Abstract

Dengue fever is a mosquito-borne infection which is most prevalent in tropical areas of the world. The causative agent of dengue fever is one of four closely related dengue viruses. Dengue fever affects about 390 million people in the world each year. Dengue fever virus is transmitted when an infected mosquito bites an individual. The symptoms of dengue fever vary based on the severity of the infection. Dengue fever is caused by a virus, and therefore there is no specific cure or treatment but prevention can help to control the disease depending on the severity of the condition. Infection with dengue virus confers a lifelong homotypic period and a short period of partial immunity of about two years.

Dengue Fever

Dengue fever is a mosquito-borne infection which is most prevalent in tropical and non-tropical areas of the world. It is a debilitating and painful condition which is caused by a dengue virus. These dengue viruses are similar to the viruses which cause yellow fever and West Nile infection. According to a report by the World Health Organization (WHO), dengue affects about 390 million people in the world each year. Approximately 96 million of these statistics result in illness. Most of the cases of dengue fever occur in the tropical areas with the highest risk occurring in Mexico, The Caribbean, The Pacific Islands, Taiwan, Southern China, Southeast Asia and the Indian Subcontinent. In the United States, most people have reported contracting dengue fever while traveling abroad. However, the risk is mounting for individuals living along the Texas-Mexico border as well as other regions in the southern United States (World Health Organization, 2014). The purpose of this paper is to discuss the process of dengue fever, signs and symptoms, treatment and pathophysiology of this infection.

The process of Dengue Fever

Dengue fever virus is transmitted when an infected mosquito bites an individual. Also, when a mosquito bites an infected person, it can transmit the virus to a healthy individual. It is spread by the mosquitoes Aedes albopictus and Aedes aegypti which are found all over the world. It is possible to have more than one infection of dengue fever (Guldahl, 2017). However, the subsequent contamination poses a higher risk of rising a severe form.  The symptoms begin to manifest in 4 to 7 days following a mosquito bite and usually and lasts for about 10 days. The clinical manifestations range from mild to severe. The common severe symptoms associated with dengue include dengue shock syndromes and dengue hemorrhagic fever (DHF) which usually require hospitalization.

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Signs and Symptoms

The symptoms of dengue fever differ depending on the acuity of the infection. Many individuals particularly children and adolescents do not experience signs and symptoms during a mild infection of dengue fever. However, when these symptoms occur, they usually begin to manifest 4 to 8 days after a person is bitten by an infected mosquito (Guldahl, 2017).

Mild dengue fever

Symptoms of a mild case of dengue fever can take up to seven days after a person is bitten by the mosquito which transmits dengue fever virus. Symptoms of mild dengue fever include an intense headache, vomiting and feeling nauseous, pain behind the eyes, high fever, recurrent body fever, and aching muscles and joints. These symptoms typically vanish after in about five days. A mild case of dengue fever usually characterized by severe or fatal clinical problems (Zhang et al. 2014).

Dengue Hemorrhagic Fever (DHF)

The signs and symptoms of DHF may be mild at first; however, these symptoms may slowly worsen within a few days. Although the symptoms similar to those of mild dengue characterized by internal bleeding. An individual with DHF may experience sensitive stomach, weak pulse, small blood spots under the skin, sensitive stomach, and a lower number of platelets in the blood (Zhang et al. 2014).  Besides, a person with DHF may have internal bleeding which can cause black vomit and stools and may experience bleeding from the nose, mouth, or gums. If not promptly treated, DHF can lead to death.

Dengue Shock Syndrome

Dengue shock syndrome (DSS) is the most severe form of dengue which can be fatal. Apart from the symptoms of mild dengue fever, a person with DSS may experience heavy bleeding, sudden hypotension or a fast drop in blood pressure, disorientation, and intense stomach pain. The infected person may also experience frequent vomiting and a bloody seeping fluid. Without prompt intervention of DSS, it can lead to death (Zhang et al. 2014).

Severe conditions of dengue fever infection can cause damage to the heart, liver, or the lungs. Blood pressure can also drop drastically to severe levels leading to shock and in some cases in death.  Various factors can predispose an individual to develop the disease or a more severe form of dengue fever. These factors include traveling or living in tropical areas or prior infection with a dengue fever virus. The previous infection with dengue fever infection raises an individual’s risk of having severe symptoms if they are infected again. Also, living in tropical and subtropical regions predispose an individual to the virus which results in dengue fever. Some high-risk regions include Caribbean, Latin America, the Western Pacific Islands, and Southeast Asia (Chandren, Wong & AbuBakar, 2015).

Treatment and Prevention

Dengue fever is caused by a virus, and therefore there is no precise cure or treatment. However, management of the infection can help to control the illness depending on the severity of the disease. Milder forms of dengue fever, treatment may include controlling dehydration and administration of painkillers. Dengue fever causes vomiting and temperature which can lead to dehydration of the body. To manage dehydration, the patient should drink plenty of water. Rehydration salts can also be used to help replace minerals and fluids (Chandren, Wong & AbuBakar, 2015).

Painkillers such as paracetamol and Tylenol help to ease pain and reduce fever. However, non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and aspirin are not recommended as they can stimulate internal bleeding. Papaya leaf extract can also be used to treat dengue fever. More severe forms of dengue fever may require a drip or intravenous fluid supplementation if the patient cannot take fluids through the mouth. Patients with severe blood transfusion can be put in blood transfusion. In severe cases of dengue fever, hospitalization can allow the patient to be managed appropriately (Chandren, Wong & AbuBakar, 2015).

Prevention and Control

Currently, the principal method to prevent or control the spread of dengue fever virus is through combating the vector mosquitoes through:

  1. Environmental management and modification to deter mosquitoes from accessing egg-laying habitats.
  2. Proper disposal of solid waste and destroying artificial habitats.
  • Regular cleaning of water storage containers to avoid the breeding of mosquitoes.
  1. Use of insecticides to treat outdoor water storage containers.
  2. Use of house personal household protection such as mosquito nets and coils.

Other preventive measures which can reduce the risk of being bitten by mosquito include:

  • Clothing: Reducing the amount of skin exposed by wearing long-sleeved shirts, long pants, and socks.
  • Mosquito repellents: Using a repellent with a minimum 10% concentration of diethylamide (DEET). Higher concentration of this chemical can be used for the longer lengths of exposure.
  • Mosquito nets and traps. Treated nets are effective in preventing mosquito Treated net can kill mosquitoes and other biting insects and can also repel insects from entering the room.
  • Window and door screens: Structural barriers such as screens can help in keeping mosquitoes way. Also avoiding strongly scented soap which may attract mosquitoes can help in decreasing chances of mosquito bites.

Pathophysiology

Infection with dengue virus confers an enduring homotypic period and a short period of partial immunity of about two years. Dengue virus is spread by a bite of an infected female mosquito. These mosquitoes require nectar for energy. The female mosquito requires blood as an appropriate source of protein that is important for the development of eggs. Humans are the primary reservoirs. Although certain primates usually found in Asia and Africa can serve as hosts for this virus but do not develop the hemorrhagic fever (Low et al. 2014).

The mosquito can transmit dengue immediately it bites a person or transmission can occur 8-12 days of viral reproduction in the salivary glands of the mosquito. Once inoculated into a human host dengue fever has an incubation period of 4-7 days. Replication of viruses occurs in the target dendritic cells. Infection of the target cells specifically those of the reticuloendothelial system such as endothelial, hepatocytes, macrophages, and dendritic cells results in the production of immune mediators. Usually, dengue presents in a positive manner similar symptoms to that of other bacterial and viral infections. The fever usually begins on the fourth day of disease. It can persist for about five days lessening with the termination of viremia and may reach 410C.  Replication of dengue virus and cellular destruction in the bone marrow are believed to cause the severe pain associated with the illness (Guldahl, 2017).

References

Chandren, J. R., Wong, L. P., & AbuBakar, S. (2015). Practices of dengue fever prevention and the associated factors among the Orang Asli in Peninsular Malaysia. PLoS neglected tropical diseases, 9(8), e0003954.

Guldahl, M. K. (2017). Dengue fever: Occurence, causes, pathogenesis, diagnosis, treatment and prevention, with a special focus on Myanmar and Norway (Master’s thesis).

Low, J. G., et al. (2014). Efficacy and safety of celgosivir in patients with dengue fever (CELADEN): a phase 1b, randomized, double-blind, placebo-controlled, proof-of-concept trial. The Lancet infectious diseases, 14(8), 706-715.

World Health Organization. (2014). Dengue and severe dengue.

Zhang, H., et al. (2014). Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis. BioMed research international, 2014.

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