleeved shirts can reduce mosquito bites when spending
time outdoors. In addition, mosquito repellents can be applied to exposed skin and
clothing to lower the risk of mosquito bites. The Centers for Disease Control
recommends mosquito repellents that contain DEET, picaridin, lemon eucalyptus oil,
or IR3535 as the active ingredient. Sleeping under a mosquito net can also provide
protection from being bitten, particularly in areas where people rest in the afternoon
or in houses with infants. What about other methods of reducing mosquito
populations?

Traps
Another method of reducing Aedes aegypti is to use ovitraps. What are ovitraps, and
how do they work? These devices are black, cylindrical containers filled with water.
The top of the ovitrap is fitted with a circular wire mesh and a floatation ring that
floats on the surface of the water in the container. Above the mesh, two paddles are
mounted. To Aedes aegypti, ovitraps appear to be ideal locations to lay their eggs.
The female lays its eggs on the paddles
Chemical Control of Dengue Mosquitoes
Chemical control can be effective in controlling mosquito populations. For instance,
insecticides can be used to kill mosquito larvae or adult mosquitoes. Can insecticides
be widely and routinely used? The use of insecticides is recommended in emergency
situations during dengue epidemics or when there is evidence that an epidemic is
emerging. On a regular basis, however, sustainable, coordinated, community-based
environmental approaches are favored over chemical methods for controlling
mosquitoes, and limited reliance on these chemicals is preferred. Why are
environmental management approaches favored? One reason is that mosquitoes can
develop resistance to insecticides. In addition, insecticides are expensive, and high
doses can be toxic to humans and other species. Therefore, it is best to be cautious
about applying these chemicals.

Bio insecticides
Could safer insecticides be used to kill mosquitoes? Bioinsecticides are a combination
of biological controls and insecticides. One example of a bioinsecticide is Bacillus
thuringiensis israelensis (Bti), which is a naturally occurring soil bacterium that can
effectively kill mosquito larvae present in water. There are many strains of Bacillus
thuringiensis, each having unique toxicity characteristics, and Bti is very specific for
mosquitoes. Bti is available in small, slow-release bricks called "mosquito dunks" that
float on the water surface and are effective in treating deep water. Other
bioinsecticides, such as pyriproxyfen and methoprene, act as juvenile hormone
analogues that prevent mosquito larvae from metamorphosizing into adults.

Biological Control of Dengue Mosquitoes

Biological approaches are also being considered as alternatives to control mosquito
populations. For example, predatory crustaceans called copepods and many varieties
of fish, including mosquitofish and goldfish, eat mosquito larvae. When these
organisms are placed in container habitats, decorative ponds, and pools, they prey on
mosquito larvae, effectively preventing mosquito development.
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Fang, J. A world without mosquitoes. Nature 466, 432–434 (2010).

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Fu, G., et al. Female-specific flightless phenotype for mosquito control. Proceedings
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