Dengue fever

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"Dengue Fever" redirects here. For the band of the same name, see Dengue Fever (band).
Dengue fever
Classification and external resources

ICD-10 A90.

ICD-9 061

DiseasesDB 3564

MedlinePlus 001374

eMedicine med/528

MeSH C02.782.417.214
Dengue virus

A TEM micrograph showing Dengue

virus virions (the cluster of dark dots
near the center).
Virus classification
Group: Group IV ((+)ssRNA)
Family: Flaviviridae
Genus: Flavivirus
Species: Dengue virus

Dengue fever (pronounced UK: /ˈdɛŋɡeɪ/, US: /ˈdɛŋɡiː/) and dengue hemorrhagic fever
(DHF) are acute febrile diseases which occur in the tropics, can be life-threatening, and are
caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae.[1]
It is also known as breakbone fever, since it can be extremely painful. It occurs widely in
the tropics, including northern Argentina, northern Australia, Bangladesh, Barbados,
Bolivia,[2] Belize, Brazil, Cambodia, Colombia, Costa Rica, Cuba, Dominican Republic,
French Polynesia, Guadeloupe, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras,
India, Indonesia, Jamaica, Laos, Malaysia, Melanesia, Mexico, Micronesia, Nicaragua,
Pakistan, Panama, Paraguay,[3] The Philippines, Puerto Rico, Samoa,[4] Western Saudi
Arabia, Singapore, Sri Lanka, Suriname, Taiwan, Thailand (ไข้เลือดออก khai lueat ok), Trinidad
and Tobago, Venezuela and Vietnam, and increasingly in southern China.[5] Unlike malaria,
dengue is just as prevalent in the urban districts of its range as in rural areas. Each serotype is
sufficiently different that there is no cross-protection and epidemics caused by multiple
serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes
(Stegomyia) aegypti or more rarely the Aedes albopictus mosquito. The mosquitoes that
spread dengue usually bite at dusk and dawn but may bite at any time during the day,
especially indoors, in shady areas, or when the weather is cloudy.[6]

The WHO says some 2.5 billion people, two fifths of the world's population, are now at risk
from dengue and estimates that there may be 50 million cases of dengue infection worldwide
every year. The disease is now endemic in more than 100 countries.[7]

Contents
[hide]

 1 Signs and symptoms

 2 Virology
o 2.1 E protein
o 2.2 prM/M protein
o 2.3 NS3 protein
o 2.4 NS5 protein
 3 Diagnosis
 4 Prevention
 5 Treatment
 6 Epidemiology
o 6.1 Recent outbreaks
 6.1.1 2010 Outbreak table
o 6.2 Blood transfusion
 7 History
o 7.1 Etymology
o 7.2 Literature
 8 Society and culture
o 8.1 Use as a biological weapon
 9 Research
o 9.1 Management
o 9.2 Wolbachia
o 9.3 Antiviral approaches
o 9.4 Sterile insect technique
 10 See also
 11 References
 12 External links
[edit] Signs and symptoms
The disease manifests as fever of sudden onset associated with headache, muscle and joint
pains (myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or
bonecrusher disease), distinctive retro-orbital pain, and rash.[8] The classic dengue rash is a
generalised maculopapular rash with islands of sparing. A hemorrhagic rash of
characteristically bright red pinpoint spots, known as petechiae can occur later during the
illness and is associated with thrombocytopenia. It usually appears first on the lower limbs
and the chest; in some patients, it spreads to cover most of the body. There may also be
severe retro-orbital pain, (a pain from behind the eyes that is distinctive to Dengue
infections), and gastritis with some combination of associated abdominal pain, nausea,
vomiting coffee-grounds-like congealed blood, or diarrhea. Some cases develop much milder
symptoms which can be misdiagnosed as influenza or other viral infection when no rash or
retro-orbital pain is present. Febrile travelers from tropical areas may transmit dengue
inadvertently to previously Dengue free populations of Aedes (Stegomyia) Aegypti
mosquitoes, having not been properly diagnosed for Dengue. Patients only transmit Dengue
when they are febrile and bitten by Aedes (Stegomyia) Aegypti mosquitoes, or (much more
unusually) via blood products. The classic dengue fever lasts about two to seven days, with a
smaller peak of fever at the trailing end of the disease (the so-called "biphasic pattern").
Clinically, the platelet count will drop until after the patient's temperature is normal. Cases of
DHF also show higher fever, variable hemorrhagic phenomena including bleeding from the
eyes,nose,mouth and ear into the gut, and oozing blood from skin pores, thrombocytopenia,
and hemoconcentration. When Dengue infections proceed to DHF symptoms, DHF causes
vascular leak syndrome which includes fluid in the blood vessels leaking through the skin and
into spaces around the lungs and belly. This fluid loss and severe bleeding can cause blood
pressure to fall, then Dengue Shock Syndrome (DSS) sets in, which has a high mortality rate.
Neurological manifestations such as encephalitis may also occur .[9]

[edit] Virology
Dengue fever is caused by Dengue virus (DENV), a mosquito-borne flavivirus. DENV is an
ssRNA positive-strand virus of the family Flaviviridae; genus Flavivirus. There are four
serotypes of DENV. The virus has a genome of about 11000 bases that codes for three
structural proteins, C, prM, E; seven nonstructural proteins, NS1, NS2a, NS2b, NS3, NS4a,
NS4b, NS5; and short non-coding regions on both the 5' and 3' ends.[10]

[edit] E protein

The DENV E (envelope) protein, found on the viral surface, is important in the initial
attachment of the viral particle to the host cell. Several molecules which interact with the
viral E protein (ICAM3-grabbing non-integrin.,[11]CD209 ,[12] Rab 5 ,[13] GRP 78 ,[14] and The
Mannose Receptor [15])have been shown to be important factors mediating attachment and
viral entry.[16]

[edit] prM/M protein

The DENV prM (membrane) protein, which is important in the formation and maturation of
the viral particle, consists of seven antiparallel β-strands stabilized by three disulphide
bonds.[16]
The glycoprotein shell of the mature DENV virion consists of 180 copies each of the E
protein and M protein. The immature virion starts out with the E and prM proteins forming
90 heterodimers that give a spiky exterior to the viral particle. This immature viral particle
buds into the endoplasmic reticulum and eventually travels via the secretory pathway to the
golgi apparatus. As the virion passes through the trans-Golgi Network (TGN) it is exposed to
low pH. This acidic environment causes a conformational change in the E protein which
disassociates it from the prM protein and causes it to form E homodimers. These homodimers
lay flat against the viral surface giving the maturing virion a smooth appearance. During this
maturation pr peptide is cleaved from the M peptide by the host protease, furin. The M
protein then acts as a transmembrane protein under the E-protein shell of the mature virion.
The pr peptide stays associated with the E protein until the viral particle is released into the
extracellular environment. This pr peptide acts like a cap, covering the hydrophobic fusion
loop of the E protein until the viral particle has exited the cell.[16]

[edit] NS3 protein

The DENV NS3 is a serine protease, as well as an RNA helicase and RTPase/NTPase. The
protease domain consists of six β-strands arranged into two β-barrels formed by residues 1-
180 of the protein. The catalytic triad (His-51, Asp-75 and Ser-135), is found between these
two β-barrels, and its activity is dependent on the presence of the NS2B cofactor. This
cofactor wraps around the NS3 protease domain and becomes part of the active site. The
remaining NS3 residues (180-618), form the three subdomains of the DENV helicase. A six-
stranded parallel β-sheet surrounded by four α-helices make up subdomains I and II, and
subdomain III is composed of 4 α-helices surrounded by three shorter α-helices and two
antiparallel β-strands.[16]

[edit] NS5 protein

The DENV NS5 protein is a 900 residue peptide with a methyltransferase domain at its N-
terminal end (residues 1-296) and a RNA-dependent RNA polymerase (RdRp) at its C-
terminal end (residues 320–900). The methyltransferase domain is comprised of an α/β/β
sandwich flanked by N-and C-terminal subdomains. The DENV RdRp is similar to other
RdRps containing palm, finger, and thumb subdomains and a GDD motif for incorporating
nucleotides.[16]

The potential factors causing hemorrhagic fever are varied. The most suspected factors are
human's cross-serotypic immune response and membrane fusion process.

Human antibodies produced in response to the virus actually increase the infection.[17]

[edit] Diagnosis
The diagnosis of dengue is usually made clinically. The classic picture is high fever with no
localising source of infection, a rash with thrombocytopenia and relative leukopenia - low
platelet and white blood cell count. Dengue infection can affect many organs and thus may
present unusually as liver dysfunction, renal impairment, meningo-encephalitis or
gastroenteritis.

1. Fever, headaches, eye pain, severe dizziness and loss of appetite.

 2. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from
mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
3. Thrombocytopenia (<100,000 platelets per mm³ or estimated as less than 3 platelets
per high power field)
4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop
in hematocrit of 20% or more from baseline following IV fluid, pleural effusion,
ascites, hypoproteinemia)
5. Encephalitic occurrences.

Dengue shock syndrome is defined as dengue hemorrhagic fever plus:

 Weak rapid pulse,

 Narrow pulse pressure (less than 20 mm Hg)
 Cold, clammy skin and restlessness.

Dependable, immediate diagnosis of dengue can be performed in rural areas by the use of
Rapid Diagnostic Test kits, which also differentiate between primary and secondary dengue
infections.[18] Serology and polymerase chain reaction (PCR) studies are available to confirm
the diagnosis of dengue if clinically indicated. Dengue can be a life threatening fever.

One test is called Platelia Dengue NS1 Ag assay, or NS1 antigen test for short, made by Bio-
Rad Laboratories and Pasteur Institute, introduced in 2006, allows rapid detection before
antibodies appear the first day of fever.[19][20]

In India, dengue diagnoses take up to a week, but has introduced in 2010 PCR (NS1) that
takes 48 hours for diagnosis, which costs 1,600 rupees.[21]

In many poverty stricken areas, a diagnosis may be too expensive and/or meaningless (given
there is no cure, only supportive therapy) so significant undereporting is expected to be the
norm.

[edit] Prevention
There is no tested and approved vaccine for the dengue flavivirus. There are many ongoing
vaccine development programs. Among them is the Pediatric Dengue Vaccine Initiative set
up in 2003 with the aim of accelerating the development and introduction of dengue
vaccine(s) that are affordable and accessible to poor children in endemic countries.[22] Thai
researchers are testing a dengue fever vaccine on 3,000–5,000 human volunteers after having
successfully conducted tests on animals and a small group of human volunteers.[23] A number
of other vaccine candidates are entering phase I or II testing.[24] As of July 2010, the National
Institutes of Health reported on their ClinicalTrials.Gov Web site that there were 19 vaccines
undergoing testing or recruiting for participants.[25] Because exposure to one of dengue's 4
serotypes provides no immunity against infection by the other types, and may make the
patient susceptible to more severe disease symptoms, testing vaccines must be performed
carefully, and usually not in areas where the disease is endemic for fear that even attenuated
virus vaccines may cause severe reactions.[26]

In 1998, scientists from the Queensland Institute of Medical Research (QIMR) in Australia
and Vietnam's Ministry of Health introduced a scheme that encouraged children to place a
water bug, the crustacean Mesocyclops, in water tanks and discarded containers where the
Aedes aegypti mosquito was known to thrive.[27] This method is viewed as being more cost-
effective and more environmentally friendly than pesticides, though not as effective, and
requires the continuing participation of the community.[28]

Even though this method of mosquito control was successful in rural provinces, not much is
known about how effective it could be if applied to cities and urban areas. The Mesocyclops
can survive and breed in large water containers but would not be able to do so in small
containers that most urban dwellers have in their homes. Also, Mesocyclops are hosts for the
guinea worm, a pathogen that causes a parasite infection, and so this method of mosquito
control cannot be used in countries that are still susceptible to the guinea worm. The biggest
dilemma with Mesocyclops is that its success depends on the participation of the community.
This idea of a possible parasite-bearing creature in household water containers dissuades
people from continuing the process of inoculation and, without the support and work of
everyone living in the city, this method will not be successful.[29]

[edit] Treatment
The mainstay of treatment is timely supportive therapy to tackle circulatory shock due to
hemoconcentration and bleeding. Close monitoring of vital signs in the critical period (up to
2 days after defervescence - the departure or subsiding of a fever) is critical. Oral rehydration
therapy is recommended to prevent dehydration in moderate to severe cases. Supplementation
with intravenous fluids may be necessary to prevent dehydration and significant
concentration of the blood if the patient is unable to maintain oral intake. A platelet
transfusion may be indicated if the platelet level drops significantly (below 20,000) or if there
is significant bleeding. The presence of melena may indicate internal gastrointestinal bleeding
requiring platelet and/or red blood cell transfusion.

Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may
worsen the bleeding tendency associated with some of these infections. Patients may receive
paracetamol, acetaminophen, preparations to deal with these symptoms if dengue is
suspected.[30]

[edit] Epidemiology

Disability-adjusted life year for dengue fever per 100,000 inhabitants in 2002.
no data < 15 15-30 30-45 45- 90-105 105-120 120-135 135-
60 60-75 75-90 150 150-250 > 250
Worldwide dengue distribution, 2006. Red: Epidemic dengue. Blue: Aedes aegypti.

Worldwide dengue distribution, 2000.

Dengue is transmitted by Aedes mosquitoes, particularly A. aegypti and A. albopictus.

The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and
North America in the 1780s, shortly after the identification and naming of the disease in
1779. A pandemic began in Southeast Asia in the 1950s, and by 1975 DHF had become a
leading cause of death among children in the region. Epidemic dengue has become more
common since the 1980s. By the late 1990s, dengue was the most important mosquito-borne
disease affecting humans after malaria, with around 40 million cases of dengue fever and
several hundred thousand cases of dengue hemorrhagic fever each year. Significant outbreaks
of dengue fever tend to occur every five or six months. The cyclical rise and fall in numbers
of dengue cases is thought to be the result of seasonal cycles interacting with a short-lived
cross-immunity[clarification needed] for all four strains in people who have had dengue. When the
cross-immunity wears off the population is more susceptible to transmission whenever the
next seasonal peak occurs. Thus over time there remain large numbers of susceptible people
in affected populations despite previous outbreaks due to the four different serotypes of
dengue virus and the presence of unexposed individuals from childbirth or immigration.

There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue
hemorrhagic fever is more likely to occur in patients who have secondary infections by
another one of dengue fever's four serotypes. One model to explain this process is known as
antibody-dependent enhancement (ADE), which allows for increased uptake and virion
replication during a secondary infection with a different strain. Through an immunological
phenomenon, known as original antigenic sin, the immune system is not able to adequately
respond to the stronger infection, and the secondary infection becomes far more serious.[31]

Reported cases of dengue are an under-representation of all cases when accounting for
subclinical cases and cases where the patient did receive medical treatment.
There was a serious outbreak in Rio de Janeiro in February 2002 affecting around one million
people and killing sixteen. On March 20, 2008, the secretary of health of the state of Rio de
Janeiro, Sérgio Côrtes, announced that 23,555 cases of dengue, including 30 deaths, had been
recorded in the state in less than three months. Côrtes said, "I am treating this as an epidemic
because the number of cases is extremely high." Federal Minister of Health, José Gomes
Temporão also announced that he was forming a panel to respond to the situation. Cesar
Maia, mayor of the city of Rio de Janeiro, denied that there was serious cause for concern,
saying that the incidence of cases was in fact declining from a peak at the beginning of
February.[32] By April 3, 2008, the number of cases reported rose to 55,000 [33]

In Singapore, there are 4,000–5,000 reported cases of dengue fever or dengue haemorrhagic
fever every year. In the year 2004, there were seven deaths from dengue shock syndrome.[34]

[edit] Recent outbreaks

Main articles: 2005 dengue outbreak in Singapore, 2006 dengue outbreak in India, 2006
dengue outbreak in Pakistan, and 2009 Bolivian dengue fever epidemic

There is an ongoing 2010 outbreak occurring in Puerto Rico with 5382 confirmed infections
and 20 deaths. [35]

The 2010 and 2009 dengue outbreaks in Key West Florida [36] [37] are similar to the 2005
Texas (25 cases) and 2001 Hawaii (122 cases) outbreaks, which were locally sustained on
American soil and not a result of travelers returning from endemic areas. [38]

American visitors to and legal/illegal immigrants from dengue-endemic regions will continue
to present a potential pathway for the dengue virus to enter the United States and infect
populations that have not been exposed to the virus for several decades.[39][40] The health risks
and rapidly escalating costs to the United States of unmonitored, unvaccinated and disease
carrying travelers, legal and illegal, has been recently considered. [41] [42]

An outbreak of dengue fever was declared in Cairns, located in the tropical north of
Queensland, Australia on 1 December 2008. As of 3 March 2009 there were 503 confirmed
cases of dengue fever, in a residential population of 152,137. Outbreaks were subsequently
declared the neighbouring cities and towns of Townsville (outbreak declared 5 January
2009), Port Douglas (6 February 2009), Yarrabah (19 February 2009), Injinoo (24 February
2009), Innisfail (27 February 2009) and Rockhampton (10 March 2009). There have been
occurrences of dengue types one, two, three, and four in the region. On March 4, 2009,
Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns, in
the first fatality since the epidemic began last year. The statement said that although the
woman had other health problems, she tested positive for dengue and the disease probably
contributed to her death.

An epidemic broke out in Bolivia in early 2009, in which 18 people have died and 31,000
infected.

In 2009, in Argentina, a dengue outbreak was declared the northern provinces of Chaco,
Catamarca, Salta, Jujuy, and Corrientes, with over 9673 cases reported as of April 11, 2009
by the Health Ministry [14]. Some travelers from the affected zones have spread the fever as
far south as Buenos Aires [15]. Major efforts to control the epidemic in Argentina are focused
on preventing its vector (the Aedes mosquitoes) from reproducing. This is addressed by
asking people to dry out all possible water reservoirs from where mosquitoes could
proliferate (which is, in other countries, known as "descacharrado"). There have also been
information campaigns concerning prevention of the dengue fever; and the government is
fumigating with insecticide in order to control the mosquito population.[43]

The first cases of dengue fever have recently been reported on the island nation of Mauritius
in the Indian Ocean. One of the South Asian countries still suffering highly from this problem
is Sri Lanka.[44]

[edit] 2010 Outbreak table

Of the countries in the table below, the only nations with lower cases and deaths so far in
2010 are Singapore, Mexico and the United States.

Reported Compared with Figures as

Country/Region Reported Cases Dengue
(Cumulative)
Deaths previous year of**
(Cumulative)
World (sum of all 1,203,609 1706
regions)
United States 198 (24-2010FL, 27- 1 (2010, Cases down 11% Aug 3,
2009FL, 25-2005TX, 122- suspected)[48] from 2009[49] 2010 [50]
2001HI) [45] [46][47]
Brazil 788,809 (3 sep) 530(aug 25, a up 158% Sep
record) 3[51]/25
aug[52]
Venezuela 79,335 - - Aug 21[53]
Philippines 77,012 534 up 108.8% Sep 4[54]
Thailand 63,528 77 up 101% Aug 27[52]
Honduras 58,587 67 N/A end Aug[55]
Malaysia 32,688 103 up 88% end Aug[56]
Sri Lanka 26,824 192 mid Jul[57]
Costa Rica 21,000 N/A 3,326 end Aug[58]
Vietnam 12,868 12 105,370 (whole Jun 15 [52]
year)
Puerto Rico 13,106 20 - end Aug[59]
Mexico 12,240 20 15,032 week 32
(sep)[60]
Dominican 8,839 41 3,000 Sep 3[52]
Republic
Singapore 2,608 41 3,050 end aug[61]
Guatemala 11,800 suspected, 1925 25 1 sep[62]
confirmed
Delhi, India 1,933 (sep 14) 4 1,153 sep 9[63]
Laos 1,032 (jun 15) 36 7,214(whole year) 20 aug[52]
Trinidad and 1,200 4 N/A end aug[64]
Tobago
Mayotte 75 - N/A sep 1[52]

[edit] Blood transfusion

Dengue may also be transmitted via infected blood products (blood transfusions, plasma, and
platelets),[65][66] and in countries such as Singapore, where dengue is endemic, the risk was
estimated to be between 1.6 and 6 per 10,000 blood transfusions.[67]

[edit] History
[edit] Etymology

The origins of the word dengue are not clear, but one theory is that it is derived from the
Swahili phrase "Ka-dinga pepo", which describes the disease as being caused by an evil
spirit.[68] The Swahili word "dinga" may possibly have its origin in the Spanish word
"dengue" meaning fastidious or careful, which would describe the gait of a person suffering
the bone pain of dengue fever.[69] Alternatively, the use of the Spanish word may derive from
the similar-sounding Swahili.[70]

[edit] Literature

Slaves in the West Indies who contracted dengue were said to have the posture and gait of a
dandy, and the disease was known as "Dandy Fever".[71] The first record of a case of probable
dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (265–420 AD)
which referred to a “water poison” associated with flying insects.[70] The first confirmed case
report dates from 1789 and is by Benjamin Rush, who coined the term "breakbone fever"
because of the symptoms of myalgia and arthralgia.[72] The viral etiology and the
transmission by mosquitoes were discovered in the 20th century by Sir John Burton Cleland.

Population movements during World War II spread the disease globally. A pandemic of
dengue began in Southeast Asia after World War II and has spread around the globe since
then.[73]

[edit] Society and culture

[edit] Use as a biological weapon

Dengue fever was one of more than a dozen agents that the United States researched as
potential biological weapons before the nation suspended its biological weapons program.[74]

[edit] Research
Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication.
Initial experiments showed a fivefold increase in defective viral RNA production by cells
treated with each drug.[75] In vivo studies, however, have not yet been done. Unlike HIV
therapy, lack of adequate global interest and funding greatly hampers the development of a
treatment regime.
[edit] Management

Singapore has managed to reduce the cases of not only dengue, but chikungunya and malaria
by introducing an Integrated Vector Management System. Cases fell from 7,500 to 4,500 in
2008[76], the 2,608 cases this year so far until aug 19, lower rate than preceeding years[77] For
chikungunya results are dramatic, cases fell from 720 in 2008 to only 22 cases this year so
far.[76]

[edit] Wolbachia

In 2009, scientists from the School of Integrative Biology at The University of Queensland
revealed that by infecting Aedes mosquitos with the bacterium Wolbachia, the adult lifespan
was reduced by half.[78] In the study, super-fine needles were used to inject 10,000 mosquito
embryos with the bacterium. Once an insect was infected, the bacterium would spread via its
eggs to the next generation. A pilot release of infected mosquitoes could begin in Vietnam
within three years. If no problems are discovered, a full-scale biological attack against the
insects could be launched within five years.[79]

[edit] Antiviral approaches

Dengue virus belongs to the family Flaviviridae, which includes the hepatitis C virus, West
Nile and Yellow fever viruses among others. Possible laboratory modification of the yellow
fever vaccine YF-17D to target the dengue virus via chimeric replacement has been discussed
extensively in scientific literature,[80] but as of 2009 no full scale studies have been
conducted.[81]

In 2006 a group of Argentine scientists discovered the molecular replication mechanism of

the virus, which could be specifically attacked by disrupting the viral RNA polymerase.[82] In
cell culture[83] and murine experiments[84][85] morpholino antisense oligomers have shown
specific activity against Dengue virus.

[edit] Sterile insect technique

The sterile insect technique, a form of biological control, has long proved difficult with
mosquitos because of the fragility of the males.[86] However, a transgenic strain of Aedes
aegypti was announced in 2010 which might alleviate this problem: the strain produces
females that are flightless due to a mis-development of their wings,[87] and so can neither
mate nor bite. The genetic defect only causes effects in females, so that males can act as
silent carriers.[86]

Dengue
Fever
(cont.)
In this Article

 What is
dengue
 fever?
 What areas
are at high
risk for
contracting
dengue
fever?
 How is
dengue <script language="JavaScript1.2" type="text/javascript"
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fever
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and signs?
 What is the From WebMD
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 Patient
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Fever -
Describe
Your
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  Dengue
Fever
Glossary
 Dengue
Fever
Index

What are
dengue fever
symptoms and
signs?

After being bitten

by a mosquito
carrying the virus,
the incubation
period ranges from
three to 15
(usually five to
eight) days before
the signs and
symptoms of
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 first
hours of illness.
The temperature
rises quickly as
high as 104 F (40
C), with relative
low heart rate
(bradycardia) and
low blood pressure
(hypotension). The
eyes become
reddened. A
flushing or pale
pink rash comes
over the face and
then disappears.
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
a rapid drop in
body temperature
(defervescence)
with profuse
sweating. This
precedes a period
with normal
temperature and a
sense of well-
being that lasts
about a day. A
second rapid rise
in temperature
follows. A
characteristic rash
appears along with
the fever and
spreads from the
extremities to
cover the entire
body except the
face. The palms
and soles may be
bright red and
swollen.

What is the
treatment for
dengue fever?

Because dengue
fever is caused by
a virus, there is no
specific medicine
or antibiotic to
treat it. For typical
dengue, the
treatment is purely
concerned with
relief of the
symptoms
(symptomatic).
Rest and fluid
intake for adequate
hydration is
important. Aspirin
and nonsteroidal
anti-inflammatory
drugs should only
be taken under a
doctor's
supervision
because of the
possibility of
worsening
hemorrhagic
complications.
Acetaminophen
(Tylenol) and
codeine may be
given for severe
headache and for
the joint and
muscle pain
(myalgia).

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Describe Your
Experience

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ask:

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with dengue fever.

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 Nonsteroid
al
Antiinflam
matory
Drugs
(NSAIDs)
- Describes
Nonsteroid
al
Antiinflam
matory
Drugs
(NSAIDs),
which are
medication
s used
primarily
to treat
inflammati
on, mild to
moderate
pain, and
fever.
 Blood
Transfusio
n - Learn
about
blood
transfusion
risks, and
the types
 such as
autologous
(your own
blood) and
donor
blood
(someone
else's
blood) and
what type
might be
best for
your
situation.
 Low Blood
Pressure -
Learn
about low
blood
pressure
(hypotensi
on). Low
blood
pressure is
blood
pressure
below
normal and
symptoms
may
include:
lightheaded
ness,
dizziness,
fainting
upon
standing
(orthostatic
hypotensio
n). There
are many
causes of
low blood
pressure,
and
treatment
is
dependant
upon the
 cause.

Read more
Dengue Fever
related articles »

Latest Medical
News

 Too Soon
to Tell
Whether
Dengue
Fever Will
Spread in
U.S.
 Avoid
Mosquito
Bites to
Prevent
Dengue
Fever in
Florida:
Expert
 Dengue
Infection
Re-
Emerges in
Florida:
CDC
 6 Insect
Repellents
Get High
Marks

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treatment options.
Featured on MedicineNet

 Causes of Fatigue Slideshow

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Dengue Fever Related Articles

 Abdominal Pain
 Aches, Pain, Fever
 Blood Transfusion
 Headache
 Low Back Pain
 Low Blood Pressure
 Nosebleed
 Pneumonia
 Rash
 Sore Throat
 Complete List »

Travel Health Topics

 Dengue Fever
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 Malaria
 Travelers' Diarrhea
 Leptospirosis
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Dengue
Fever
(cont.)
In this Article

 What is
dengue
fever?
 What areas
are at high
risk for
contracting
dengue
fever? <script language="JavaScript1.2" type="text/javascript"
 How is src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionI
dengue D=101369503724&amp;tile=101369503724&amp;xpg=4093&amp;sec=
fever 8000&amp;artid=6243&amp;site=2&amp;affiliate=22&amp;uri=subject
contracted? %3Ddengue%5Ffeverpage%3D3&amp;pos=121"></script>
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dengue
fever
symptoms From WebMD
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 What is the Digestive Disorders Resources
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for dengue  Constipation Causes and Relief
fever?  Probiotics Can Ease Diarrhea
 What is the
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for typical
dengue  Which Foods Are Highest in Fiber?
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c fever?
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fever?
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Fever At A
Glance
 Patient
Discussion
s: Dengue
Fever -
Describe
Your
Experience
 Dengue
Fever
Glossary
 Dengue
Fever
Index

What is the
prognosis for
typical dengue
fever?

Typical dengue is
fatal in less than
1% of cases. The
acute phase of the
illness with fever
and myalgias lasts
about one to two
weeks.
Convalescence is
accompanied by a
feeling of
weakness
(asthenia), and full
recovery often
takes several
weeks.

What is dengue
hemorrhagic
fever?
Dengue
hemorrhagic fever
(DHF) is a specific
syndrome that
tends to affect
children under 10
years of age. It
causes abdominal
pain, hemorrhage
(bleeding), and
circulatory
collapse (shock).
DHF is also called
Philippine, Thai,
or Southeast Asian
hemorrhagic fever
and dengue shock
syndrome.

DHF starts
abruptly with high
continuous fever
and headache.
There are
respiratory and
intestinal
symptoms with
sore throat, cough,
nausea, vomiting,
and abdominal
pain. Shock occurs
two to six days
after the start of
symptoms with
sudden collapse,
cool, clammy
extremities (the
trunk is often
warm), weak
pulse, and
blueness around
the mouth
(circumoral
cyanosis).

In DHF, there is
bleeding with easy
bruising, blood
spots in the skin
(petechiae),
spitting up blood
(hematemesis),
blood in the stool
(melena), bleeding
gums, and
nosebleeds
(epistaxis).
Pneumonia is
common, and
inflammation of
the heart
(myocarditis) may
be present.

Patients with DHF

must be monitored
closely for the first
few days since
shock may occur
or recur
precipitously
(dengue shock
syndrome).
Cyanotic (bluish)
patients are given
oxygen. Vascular
collapse (shock)
requires
immediate fluid
replacement.
Blood transfusions
may be needed to
control bleeding.

The mortality
(death) rate with
DHF is significant.
It ranges from 6%-
30%. Most deaths
occur in children.
Infants under a
year of age are
especially at risk
of dying from
DHF.

 « Previous
 1
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  4
 5
 Next »

 Dengue
Fever
Index
 Glossary

Next: How can

dengue fever be
prevented? »

Share | | | | | More

Dengue Fever -
Describe Your
Experience

The MedicineNet
physician editors
ask:

Please describe
your experience
with dengue fever.

Comment
submissions for
this question have
ended.
See 20 Viewer
Comments

View Comments

Feel Wiped Out

Working Odd
Hours?

 Learn
 about a
Medical
Condition
Called
Shift Work
Disorder
 Talk to
Your
Doctor
about Your
Symptoms
 Ask Your
Doctor
About
Options

Learn More

From Our Sponsor

close

Suggested
Reading by Our
Doctors

 Nonsteroid
al
Antiinflam
matory
Drugs
(NSAIDs)
- Describes
Nonsteroid
al
Antiinflam
matory
Drugs
(NSAIDs),
 which are
medication
s used
primarily
to treat
inflammati
on, mild to
moderate
pain, and
fever.
 Blood
Transfusio
n - Learn
about
blood
transfusion
risks, and
the types
such as
autologous
(your own
blood) and
donor
blood
(someone
else's
blood) and
what type
might be
best for
your
situation.
 Low Blood
Pressure -
Learn
about low
blood
pressure
(hypotensi
on). Low
blood
pressure is
blood
pressure
below
normal and
symptoms
may
include:
lightheaded
 ness,
dizziness,
fainting
upon
standing
(orthostatic
hypotensio
n). There
are many
causes of
low blood
pressure,
and
treatment
is
dependant
upon the
cause.

Read more
Dengue Fever
related articles »

Latest Medical
News

 Too Soon
to Tell
Whether
Dengue
Fever Will
Spread in
U.S.
 Avoid
Mosquito
Bites to
Prevent
Dengue
Fever in
Florida:
Expert
 Dengue
Infection
Re-
Emerges in
Florida:
CDC
 6 Insect
Repellents
Get High
 Marks

Privacy Policy

GI Disorders

Get the latest

treatment options.

Featured on MedicineNet

 Causes of Fatigue Slideshow

 Living with COPD
 Sleep Disorders Slideshow

Top 10
Dengue Fever Related Articles

 Abdominal Pain
 Aches, Pain, Fever
 Blood Transfusion
 Headache
 Low Back Pain
 Low Blood Pressure
 Nosebleed
 Pneumonia
 Rash
 Sore Throat
 Complete List »

Travel Health Topics

 Dengue Fever
 Typhoid Fever
 Malaria
 Travelers' Diarrhea
 Leptospirosis
 Travel Health RSS
 Take a Quiz
Latest Travel Health News

 Health Tip: Help Prevent Travelers' Diarrhea

 Spectators Need to Prepare for Olympic Games, Too
 Health Tip: Stay Healthy on a Cruise
 Cruise-Ship Sickness Caused by Poor Cleaning
 Dialysis While Traveling Could Be Risky
 Want More News? Sign Up for MedicineNet Newsletters!
 Health News Feed

Dengue Fever
(cont.)
In this Article

 What is
dengue fever?
 What areas are
at high risk for
contracting
dengue fever?
 How is dengue
fever
contracted?
 What are
<script language="JavaScript1.2" type="text/javascript"
dengue fever
src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transacti
symptoms and
onID=342555111631&amp;tile=342555111631&amp;xpg=4093&am
signs?
p;sec=8000&amp;artid=6243&amp;site=2&amp;affiliate=22&amp;uri
 What is the
=subject%3Ddengue%5Ffeverpage%3D4&amp;pos=121"></script>
treatment for
dengue fever?
 What is the
prognosis for
typical dengue From WebMD
fever?
Digestive Disorders Resources
 What is
dengue  Constipation Causes and Relief
hemorrhagic  Probiotics Can Ease Diarrhea
 fever? Featured Centers
 How can
dengue fever  Which Foods Are Highest in Fiber?
be prevented?  How Bad Is Your Diet? Assess Yourself
 Where can  12 Tips to Stay Awake Naturally
people get
more Health Solutions From Our Sponsors
information on
dengue fever?  Depression Med for You?
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 Dengue Fever  Living with Obstructive Asthma
Glossary  Trouble Breathing? Take the COPD Health Check
 Dengue Fever
Index

How can dengue

fever be
prevented?

The transmission of
the virus to
mosquitoes must be
interrupted to prevent
the illness. To this
end, patients are kept
under mosquito
netting until the
second bout of fever is
over and they are no
longer contagious.

The prevention of
dengue requires
control or eradication
of the mosquitoes
carrying the virus that
causes dengue. In
nations plagued by
dengue fever, people
are urged to empty
stagnant water from
old tires, trash cans,
and flower pots.
Governmental
initiatives to decrease
mosquitoes also help
to keep the disease in
check but have been
poorly effective.

To prevent mosquito
bites, wear long pants
and long sleeves. For
personal protection,
use mosquito repellant
sprays that contain
DEET when visiting
places where dengue
is endemic. Limiting
exposure to
mosquitoes by
avoiding standing
water and staying
indoors two hours
after sunrise and
before sunset will
help. The Aedes
aegypti mosquito is a
daytime biter with
peak periods of biting
around sunrise and
sunset. It may bite at
any time of the day
and is often hidden
inside homes or other
dwellings, especially
in urban areas.

There is currently no
vaccine available for
dengue fever. There is
a vaccine undergoing
clinical trials, but it is
too early to tell if it
will be safe or
effective. Early results
of clinical trials show
that a vaccine may be
available by 2012.

Where can people

get more
information on
dengue fever?

"Dengue," Centers for

Disease Control and
Prevention
http://www.cdc.gov/D
engue/

Dengue Fever At A
Glance

 Dengue fever
is a disease
caused by a
family of
viruses that are
transmitted by
mosquitoes.
 Symptoms
such as
headache,
fever,
exhaustion,
severe joint
and muscle
pain, swollen
glands
(lymphadenop
athy), and
rash. The
presence (the
"dengue
triad") of
fever, rash,
and headache
(and other
pains) is
particularly
characteristic
of dengue
fever.
 Dengue is
prevalent
throughout the
tropics and
subtropics.
Outbreaks
have occurred
 recently in the
Caribbean,
including
Puerto Rico,
the U.S. Virgin
Islands, Cuba,
and Central
America.
 Because
dengue fever is
caused by a
virus, there is
no specific
medicine or
antibiotic to
treat it. For
typical dengue
fever, the
treatment is
purely
concerned
with relief of
the symptoms
(symptomatic).
 The acute
phase of the
illness with
fever and
myalgias lasts
about one to
two weeks.
 Dengue
hemorrhagic
fever (DHF) is
a specific
syndrome that
tends to affect
children under
10 years of
age. It causes
abdominal
pain,
hemorrhage
(bleeding), and
circulatory
collapse
(shock).
 The prevention
of dengue
fever requires
 control or
eradication of
the mosquitoes
carrying the
virus that
causes dengue.
 There is
currently no
vaccine
available for
dengue fever.

REFERENCES:

Canada. Public Health

Agency of Canada.
"Dengue in South East
Asia." Aug. 23, 2007.
<http://www.phac-
aspc.gc.ca/tmp-
pmv/2007/dengue070
823_e.html>.

"Dengue Fever in Key

West." Florida
Department of Health.
<http://www.doh.state
.fl.us/Environment/me
dicine/arboviral/Deng
ue_FloridaKeys.html>
.

Switzerland. World
Health Organization.
"Planning Social
Mobilization and
Communication for
Dengue Fever
Prevention and
Control."
<http://www.who.int/t
dr/publications/public
ations/pdf/planning_d
engue.pdf>.

Switzerland. World
Health Organization.
"Vector-Borne Viral
Infections."
<http://www.who.int/
vaccine_research/dise
ases/vector/en/index.h
tml>.

United States. Centers

for Disease Control
and Prevention.
"Dengue." May 20,
2010.
<http://www.cdc.gov/
Dengue/>.

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/mmwr
html/mm5919a1.htm>
.

Last Editorial Review: 7/22/2010

 « Previous
 1
 2
 3
 4
 5
 Next »

 Dengue Fever
Index
 Glossary

Dengue Fever -
Describe Your
Experience

The MedicineNet
physician editors ask:

Please describe your

experience with
dengue fever.

Comment submissions
for this question have
ended.
See 20 Viewer
Comments

View Comments

Feel Wiped Out

Working Odd
Hours?

 Learn about a
Medical
Condition
Called Shift
Work Disorder
 Talk to Your
Doctor about
Your
Symptoms
 Ask Your
Doctor About
Options

Learn More

From Our Sponsor

close

Suggested Reading by
Our Doctors

 Nonsteroidal
Antiinflammat
ory Drugs
(NSAIDs) -
Describes
Nonsteroidal
Antiinflammat
ory Drugs
(NSAIDs),
which are
medications
used primarily
to treat
inflammation,
mild to
moderate pain,
and fever.
 Blood
Transfusion -
Learn about
blood
transfusion
risks, and the
types such as
autologous
(your own
blood) and
donor blood
(someone
else's blood)
and what type
might be best
for your
situation.
 Low Blood
Pressure -
Learn about
low blood
pressure
(hypotension).
Low blood
pressure is
blood pressure
below normal
 and symptoms
may include:
lightheadednes
s, dizziness,
fainting upon
standing
(orthostatic
hypotension).
There are
many causes
of low blood
pressure, and
treatment is
dependant
upon the
cause.

Read more Dengue

Fever related articles
»

Latest Medical
News

 Too Soon to
Tell Whether
Dengue Fever
Will Spread in
U.S.
 Avoid
Mosquito
Bites to
Prevent
Dengue Fever
in Florida:
Expert
 Dengue
Infection Re-
Emerges in
Florida: CDC
 6 Insect
Repellents Get
High Marks

Privacy Policy

GI Disorders

Get the latest

treatment options.

Featured on MedicineNet

 Causes of Fatigue Slideshow

 Living with COPD
 Sleep Disorders Slideshow

Top 10
Dengue Fever Related Articles

 Abdominal Pain
 Aches, Pain, Fever
 Blood Transfusion
 Headache
 Low Back Pain
 Low Blood Pressure
 Nosebleed
 Pneumonia
 Rash
 Sore Throat
 Complete List »

Travel Health Topics

 Dengue Fever
 Typhoid Fever
 Malaria
 Travelers' Diarrhea
 Leptospirosis
 Travel Health RSS
 Take a Quiz

Dengue fever Guide

Doctor-reviewed article from RightHealth and A.D.A.M.

 « Full Article
 « Definition
 « Alternative Names
 « Causes, Incidence, And Risk Factors
 « Symptoms
  « Signs And Tests
 « Treatment
 « Expectations (Prognosis)
 « Complications
 « Calling Your Health Care Provider
 « Prevention
 « References
Symptoms
Dengue fever begins with a sudden high fever, often as high as 104 - 105 degrees Fahrenheit.
A flat, red rash may appear over most of the body 2 - 5 days after the fever starts. A second
rash, which looks like the measles, appears later in the disease. Infected people may have
increased skin sensitivity and are very uncomfortable.
Other symptoms include:
 Headache (especially behind the eyes)
 Fatigue
 Joint aches
 Muscle aches
 Nausea
 Swollen lymph nodes
 Vomiting

Read more:
http://www.righthealth.com/topic/Dengue_Fever_Symptoms/overview/adam20?fdid=Adamv
2_001374&section=Symptoms#ixzz0zxBi35rq

Latest Travel Health News

 Health Tip: Help Prevent Travelers' Diarrhea

 Spectators Need to Prepare for Olympic Games, Too
 Health Tip: Stay Healthy on a Cruise
 Cruise-Ship Sickness Caused by Poor Cleaning
 Dialysis While Traveling Could Be Risky
 Want More News? Sign Up for MedicineNet Newsletters!
 Health News Feed

<script language="JavaScript1.2" type="text/javascript"

src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionID=342555111631
&amp;tile=342555111631&amp;xpg=4093&amp;sec=8000&amp;artid=6243&amp;site=2&
amp;affiliate=22&amp;uri=subject%3Ddengue%5Ffeverpage%3D4&amp;pos=113"></script
>
 Doctor-reviewed article from RightHealth and A.D.A.M.

 « Full Article

 « Definition

 « Alternative Names

 « Causes, Incidence, And Risk Factors

 « Symptoms

 « Signs And Tests

 « Treatment

 « Expectations (Prognosis)

 « Complications

 « Calling Your Health Care Provider

 « Prevention

 « References

Signs And Tests

Tests that may be done to diagnose this condition include:

 Antibody titer for dengue virus types

 Complete blood count (CBC)

 Serology studies to look for antibodies to dengue viruses

Read more:
http://www.righthealth.com/topic/Dengue_Fever_Symptoms/overview/adam20?fdid=Adamv2_001
374&section=Symptoms#ixzz0zxBsgTVM

Treatment

There is no specific treatment for dengue fever. You will need fluids if there are signs of dehydration.
Acetaminophen (Tylenol) is used to treat a high fever. Avoid taking aspirin.

Read more:
http://www.righthealth.com/topic/Dengue_Fever_Symptoms/overview/adam20?fdid=Adamv2_001
374&section=Symptoms#ixzz0zxC0w6Yl
Expectations (Prognosis)

The condition generally lasts a week or more. Although uncomfortable, dengue fever is not deadly.
People with the condition should fully recover.

Read more:
http://www.righthealth.com/topic/Dengue_Fever_Symptoms/overview/adam20?fdid=Adamv2_001
374&section=Symptoms#ixzz0zxCCJAHu

Complications

 Febrile convulsions

 Severe dehydration

Dehydration Guide

Doctor-reviewed article from RightHealth and A.D.A.M.

 « Full Article

 « Definition

 « Causes, Incidence, And Risk Factors

 « Symptoms

 « Signs And Tests

 « Treatment

 « Expectations (Prognosis)

 « Complications

 « Calling Your Health Care Provider

 « Prevention

 « References

Definition

Dehydration means your body does not have as much water and fluids as it should. Dehydration can
be caused by losing too much fluid, not drinking enough water or fluids, or both. Vomiting and
diarrhea are common causes.

Infants and children are more susceptible to dehydration than adults because of their smaller body
weights and higher turnover of water and electrolytes. The elderly and those with illnesses are also
at higher risk.
Dehydration is classified as mild, moderate, or severe based on how much of the body's fluid is lost
or not replenished. When severe, dehydration is a life-threatening emergency.

Causes, Incidence, And Risk Factors

Your body may lose too much fluids from:

 Vomiting or diarrhea

 Excessive urine output, such as with uncontrolled diabetes or diuretic use

 Excessive sweating (for example, from exercise)

 Fever

You might not drink enough fluids because of:

 Nausea

 Loss of appetite due to illness

 Sore throat or mouth sores

Dehydration in sick children is often a combination of both -- refusing to eat or drink anything while
also losing fluid from vomiting, diarrhea, or fever.

Symptoms

 Dry or sticky mouth

 Low or no urine output; concentrated urine appears dark yellow

 Not producing tears

 Sunken eyes

 Markedly sunken fontanelles (the soft spot on the top of the head) in an infant

 Lethargic or comatose (with severe dehydration)

In addition to the symptoms of actual dehydration, you may also have vomiting, diarrhea, or the
feeling that you "can't keep anything down," all of which could be causing the dehydration.

Signs And Tests

A physical examination may also show signs of:

 Low blood pressure

 Blood pressure that drops when you go from lying down to standing

 Rapid heart rate

  Poor skin turgor -- the skin may lack its normal elasticity and sag back into position slowly
when pinched up into a fold by the doctor; normally, skin springs right back into position

 Delayed capillary refill

 Shock

Tests include:

 Blood chemistries (to check electrolytes, especially sodium, potassium, and bicarbonate
levels)

 Urine specific gravity (a high specific gravity indicates significant dehydration)

 BUN (blood urea nitrogen -- may be elevated with dehydration)

 Creatinine (may be elevated with dehydration)

 Complete blood count (CBC) to look for signs of concentrated blood

Other tests may be done to determine the specific cause of the dehydration (for example, a blood
sugar to check for diabetes).

Treatment

Drinking fluids is usually sufficient for mild dehydration. It is better to have frequent, small amounts
of fluid (using a teaspoon or syringe for an infant or child) rather than trying to force large amounts
of fluid at one time. Drinking too much fluid at once can bring on more vomiting.

Electrolyte solutions or freezer pops are especially effective. These are available at pharmacies.
Sport drinks contain a lot of sugar and can cause or worsen diarrhea. In infants and children, avoid
using water as the primary replacement fluid.

Intravenous fluids and hospitalization may be necessary for moderate to severe dehydration. The
doctor will try to identify and then treat the cause of the dehydration.

Most cases of stomach viruses (also called viral gastroenteritis) tend to resolve on their own after a
few days. See also: diarrhea

Expectations (Prognosis)

When dehydration is recognized and treated promptly, the outcome is generally good.

Complications

Untreated severe dehydration may result in seizures, permanent brain damage, or death.

Calling Your Health Care Provider

Call 911 if you or your child have the following symptoms

 Dizziness
  Lightheadedness

 Lethargy

 Confusion

Call your doctor right away if you or your child has any of the following symptoms:

 Not producing tears

 Sunken eyes

 Little or no urine output for 8 hours

 Dry skin that sags back into position slowly when pinched up into a fold

 Dry mouth or dry eyes

 Sunken soft-spot on the top of your infant's head

 Fast-beating heart

 Blood in the stool or vomit

 Diarrhea or vomiting (in infants less than 2 months old)

 Listlessness and inactiveness

Also call your doctor if you are not sure whether your attempts to give your child proper fluids are
working.

Also call your doctor if:

 An illness is combined with the inability to keep down any fluids

 Vomiting has been going on for longer than 24 hours in an adult or longer than 12 hours in a
child

 Diarrhea has lasted longer than 5 days in an adult or child

 Your infant or child is much less active than usual or is irritable

 You or your child have excessive urination, especially if there is a family history of diabetes
or you are taking diuretics

Prevention

Even when healthy, drink plenty of fluid every day. Drink more when the weather is hot or you are
exercising.

Carefully monitor someone who is ill, especially an infant, child, or older adult. If you believe that
dehydration is developing, consult a doctor before the person becomes moderately or severely
dehydrated. Begin fluid replacement as soon as vomiting and diarrhea start -- DO NOT wait for signs
of dehydration.

Always encourage the person to drink during an illness, and remember that a person's fluid needs
are greater when that person has fever, vomiting, or diarrhea. The easiest signs to monitor are urine
output (there should be frequent wet diapers or trips to the bathroom), saliva in the mouth, and
tears when crying.

References

Barkin RM, Ward DG. Infectious diarrheal diseases and dehydration. In: Marx J, ed. Rosen’s
Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa: Mosby Elsevier;
2006:chap 171.

Landry GL. Heat injuries. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook
of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 688.

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CYt0

CONVULSIONS-
Seizures Guide

Doctor-reviewed article from RightHealth and A.D.A.M.

 « Full Article

 « Definition

 « Alternative Names

 « Considerations

 « Common Causes

 « Home Care

 « Call Your Health Care Provider If

 « What To Expect At Your Health Care Provider's Office

 « Prevention

 « References

Definition
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal
electrical activity in the brain.

See also:

 Generalized tonic clonic seizure

 Partial (focal) seizure

 Petit mal (absence) seizure

 Epilepsy

 Fever (febrile) convulsions (seizures in children with high fever)

Alternative Names

Secondary seizures; Reactive seizures; Seizure - secondary; Seizure - reactive

Considerations

There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are
involved. Many, if not all, types of seizures cause loss of awareness and some cause twitching or
shaking of the body.

However, some seizures may be hard to notice because they consist of staring spells that can easily
go unnoticed. Occasionally, seizures can cause temporary changes in sensation or vision.

Symptoms of seizures come on suddenly, over just seconds to a minute, and may include:

 Change in consciousness, so that you can't remember some period of time

 Change in emotion, like unexplainable fear, panic, joy, or laughter

 Change in sensation of the skin, usually spreading over the arm, leg, or trunk

 Changes in vision, including flashing lights, or (rarely) hallucinations (seeing things that aren't
there)

 Loss of muscle control and falling, often very suddenly

 Muscle movement such as twitching that might spread up or down an arm or leg

 Muscle tension/tightening that causes twisting of the body, head, arms, or legs

 Tasting a bitter or metallic flavor

Symptoms may stop after a few minutes, or continue for 15 minutes. They rarely continue longer.

Shaking of the entire body when it occurs should last a few minutes and stop within 5 minutes.

Common Causes
A seizure may be related to a temporary condition, such as exposure to drugs, withdrawal from
certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the repeated
seizures do not happen again once the underlying problem is corrected, the person does not have
epilepsy.

In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be
abnormally excited.

In some people, a problem that is passed down through families (inherited) affects nerve cells in the
brain, which leads to seizures. In these cases, the seizures happen spontaneously, without an
immediate cause, and repeat over time. This is epilepsy.

Idiopathic seizures are chronic seizures that occur without an identifiable cause. They usually begin
between ages 5 and 20, but can occur at any age. The person can have a family history of epilepsy or
seizures.

Other more common causes of seizures include:

 Tumors (such as brain tumor) or other structural brain lesions (such as bleeding in the brain)

 Traumatic brain injury, stroke, or a transient ischemic attack (TIA)

 Stopping alcohol after drinking heavily on most days

 Illnesses that cause the brain to deteriorate

 Dementia such as Alzheimer's disease

 Problems that are present from before birth (congenital brain defects)

 Injuries to the brain that occur during labor or at the time of birth

 Low blood sugar or sodium levels in the blood

 Kidney or liver failure

 Use of cocaine, amphetamines, or certain other recreational drugs

 Stopping certain drugs, such as barbiturates and benzodiazepines, after taking them for a
period of time

 Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)

 Phenylketonuria (PKU) can cause seizures in infants.

Home Care

If someone who has never had a seizure before has one, call 911 or your local emergency number
immediately.

Persons with epilepsy should always wear a medical alert tag.

Most seizures stop by themselves. However, a person having a generalized seizure may be injured;
breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a generalized seizure,
it is important to protect the person from injury. Turn the person on the side, so that any vomit
leaves the body and does not enter the lungs. See: Seizure first aid

After a generalized seizure, most people go into a deep sleep. Do not prevent the person from
sleeping. The person will probably be disoriented, or possibly agitated for awhile after awakening.

EMERGENCY FIRST AID

 Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the
teeth. You can cause more damage than you can prevent.

 Do not try to hold the person down during the seizure.

 Turn the person to the side if vomiting occurs. Keep the person on his or her side while
sleeping after the seizure is over.

 If the person having a seizure turns blue or stops breathing, try to position their head to
prevent their tongue from blocking their airways. Breathing usually starts on its own once
the seizure is over.

 CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed
during the seizure.

If a person has repeated or prolonged seizures without regaining consciousness or returning to

normal behavior, the body may develop a severe lack of oxygen. This an emergency situation. Seek
immediate medical help.

AFTER THE SEIZURE

Treat any injuries from bumps or falls. Record details of the seizure to report to the person's primary
health care provider. You should note the following details:

 How long it lasted

 What body parts were affected

 Type of movements or other symptoms

 Possible causes

 How the person behaved after the seizure

Call Your Health Care Provider If

If this is the first time someone has ever had a seizure, or if this is an unusually long seizure in
someone who has a seizure disorder, call 911 or your local emergency number immediately. These
symptoms can be caused by life-threatening conditions, such as a stroke or meningitis.
Report all seizures (even a mild one) to the health care provider. If the person is known to have
epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or
other instructions given.

What To Expect At Your Health Care Provider's Office

Often, a person who has had a new or severe seizure will be seen in an emergency room, rather than
a doctor's office.

The health care provider will try to diagnose the type of seizure based on the symptoms.

Other medical conditions that can cause a seizure or similar symptoms will be ruled out. Disorders
that may cause similar symptoms include fainting, TIA or stroke, rage or panic attacks, migraine
headaches, sleep disturbances, and conditions that cause loss of consciousness.

The following tests may be done:

 Blood tests

 CT scan of the head or MRI of the head

 EEG (usually not in the emergency room)

 Lumbar puncture (also called a spinal tap)

The need for further tests or treatment depends on a number of factors.

 A single seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating
or avoiding that trigger.

 A new seizure without an obvious trigger will require further testing and possible treatment.

 A seizure in a person with known epilepsy will require tests to make sure the patient is
taking the correct dose of their medicines. A possible change in medicines may be needed.

Prevention

Instructions for taking any prescribed medications should be strictly followed. Family members
should observe and record any seizure information to make sure the person gets proper treatment.

Good health habits may help to control seizures. Because sleep deprivation, stress, and a poor diet
can contribute to increased seizures, good sleep habits, stress reduction, proper exercise, and sound
nutrition may help.

There is no specific way to prevent all seizures. Use helmets when appropriate to prevent head
injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid recreational
drugs. People with epilepsy should take medication as directed and avoid excessive amounts of
alcohol.

People with uncontrolled seizures should not drive. Each state has a different law that determines
which people with a history of seizures are allowed to drive. People with uncontrolled seizures also
should avoid activities where loss of awareness would cause great danger, such as climbing to high
places, biking, and swimming alone.

References

Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed.
Philadelphia, PA: Saunders Elsevier; 2007:chap 52.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first
seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the
American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1991-
2007.

Pollack CV Jr. Seizures. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice.
6th ed. Philadelphia, PA: Mosby Elsevier; 2006:chap 100.

Spenser SS. Seizures and epilepsy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed.
Philadelphia, PA: Saunders Elsevier; 2007:chap 426.

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sIa2

Prevention

Clothing, mosquito repellent, and netting can help reduce exposure to mosquitoes. Traveling during
periods of minimal mosquito activity can also be helpful.

Mosquito abatement programs may reduce the risk of infection.

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#ixzz0zxDeunbR