What Should You Know About Dengue Fever?

Dengue fever is a mosquito-borne illness affecting people in tropical and subtropical areas. It is also known as breakbone fever, which results from a viral infection. It can lead to severe disease in some cases. Four different viruses can cause dengue fever through Aedes mosquitoes. It causes a high fever and flu-like symptoms. The extreme form of dengue fever, called Dengue hemorrhagic fever, may lead to severe bleeding, shock, and death.

Dengue virus is transmitted mainly by the female mosquitoes of the species Aedes aegypti and, to a small extent, by Aedes albopictus. They are also vectors of chikungunya, yellow fever, and Zika viruses. Dengue is most prevalent in the tropics and is influenced by climatic conditions, social and environmental factors, etc. The virus that causes dengue belongs to the Flaviviridae family, mainly the four distinct serotypes of the virus, which are DENV-1, DENV-2, DENV-3, and DENV-4. Recovery from a particular serotype infection is believed to provide lifelong immunity against that serotype. But cross-immunity to the other serotypes after recovery is only partial and is temporary. Secondary infection by different serotypes increases the risk of developing severe dengue.

Symptoms of dengue fever range from mild to severe. Severe symptoms indicate dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF). These require urgent medical attention. If not detected and treated early, it can lead to death due to bleeding. The disease progresses through 3 stages, including the febrile phase, critical phase, and recovery phase.

Stages Of Dengue fever

Stage I:

The acute fever stage prolongs from day 1 to day 5. The patient develops a high fever with abdominal pain, nausea, and vomiting. An antipyretic should be given immediately to lower the body temperature and protect the body from minimal fluid loss. The patient should stay hydrated, and the fluid loss should be replaced by rehydration through food and electrolytes.

Stage II:

This stage lasts from day 5 to day 7 when the body temperature drops within 24 hours, the plasma leaks, and the blood pressure drops. The patient feels very weak and restless, with cold, clammy skin and a quick pulse. In severe cases with very low platelets, the patient might vomit blood due to internal bleeding and can die of circulatory failure or respiratory failure from internal bleeding and fluid retention. In order to prevent blood perfusion to the vital organ, it is imperative to provide an appropriate intravenous fluid to the patients in this stage.

Stage III:

This is the recovery phase. It usually takes a few days for the patients to return to normal. At this stage, the patient gains back the appetite, has a slower pulse rate, and develops a convalescent rash on the legs and arms.

Symptoms Of Dengue Fever

Symptoms of dengue fever depend on the severity of the disease. However, around 75% of people with dengue fever may not experience any symptoms.

Mild symptoms:

A sudden fever of around 104°F (40°C) with one or more of the following symptoms such as:

• Aching muscles and joints
• Rash
• Pain behind the eyes
• Nausea and vomiting
• Facial flushing
• Sore throat
• Headache
• Red eyes

The symptoms usually last between 2–7 days, and most patients feel better after a week. The temperature may spike but goes down and spike again intermittently. Mild symptoms are often confused with other similar illnesses, such as malaria, chikungunya, and other diseases like fever, rashes, aches, and pains. The most common symptoms of dengue are the following:

• Nausea and vomiting
• Rashes
• Aches and pains in the eyes, joints, and bones.
• Symptoms of dengue typically last about 2–7 days.

Severe symptoms:

Around five percent of the cases become severe fever and can be life-threatening. The symptoms include:

• Abdominal pain or tenderness
• Vomiting
• Bleeding from the nose or gums
• Blood vomiting
• Blood in the stools
• Extreme fatigue
• Restlessness and irritability
• Intermittent fever and chills
• Cold sweat with cold and clammy skin
• Weak and rapid pulse
• Low blood pressure

Severe signs and symptoms can indicate dengue shock or dengue hemorrhagic fever. They are potentially fatal. Dengue fever causes a high fever along with some of the following signs and symptoms:

• Headache
• Muscle, bone, or joint pain
• Nausea
• Vomiting
• Pain behind the eyes
• Swollen glands
• Rash

Dengue hemorrhagic fever, also called dengue shock syndrome, is a life-threatening emergency that develops very quickly. The warning signs usually begin on the first few days after the fever subsides, and the symptoms are:

• Severe stomach pain
• Persistent vomiting
• Bleeding from your gums or nose
• Blood in your urine, stools, or vomit
• Bleeding under the skin, which might look like bruising
• Difficult or rapid breathing
• Fatigue
• Irritability or restlessness

When To Seek Medical Help?

It is essential to seek immediate medical attention if you’ve recently visited an area in which dengue fever is prevalent or developed a fever and any of the warning signs. Warning signs include severe stomach pain, vomiting, difficulty breathing, blood in your nose, gums, vomit, or stools.

Prognosis

Most cases of dengue fever recover within a week or so. However, in some cases, symptoms may get worse and become fatal. Severe dengue occurs when the blood vessels become damaged and leaky, leading to fluid and plasma loss. As an effect, the number of platelets in the blood circulation begins to decrease quickly, leading to shock, internal bleeding, organ failure, and death.

What is the Main Cause Of Dengue Fever?

Dengue is caused by four types of dengue viruses, one type at a time. Dengue fever is spread through two types of mosquitoes that carry and spread the dengue viruses. They are the Aedes aegypti mosquito and to a lesser extent, the Aedes albopictus mosquito. The infection spreads like a chain. When these mosquitoes bite a dengue-infected person, the virus enters the mosquito and when the infected mosquitoes bite other people, the virus enters their bloodstream and leads to an infection. Four serotypes of the dengue virus can cause dengue fever. They are transmitted either by the Aedes aegypti mosquito or the Aedes albopictus mosquito. A person may acquire dengue fever more than once and become lifelong immune to the specific virus that caused it, but will not be immune to the other three dengue serotype viruses.

This means that a person can be infected again in the future by one of the other three virus types. The risk of developing severe dengue fever increases when a person gets dengue fever a second, third, or fourth time.

Complications

Severe dengue fever can cause internal bleeding, organ damage, and a steep decrease in blood pressure causing shock. In some cases, severe dengue fever can lead to death. Women who get dengue fever during pregnancy may be able to spread the virus to the baby during childbirth. Additionally, babies of women who contract dengue fever during pregnancy have a higher risk of pre-term birth, low birth weight, or fetal distress.

Treatment For Dengue Fever

There are no specific treatment methods for dengue fever that can be managed symptomatically. The treatment for mild symptoms includes:

• Drinking water to help prevent dehydration
• Getting plenty of rest
• Using painkillers and antipyretics can help reduce pain and temperature.
• It is better to avoid nonsteroidal anti-inflammatory drugs as they can increase the risk of internal bleeding.

Some cases may require hospitalization with the following:

• IV fluid supplementation
• Blood transfusion
• Platelet transfusion

Seek immediate medical help if you have any of the given signs and symptoms of dehydration:

• Decreased urination
• Dry mouth or lips
• Lethargy and confusion
• Cold and clammy limbs

Transmission

• Dengue virus is spread to people through the bites of infected mosquitoes of Aedes aegypti and Aedes albopictus. These mosquitoes are also vectors that spread Zika and chikungunya viruses. These mosquitoes breed and lay eggs in stagnant waters in the places indoors and outdoors. These mosquitoes typically actively bite during the night. The mosquitoes become infected when they bite a person infected with the virus. The virus enters the mosquito, infects and spreads it to other people with every bite. Once infected, the mosquito is capable of transmitting the dengue virus for the rest of its life.
• From mother to child: A pregnant woman infected with dengue can pass the virus to the baby during pregnancy and childbirth. There has been only one report about a case that has spread through breast milk. Despite this, the mothers are encouraged to breastfeed, considering that the benefits outweigh the dengue risks.
• Through infected blood, laboratory, or healthcare setting exposures. Dengue can also be spread through blood transfusion, organ transplant, or needle stick injury.
• Human-to-mosquito transmission: Mosquitoes can become infected by people infected with the dengue virus. Infection from human to mosquito can occur up to two days before someone shows symptoms of the illness or up to 2 days after the fever has subsided.

How Is Dengue Fever Diagnosed?

Doctors can diagnose a dengue infection through a blood test to identify the dengue virus or its antibodies. Some of the tests to identify and diagnose the dengue virus are:

• Dengue RNA PCR test: It can detect dengue virus in the early stage of infection and also help to detect the particular strain of dengue virus causing infection.
• Viral antigen detection test or Dengue NS1 Antigen Test: NS1 means non-structural protein 1. It can also detect the virus in the early infection stage and should be done within the first five days of the appearance of symptoms.
• Dengue virus-specific antibodies IgG and IgM test: The IgM antibodies appear in the early stage of infection, and their detection, while symptoms have already occurred, indicates dengue infection. IgM antibodies cannot be detected one to three months after infection. IgG antibodies detect disease in the late stage as IgG levels increase slowly.
• Platelet count: This is lowered in dengue hemorrhagic fever. The average platelet count is 1.5 lac to 4.5 lac/microliter of blood. Low platelet count is medically termed thrombocytopenia. In dengue cases, platelet count may drop to as low as 20000 to 40000 / microliter of blood.

Sometimes doctors suggest a combination of blood tests and imaging tests to diagnose dengue fever infection, as the initial symptoms may be similar to other fevers, such as malaria, chikungunya, etc. Tests may include:

• Complete blood count (CBC): To check the platelet count typical of the illness’s later stages and detect the decrease in hematocrit, hemoglobin, and red blood cell count.
• D-dimer: D-dimer is a protein by-product produced when the blood clot dissolves in the body. The D-dimer levels in the blood are increased during dengue fever.
• A fibrinogen test: Fibrinogen is a blood protein made in the liver and helps blood clotting. The test is done to check the fibrinogen levels in case of complicated dengue hemorrhagic fever patients tend to have excessive bleeding.
• Fibrin degradation products blood test: Fibrin degradation products (FDPs) are the residues left when the blood clots dissolve in the blood. Increased FDPs indicate primary or secondary fibrinolysis due to dengue hemorrhagic fever.

Who Is At Risk For Dengue Fever?

People with previous infections with the dengue virus are more at high risk of developing severe dengue fever.
Living or traveling in tropical and subtropical areas increases the risk of exposure to the virus that causes dengue fever. Southeast Asia, the Pacific islands, Latin America, and Africa are the most high-risk areas.

Prevention Of Dengue Fever

When there is an endemic or if a person is at risk of getting infected with dengue, it’s essential to protect from mosquito bites. If a person is already infected, it is necessary to avoid further bites as you may transmit the virus to uninfected mosquitoes, infecting other people. The proximity of mosquito vector breeding areas in the surroundings is a significant risk factor for dengue. Therefore, the primary strategy to control or prevent dengue virus transmission is to combat the mosquito vectors. The two main ways to protect from dengue infection are preventing mosquito bites and proper vaccination.

Protection from mosquitoes

The best way to reduce the risk of acquiring dengue fever is to protect yourself from mosquito bites:

• Use an EPA-registered insect repellent that contains 20% to 30% DEET to keep Aedes mosquitos away.
• Remove standing and stagnant water such as buckets, bird baths, and unused things in the garden that may hold rainwater and prevent water from pooling in and around the house.
• Keep the mosquitos outside the home using mosquito nets, sprays, and screens, and keep windows and doors closed as much as possible.
• Use mosquito nets throughout the day and night in areas where dengue is prevalent, as the dengue-causing mosquitoes are active throughout the day.
• Avoid traveling to areas where dengue fever is prevalent if you are pregnant.
• Dispose of the waste properly and remove things that can hold water in the surrounding areas.
• Cover or empty and clean the water storage containers every week.
• Apply appropriate insecticides to water storage containers and water stagnant pits and pools.
• Wear clothes that minimize skin exposure to mosquito bites.
• Educate the community about the risks of mosquito-borne diseases.
• Engage with the community to improve awareness, participation, and mobilization for sustained vector control.
• Active monitoring and surveillance of vectors should be carried out to determine the effectiveness of control interventions.
• Vector surveillance should also be combined with clinical and environmental management.

Vaccination against dengue fever

Vaccination must be considered as part of an integrated dengue prevention and control strategy. Vaccinated or not, a person should seek immediate health care if they experience dengue-like symptoms.

• The first dengue vaccinewas developed in December 2015 and has been approved by regulatory health authorities in 20 countries.
• The use of the vaccine is indicated for people living in endemic areas, aged 9-45 years, who have had at least one episode of dengue virus infection in the past. New dengue vaccines are also under evaluation.
• The dengue vaccine is recommended only if a person has had a previous dengue infection. However, it can reduce the risk of dengue hemorrhagic fever if the person is infected with a different serotype of the dengue virus in the future.
• Getting vaccinated is not recommended and is risky if the person has never had a dengue infection. Because getting infected once with dengue makes a person more likely to get sicker if infected with another version of the dengue virus.
• People will be tested to check for signs of a previous dengue infection to confirm that they have had a dengue infection before getting the vaccine.

Managing The Symptoms Of Dengue Fever

Managing the symptoms is the only way to treat dengue fever. Follow the given recommendations, such as:

• Keeping yourself hydrated by drinking plenty of water and fluids.
• Getting as much rest as possible.
• Treating pain with acetaminophen only.
• Avoid taking ibuprofen or aspirin. They may increase the risk of developing internal bleeding.

Also Read 9 Helpful Tips To Prevent Dengue Fever

Home remedies for Dengue fever

Please note that these home remedies are suggested as a supportive therapy, not as a replacement for the physician’s consultation and treatment. In case of suspected symptoms, it is strongly recommended to consult a physician.

• Papaya Leaves: Many research reports that papaya leaves play a crucial role in fighting dengue fever. It helps to increase the platelet counts, which decreases during dengue infection. Typically, it is advised to consume these leaves or raw papaya in the juice form along with orange and lime juice, a little honey, a dash of pepper, and salt.
• Mix of herbs: Regular consumption of tulsi, amla, papaya, ashwagandha, ginger, giloy, and aloe vera can help control the spread of the disease.
• Coconut Water: Coconut water is very beneficial for replenishing fluid loss and is loaded with electrolytes and nutrients.
• Turmeric: The consumption of turmeric with milk helps in faster recovery.
• Fenugreek: Fenugreek helps to induce sleep and helps in easing body pain. It is also known to bring down high fevers.
• Ginger: The ginger water helps combat nausea and vomiting most dengue patients experience.

Homeopathic Treatment

Homoeopathy can be helpful as a prophylactic in preventing dengue outbreaks. The medicines are selected through a person’s individual symptoms and symptom similarity. Homeopathic medicines can be beneficial in treating the symptoms of mild to moderate cases under the guidance of a registered homeopathic physician. However, it is vital to get immediate emergency care and hospitalization in case of severe cases of dengue fever. Some of the best homeopathic remedies for dengue fever are the ones selected based on the individual symptoms. One has to consult a doctor for the same.

Homeopathic Medicines for Dengue Hemorrhagic Fever

There are many homeopathic medicines to manage and control the bleeding in Dengue hemorrhagic fever. But it is always advised to seek immediate emergency medical help from a conventional mode of treatment as this condition is critical and can be life-threatening that may need hospitalization. However, homeopathic medicines can be used alongside conventional therapy once the patient is stabilized.

Homeopathic medicine as preventive

In homeopathy, a genus epidemicus can be selected for any sporadic and epidemic situations through the totality of symptoms related to the current endemic or epidemic. It is done by studying and analyzing the signs and symptoms of at least around 20-30 cases from different areas and regions. The symptoms are then put through a process of individualization and repertorisation, and the most similar remedy to the totality of symptoms is selected as the prophylactic remedy.

Homeopathic remedies for increasing the platelet count

There are many homeopathic medicines for thrombocytopenia. One has to consult a doctor before using them.

Conclusion

Dengue fever is a severe and exhausting mosquito-borne disease caused by dengue viruses. Though most cases are mild or asymptomatic, severe dengue infection can be dangerous and fatal. The treatment is usually symptomatic and may need IV, electrolytes, or blood transfusion in extreme cases. A blood transfusion can increase the platelet count.

In addition to conventional treatment, taking a proper diet and lots of fluids is essential for a speedy recovery. Home remedies such as papaya leaf extract, green leafy vegetables, fruits, iron-rich foods, foods rich in vitamin C and vitamin K, and supplements can help increase platelet counts during infection.
Stay away from mosquito bites and watch for the warning signs of severe dengue. If you get sick while traveling, get immediate emergency medical care.

FREQUENTLY ASKED QUESTIONS

1. How do you confirm dengue?

Most cases of dengue fever do not show any symptoms. Even if there are any, it is usually mild. But sometimes, it can get severe and require immediate medical attention. Dengue fever is diagnosed with a blood test. This can confirm and identify the dengue virus.

2. How long does dengue fever last?

The initial symptoms of dengue fever usually last for three to seven days. Most people feel better and recover after this, but some with severe dengue may require hospitalization and treatment.

3. Does dengue need hospitalization?

Usually, it is not necessary. But if the infected person shows any warning signs of severe dengue, it is crucial to visit the nearest hospital immediately as it can have life-threatening consequences.

4. Which fruit is good for dengue?

Research suggests that fruits like papaya, apples, banana, oranges, pomegranates, and kiwi can help in the recovery of dengue fever as they are rich in vitamin C, and have anti-inflammatory qualities. While most fruits are advisable to take during dengue, avoiding salicylate-rich fruits such as avocados, berries, cherries, grapes, peaches, and plums is better.

5. What should we avoid in dengue?

There are no specific dietary restrictions for dengue fever. Mostly it is advised to take a balanced, healthy diet that is easy to digest. Dengue patients should avoid high-fat and spicy foods, as well as caffeinated drinks, etc. Increase the fluid intake and consume warm water instead of regular water.

6. Can Homeopathy treat dengue?

Homeopathic medicines for dengue fever are usually selected according to the symptoms. Homeopathic physicians manage the symptoms of dengue fever along with conventional treatment.

7. What are the best homeopathic medicines for increasing platelet count?

Homeopathic medicines for increasing the platelet count are the ones selected by the physician based on the similimum and condition specific drugs.