DENGUE FEVER

Introduction:

Also known as breakbone fever, it is an acute,

infectious tropical disease, commenest
arboviral disease, caused by dengue virus.

Transmitted from:

• Person to person

• Bite of infective, female, aedes mosquito

Clinically it is characterized by:

• High fever
• Headache
• Bodyache
• Severe joint and muscular pain

In a small proportion the disease progresses to

life-threatening complications such as dengue
hemorrhagic fever (which may lead to
severe hemorrhage) and dengue shock
syndrome (where a very low blood pressure
can cause organ dysfunction.
Epidemiology
• Nearly 2.5 billon people are at risk from dengue
• WHO currently estimated there may be 50
million cases of dengue infection worldwide every
year
• In India, an epidemic occurred in 1996 in Delhi.
About 10,000 cases and 400 death were reported.
• During 1997, another epidemic occurred in
Maharashtra.
• During 2003, there were about 12750 cases with
217 death in the country,
• Thus, Dengue fever is an emerging public health
problem in India, with cyclic epidemics, of whom
a very large proportion are chidren.

Agent Factors
Causative agent: The dengue virus, a member of
Flavivirus group, belong to castles group B and
family Togaviridae. It is RNA virus, spherical, 17 to
25 mμ in diameter. Serologically there are 4 types,
DENV-1, DENV-2, DENV-3 and DENV-4.
Period of Communicability: is first 4-5 days of
illness

Reservoir: Man is the chief reservoir. However

monkeys are the reservoir in Malaysian forests. No
carrier state exists.

Age incidence: common among young children

and adults.

Sex incidence: it is more among men than among

women

Immunity: One attack confers type specific

immunity for about 9 months against a particular
serotype of virus and partial cross immunity against
the other types However several attacks with the
same sero type confers lifelong immunity.

Mode of transmission: is by the bite of infective,

female, aedes mosquito
Vectors: The most efficient vector is Aedes aegypti
mosquito (black mosquito with white bands aka
Tiger mosquito, anthrophilic, it is an aggressive day
biter). It is most efficient because of its peri-
domestic habit, i.e. it breeds near human
habitations, in the water collected in artificial
containers like coconut shell broken pot, flower
vase, broken bottle, and air coolers.

Incubation period: Varies from 8 to 10 days

Pathophysiology:
Increased capillary permeability
(Due to activation of the complement by dengue
antigen)

Leakage of plasma, fluid and erythrocytes

 To interstial space and serous cavity
(pleura and peritoneum)

Hypovolemia

Pathology:
In tissue-hemodynamic alterations with generalized
vascular congestion, increased permeability,
and mast cell recruitment in lungs

In liver- diffuse hepatitis with midzonal necrosis and

steatosis, focal necrosis area, and normal
histology in some children