Description

• Dengue fever is caused by dengue viruses and transmitted by the Aedes aegypti mosquito
• Dengue classically presents with high fever, headache, body aches, exanthem, and generalized lymphadenopathy. Symptoms usually subside within one week
• Some cases progress to the more severe dengue hemorrhagic fever (DHF) with thrombocytopenia, spontaneous bleeding, and potentially shock (dengue shock syndrome)

Types

Classic dengue fever

• Children are usually asymptomatic
• Starts with fever and malaise that lasts for 1 week
• Severe arthralgia and myalgia (break-bone fever)
• Severe headache and retro-orbital pain
• Maculopapular, measles-like exanthem (typically appears 2–5 days following fever)
• Generalized lymphadenopathy

Dengue hemorrhagic fever 

• Occurs in 1–3% of cases
• Generally develops as the initial fever subsides (1 week after onset)
• Temperature changes range from hypothermia to a second spike in fever
• Abdominal pain, vomiting
• Changes in mental status (e.g. confusion)
• Hemorrhagic manifestations(e.g. petechiae, epistaxis, gingival bleeding) 
• Positive capillary fragility test 
• Increased vascular permeability with signs of pleural effusion and/or ascites

Dengue shock syndrome: Dengue hemorrhagic fever + shock

Differential diagnosis

• Exanthematous fever- in dengue there is no catarrhal
• Chikungunya- severe joint pains make this a DD for dengue

Investigation

• Blood counts: Total Count- low
• PCV is increased > 20 percent
• Thrombocytopenia < 1 lakh
• X-ray chest: pleural effusion
• Blood culture or PCR- yield virus within 5 days of onset
• NS 1 antigen test- first few days of illness
• IgM antibodies- after 5 days of illness
• Tourniquet test: positive

Treatments

• Jwaraghna and Rakta pittahara chikitsa

Kashayas

• Nishundi shadanga toya, Drakshadi Kashaya, Guduchyadi Kashaya
  • 1 year to 5 years: ½ tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 5 to 10 years: 1 tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery

 Gutikas

• Gopeechandanadi gutika, Sudarshanam gutika ,Gopeechandandi gutika
• 1-6 Years: ½ tab tds 
• 6-15 years: 1 tab tds

Department

Kaumarabhrithya