Dengue Fever

Symptoms Symptoms of typical uncomplicated (classic) dengue usually start with fever within 4 to 7 days after you have been bitten by an infected mosquito and include High fever, up to 105ºF Severe headache Retro-orbital (behind the eye) pain Severe joint and muscle pain Nausea and vomiting Rash The rash may appear over most of your body 3 to 4 days after the fever begins, and then subsides after 1 to 2 days. You may get a second rash a few days later. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus Marked damage to blood and lymph vessels Bleeding from the nose, gums, or under the skin, causing purplish bruises This form of dengue disease can cause death. Symptoms of dengue shock syndrome--the most severe form of dengue disease--include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus Fluids leaking outside of blood vessels Massive bleeding Shock (very low blood pressure) This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

Prevention

The best way to prevent dengue virus infection is to take special precautions to avoid being bitten by mosquitoes. Several dengue vaccines are being developed, but none is likely to be licensed by the Food and Drug Administration in the next few years.

When outdoors in an area where dengue fever has been found

• Use a mosquito repellent containing DEET, picaridin, or oil of lemon eucalyptus
• Dress in protective clothing—long-sleeved shirts, long pants, socks, and shoes

Because Aedes mosquitoes usually bite during the day, be sure to take precautions, especially during early morning hours before daybreak and in the late afternoon before dark.

Other precautions include

• Keeping unscreened windows and doors closed
• Keeping window and door screens repaired
• Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths, discarded tires, etc.

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You may have seen the Fiji Times article stating that Medical authorities in Fiji have confirmed a national Dengue fever outbreak. As of last Friday, 53 suspected cases of Dengue had been reported throughout Fiji. More than four new cases are being reported each day.

It is important that you recognise possible symptoms you have Dengue and seek medical help early on. It's also important that we know of the possible diagnosis, as you can pass it on if bitten by a mosquito while having a fever, and that mosquito bites another person.

More about Dengue fever is available on http://en.wikipedia.org/wiki/Dengue_fever . For those of you that don't have Internet, here is the info:

NB: Do not take Aspirin.

Signs and symptoms
This infectious disease is manifested by a sudden onset of fever, with severe headache, muscle and joint pains (myalgias and arthralgias—severe pain gives it the name break-bone fever or bonecrusher disease) and rashes. The dengue rash is characteristically bright red petechiae and usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting or diarrhea.

Other symptoms include

• fever;
• chills;
• constant headaches;
• bleeding from nose, mouth or gums;
• severe dizziness; and,
• loss of appetite.

Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash is present. Thus travelers from tropical areas may pass on dengue in their home countries inadvertently, having not been properly diagnosed at the height of their illness. Patients with dengue can pass on the infection only through mosquitoes or blood products and only while they are still febrile.

The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called "biphasic pattern"). Clinically, the platelet count will drop until the patient's temperature is normal.

Treatment
The mainstay of treatment is supportive therapy. Increased oral fluid intake is recommended to prevent dehydration. Supplementation with intravenous fluids may be necessary to prevent dehydration and significant concentration of the blood if the patient is unable to maintain oral intake. A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant bleeding.

The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion.

Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding tendency associated with some of these infections. Patients may receive paracetamol preparations to deal with these symptoms if dengue is suspected