Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been

bitten by an infected mosquito and include:

High fever, up to 105 degrees Fahrenheit Severe headache Retro-orbital (behind the eye) pain Severe joint and muscle pain Nausea and vomiting Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

Marked damage to blood and lymph vessels Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death. Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus

Fluids leaking outside of blood vessels Massive bleeding Shock (very low blood pressure) Dengue fever is a disease caused by a family of viruses that are transmittedby mosquitoes. It is an acute illness of sudden onset that usually follows a benigncourse with headache, fever, exhaustion, severe joint and muscle pain, swollenglands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever,rash, and headache (and other pains) are particularly characteristics of dengue.

Dengue feverand dengue hemorrhagic fever (DHF) are acutefebrile diseases caused by four closely related virus serotypes of the genusFlavivirus, familyFlaviviridae. The geographical spread is similar to malaria. Each serotypeis sufficiently different that there is no cross-protection and epidemics caused bymultiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humansby the Aedes aegypti(rarely Aedes albopictus) mosquito, which feeds during theday.

Dengue hemorrhagic fever is a more severe form of the viral illness.Manifestations include headache, fever, rash, and evidence of hemorrhage in thebody.Petechiae (small red or purple blisters under the skin), bleeding in the noseor gums, black stools, or easy bruising are all possible signs of hemorrhage. Thisform of dengue fever can be life-threatening or even fatal. Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) isa potentially lethal complication, affecting mainly children. Early clinicaldiagnosis and careful clinical management by experienced physicians and nursesincrease survival of patients. Well, well discuss it later.

What is dengue hemorrhagic fever? Here, weve spoken ofdengue hemorrhagic fever several times; lets take a little close look at this: The WHO definition of dengue haemorrhagic fever has been in use since 1975; all four criteria must be fulfilled: 1.Fever, bladder problem, constant headaches, severe dizziness and loss of appetite. 2.Hemorrhagic tendency (positive tourniquet test, spontaneous bruising,bleeding frommucosa, gingiva, injection sites, etc.; vomiting blood, orbloodydiarrhea) 3.Thrombocytopenia (<100,000 platelets per mm or estimated as less than 3 platelets per high power field) 4. Evidence of plasma leakage (hematocrit more than 20% higher thanexpected, or drop in haematocrit of 20% or more from baseline followingIV fluid, pleural effusion, ascites, hypoproteinemia) In other words, dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called

In DHF, there is bleeding with easy bruising, blood spots in the skin(petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleedinggums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of theheart (myocarditis) may be present. 4 Patients with DHF must be monitored closely for the first few days since shockmay occur or recur precipitously. Cyanotic (bluish) patients are given oxygen.Vascular collapse (shock) requires immediate fluid replacement. Bloodtransfusions may be needed to control bleeding. What are the signs and symptoms of dengue? After being bitten by a mosquito carrying the virus, the incubation periodranges from three to 15 (usually five to eight) days before the signs and symptomsof dengue appear. Dengue starts with chills, headache, pain upon moving the eyes,and low backache. Painful aching in the legs and joints occurs during the firsthours of illness. The temperature rises quickly as high as 104 F (40 C), withrelative low heart rate (bradycardia) and low blood pressure (hypotension). Theeyes become reddened. A flushing or pale pink rash comes over the face and thendisappears. The glands (lymph nodes) in the neck and groin are often swollen. Fever and other signs of dengue last for two to four days, followed by rapiddrop in temperature (defervescence) with profuse sweating. This precedes a periodwith normal temperature and a sense of well-being that lasts about a day. A secondrapid rise in temperature follows. A characteristic rash appears along with the 2 fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen. Symptoms range from a mild fever, to incapacitating high fever, withsevere headache, pain behind the eyes, muscle and joint pain, and rash. There areno specific antiviral medicines for dengue. It is important to

maintain hydration.Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs(e.g. Ibuprofen) is not recommended.

A tourniquet test (also known as a Rumpel-Leede Capillary-Fragility Test or simply a capillary fragility test) determines capillary fragility. It is a clinicaldiagnostic method to determine a patient's haemorrhagic tendency. It assesses fragility of capillary walls and is used to identify thrombocytopenia (a reduced platelet count). The test is defined by the WHO as one of the necessary requisites for diagnosis of Dengue fever. A blood pressure cuff is applied and inflated to a point between the systolic and diastolic blood pressures for five minutes. The test is positive if there are 10 or more petechiae per square inch. In DHF the test usually gives a definite positive result with 20 petechiae or more.[1] This test does not have high specificity. Interfering factors with this test are women who are premenstrual, postmenstrual and not taking hormones, or those with sun damaged skin, since all will have increased capillary fragility

Ranitidine ( /rntdin/; trade name Zantac) is a histamine H2-receptor antagonist that inhibits stomach acid production. It is commonly used in treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). Ranitidine is also used alongside fexofenadine and other antihistamines for the treatment of skin conditions such as hives. Ranitidine is also known to give false positives for methamphetamine on drug tests Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since Benadryl contains one of several antihistamines and is used for the temporary relief of seasonal and perennial allergy symptoms. It will also help with normal symptoms of insect stings even if there is no allergic reaction. Benadryl is available for oral or topical use.

Paracetamol INN ( /prsitml/ or /prstml/), or acetaminophen USAN ( i /sitmnfn/), is a widely used over-the-counteranalgesic (pain reliever) and antipyretic (fever reducer). It is commonly used for the relief of headaches, other minor aches and pains