Dengue fever - symptoms, diagnosis, treatment, prevention

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Dengue fever - symptoms, diagnosis, treatment, prevention

Dengue fever is a viral infection carried by mosquitoes.  It is increasingly widespread around the world and is common in various travel destinations popular with Bangladesh, including South East Asia and the Pacific Islands. 
 
Up to 400 million people are infected each year around the world, while in Bangladeshi there were 125 cases of dengue fever reported in 2015, all of which were contracted overseas.

Transmission of the virus

Dengue fever cannot be passed directly from one infected person to another. It is a mosquito-borne infection that requires a specific variety of mosquito (the “Aedes” mosquito) to pass it from person to person.  The mosquito transmits the virus by biting an infected individual then biting someone else.
 
The incubation period (the time between infection with the virus and appearance of signs and symptoms) is, on average, five to eight days.

Signs and symptoms

Dengue fever can range in severity from a mild flu-like illness, to a condition that produces severe, debilitating symptoms. The onset of symptoms is usually sudden and initial symptoms commonly include: 
  • High fever
  • Headache
  • Pain in the muscles and joints - particularly in the legs
  • Pain behind the eyes - particularly when moving them
  • Red eyes
  • Nausea and vomiting
  • Enlarged lymph nodes
  • A red flush to the face
  • Lower back pain
  • Severe weakness
  • Severe fatigue.
After two to three days the fever reduces and significant sweating occurs. A day or so later the fever rises again and a red rash begins on the arms and legs, then spreads to the chest, abdomen and back. In addition, the palms of the hands and the soles of the feet become swollen and turn bright red.
 
Most people fully recover from dengue fever, although the weakness and fatigue may last for several weeks.
 
After infection with dengue fever, the body is immune to the condition for about a year. Subsequent infection with dengue fever tends to produce more severe symptoms than initial infections.

Complications

The most serious complication of dengue fever is when the condition progresses to dengue haemorrhagic fever. It most commonly occurs in children under the age of 10 years and is characterised by severe symptoms of dengue fever accompanied by bleeding from the gums, nose, bowel, and into internal organs.  Bruising and blood spots under the skin may be present and pneumonia and inflammation of the heart may occur.  Dengue haemorrhagic fever is a severe condition that is fatal in approximately five percent of infected individuals.
 
People who have previously been infected with dengue fever are at an increased risk of developing dengue haemorrhagic fever with subsequent dengue fever infections.

Diagnosis

When making a diagnosis of dengue fever a doctor will ask whether the patient has recently visited the tropics.  The doctor will take a full history of the symptoms (including their severity and duration) and will perform a physical examination. The doctor will look for the characteristic combination of fever, rash and headache that occurs with dengue fever. This combination of symptoms is known as the “dengue triad”.
 
Because dengue fever can be confused with other conditions such as influenza, measles, malaria or typhoid fever, the doctor is likely to take blood tests in order to definitively diagnose the condition.

Treatment

As dengue fever is caused by a virus there is no specific treatment and antibiotics are of no benefit in combating the condition. Treatment is supportive and includes: 
  • Rest
  • Encouraging adequate fluid intake
  • Pain relieving medications such as paracetamol - which can help to relieve discomfort and to reduce the fever. Aspirin and non-steroidal anti-inflammatory medications should be avoided however as these can increase bleeding.
In cases of dengue haemorrhagic fever, hospitalisation and treatment with intravenous fluids or transfusions of blood or blood products may be necessary, particularly if bleeding is severe.

Prevention

There is no vaccine for dengue fever.  Prevention involves avoiding being bitten by mosquitoes while in regions where dengue fever occurs.  The Auckland Regional Public Health Service recommends the following measures to protect against acquiring dengue fever: 
  • Wear clothing/hats that cover the arms, legs and head
  • Wear shoes rather than sandals
  • Apply insect repellent to skin. The most effective repellents are those containing DEET (diethyl toluamide) at a concentration of between 30% and 50%
  • Apply permethrin insecticide to clothes
  • Use mosquito nets impregnated with permethrin
  • Use electric insect-repellent devices or mosquito coils
  • When possible, stay in accommodation that has screens on doors and windows or is air-conditioned.

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