The threat of Coronavirus is not completely over yet and the Dengue virus has knocked us. There is an influx of Dengue fever or break-bone fever patients in the Hospitals. The severity and the mortality of dengue are very high. Moreover, hemorrhagic dengue fever is more fatal and causes high mortality.
The severity of the disease varies according to the type of strain or serotype of the virus. There are four main serotypes of the dengue virus including DENV-1, DENV-2, DENV-3, and DENV-4. We should know which strain is more deadly and what impact hemorrhagic dengue fever is on us.
Watch this Video – Dengue Fever Causes, Symptoms, Prevention and Treatment
Dengue Fever Symptoms
The symptoms of Dengue fever are very severe in nature. The body pain is unbearable, pain is like broken bones that’s why it’s called break-bone fever too. If classical Dengue Fever is associated with rashes and bleeding symptoms called Dengue Hemorrhagic fever.
The symptoms last almost a week just like other viral fevers. The first symptom appears after 5 to 7 days of a mosquito bite which is called the incubation period. The symptoms of dengue fever may vary depending on the type of fever. Following are the common symptoms of dengue fever.
- High fever up to 104 degrees Fahrenheit
- Severe headache or a frontal headache
- Pain behind the eyes or behind the eyeballs
- Muscle pain
- Severe pain in joints and bones
- Nausea and Vomiting
- Weakness and restlessness
- Red-colored rashes on the skin
- Bleeding from nose or gums and in stool especially in dengue hemorrhagic fever
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Types of Dengue Fever
There are mainly three types of dengue fever based on the clinical presentation of the disease. Dengue virus has different strains or variants called DENV-1, DENV-2, DENV-3, and DENV-4. Each strain of the virus has a different clinical presentation in terms of the severity of the symptoms. Dengue Fever is classified into 3 types, based on the severity of the symptoms.
- Classical dengue Fever or Break Bone fever
- Dengue Hemorrhagic Fever (DHF)
- Dengue Shock Syndrome (DSS)
Classical Dengue Fever
The symptoms of classical fever are less severe. The patient runs high-grade fever with chills, Severe Headache, body aches, and joint pain. Also complaints of Nausea, Vomiting, Myalgia, and weakness. These symptoms last for a minimum of a week with or without rashes on the skin.
The patient starts recovering after a 6-7th day of the disease. Even without any specific treatment and get fully recovered within a period of 2 weeks. Hydration is a very important aspect to manage the disease. A lot of liquids, juices, and water are helpful to maintain hydration.
Thrombocytopenia (low platelets counts) is observed from the 3rd day onwards on blood examination. It progresses generally when fever is subsided. The good thing is that there is no sign or symptoms of bleeding in classic dengue fever except rashes on the skin in a few cases. Thrombocytopenia is a condition when platelets count is lower than the normal limit in the blood.
Hemorrhagic Dengue Fever
Hemorrhagic Dengue fever is more deadly and mainly caused by the DENV-2 strain of Dengue Virus. DENV-2 is also called the D2 strain which is the most dangerous serotype of the dengue virus among all. D2 strain can also cause dengue shock syndrome.
Symptoms are mild to severe and very similar to the classic Dengue fever. But after 3-4 days, the intensity of hemorrhagic symptoms increases. However, fever starts lowering down after the 5th day. Red-colored rashes appear on the skin, bleeding from the gums and nose can also appear. The appearance of rashes and bleeding from gums means that patient may have internal bleeding. The reason for this would be a significant reduction in the amount of platelets count.
The risk of internal bleeding increases with low platelets counts. When the platelets count goes down further it causes hemorrhage. The symptoms of dengue hemorrhagic fever occur only in 10-15% of patients. If bleeding is continued and is not treated in time can cause even death.
Hemorrhagic Dengue fever requires full blood transfusion or platelets transfusion. It helps in maintaining the volume of the blood and controlling internal bleeding.
Dengue Shock Syndrome
This type of dengue fever is more deadly and the outcome is very fatal. Most of the deaths are due to dengue shock syndrome. All the symptoms are very intense and the patient starts having bleeding symptoms early. The toxins released by the dengue virus cause low blood pressure. The patient goes into a state of shock due to internal bleeding and low blood pressure. This further leads to multi-organ failure and even can cause death.
Causes of low platelets count in Dengue Fever
Initial symptoms of dengue fever like high-grade fever, severe intense headache, nausea, vomiting, and body pain. These symptoms last for 6-7 days and then subsides but the platelets count decreased. Dengue virus starts multiplying and releases toxins in the body in the first 4-5 days. The toxins released by the dengue virus cause intense symptoms and low platelet count too. The immune system of our body starts responding to the virus which produces antibodies. There is a fight between the virus and the antibodies which further intensifies the symptoms because the platelets counts drop drastically.
Moreover, the antibodies start attacking our own platelets counts mistakenly. Low platelets count causes the risk of internal bleeding. When the viral load is lowered in the body, other symptoms also subsided and platelets count starts going up again.
Types of Dengue Virus
Dengue virus is an RNA-based virus that enters the human body through the bites of the female Aedes aegypti mosquito. There are four main types of dengue virus which are known as dengue virus strains. According to the serotype of the virus DENV-1, DENV-2, DENV-3, and DENV-4.
DENV-2 is the most dangerous among the four strains. D2 is the main cause of hemorrhagic fever and it also causes more deaths.
Can Dengue Fever happen twice to a person?
Generally, dengue fever spreads through one type of strain in one population. Antibodies are developed against that specific strain. But if the dengue gets spread through a new strain different from the earlier one. Then the antibodies that were made against the first strain will not be effective for the new strain.
It proves that the patient who had dengue earlier with one specific strain can be infected again with another strain of the dengue virus. That’s why when a new strain comes in it infects those also who had the dengue with other strain earlier. But if it’s the same strain then the patient had a lifelong immunity against that.
For example, if someone had dengue with DENV-1 strain. And next time Dengue has spread through the same strain DENV-1 again. Then this person who had an infection with DENV-1 strain is safe because antibodies are available to fight with DENV-1 strain. But if the Strain is new among DENV-2, DENV-3, or DENV-4 then this can infect the person also who had dengue earlier with DENV-1.
How does Dengue Fever Spread?
Dengue fever is spread by the bite of the female Aedes aegypti mosquito. The Aedes aegypti mosquito bites mainly during the day hours. Dengue fever mosquitoes lay eggs on clean and stagnant water. If this water remains stagnant for more than a week, then dengue mosquitoes are born.
When a female Aedes aegypti mosquito bites a patient with dengue fever. The virus is passed into the mosquito from the patient’s blood. Then the virus reaches the gut of mosquitoes and starts replicating. Dengue Virus multiplies further in the gut and then reaches the salivary gland of mosquitoes. When the infected mosquito bites a healthy person, it passes the dengue virus into the blood of healthy people. The virus further multiplies in the human body for 5-7 days. The first symptom of the disease appears after the period of 5-7 days of the mosquito bite. This period for which the virus was in the latent phase in the human body is called the incubation period.
What are the recommended Tests for Dengue?
There are many types of dengue fever tests done on different stages of dengue fever to diagnose the dengue disease. Each test has its own significance at different stages of dengue fever.
Dengue NAAT – Nuclear Amplification Test
NAAT test can be done during the first 7 days of the disease after 1st symptom appears. This can be done through blood plasma, serum, or cerebrospinal fluid (CSF). It’s useful in the acute phase of the disease in the first week, so it’s considered good to do this test immediately after symptoms appear. But after 7 days of the period, this can be negative and should go with a dengue serology test.
Dengue NS1 Test
It’s also considered useful to do a dengue NS1 test in 1st week of the disease because the virus releases more Antigens during this phase in week one. Dengue NS1 test is done through a blood sample and tells about the presence of the virus in the body.
Dengue serology test along with NS1 test is more significant to diagnose the disease and to confirm the stage of the disease. An NS1 test positive result indicates the presence of the virus but if the NS1 antigen report is negative it doesn’t mean that patient did not have dengue fever. To check this serology test gives the confirmation if antibodies against the dengue virus are present in the body or not. If dengue antibodies are there in the serology test it confirms the diagnosis.
Dengue serology test (IgM and IgG antibodies test)
Dengue serology test includes IgM and IgG antibodies and both the tests have their own importance. IgM antibodies begin to form early in the diseases and show up positive IgM antibodies test 5-7th days onwards of first symptoms. IgM antibodies last for weeks and then disappear. When the disease gets started cured and the acuteness of the disease subsided, the IgG antibodies also started developing after 5-7 days of symptoms.
The presence of IgG antibodies and negative IgM on serology tests indicates that the patient has developed immunity against the specific strain of the dengue virus. IgG antibodies can last forever in the body and provide lifelong immunity against the dengue virus.
Dengue Fever Treatment
There is no specific treatment is available for dengue or break bone fever. The only option is the symptomatic and supportive treatment for classical dengue fever. Further, it depends on the type of the fever and the presentation of the disease.
Common Treatment Options for Dengue
Some natural home medicines and home remedies are very effective in managing the disease.
- Paracetamol – To subside and control the fever, it can be in the form of tablets or IV injectables through IV fluid. (Should be taken under doctors advice)
- Cold sponging
- Fluid maintenance and maintaining the hydration
- Uses of more juices, liquids, and water or oral rehydration solution
- Anti Antiemetic medicines to control vomiting and nausea
- Use Juicy fruits and citrus fruits
Papaya Leaves for Dengue
Papaya leaves are easily available and the juice of papaya leaves is very useful in dengue treatment. It acts as antiviral herbal medicine and helps in promoting platelets production in the body. Papaya juice with Giloy herbal powder twice a day for a week helps in reducing the severity of dengue fever.
Blood Transfusion or Platelets Transfusion
Classical dengue fever can be treated at home without hospitalization. If there are symptoms of bleeding or risk of internal bleeding or dengue shock syndrome then blood transfusion is recommended. Blood or platelets transfusion is advised only if the patient’s platelets counts are very low and bleeding signs are significantly observed.
Prevention of Dengue or Break Bone Fever
There is no effective vaccine available against all the strains of the Dengue virus yet. Some countries have developed dengue vaccine but so far it has not been used across the world because one vaccine doesn’t work against all dengue strains. Therefore, only a few measures are helpful in preventing dengue fever and controlling the outbreaks of dengue.
- Wear full sleeve clothing, do not expose skin
- Use anti-mosquito creams/lotions
- Do not allow water to collect, pour the water from the pots placed on the roof and change the water every week.
- Clean your water coolers every week
- Sprinkle kerosene oil on the water where the water is stagnant
- Use mosquito nets while sleeping especially for patients
Conclusion
Prevention is the only cure, be careful to stay healthy
