DENGUE FEVER ATTACKS PAKISTAN

"This page is about general information, vector, incubation period, quarantine period, common presenting complaints and D/D."

EVERY PATIENT SUSPECTED OF OR CONFIRMED DENGUE FEVER MUST USE MOSQUITO REPELLENT CREAM,USE FULL SLEEVE CLOTHES,MOSQUITO NET AT NIGHT OR REMAIN IN MOSQUITO FREE ENVIRONMENT DURING FEVER AND AT LEAST TWO DAYS AFTER BEING AFEBRILE,OTHERWISE PATIENT WILL ACT AS RESEVOIR FOR FURTHER SPREAD OF DENGUE FEVER.

THIS WILL HELP

1. TO AVOID FURTHER SPREAD OF DISEASE IN COMMUNITY.

2. TO REDUCE UNNECESSARY WORKLOAD IN PUBLIC HOSPITALS.

8O% OF THE PATIENTS REMAIN ASYMPTOMATIC OR HAVE MINOR COMPLAINTS AND ARE RELIEVED BY REST AND/OR PARACETAMOL AND ARE NOT REPORTED. USE ONLY PARACETAMOL FOR FEVER AND PAIN, NSAIDS LIKE BRUFEN OR ASPIRIN SHOULD NEVER BE USED.

A PATIENT ONCE HAVING DENGUE FEVER WILL BE IMMUNE FOR THIS TYPE OF DENGUE FEVER FOR REST OF HER LIFE BUT FOR 3-6 MONTHS FOR EVERY TYPE OF DENGUE FEVER.

DIABETICS SHOULD HAVE THEIR BLOOD SUGAR DONE TWICE A DAY AND LEVEL
SHOULD BE AROUND 180mg/100ml OR LESS THAN 10MMOL/L
AVOID HYPOGLYCAEMIA. USE SUGAR FREE LIQUIDS.

PATIENTS OF IHD USING ASPIRIN SHOULD STOP IT FOR O7 DAYS AT LEAST.

CAUSATIVE AGENT

DENGUE VIRUS                  TYPE RNA --DEN1, DEN2, DEN3, DEN4
IN PAKISTAN ALL FOUR TYPES ARE PRESENT BUT DEN TYPE 2 AND 3 ARE MORE PREVALENT.

VECTOR

IT IS AN AGENT, WHICH TRANSMITS VIRUS FROM AN INFECTED PERSON TO HEALTHY PERSON. IT IS FEMALE AEDES AEGYPTI MOSQUITOES AND OTHER AEDES SPECIES WHICH BECOME INFECTIVE IN 7-10 DAYS AFTER BITTING AN INFECTED PERSON.

THE FLIGHT OF THIS MOSQUITO IS 70-100 M.

THE LIFE SPAN OF THIS MOSQUITO IS ABOUT 30 DAYS DURING WHICH IT CAN INFECT ABOUT 14 PEOPLE AND THERE IS VERTICAL TRASMISSION OF VIRUS IN LARVA.

INCUBATION PERIOD

IT IS THE TIME AFTER A PERSON IS BEING BITTEN BY AN INFECTED MOSQUITO AND APPEARANCE OF SYMPTOMS.

IT IS THREE TO FOURTEEN DAYS IN DENGUE FEVER.

QUARANTINE PERIOD

IT IS THE TIME DURING WHICH THE PATIENT SHOULD NOT TRAVEL TO NON EPIDEMIC OR NON ENDEMIC AREAS. IT IS TILL VIRAEMIA OR NS 1 IS POSITIVE. IN DENGUE FEVER IT IS USUALLY UP TO 07 DAYS.

COMMON SYMPTOMS

1.SUDDEN ONSET OF HIGH GRADE FEVER WITH SHIVERING IN THE ABSCENCE OF ANY OBVIOUS SOURCE OF INFECTION, LIKE TONSILLITIS, ACUTE SOM, ACUTE PYELONEPHRITIS, ACUTE CHOLECYSTITIS ECT.

2. FRONTAL HEADACHE, PAIN BEHIND EYES, ACHES AND PAINS, MYALGIAS, SEVERE BONE PAINS THAT IS WHY CALLED BREAKING BONE FEVER, WHICH ARE MUCH MORE IN SEVERITY AS COMPARED TO FEVER.

3. BITTER TASTE, NAUSEA, PAIN EPIGASTRIUM, PAIN ABDOMEN.

4. CAN PRESENT WITH GASTROENTERITIS.

5. HEMATURIA
6. INCREASED NORMAL MENSTRUAL FLOW OR UNEXPECTED VAGINAL BLEEDING.

7. MAY PRESENT WITH FLU LIKE SYMPTOMS.

"IF TWO PHASES THEN DF-DENGUE FEVER”

1. FEBRILE PHASE 01- 07DAYS.

2. COVALESCENT OR RECOVERY PHASE USUALLY STARTING WITH AN ITCHING RASH.

"IF THREE PHASES THEN DHF"

1. FEBRILE PHASE LASTS 01-07 DAYS USUALLY 2 TO 3 DAYS.

2. CRITICAL PHASE 24-48HRS.

3. CONVALESCENT OR RECOVERY PHASE

VERY IMPORTANT IF IT FOLLOWS CRITICAL PHASE BECAUSE OF REABSORPTION OF FLUID FROM THE THIRD SPACE. THERE WILL BE INCREASED DIURESIS AND BEAWRE OF HYPOKALAEMIA.

NOTE: - THE DIFFERENCE BETWEEN DF AND DHF IS PRESENCE OF CRITICAL PHASE WHICH LASTS FOR ABOUT 24- 48 HOURS AND NEED PROPER FLUID MANGEMENT DUE TO PLASMA LEAK .NOTE START AND END OF CRITICAL PHASE.IT MAY BE SHORTER IN CHILDREN.ALWAYS USE RIGHT FLUID IN RIGHT VOLUME.

D/D: ACUTE TONSILLITIS, PYELONEPHRITIS, ACUTE HEPATITS, MALAIRIA, , TYPHOID FEVER, AND ACUTE CHOLECYSTITIS.