DENGUE

Dr. Muhammad Ayub Khan (FCPS)

Consultant Physician and Endocrinologist
Manager Medical Services - MM

Table of Content

Dengue and its causative agent

Transmission and vectors
Geographic distribution
Breeding sites & life cycle of Aedes
Signs and symptoms of Dengue
Diagnosis,
Treatment,
Prevention
Final words

What is Dengue?
Is an acute fever producing infectious
disease caused by Dengue virus.
Mostly found in the tropics
Complications can be fatal
It is also known as Dengue fever , breakbone
fever or Dengue hemorrhagic fever
Bauman, R., (2006). Microbiology disease by systems. San Francisco , CA: Pearson Benjamin Cumming Publishers

Causative agent of Dengue

Dengue is cause by a RNA virus
This virus is a member of the viral family
Flaviviridae.
Dengue virus

Bauman, R., (2006). Microbiology disease by systems. San Francisco , CA: Pearson Benjamin Cumming
Publishers

Transmission of Dengue
A mosquito is the biological vector
This mosquito is the intermediate host for some
viruses
Aedes albopictus/aegypti are generally associated
with the spread of dengue fever
Biting around the ankles and knees close to the
ground in the daytime.
Only female mosquitoes will bite; mostly in the
daytime
Akram, W., (n.d.). Aedes as a vector of Dengue: a possible threat to our lives. Khwarzimig Science
Society. University of Agriculture, Faisalabad. Retrieved April 19, 2010 from
http://www.khwarzimic.org/takveen/dengue_kss.pdf

Aedes albopictus
The Asian tiger mosquito or Aedes
albopictus is a vector for many viruses
including dengue fever and Eastern
equine encephalitis virus

Rios, L., Maruniak, J.E. (2008). Asian tiger mosquito. University of Florida Institute of
Food and Agricultural Sciences .

Aedes albopictus

Aedes aegypti

The most competent vector of dengue virus and yellow fever

As A. albopictus, this mosquito depend greatly on stored
water for breeding sites.
Male and Females adults feed on nectar of plants
Females bloodfeed primarily on humans in order to produce
eggs
A. aegypti bites during the day, indoor as well as outdoors
Zettel, C., Kaufman, P. (2008). Yellow fever mosquito. University of Florida Institute of Food and
Agricultural Sciences.

Aedes aegypti

Geographic distribution of Dengue

Dengue disease occurs in tropical and
subtropical areas
Endemic in over 100 countries in the Caribbean,
America, Africa, the Pacific Islands, Hawaii,
Asia, Eastern Mediterranean and Australia
Before 1970 only nine countries had experience
dengue hemorrhagic fever epidemics, a number
that had increased more than four-fold by 1995

World Health Organization, (2009). Dengue and Dengue haemorrhagic fever. Retrieved April 19, 2010 from
http://www.who.int/mediacentre/factsheets/fs117/en/

Geographical distribution of Dengue

Common breeding sites

Dengue cases usually increase during the rainy
season
The spread of the mosquito is attributed to poor
environmental sanitation
When it rains the water gets stored in any place
such as discarded tires, broken bottles, and even
shoes
Other examples are soda cans, birdbaths, rain
gutters, toys, pool covers, tree stumps, and
garbage cans.
Illinois Environmental Protection Agency, (2007). Mosquito-Borne illnesses prevention techniques.

Aedes aegypti life cycle

2-7 days
>4 days
2 days

Package

Signs and Symptoms of Dengue Fever

High fever, up to 105 F (40.6 C)

A rash over most of your body, can subside after a couple of days and
then reappear
Severe headache, backache or both
Pain behind your eyes
Severe joint and muscle pain (breakbone fever)
Nausea and vomiting
Signs and symptoms usually begin about four to seven days after
being bitten by A. aegypti.
Mild dengue fever rarely causes death, it is usually self-limiting

Mayo clinic, (2010). Dengue fever symptoms.

Symptoms of Dengue Fever

Example of a skin rash due to

dengue fever

Signs and Symptoms of Dengue

Hemorrhagic fever (DHF)
A more severe form of dengue that begins the same way
as dengue fever but become worse after several days
Significant damage to your blood and lymph vessels
A decrease in the number of blood cells that help your
blood clot (platelets)
Bleeding from nose and mouth
Bleeding under the skin, which gives the appearance of
bruising
Death
Mayo clinic, (2010). Dengue fever symptoms.

Signs and Symptoms of Dengue

Shock
Syndrome
(DSS)
The most severe form of the disease

It may start with the signs and symptoms of mild dengue

plus
Severe abdominal pain
Frequent vomiting
Disorientation
Fluid (plasma) leakage from blood vessels
Heavy bleeding
A sudden drop in blood pressure (shock)
Death
Mayo clinic, (2010). Dengue fever symptoms.

Why does different clinical

manifestations of Dengue exists?

There are four different types (serotypes) of the dengue

virus
These are DEN-1, DEN-2, DEN-3 and DEN-4
Recovery from infection by one provides lifelong
immunity against that virus, confers only partial and
transient protection against subsequent infection by the
other three viruses
There is evidence that sequential infection increases the
risk of developing dengue hemorrhagic fever
World Health Organization, (2009). Dengue and dengue haemorrhagic fever. Retrieved April
19,2010 from http://www.who.int/mediacentre/factsheet/fs117/en/

Diagnosis for Dengue

Travel history and symptom profile

Detection of antibodies against the virus
PCR -RT
Complete blood count
Chemistry panel
Liver function test

Price, D.D., Wilson, S.R., (2009). Dengue fever: differential diagnoses and
workout.

Treatment for Dengue

No specific therapeutic agents exist for
dengue infections
Bed rest and hydration therapy
Fever control with acetaminophen.
Aspirin should be avoid because of
anticoagulant properties, children should
avoid aspirin when a viral infection is
suspected
Monitoring of signs and symptoms for
warning signs of DHF or DSS

Preventive Measure for Travelers

No vaccine or drugs are available for the prevention of dengue
Preventive measure should be taken to avoid the bite of the
mosquito
Well screen accommodations or air conditioning
Use of insecticide indoors
Apply insect repellent to skin and clothing.
Empty , clean or cover any standing water that can be a
mosquito-breeding site

Center for Disease Control and Prevention, (2009). Other infectious disease related to travel, dengue fever (DF) and
dengue hemorrhagic fever (DHF).

Incidence of Dengue Fever

Global incidence of dengue has grown dramatically
2500 million people- two fifths of the worlds populationare now at risk from dengue
WHO estimates 50 million to 100 million cases of
dengue infection worldwide every year

World Health Organization, (2009) Dengue and dengue haemorrhagic fever.

More Statistics
An estimated 500,000 people with DHF
require hospitalization each year, a large
proportion are children, about 2.5% of
these die
DHF fatality rates can exceed 20% without
proper treatment
World Health Organization, (2009) Dengue and dengue haemorrhagic fever.

Final word of advice for prevention

The times of higher risk of being bitten by the
female mosquito is 2 to 3 hours after
daybreak and 3 to 4 hours before nightfall
The mosquito can feed indoors as well as
outdoors
Precautions as mention before should be
taken especially at peak biting activity time
The risk of exposure may be lower in
modern, air-conditioned hotels with well-kept
grounds
Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews,
July 1998, p.480-496.

Thank you .

Q&A