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Dengue Fever in Adults: Condition, Treatments, and Pictures – Overview

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Images of Dengue Fever

Overview

Dengue fever is a viral illness passed to humans through the bite of an infected mosquito. The disease is rare in the United States, with approximately 200 cases occurring every year, but it is common worldwide, with up to 100,000 cases a year. The mosquitoes that carry the dengue fever virus (a member of the flavivirus family) live in tropical areas, and they tend to bite humans during the day. There is a delay of about 2–7 days between the mosquito bite and the onset of symptoms, so it is possible that travelers to these areas will return home before they start having symptoms. Dengue fever is not contagious between humans; it is only passed from mosquitoes to humans. However, an infected human could pass the virus back to a mosquito, which could then infect other humans. Dengue fever is also known as breakbone fever, because the illness causes terrible muscle and bone pain.

Who’s at risk?

Travelers to endemic areas, such as Caribbean, Central America, South America, Southeast Asia, and Africa, should be aware of the risk of dengue fever. Children tend to have more severe disease with increased risk of death.

Signs and Symptoms

The symptoms of dengue fever usually occur in 2 phases, starting 2–7 days after the mosquito bite.

Early phase (first 3–4 days):

  • High fever
  • Chills
  • Eye pain
  • Headache
  • Muscle and joint pain, particularly the lower back

Later phase (second 3–4 days):

  • Diminishing fever (defervescence)
  • Rash – typically, bright red-purple dots appearing first on the arms, and legs, and possibly pink-red patches all over the body
  • Nausea
  • Vomiting
  • Cough
  • Sore throat
  • Runny nose
  • Sometimes return of high fever
  • Occasionally, presence of bleeding from the nose and gums in hemorrhagic (bleeding) symptoms
  • Rarely, organ failure from massive internal bleeding

Self-Care Guidelines

To prevent dengue fever, protect yourself from all mosquito bites:

  • Wear neutral-colored long-sleeved shirts and pants that have been pretreated with a special long-lasting insecticide.
  • Cover exposed skin with insecticide.
  • Sleep under a mosquito net.
  • Avoid spending time outdoors during the day, when dengue fever mosquitoes are mostly likely to bite.
  • Get rid of areas of standing water, such as tires, flower pots, and puddles that may breed mosquitoes.
  • Before traveling to any tropical climate, check with the cdc.gov Web site to learn if there is a current dengue fever epidemic in that area.

Note: In the case of severe dengue fever, taking fever-reducing medicines such as acetaminophen, aspirin, and ibuprofen can be very harmful. Do NOT take these or any other medications without discussing with your doctor. For any illness with fever, be sure to rest and stay well hydrated.

When to Seek Medical Care

Always seek medical care for any illness with high fever that persists or is painful. In general, any rash that looks like red-purple pinpoint dots (petechiae), particularly if it accompanies an illness with fever, should be evaluated by a doctor.

Because dengue fever is a rare diagnosis in the US, be sure to mention your travel history to your doctor.

Treatments Your Physician May Prescribe

Your doctor can diagnosis dengue fever by testing your blood for the presence of antibodies to the virus. There is no treatment for dengue fever. Your doctor will provide symptomatic care by treating your symptoms as they arise.

In the case of hemorrhagic (bleeding) symptoms, you may be given a blood transfusion. Usually, your doctor will prescribe fever-reducing medicines and pain medicines.

A vaccine has been approved in Brazil, Mexico, and the Philippines.

Dengue Fever in Adults: Condition, Treatments, and Pictures – Overview

51361
36

Information for
Atlas

caption goes here…

Images of Dengue Fever

Overview

Dengue fever is a viral illness passed to humans through the bite of an infected mosquito. The disease is rare in the United States, with approximately 200 cases occurring every year, but it is common worldwide, with up to 100,000 cases a year. The mosquitoes that carry the dengue fever virus (a member of the flavivirus family) live in tropical areas, and they tend to bite humans during the day. There is a delay of about 2–7 days between the mosquito bite and the onset of symptoms, so it is possible that travelers to these areas will return home before they start having symptoms. Dengue fever is not contagious between humans; it is only passed from mosquitoes to humans. However, an infected human could pass the virus back to a mosquito, which could then infect other humans. Dengue fever is also known as breakbone fever, because the illness causes terrible muscle and bone pain.

Who’s at risk?

Travelers to endemic areas, such as Caribbean, Central America, South America, Southeast Asia, and Africa, should be aware of the risk of dengue fever. Children tend to have more severe disease with increased risk of death.

Signs and Symptoms

The symptoms of dengue fever usually occur in 2 phases, starting 2–7 days after the mosquito bite.

Early phase (first 3–4 days):

  • High fever
  • Chills
  • Eye pain
  • Headache
  • Muscle and joint pain, particularly the lower back

Later phase (second 3–4 days):

  • Diminishing fever (defervescence)
  • Rash – typically, bright red-purple dots appearing first on the arms, and legs, and possibly pink-red patches all over the body
  • Nausea
  • Vomiting
  • Cough
  • Sore throat
  • Runny nose
  • Sometimes return of high fever
  • Occasionally, presence of bleeding from the nose and gums in hemorrhagic (bleeding) symptoms
  • Rarely, organ failure from massive internal bleeding

Self-Care Guidelines

To prevent dengue fever, protect yourself from all mosquito bites:

  • Wear neutral-colored long-sleeved shirts and pants that have been pretreated with a special long-lasting insecticide.
  • Cover exposed skin with insecticide.
  • Sleep under a mosquito net.
  • Avoid spending time outdoors during the day, when dengue fever mosquitoes are mostly likely to bite.
  • Get rid of areas of standing water, such as tires, flower pots, and puddles that may breed mosquitoes.
  • Before traveling to any tropical climate, check with the cdc.gov Web site to learn if there is a current dengue fever epidemic in that area.

Note: In the case of severe dengue fever, taking fever-reducing medicines such as acetaminophen, aspirin, and ibuprofen can be very harmful. Do NOT take these or any other medications without discussing with your doctor. For any illness with fever, be sure to rest and stay well hydrated.

When to Seek Medical Care

Always seek medical care for any illness with high fever that persists or is painful. In general, any rash that looks like red-purple pinpoint dots (petechiae), particularly if it accompanies an illness with fever, should be evaluated by a doctor.

Because dengue fever is a rare diagnosis in the US, be sure to mention your travel history to your doctor.

Treatments Your Physician May Prescribe

Your doctor can diagnosis dengue fever by testing your blood for the presence of antibodies to the virus. There is no treatment for dengue fever. Your doctor will provide symptomatic care by treating your symptoms as they arise.

In the case of hemorrhagic (bleeding) symptoms, you may be given a blood transfusion. Usually, your doctor will prescribe fever-reducing medicines and pain medicines.

A vaccine has been approved in Brazil, Mexico, and the Philippines.

Symptoms, Treatment, Vaccine, Rash, Causes & Contagious

Ahmad, Nisar, et al. “Dengue Fever Treatment With Carica papaya Leaves Extracts.” Asian Pac J Trop Biomed 1.4 Aug. 2011: 330-333.

Anwar, Sarah. “First Dengue Vaccine Approved By WHO After Twenty Years of Clinical Studies. ” ContagionLive.com. Apr. 19, 2016. <http://www.contagionlive.com/news/first-dengue-vaccine-is-approved-by-who-after-twenty-years-of-clinical-studies?utm_source=Informz&utm_medium=Contagion+Live&utm_campaign=Contagion_Live_
Trending_2_4-19-16>.

Canada. Public Health Agency of Canada. “Dengue Fever: Global Update.” June 3, 2011. <http://www.phac-aspc.gc.ca/tmp-pmv/thn-csv/dengue-eng.php>.

Canada. Public Health Agency of Canada. “Dengue in South East Asia.” Aug. 23, 2007. <http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070823_e.html>.

“Dengue Fever in Key West.” Florida Department of Health. <http://www.doh.state.fl.us/Environment/medicine/arboviral/Dengue_FloridaKeys.html>.

Dengue Vaccine Initiative. <http://www.denguevaccines.org/>.

Effler, P.V., et al. “Dengue Fever, Hawaii, 2001-2002.” Emerg Infec Dis 11.5 May 2005: 742-749. <http://www.ncbi.nlm.nih.gov/pubmed/15890132>.

Hendrick, Bill. “FDA OKs Test for Dengue Fever. ” WebMD.com. Apr. 13, 2011. <https://www.webmd.com/news/20110413/fda-oks-test-for-dengue-fever>.

New Zealand. Auckland Regional Public Health Service. “Dengue Fever, Zika & Chikungunya.” September 2015. <http://www.arphs.govt.nz/health-information/communicable-disease/dengue-fever-zika-chikungunya#.VgB53HvBdgo>.

Seet, Raymond C.S., Amy M.L. Quek, and Erle C.H. Lim. “Post-infectious fatigue syndrome in dengue infection.” Journal of Clinical Virology 38 (2007): 1-6. <http://189.28.128.102/portal/arquivos/kitdengue2/aspectosclinicos/textos/
postinfection_fatigue_syndrome.pdf>.

Shepherd, Suzanne Moore. “Dengue.” Medscape.com. Oct. 5, 2015. <http://emedicine.medscape.com/article/215840-overview#a6>.

Switzerland. World Health Organization. “Dengue and Severe Dengue.” April 2016.<http://www.who.int/mediacentre/factsheets/fs117/en/&gt.

Switzerland. World Health Organization. “Dengue Fever — Sri Lanka.” July 19, 2017.
<http://www. who.int/csr/don/19-july-2017-dengue-sri-lanka/en/>.

Switzerland. World Health Organization. “Dengue vaccine research.” Dec. 14, 2015. <http://www.who.int/immunization/research/development/dengue_vaccines/en/>.

Switzerland. World Health Organization. “Planning Social Mobilization and Communication for Dengue Fever Prevention and Control.” <http://www.who.int/tdr/publications/publications/pdf/planning_dengue.pdf>.

Switzerland. World Health Organization. “Vector-Borne Viral Infections.” <http://www.who.int/vaccine_research/diseases/vector/en/index.html>.

United States. California Department of Public Health. “Aedes aegypti and Aedes albopictus Mosquitoes.” <https://www.cdph.ca.gov/HEALTHINFO/DISCOND/Pages/Aedes-albopictus-and-Aedes-aegypti-Mosquitoes.aspx>.

United States. Centers for Disease Control and Prevention. “Chikungunya.” Oct. 6, 2010. <http://www.cdc.gov/ncidod/dvbid/chikungunya/>.

United States. Centers for Disease Control and Prevention. “Dengue.” June
15, 2015. <http://www.cdc.gov/Dengue/>.

United States. Centers for Disease Control and Prevention. “Dengue.” Oct. 28, 2010. <http://www.cdc.gov/dengue/epidemiology/index.html>.

United States. Centers for Disease Control and Prevention. “Dengue Hemorrhagic Fever — U.S.-Mexico Border, 2005.” Aug. 8, 2007. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a1.htm>.

United States. Centers for Disease Control and Prevention. “Locally Acquired Dengue — Key West, Florida, 2009-2010.”
Morbidity and Mortality Weekly Report 59.19 May 21, 2010: 577-581. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5919a1.htm>.

United States. FDA. “First FDA-approved vaccine for the prevention of dengue disease in endemic regions.” May 1, 2019. <https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-dengue-disease-endemic-regions>.

United States. State of Hawaii, Department of Health. “Dengue Outbreak 2015. ” Jan. 8, 2016. <http://health.hawaii.gov/docd/dengue-outbreak-2015/>.

“Why a Vaccine.” Dengue Vaccine Initiative. <http://www.denguevaccines.org/why-a-vaccine>.

Dengue fever – Symptoms and causes

Overview

Dengue (DENG-gey) fever is a mosquito-borne illness that occurs in tropical and subtropical areas of the world. Mild dengue fever causes a high fever and flu-like symptoms. The severe form of dengue fever, also called dengue hemorrhagic fever, can cause serious bleeding, a sudden drop in blood pressure (shock) and death.

Millions of cases of dengue infection occur worldwide each year. Dengue fever is most common in Southeast Asia, the western Pacific islands, Latin America and Africa. But the disease has been spreading to new areas, including local outbreaks in Europe and southern parts of the United States.

Researchers are working on dengue fever vaccines. For now, in areas where dengue fever is common, the best ways to prevent infection are to avoid being bitten by mosquitoes and to take steps to reduce the mosquito population.

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Symptoms

Many people experience no signs or symptoms of a dengue infection.

When symptoms do occur, they may be mistaken for other illnesses — such as the flu — and usually begin four to 10 days after you are bitten by an infected mosquito.

Dengue fever causes a high fever — 104 F (40 C) — and any of the following signs and symptoms:

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

Most people recover within a week or so. In some cases, symptoms worsen and can become life-threatening. This is called severe dengue, dengue hemorrhagic fever or dengue shock syndrome.

Severe dengue happens when your blood vessels become damaged and leaky. And the number of clot-forming cells (platelets) in your bloodstream drops. This can lead to shock, internal bleeding, organ failure and even death.

Warning signs of severe dengue fever — which is a life-threatening emergency — can develop quickly. The warning signs usually begin the first day or two after your fever goes away, and may include:

  • 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 see a doctor

Severe dengue fever is a life-threatening medical emergency. Seek immediate medical attention if you’ve recently visited an area in which dengue fever is known to occur, you have had a fever and you develop any of the warning signs. Warning signs include severe stomach pain, vomiting, difficulty breathing, or blood in your nose, gums, vomit or stools.

If you’ve been traveling recently and develop a fever and mild symptoms of dengue fever, call your doctor.

Causes

Dengue fever is caused by any one of four types of dengue viruses. You can’t get dengue fever from being around an infected person. Instead, dengue fever is spread through mosquito bites.

The two types of mosquitoes that most often spread the dengue viruses are common both in and around human lodgings. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito. Then, when the infected mosquito bites another person, the virus enters that person’s bloodstream and causes an infection.

After you’ve recovered from dengue fever, you have long-term immunity to the type of virus that infected you — but not to the other three dengue fever virus types. This means you can be infected again in the future by one of the other three virus types. Your risk of developing severe dengue fever increases if you get dengue fever a second, third or fourth time.

Risk factors

You have a greater risk of developing dengue fever or a more severe form of the disease if:

  • You live or travel in tropical areas. Being in tropical and subtropical areas increases your risk of exposure to the virus that causes dengue fever. Especially high-risk areas include Southeast Asia, the western Pacific islands, Latin America and Africa.
  • You have had dengue fever in the past. Previous infection with a dengue fever virus increases your risk of severe symptoms if you get dengue fever again.

Complications

Severe dengue fever can cause internal bleeding and organ damage. Blood pressure can drop to dangerous levels, 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 get dengue fever during pregnancy have a higher risk of pre-term birth, low birth weight or fetal distress.

Prevention

Vaccine

In areas of the world where dengue fever is common, one dengue fever vaccine (Dengvaxia) is approved for people ages 9 to 45 who have already had dengue fever at least once. The vaccine is given in three doses over the course of 12 months.

The vaccine is approved only for people who have a documented history of dengue fever or who have had a blood test that shows previous infection with one of the dengue viruses — called seropositivity. In people who have not had dengue fever in the past (seronegative), receiving the vaccine appears to increase the risk of severe dengue fever and hospitalization due to dengue fever in the future.

Dengvaxia is not available for travelers or for people who live in the continental United States. But in 2019, the U.S. Food and Drug Administration approved the vaccine for people ages 9 to 16 who have had dengue fever in the past and who live in the U.S. territories of American Samoa, Guam, Puerto Rico and the U. S. Virgin Islands — where dengue fever is common.

Prevent mosquito bites

The World Health Organization stresses that the vaccine is not an effective tool on its own to reduce dengue fever in areas where the illness is common. Preventing mosquito bites and controlling the mosquito population are still the main methods for preventing the spread of dengue fever.

If you live in or travel to an area where dengue fever is common, these tips may help reduce your risk of mosquito bites:

  • Stay in air-conditioned or well-screened housing. The mosquitoes that carry the dengue viruses are most active from dawn to dusk, but they can also bite at night.
  • Wear protective clothing. When you go into mosquito-infested areas, wear a long-sleeved shirt, long pants, socks and shoes.
  • Use mosquito repellent. Permethrin can be applied to your clothing, shoes, camping gear and bed netting. You can also buy clothing made with permethrin already in it. For your skin, use a repellent containing at least a 10% concentration of DEET.
  • Reduce mosquito habitat. The mosquitoes that carry the dengue virus typically live in and around houses, breeding in standing water that can collect in such things as used automobile tires. You can help lower mosquito populations by eliminating habitats where they lay their eggs. At least once a week, empty and clean containers that hold standing water, such as planting containers, animal dishes and flower vases. Keep standing water containers covered between cleanings.


Nov. 18, 2020

Dengue Fever (for Parents) – Nemours KidsHealth

What Is Dengue Fever?

Dengue (DEN-gee) fever is a tropical disease caused by a virus carried by mosquitoes. The virus can cause fever, headaches, rashes, and pain throughout the body. Most cases of dengue fever are mild and go away on their own after about a week.

Dengue fever rarely strikes in the United States — the last reported outbreak was in Texas in 2005. But if you plan to travel to a foreign country, especially one in the tropics, it’s wise to guard against dengue fever. Wearing insect repellent, covering sleep areas with netting, and avoiding the outdoors at dusk and dawn (when mosquitoes are most active) can help lower the chances of infection.

What Causes Dengue Fever?

Dengue fever is caused by four similar viruses spread by mosquitoes of the genus Aedes, which are common in tropical and subtropical areas worldwide.

When an Aedes mosquito bites a person who has been infected with a dengue virus, the mosquito can become a carrier of the virus. If this mosquito bites someone else, that person can be infected with dengue fever. The virus can’t spread directly from person to person.

In rare cases, dengue fever can lead to a more serious form of the disease called dengue hemorrhagic fever (DHF). DHF can be life-threatening and needs to be treated right away.

What Are the Signs & Symptoms of Dengue Fever?

Symptoms of dengue fever are generally mild in younger children and those who have the disease for the first time. Older kids, adults, and those who have had a previous infection may have moderate to severe symptoms.

Common signs and symptoms of dengue fever include:

  • high fever, possibly as high as 105°F (40°C)
  • pain behind the eyes and in the joints, muscles and/or bones
  • severe headache
  • rash over most of the body
  • mild bleeding from the nose or gums
  • bruising easily

Dengue fever used to be called “breakbone fever,” which might give you an idea of the severe bone and muscle pain it sometimes can cause. The fever isn’t actually breaking any bones, but it can sometimes feel like it is.

How Long Does Dengue Fever Last?

Symptoms can start anywhere from 4 days to 2 weeks after being bitten by an infected mosquito, and typically last for 2 to 7 days.

After the fever eases, other symptoms can get worse and may cause more severe bleeding; gastrointestinal problems like nausea, vomiting, or severe abdominal (belly) pain; and respiratory problems like difficulty breathing. Dehydration, heavy bleeding, and a rapid drop in blood pressure (shock) can follow if DHF goes untreated. These symptoms are life-threatening and need immediate medical care.

Someone who’s had the illness becomes immune to that particular type of the virus (but can still be infected by any of the other three types).

How Is Dengue Fever Diagnosed?

If you think your child might have dengue fever, call a doctor right away. You should also call a doctor if your child has recently been to a region that has dengue fever and has a fever or severe headache.

To make a diagnosis, the doctor will examine your child and evaluate the symptoms. The doctor will ask about your child’s medical history and recent travels, and send a blood sample for testing.

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How Is Dengue Fever Treated?

No specific treatment is available for dengue fever. Mild cases are managed with lots of fluids to prevent dehydration and getting plenty of rest. Pain relievers with acetaminophen can ease the headaches and pain associated with dengue fever. Pain relievers with aspirin or ibuprofen should be avoided, as they can make bleeding more likely.

Most cases of dengue fever go away within a week or two and won’t cause any lasting problems. If someone has severe symptoms of the disease, or if symptoms get worse in the first day or two after the fever goes away, seek immediate medical care. This could be an indication of DHF, which is a medical emergency.

To treat severe cases of dengue fever at a hospital, doctors will give intravenous (IV) fluids and electrolytes (salts) to replace those lost through vomiting or diarrhea. When started early, this is usually enough to effectively treat the disease. In more advanced cases, doctors may have to do a blood transfusion.

In all cases of dengue infection, efforts should be made to keep the infected person from being bitten by mosquitoes. This will help prevent the illness from spreading to others.

Can Dengue Fever Be Prevented?

There’s no vaccine to prevent dengue fever. The best protection is to prevent bites by an infected mosquito. Be sure to:

  • Use screens on doors and windows, and promptly repair broken or damaged screens. Keep unscreened doors and windows shut.
  • Have kids wear long-sleeved shirts, long pants, shoes, and socks when they go outside, and use mosquito netting over their beds at night.
  • Use insect repellent as directed on kids. Choose one with DEET or oil of lemon eucalyptus.
  • Limit the amount of time kids spend outside during the day, especially in the hours around dawn and dusk, when mosquitoes are most active.
  • Don’t give mosquitoes places to breed. They lay their eggs in water, so get rid of standing water in things like containers and discarded tires, and be sure to change the water in birdbaths, dog bowls, and flower vases at least once a week.

By taking these precautions and keeping your kids away from areas that have a dengue fever epidemic, the risk of contracting dengue fever is small for international travelers.

MUCOCUTANEOUS MANIFESTATIONS OF DENGUE FEVER

Indian J Dermatol. 2010 Jan-Mar; 55(1): 79–85.

Emy Abi Thomas

From the Department of Dermatology, Christian Medical College, Ludhiana, India.

Mary John

1From the Department of Medicine, Christian Medical College, Ludhiana, India.

Bimal Kanish

From the Department of Dermatology, Christian Medical College, Ludhiana, India.

From the Department of Dermatology, Christian Medical College, Ludhiana, India.

1From the Department of Medicine, Christian Medical College, Ludhiana, India.

Address for correspondence: Dr. E.A Thomas, Department. of Dermatology, Christian Medical College, Ludhiana, India. E-mail: [email protected]

Received 2009 Aug; Accepted 2009 Sep.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Dengue viral infection is a cause of considerable morbidity and mortality and may be associated with a variety of mucocutaneous manifestations that may provide important early clues to the diagnosis of this condition. Cutaneous and mucosal findings like confluent erythema, morbilliform eruptions, and hemorrhagic lesions may figure prominently in the clinical features of dengue. The differential diagnoses include a large number of bacterial and viral exanthems as well as drug rash.

Keywords: Dengue fever, mucocutaneous, rash

Introduction

Although it has been said that the eyes are the window to the soul, it may also be said that the skin is the window to within. The skin can provide important clues to systemic diseases, enabling the practitioner to make a tremendous contribution to patient care if cutaneous manifestations in a systemic disorder can be identified. This article focuses on the various mucocutaneous manifestations associated with dengue viral infection.

Dengue fever (DF) is a severe, flu-like illness that affects infants, children, adolescents, and adults. The incubation period of DF after the mosquito bite is between 3 and 8 days. The clinical features vary according to the age of the patient. Infants and young children usually have only a nonspecific febrile illness, with a rash that is hard to distinguish from other viral illnesses.[1] The more severe cases usually occur in older children and adults and are characterized by a rapidly rising temperature (> 39°C) that lasts approximately 5 to 6 days and sometimes may be biphasic. During the febrile period, the patient may experience severe headache, retro-orbital pain, myalgia, arthralgia, nausea, and/or vomiting. More than 50% of infected patients report having a rash during this period that initially is macular or maculopapular and becomes diffusely erythematous.[2] Minor hemorrhagic manifestations such as petechiae, epistaxis, and gingival bleeding occur in some patients.

Etiopathogenesis

There are four serotypes of the dengue virus (DEN 1-4). Dengue virus is a single-stranded RNA virus transmitted mainly by the mosquito Aedes aegypti. Various hypotheses regarding the etiology are as follows:

  1. Viral replication, which occurs primarily in macrophages, although dendritic cells (Langerhans cells) in skin may be the early targets of infection.[3]

  2. Direct infection of the skin by dengue virus.[4]

  3. Immunologic and chemically mediated mechanisms induced by interaction of the virus with the host.[4]

However, De Andino et al. concluded that the absence of evidence for direct viral involvement or for immune complexes in the skin lesions could be due to viral host interaction inducing release of unidentified chemical mediators in the skin and that the rash has nothing to do with the direct viral invasion or with the presence of immune complexes. [5]

Infections with the dengue virus can cause a spectrum of three clinical syndromes with classic DF, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). World Health Organization criteria exist for the classification of dengue into these three clinical categories [];[6] however, there is a significant overlap between the categories.[7]

Table 1

World Health Organization criteria for dengue fever, dengue hemorrhagic fever, and dengue shock syndrome

Dengue fever Dengue hemorrhagic fever Dengue shock syndrome
An acute febrile illness with more than two of the following manifestations: All of the following must be present All four criteria for DHF must be met plus evidence of circulatory failure manifested by rapid and weak pulse and narrow pulse pressure or hypotension for age, systemic pressure <80 mmHg for those < age 5 years or <90 mmHg for those > age 5 years
Fever or history of acute fever lasting 2-7 days
 Headache Bleeding, evidenced by at least one of the following:
 Retroorbital pain
 Myalgia  Positive tourniquet test result
 Arthralgia  Petechiae, ecchymoses or purpura
 Rash  Bleeding from the mucosa, GI tract, infection sites, or other location.
 Hemorrhagic manifestation Cold clammy skin and restlessness
 Leukopenia  Hematemesis or melena
AND Thrombocytopenia (<1,00,000 cells/mm3)
 Supportive serology Evidence of plasma leakage caused by increased vascular permeability, manifested by at least one of the following:
OR
 Occurrence at the same location and time as other confirmed cases of DF  Increase in hematocrit ≥20% above average for age, sex, and population
Laboratory criteria
 Isolation of dengue virus ≥ fourfold change in antibody titers  Decrease in hematocrit after volume replacement treatment ≥20% of baseline.
 Demonstration of dengue virus antigen  Signs of plasma leakage such as pleural effusion, ascites and hypoproteinemia
 Detection of dengue virus genomic sequence

Cutaneous Manifestations

The characteristic exanthem of DF is estimated to occur in 50-82% of patients with DF.[8,9] Cutaneous findings figure prominently in the clinical manifestations of DF and DHF. In DF, the initial rash is a transient flushing erythema of face that typically occurs shortly before or within the first 24-48 hours of the onset of symptoms and is thought to be the result of capillary dilatation. The second rash usually occurs 3-6 days after the onset of fever and it is characterized by asymptomatic maculopapular or morbilliform eruption []. In some cases, individual lesions may coalesce and are then seen as generalized confluent erythema with petechiae and rounded islands of sparing-“white islands in a sea of red”[8,10] [] and is thought to be due to an immune response to the virus. The rash in DF is usually asymptomatic, pruritus being reported in a substantial minority of patients in different studies; that is, 16% and 27.6%.[11,12] Some patients display only the initial rash and recover completely, while others develop the more generalized eruption.[13] The generalized rash characteristically starts on the dorsum of the hands and feet and spreads to the arms, legs, and torso and it lasts for several days and subsides without desquamation. The morbilliform, maculopapular rash usually spares palms and soles. Less frequently, rashes of two other types may occur.[11] An eruption of fine macule over pressure areas may accompany the premonitory symptoms and herald the onset of fever. In some cases, the end of the fever is also marked by cutaneous changes in the form of a purpuric eruption on the hands, forearms, feet and legs, and in the mouth. Hemorrhagic manifestations on the skin such as petechiae [], purpura, or ecchymosis with positive tourniquet test are commonly seen in DHF and DSS and rarely in DF. Tourniquet test is performed by inflating a blood pressure cuff on the upper aspect of arm to a point midway between systolic and diastolic pressures for 5 minutes. The test is considered positive when >20 petechiae/2.5 cm2 are observed.[13] Hemorrhagic manifestations usually appear 4-5 days after the onset of fever.

Diffuse exanthematous rash

Confluent erythematosus rash with island of sparing

Petechial rash over chest

Mucosal Manifestations

Mucosal involvement is estimated to occur in 15% to 30% of patients with dengue viral infections and more commonly in patients with DHF than with DF.[12] The mucosal manifestations noted in dengue viral infections are conjunctival and scleral injection [], small vesicles on the soft palate, erythema and crusting of lips and tongue. Chadwick et al. [11] reported conjunctival involvement in 14% of patients; however, some reports have shown a higher percentage of mucosal involvement, e.g. scleral injection (90%) and vesicles on the soft palate (> 50%).[14]

Histopathology

In some of the studies on dengue skin pathology, biopsies performed on the local skin lesions showed that the epithelium was not involved and no inclusion bodies were found. The chief abnormality was found in and about the small blood vessels and consisted of endothelial swellings, a site of flavivirus replication, perivascular edema, and infiltration with mononuclear cells.[5,15] The epidermis and the rest of the dermis and subcutaneous tissues were normal.

Immunofluorescence

In the study by De Andino et al.,[5] direct immunofluorescence of involved skin was negative for the deposition of immunoglobulins and complement and, for the presence of dengue viral antigen. Also attempts to isolate dengue virus from the involved skin were negative in all cases even though the virus was isolated from the serum of two of these patients.

In contrast to the above findings, in an immunofluorescence study of skin rash in DHF patients in Thailand, deposits of dengue antigen, IgM, and complements were found in the upper dermal plexus of 6/53 patients.[16]

The skin eruption with the accompanying systemic signs and symptoms may mimic other viral and nonviral diseases, making laboratory confirmation necessary for a correct diagnosis. The incidence of rash may vary with the virus strain.[17]

Differential Diagnosis

When confronted with a febrile patient who has a rash similar to that seen with DF, the differential diagnosis is quite broad. The initial flushing erythema of the chest, head, and neck in association with fever can be seen in the early stages of many viral and bacterial infections []. The generalized morbilliform eruption in association with fever can be seen in the later stages of various viral exanthems and bacterial infections [].

Table 2

Differential diagnosis of classic dengue fever associated flushing erythema

Disease Incubation/presenting symptoms Morphology Distribution of rash Associated findings Laboratory finding
Chikungunya fever 3-12 days, fever, arthralgia, myalgia, headache ± vomiting Flushing erythema Face, upper chest Severe joint pains, conjunctival injection Normal CBC, raised ESR, raised C-reactive protein, Chikungunya IgM positive
Scarlet fever 2-4 days, fever, pharyngitis ± vomiting, abdominal pain, ± convulsions Pinpoint papules on an erythematous back ground (sand paper), linear petechiae (pastia’s lines), membranous desquamation of palms/soles Generalized, spares palms and soles Exudative pharyngitis ASO titer positive, leucocytosis, raised ESR
Kawasaki disease High fever, irritability Flushing macular erythema, non pruritic erythematous plaques, erythema marginatum, desquamation of palms/soles Most prominent on trunk and extremities Conjunctivitis, strawberry tongue, coronary artery aneurysms, lymphadenopathy Leucocytosis, raised ESR, thrombocytosis during second to third week, sterile pyuria in the 1st wk
Toxic shock syndrome Sudden onset fever Erythroderma or scarlatiniform rash Generalized Hypotension, renal involvement, focus of infection Raised serum creatinine phosphokinase level
Erythema infectiosum (fifth disease Parvovirus B-19) 6 days, nonspecific fever and malaise Macular erythema on face (1-4 days) Slapped cheek appearance of face followed by extremities, lacy rash over extensor surfaces Aplastic crisis in sickle cell disease, women may develop arthritis, spontaneous abortions IgM anti-bodies positive

Table 3

Differential diagnosis of classic dengue fever associated morbilliform eruption

Disease Incubation/presenting symptoms Morphology Distribution of rash Associated findings Laboratory findings
Measles 8-12 days, rhinitis, cough, fever Erythematous macules and papules, later becomes confluent Begins on neck and face, spreads down and become generalized and as it fades it leaves a brownish hue with fine desquamation Koplik’s spots, exudative conjunctivitis, photophobia, pneumonia Leucopenia, low ESR, IgM positive (measles, immunoglobulin)
German measles (Rubella) 14-23 days, mild URI, fever, eye pain, lymphadenopathy Pinpoint maculopapular rash Begins on face and spreads to trunk and extremities Tender cervical lymphadenopathy, transient polyarthralgia and polyarthritis irritability, febrile seizures Nasal culture for virus antibody titers
Roseola (Exanthem subitum HHV-6) 5-15 days, high fever for 3-5 days, diarrhea, cough Pale pink macules and papules Trunk, neck and proximal extremities Leucocytosis at the onset and leucopenia later
Infectious mono-nucleosis Fever, malaise Polymorphic macularerythema ± petechiae, urticaria, erythema multiforme like lesions Generalized Pharyngitis, lymphadenopathy, pinhead petechiae at the junction of soft and hard palate (Forschheimer’s spots) Leukocytosis, atypical lymphocytes LFT (transaminases and bilirubin) may be elevated, serology for heterophilic antibodies positive
Secondary syphilis Fever, headache, pharyngitis Polymorphic macules/papules/psoriasiform papules Generalized Lymphadenopathy ± condyloma lata ± moth eaten alopecia VDRL positive
Typhoid fever Fever, vomiting, diarrhea, headache 2-3 mm pink grouped papules (Rose spots) generalized erythema “erythema typhosum” Generalized, trunk Rose spot cultures may be Salmonella typhi positive
Chikungunya fever 3-12 days, fever, arthralgia, myalgia, headache, vomiting Flushing erythema maculopapular lesions, ± petechiae Trunk and extremities Severe joint pains, conjunctival injection Normal CBC, raised ESR, raised C-reactive protein, Chikungunya IgM positive
Lepto-spirosis Acute phase: Fever, headache, myalgia, pharyngitis Morbilliform rash Generalized Immune phase: hemorrhage, jaundice, organ failure Leukocytosis, microscopic agglutination test is positive
Acute retroviral syndrome (HIV) Fever, fatigue headache Maculopapular rash Trunk and upper arms ± palms and soles Myalgia, lymphadenopathy HIV RNA, P24 antigen
Rocky mountain spotted fever 3-12 days, fever, malaise, headache Erythematous macules, evolves to petechiae and purpura Begins on wrist, ankles; spreads centrally; seen on palms and soles Hepatosplenomegaly, hyponatremia, myalgias, CNS involve ment Rickettsial group specific serologic tests positive
Drug exanthem 4-6 days, fever, malaise Maculopapular or urticarial Generalized symmetric often spares the face, palms and soles may be involved Periorbital edema, fever ESR is low

As illustrated in Tables and , the differential diagnosis of DF is broad. It is imperative to exclude Chikungunya fever as its clinical presentation is almost indistinguishable from DF and a similar epidemic is occurring in various parts of the world.

Clinical features favoring Chikungunya fever over DF include a more rapid onset of symptoms, more severe rash, worse conjunctival injection, shorter febrile period,[18] and fewer signs of easy bleeding.[19] Although both conditions are associated with severe arthralgias, patients with Chikungunya fever are more likely to contort themselves into characteristic postures because of severe joint pain.[19]

The rash in scarlet fever begins 12-48 hours after the onset of fever, starts as erythema of the neck, chest, and axillae, and within 4-6 hours it becomes generalized. The rash consists of tiny papules on an erythematous background. Visually, it resembles ‘sunburn with goose pimples’ and feels like sand paper. Pastia’s lines (linear petechial streaks) are seen in the axillary, antecubital, and inguinal areas. The cheeks are flushed with circumoral pallor. The tongue is initially white with bright red papillae, but later becomes beefy red (red strawberry tongue).[20] After 7-10 days, desquamation occurs, most severely affecting the hands and feet, and lasts for 2-6 weeks.

A skin eruption is seen in over 80% of patients with Kawasaki disease[21] and is usually morbilliform or macular but may also be scarlatiniform, erythema multiforme-like, or pustular. A characteristic cutaneous feature is erythema of the perineum, which often desquamates within 48 hours. The conjunctival injection of Kawasaki disease is characterized by perilimbal sparing and lack of increased tearing or exudates.

The cutaneous manifestations are more extensive and predictable in staphylococcal toxic shock syndrome than in streptococcal toxic shock syndrome. Patients usually develop a diffuse scarlatiniform exanthem that starts on the trunk and spreads centripetally with erythema and edema of palms and soles. Erythema of the mucous membranes, a strawberry tongue, and hyperemia of the conjunctivae are also present. Desquamation of the hands and feet occurs 1-3 weeks after the onset of symptoms.[22]

Erythema infectiosum, which is also known as fifth or slapped cheek disease, is another condition that has to be differentiated from DF, though it is most common in children between 4 and 10 years of age. The initial stage of the exanthem consists of bright red macular erythema of the cheeks, with sparing of the nasal bridge and circumoral regions. One to four days later, the second stage appears in the form of erythematous macules and papules, which progress to a lacy, reticulate pattern, occurring most often on the extremities and to a lesser extent on the trunk.[23]

Measles classically presents with a prodrome and a pathognomonic enanthem Koplik’s spots, appears during the prodrome, and is composed of gray-white papules on the buccal mucosa opposite the premolar teeth.[24] The exanthem appears over 2-4 days and consists of erythematous macules and papules that begins on the forehead, hairline, and behind the ears and then spread in a cephalocaudal direction. On the fifth day, the exanthem starts to fade in the same order as it appeared.

Cutaneous manifestations of rubella typically presents 1-5 days following the prodrome as an eruption of erythematous macules and papules on the face and spreads in a cephalocaudal direction. In 2% of cases, petechiae on the soft palate occur late in the prodromal phase or early in the eruptive phase. The cutaneous eruption tends to fade in 2-3 days in the same order as it appeared.[25]

Roseola infantum is a viral disease common in infants, characterized by high fever and skin rash. Cutaneous eruption in roseola is erythematous almond-shaped macules and papules on the trunk, neck, and proximal extremities. An enanthem of red papules on the soft palate and uvula (Nagayama’s spots) may be seen; HHV-6 infection should be suspected in infants with febrile convulsions, even those without the examthem.[26]

Cutaneous findings are observed in 5% of patients with infectious mononucleosis and include macular, papular, urticarial, petechial, scarlatiniform, or erythema multiforme like eruptions. Palatal petechiae may be present. Up to 90% of patients with infectious mononucleosis who receive ampicillin or amoxicillin develop a maculopapular eruption.[27,28]

In secondary syphilis, the most commonly observed clinical presentation is a generalized nonpruritic papulosquamous eruption. Snail track ulcers in the oral cavity and Condyloma lata of the moist areas are other features.[29]

In typhoid fever, the characteristic cutaneous sign is the ‘rose spot’. It is a 2-8 mm, pink, blanching papule that is usually found on the anterior trunk in groups of 5-15 lesions.[30] They occur in up to 50% of patients with typhoid fever and less often in nontyphoidal enteric fever. Rose spots often occur in crops during the second to fourth weeks of the illness, and salmonella can usually be cultured from these lesions.

In leptospirosis, skin manifestation is not very common. Sometimes a blotchy macular erythema or purpura may be seen on the legs.[31]

The earliest cutaneous manifestation of HIV infection may be an exanthem occurring as a manifestation of primary HIV infection. The generalized morbilliform exanthem of ‘acute retroviral syndrome’ typically spares the palms and soles and it usually lasts for 4-5 days.[32]

Rashes are among the most common adverse reactions to drugs. They occur in many forms and mimic many dermatoses. They occur in 2-3% of hospitalized patients.[33–35] Exanthematous or maculopapular drug eruption are the commonest and they occur suddenly often with fever, 7-10 days after the drug is first taken. They are generalized, symmetric, and often pruritic. Maculopapular eruptions are often indistinguishable from viral exanthems and it is usually due to ampicillin or amoxicillin, but any drug can trigger it. Red macules and papules become confluent in a symmetric, generalized distribution that often spares the face. Itching is common. Mucous membranes, palms, and soles may be involved. Fever may be present from the onset. These eruptions are identical in appearance to a viral exanthem and routine laboratory tests usually fail to differentiate the two diseases. Lesions clear rapidly following withdrawal of the implicated agent and may progress to a generalized exfoliative dermatitis if use of the drug is not discontinued.

DF should be considered in the differential diagnosis of fever and rash in a patient residing or returning from an endemic area,[13] and dermatologists should be aware of the distinctive exanthem of DF. Recognition of DF rash permits a rapid and early diagnosis, which is critical, as DF can progress to life-threatening DHF or DSS.

Footnotes

Source of support: Nil

Conflict of Interest: Nil.

References

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Dengue rashes: Appearance, Symptoms and Meaning

Dengue rashes are a unique marker of the illness. 

“Most seasonal infections are characterized by high fever and so it can become difficult to differentiate between fever and dengue” says Dr Mayank Uppal, Consultant, General Medicine at Sitaram Bhartia Hospital in South Delhi.

“Watch out for the presence of dengue rashes and pain behind the eye which are unique to dengue.”  

How do you know if you have dengue?

If you are displaying the following symptoms, you should get checked:

  • Sudden onset of high fever
  • Appearance of dengue rashes during fever
  • Pain behind the eye

In addition to these symptoms, you may also experience:

  • Body ache
  • Immense discomfort during fever
  • Loss of appetite
  • Headache

“Besides a clinical examination of symptoms, a blood test for dengue is the final confirmation of dengue fever” says Dr Mayank.

What is dengue rash?

Dengue rashes may appear within 3-4 days of the fever and cover most of your body.

“Rashes are a distinctive sign of dengue but they may not manifest in every case” highlights Dr Mayank.

How does dengue rash look like?

These are small, red pinhead-like rashes which seem to be deeply embedded in the skin. These rashes cannot be felt by running your hand across it.

Are rashes in dengue itchy?

Sometimes dengue rashes can be itchy and this may make you even more uncomfortable and irritable during the fever. If you have itchy rashes, you may also complain of increased skin sensitivity along with swelling of the palms or soles.

When does the rash go away?

The rash may go away as the fever starts to fade and you start to recover.

“Since dengue is a dynamic disease, you should keep an eye on whether the rashes are increasing or decreasing” emphasises Dr Mayank.

“An increase in rashes could be an indication of decreasing platelet count. This would require close monitoring to prevent any complication.”

Sunaina’s battle with Dengue Rashes

Sunaina’s high fever was identified as dengue early on due to the appearance of rashes all over her body. After consulting Dr Mayank and taking the prescribed medicines, Sunaina was getting better day by day.

She also kept a water bottle by her side to ensure she was well – hydrated.

As the fever started abating, she noticed that her rashes got itchy which made her very irritable. Restless, she consulted Dr Mayank hoping for a solution.

“The rashes made me miserable – I couldn’t even eat or sleep properly” wailed Sunaina.

“Dengue rashes can turn itchy as the temperature starts to lower down” informs Dr Mayank.

“Don’t worry! This itchiness only lasts for 24-48 hours after the fever breaks and can be handled by applying certain soothing agents”

Dr Mayank prescribed medicinal ointments to Sunaina, which provided great relief.

“I actually felt better after using the prescribed ointments. I am glad I didn’t ignore the itching and consulted my doctor about it” concluded Sunaina in a follow-up consultation.

This blog post is written with Dr Mayank Uppal‘s editorial inputs. He has over 7 years of experience as a physician with a strong belief in comprehesive care.

90,000 Doctors have denied the emergence of immunity to COVID-19 from dengue

People who have suffered dengue fever may become immune to the coronavirus, American scientists have found. According to their research, in those regions where outbreaks of the tropical virus were previously recorded, there are much fewer cases of COVID-19. Doctors interviewed by Gazeta.Ru did not agree that fever develops immunity to coronavirus, and the low number of COVID-19 patients in these regions was associated with the socio-economic level of the population and the diseases they suffer.

Those who have had dengue fever may become immune to the new type of coronavirus infection. This is stated in a study published by Reuters – it was conducted by professor at the American Duke University Miguel Nicolelis.

In this work, the researchers compared the geographical distribution of coronavirus cases in several regions of Brazil, other parts of Latin America, Asia and the Pacific and Indian Oceans with the spread in these same zones of fever in 2019 and 2020.

Nicolelis drew attention to the fact that large outbreaks of dengue fever have occurred in places with a lower prevalence of coronavirus infection this year and last year. In addition, blood tests of people who are immune to tropical disease show false positives for COVID-19.

“This striking finding suggests the intriguing possibility of immunological cross-reactivity between the dengue flavivirus and SARS-CoV-2 serotypes.

If this hypothesis is confirmed, it could mean that dengue fever or immunization [against it] with an effective and safe vaccine could provide a certain level of immunological protection against the coronavirus, ”Nicolecis said in an interview with Reuters.

Director of the Institute of Medical Parasitology, Tropical and Vector-borne Diseases of Sechenov University, Alexander Lukashev, explained to Gazeta.Ru that the virus that causes dengue fever and the coronavirus are unrelated viruses.

“They are more different than we are from E. coli. Therefore, the likelihood that these are precisely cross-reactive antibodies, that is, those that have developed as a result of one infection and act on another, is extremely low. On the other hand, in epidemiology it often happens that some phenomena or factors are statistically related, but at the same time independent, ”the specialist noted.

Lukashev added that in different countries there may be different factors that work together. For example, it is well known that coronavirus outbreaks are less severe in countries with lower socioeconomic levels. However, they are more prone to dengue outbreaks.

The most severe outbreaks of coronavirus were recorded in countries with a high social level and proportion of the age population. However, due to climatic conditions there can be no outbreaks of dengue fever.

“In most tropical countries, dengue is carried by mosquitoes. There are four types of dengue virus in total. For the first time, the disease usually proceeds rather calmly, that is, it can be fever, rash, weakness, general infectious symptoms – serious consequences are rare.

But if a person falls ill a second time, with a different type, then it proceeds much more difficult and may end in death, ”Lukashev explained.

Infectionist Lilia Drozdova added that with dengue symptoms such as fever, intoxication, myalgia appear (muscle pain – “Newspaper.Ru “), arthralgia (joint pain -” Gazeta.Ru “), rash and swollen lymph nodes.

“Recovery usually takes two to seven days. Every year, more than 50 million people become infected with the virus and between 10 and 20 thousand people die. Sources of infection are sick people, monkeys and bats. The transmission of infection from a sick person is carried out by mosquitoes, ”Drozdova clarified in a conversation with Gazeta. Ru.

The physician also clarified that, for example, in Africa, there cannot be a large outbreak of coronavirus, since they have many different diseases and their immune response is stronger.

“In those countries where people are accustomed to different viruses and bacteria, the number of cases will certainly be lower. Or it will be asymptomatic. It is difficult to assess, since those regions mentioned in the study are unlikely to have carried out mass testing of the population, ”the specialist concluded.

90,000 What is dengue fever and how to protect yourself from it

Dengue fever is one of those diseases in which early diagnosis and seeking medical attention is of fundamental importance.

Thailand celebrated Songkran, which means that very soon we will all begin to gradually feel the approach of the rainy season. This period is fraught with a danger that is known to everyone who has lived in Thailand for a long time, but for new expats and tourists it may not be obvious. The combination of high humidity and heat is ideal breeding weather for mosquitoes, including the species Aedes aegypti, which spread dengue fever. At the same time, the Ministry of Health predicts that this year the epidemiological situation will be worse than in the past (see.here).

Dengue in a mild form is often indistinguishable from a cold, and some people who have had a fever may not even realize that they are faced with this disease. However, this does not mean that dengue, as well as the common cold, are not dangerous. According to a 2016 report from the Thai Ministry of Health, the most dangerous diseases in the country are pneumonia and dengue fever, which look like a common cold at an early stage. In 2015, pneumonia claimed 406 lives, and the total number of those hospitalized with this diagnosis exceeded 190 thousand.Dengue fever killed 116 people (mainly children and adolescents aged 5 to 14 years), and the total number of hospitalized patients in 12 months exceeded 123 thousand people.

What is dengue?

Dengue fever is a viral infection transmitted by mosquitoes of the species Aedes aegypti (and, to a lesser extent, A. albopictus). The first signs of the disease appear 3-14 days after being bitten by an infected mosquito.

As indicated on the World Health Organization (WHO) website, symptoms range from mild fever to severe disabling fever accompanied by severe headache, eye pain, muscle and joint pain, and rash.It is the rash that distinguishes dengue from the common cold or flu. WHO points out that dengue should be considered when a high fever (40 ° C) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen lymph nodes, or rash.

There is also a severe form of dengue fever, the so-called hemorrhagic fever. Unlike the type of disease described above, severe dengue can be fatal.Its characteristic features, in addition to those already listed, are abdominal pain, vomiting and bleeding. In general, dengue is most dangerous for children, older people and people with poor health.

There is no specific treatment for dengue fever, but early clinical diagnosis and professional medical care can save a patient’s life even with a severe course of the disease. That is why Thai experts recommend taking tests for dengue in all cases when the “common cold” does not subside after three to four days or is accompanied by dengue symptoms.

According to the WHO, more than 70% of the disease burden is in Southeast Asia and Phuket is at risk. At the same time, early detection of the disease and seeking appropriate medical care can reduce the mortality rate to 1% and below. In particular, doctors can prevent the development of complications that can lead to death.

Is there a dengue vaccine?

Until recently, there was no cure or vaccine against dengue, but a breakthrough has occurred.The vaccine was developed by Sanofi Pasteur, which has studied the disease in many regions, including Thailand. Dengvaxia (CYD-TDV) was first approved in Mexico, then the vaccine was approved for use in the Philippines, Singapore and other Asian countries. Sanofi Pasteur has invested $ 1.6 billion in vaccine development and 20 years of work.

Dengvaxia appeared in Phuket hospitals in January last year. Doctors welcomed the vaccine positively, despite the fact that it does not provide full protection against dengue, but is not cheap at the same time (the original price was about 10 thousand US dollars).baht).

In trials, the vaccine prevented the development of the disease in only 60-65% of the subjects (in comparison with patients who received placebo). However, on a number of other parameters, Dengvaxia proved to be much more effective. The vaccine protects against the development of severe dengue by 93%, the need for hospitalization is reduced by 80%. Such figures, in particular, were cited by Dr. Umar Banpamai Samitivej Sukhumvit Hospital, which was the first to receive Dengvaxia.

The vaccine, according to Dr. Banpamai, is done in three stages at six-month intervals and remains effective for five to six years.People aged 9-45 can be vaccinated.

How else to protect yourself?

Until a reliable and affordable vaccine is freely available, residents and visitors to Thailand are guided by the principle that the disease is easier to prevent than to cure. Since the disease is spread by mosquitoes, the most reliable way of protection is to kill mosquito larvae in a timely manner in order to prevent a sharp increase in their population.

Epidemiologists remind that mosquitoes lay their larvae in places with stagnant water.The best thing is to get rid of this water in a timely manner. If this is not possible, then it is necessary to regularly check such containers and process them with appropriate means, which can be bought in almost any store. Even simple soap kills carriers of infection.

It is also helpful to use mosquito repellents, cover windows and doors with mosquito nets, and use other insect repellents. But most importantly, in case of a suspicious cold, go to the nearest hospital.The dengue test is done within one hour, if you have social insurance (if you officially work in Thailand), the procedure is free, and no doctor will think that you are distracting him from more important matters with a simple cold.

Dengue fever – symptoms, treatment, prevention, diagnosis

There are enough insects in Thailand. The main danger is that some Thai mosquitoes are carriers of dengue fever. The disease is similar to the spread of encephalitis by ticks.Not every tick is dangerous. And if you follow preventive measures, you can protect yourself from a bite. The Thai government is fighting the spread of the fever. The grounds of hotels, condos and villages are periodically treated with smoke that kills mosquito larvae.

Every year the Russian media sound the alarm about the epidemic of dengue fever in Thailand. In terms of spread and outbreaks, this disease resembles the flu. Cases of fever are recorded among vacationers not only in Thailand, but also in Vietnam, Indonesia, India, Bangladesh, Hong Kong, Singapore, and the Maldives.According to 2018 data, Rospotrebnadzor reported 230 cases of fever among Russian tourists throughout Asia. For comparison, only Thailand was visited by about 1.5 million Russians.

What is Dengue Fever?

Dengue fever is a viral infection transmitted through the bite of a female Aedes aegypti and Aedes albopictus mosquito. They live not only in the jungle, but also in cities, in areas with stagnant water, including puddles, decorative ponds and water reservoirs. Mosquitoes are active both outdoors and indoors during daylight hours.

There are 4 strains of Dengue fever, and one mosquito can carry several types of virus at the same time. In recovered people, immunity from the infected type of the virus lasts up to 2 years, from the rest within 1-3 months. Dengue fever is not unique to Thailand. Countries in Asia and Latin America are most susceptible to the spread of the disease. And there are cases of fever in Europe every year.

According to the WHO, tourists returning from low- and middle-income countries are most often diagnosed with two diseases: malaria and dengue fever.There are cases of malaria in Thailand, but they are found in the north of Thailand. There were no cases of malaria among my friends and acquaintances in Phuket, which cannot be said about dengue fever. She was sick 20-30 people from my environment. All cases were mild to moderate, all cases recovered.

Fever symptoms

The first symptoms of fever appear 4-7 days after the bite. They are similar to the first signs of the flu. The patient’s temperature rises to 39-40 degrees, pain in muscles, joints and bones appears.Sometimes the first symptoms include pain behind the eyeballs, migraines, and a rash all over the body. In some cases, dengue fever can be asymptomatic. A colleague of mine complained of a slight headache for four days until she went to the doctor who diagnosed dengue fever.

Dengue haemorrhagic fever

In rare cases, the disease can progress to a hemorrhagic form. Symptoms then become severe abdominal pain, vomiting, diarrhea, cramps, bruising, and internal bleeding.The high temperature lasts 2-7 days. Complications during a fever can lead to circulatory failure, shock and death. But according to statistics, mortality is less than 1%. Dengue hemorrhagic fever requires hospitalization and mandatory medical supervision.

Treatment

With typical symptoms, tests may not immediately show disease. Usually, the diagnosis is confirmed on the 3-4th day. Dengue fever works differently for different people. My colleague suffered a mild form and even went to work during the first days.There are severe cases when a patient spends several days in a hospital under an IV. It is always necessary to monitor the level of platelets to avoid a sharp decline and the formation of internal bleeding.

There is no specific treatment for dengue fever. Doctors prescribe paracetamol to bring down fever and relieve pain. For treatment, you should not take aspirin, nurofen, ibuprofen, citramone and other drugs that reduce blood clotting. These drugs are dangerous for dengue.Paracetamol is sold at any 7-11 under the Sara, Tiffy and Tylenol brands.

Thais recommend drinking a decoction of papaya leaves for dengue fever. They contain antioxidants that stabilize the erythrocyte membrane and enzymes that prevent platelet destruction. Pour boiling water over fresh or dried papaya leaves, leave for 15 minutes and drink 200 ml 2-3 times a day. For the best effect, you can use the juice made from grated papaya leaves.

Drinking water and electrolytes are recommended.Any 7-11 sells a natural electrolyte – coconut water in tetrapacks and bottles. If you can’t get to the market and buy coconuts there, drink coconut water from minimarkets. On the medicine rack at 7-11 you will find chemical electrolytes in sachets.

Appetite disappears during dengue fever. Some people who are sick do not eat at all for several days. The best solution would be cocktails with oranges and kiwi. Drinking turmeric milk helps with recovery. Broccoli and spinach are recommended.Avoid fatty, fried and spicy foods, caffeinated drinks and alcohol.

How to protect yourself from dengue fever?

No dengue vaccine has yet been invented in Thailand. Several years ago, in Bangkok Hospital, vaccinations were given, but their effect was short-lived.

The case map is not homogeneous. Most of the cases were registered in the northeast of Thailand, where there are almost no tourists. The top five provinces with high scores are Rayong, Chaiyaphum, Khon Kaen, Mae Hong Son and Nakhon Ratchasima.In tourist regions like Phuket, Pattaya, Koh Samui, Hua Hin, the number of cases of dengue fever is much lower. In any case, for prevention, you should adhere to the rules described below.

  • Get insurance that covers dengue treatment. On the Cherekhapa website, open the “Health Insurance” tab and check the box next to “Dengue Fever Insurance”.
  • Most cases of Dengue fever infections are during the rainy season from May to October.During this period, you should be especially careful with the means of protection.
  • Use fumigators in hotel rooms. They can be purchased at any convenience store or large shopping center.
  • Use Sketolene, Off, Soffell and lemongrass mosquito repellent for protection.
  • To protect children, use Johnson’s Baby Clear Lotion Anti Mosquito and anti mosquito bracelets available at pharmacies and malls.
  • When going trekking in the jungle, wear long sleeves and tight pants.
  • For any symptoms (fever, bone aches, chills) go to the hospital.
  • Take paracetamol to bring down the temperature. By no means is it aspirin, which is a blood thinner. And get tested for the level of platelets.
  • Decoction of papaya leaves or juice from papaya leaves relieves symptoms of fever. But it tastes bitter and unpleasant.
  • Drink plenty of fluids, coconut water, and electrolytes.

How to treat mosquito bites?

Itching after being bitten by ordinary mosquitoes can be easily removed with Thai balms or essential oil from an inhaler. If you are allergic to insects, use Systral Cream. It needs to be smeared pointwise on the bite sites. The cream also helps after jellyfish burns and sand fly bites.

I have not seen sand flies in Phuket itself. But they definitely are on the Hong Islands in Krabi, Rang Yai, Chang and Mak in the Gulf of Thailand.You should not be afraid of them. But remember how to act in case of a bite. Health to you!

It will be interesting for you to read:

Snakes in Thailand – poisonous and not so poisonous
Dangerous marine animals in Thailand
How to protect yourself from deception in Thailand?
How not to spoil your vacation?

90,000 Dengue fever: symptoms, causative agent, transmission routes

Dengue fever is an infectious disease carried by insects. The pathology has a clear geographic reference and often occurs in the countries of Southeast Asia, regions with a subtropical climate in Australia and South America.Due to the intensive development of tourism in these regions, cases of the disease are also noted in other states, but they are isolated. Every year, Dengue fever is diagnosed in hundreds of thousands of inhabitants of the planet, some of whom do not have the opportunity to receive timely medical care and have to put up with serious complications of the infection.

Causes of Dengue Fever

The causative agent of the disease is the Dengue arbovirus, which can be found in the body of mosquitoes and arthropods.There are several of its serotypes, each of which gives approximately the same picture of the disease in the human body. The pathogen is resistant to climatic factors, however, it quickly dies under the influence of UV radiation and with a sharp increase in ambient temperature.

The transmission mechanism of Dengue fever disease is associated with mosquitoes of the genus Aedes, which feed on human and animal blood. When an infected subject is bitten, the pathogen enters the mosquito’s bloodstream, where it multiplies rapidly without harm to the “host” organism.The incubation period can be up to 14 days, after which the insect and its bites become infectious. One contact of a Dengue fever carrier with a healthy body is enough for the virus to enter its bloodstream, and the intensive development of the disease begins.

In the human body, the incubation period of the virus lasts about 7-15 days, and the acute stage lasts from 7 to 12 days. The course of the disease is undulating and consists of two peaks in the increase in body temperature, between which there is a decrease in symptoms.However, this is not a reason to stop the treatment started, otherwise the risk of relapse and complications increases significantly.

Disease symptoms

After being bitten by a mosquito, the virus enters the cells of the lymph nodes and blood vessels, where its intensive replication begins. As the volume of pathogenic particles increases, they spread throughout the body and penetrate into the internal organs, partially blocking their functioning. An intoxication syndrome occurs, the first sign of which is a febrile state.

Also among the symptoms of Dengue fever:

  • headache;
  • copious discharge from the respiratory tract;
  • aches in muscles and joints;
  • vomiting and nausea, other signs of a disorder of the digestive system;
  • diarrhea;
  • drop in blood pressure.

Forms of the disease

The symptomatic picture allows you to classify the disease as follows:

The classic form of Dengue fever.More often observed with a primary lesion. Typical symptoms are a significant increase in body temperature, which after 3 days is replaced by the normalization of the patient’s condition, after which the fever repeats again. Also, the disease is indicated by signs of intoxication, muscle pain, discomfort in the spine, swelling of the face, neurological disorders in the form of dizziness and insomnia. A rash on the body that occurs at the initial stage of the disease disappears after 3-7 days. The rash may resemble scarlet fever, have the appearance of small hemorrhages, or look like blisters.

Hemorrhagic form. More often observed in persons secondarily infected with the causative agent of Dengue fever. The incubation period can last up to 10 days, after which symptoms appear in the form of intoxication, lethargy and characteristic rashes. The latter can appear from several points to an extensive spot, which often has complications in the form of nosebleeds and internal hemorrhages. Blood particles are observed in the patient’s feces and urine.

Dengue fever in children.In the child’s body, the pathogen makes itself felt with blurred symptoms, which complicates the diagnosis and does not allow timely treatment. Most often, patients have symptoms of Dengue fever such as intoxication syndrome, fever and rash, dry cough and shortness of breath. The duration of the disease is about 7 days.

The likelihood of complications

Patient refusal to see a doctor for help with dengue fever can cause:

  • edema and brain damage;
  • inflammation of the nerves;
  • otitis media;
  • thrombophlebitis;
  • signs of toxic shock;
  • Premature birth or intrauterine fetal death for pregnant women.

Diagnostic Methods

The doctor makes a preliminary diagnosis already at the stage of the initial examination and collection of anamnesis. Unmistakable signs of fever are skin rashes, swollen lymph nodes, pain in joints and muscles, and undulating development of a fever. If the patient has recently been in countries “dangerous” from the point of view of infection, he is immediately referred for laboratory tests:

  • A polymerase chain reaction method that detects the content of virus particles in the blood.Due to its high accuracy, it is a priority in diagnostics.
  • Serological methods of blood tests, thanks to which it is possible to clarify the presence of antibodies in the blood to the causative agent of the disease.
  • General blood analysis. With a decrease in the level of leukocytes and platelets relative to the standard level, we can talk about the pathological state of the body.

Differentiated diagnostics allows to accurately establish the fact of infection.Its goal is to eliminate malaria, influenza, measles and rubella, which have similar symptoms at the initial stage of the disease.

To establish the hemorrhagic form of Dengue fever allows the so-called flagellar test. A tourniquet is applied to the patient’s upper limb, after removing which, after five minutes, new areas of rashes can be seen on the skin.

Treatment

A mandatory requirement for a patient in the treatment of Dengue fever is immediate hospitalization.Treatment is carried out under the strict supervision of a physician and includes taking the following drugs:

  • Painkillers and anti-inflammatory drugs.
  • Hypnotic and sedative formulations.
  • Glucocorticosteroids for the elimination of symptoms of intoxication.
  • Antibiotics that destroy pathogens.
  • Multivitamin complexes to support the immune system.

To prevent dehydration while treating the symptoms of Dengue fever, drinking plenty of fluids and infusion therapy (droppers) with glucose preparations are recommended.

Diagnostics and treatment of Dengue fever in the clinic of JSC “Medicine”

Having found in yourself signs of a dangerous disease after returning from the countries of the tropical region of Asia, immediately make an appointment with the infectious disease specialist of the clinic of JSC “Medicine”. At your service is its own diagnostic center and outpatient clinic, where you can undergo a treatment course under the supervision of a specialist. Each visitor is guaranteed an attentive attitude, confidentiality, a full range of necessary diagnostic and therapeutic procedures.Appointments are made online and by phone during business hours.

Questions and Answers

How is Dengue fever spread?

The source of infection is the blood of a sick person, monkeys or bats. When bitten by a mosquito of the genus Aedes, infected blood enters the insect’s body, where the pathogen multiplies rapidly in favorable conditions. When a healthy animal or person is bitten, the infection enters the victim’s body, where it soon makes itself felt with characteristic dangerous symptoms.

Why is Dengue fever dangerous?

In the absence of timely medical care, Dengue fever can cause serious complications from the brain, nervous system and liver tissue. Sick people may develop signs of the following diseases:

  • meningitis, encephalitis;
  • inflammation of the nerves;
  • a state of acute psychosis;
  • otitis media;
  • thrombophlebitis;
  • a state of toxic shock.

For pregnant women, the disease is dangerous with the risk of premature birth and intrauterine fetal hypoxia.