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Understanding Dengue Treatment: Options, Efficacy, and Precautions

Dengue fever is a mosquito-borne viral illness endemic in more than 120 countries, posing a significant public health challenge globally. According to the World Health Organization, approximately 390 million dengue infections occur each year, of which around 25% manifest clinically. While dengue is often mild and self-limiting, severe cases can lead to Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS), both potentially fatal if not adequately managed. This article aims to provide an in-depth overview of dengue fever, its epidemiology, transmission, clinical presentation, diagnosis, treatment, and prevention strategies.

Causative Agent and Transmission

Dengue fever is caused by the dengue virus, which belongs to the genus Flavivirus. There are four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4), each capable of causing disease. The primary vector for dengue transmission is the female Aedes mosquito, particularly Aedes aegypti and Aedes albopictus. Transmission occurs when a mosquito feeds on a human already infected with the virus, subsequently spreading it to other humans through bites.

Epidemiology

The geographical spread of dengue has increased dramatically over the past decades. It is now endemic in regions including Southeast Asia, the Western Pacific, the Americas, Africa, and the Eastern Mediterranean. Dengue occurs mainly in tropical and subtropical climates, although occasional cases have been reported in temperate regions.

Dengue Symptoms

Dengue fever is an acute viral illness that varies widely in severity, from a mild, flu-like illness to more serious conditions such as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Understanding the symptoms is crucial for early diagnosis and appropriate management. Below is a comprehensive outline of the symptoms associated with dengue fever, ranging from mild to severe.

Mild Dengue Fever

Initial Phase (Day 1-3)

  • Fever: Sudden onset of high fever, often reaching up to 104°F (40°C).
  • Headache: Intense headache that is generally described as “splitting” or “debilitating.”
  • Chills: Episodes of chills and a general feeling of cold despite the high fever.

Middle Phase (Day 4-6)

  • Retro-orbital Pain: Pain behind the eyes, exacerbated by eye movement.
  • Myalgia: Muscle pain that can range from mild to severe.
  • Arthralgia: Joint pain that is often intense and may be mistaken for other conditions like arthritis.
  • Nausea and Vomiting: Episodes of nausea often lead to vomiting.

Recovery Phase (Day 7 Onwards)

  • Fatigue: Extreme tiredness and a feeling of exhaustion can last for weeks.
  • Skin Rash: Rashes may appear or spread, sometimes manifesting as itchy and/or peeling skin.

Dengue Hemorrhagic Fever (DHF)

DHF usually starts off similarly to mild dengue fever but progresses into more severe symptoms, including:

  • Hemorrhagic Manifestations: Symptoms include gum bleeding, nosebleeds, and easy bruising.
  • Gastrointestinal Bleeding: Blood in vomit or stools.
  • Thrombocytopenia: A low platelet count often leads to clotting issues.
  • Hemoconcentration: An increase in hematocrit, indicating fluid leakage from blood vessels.

Dengue Shock Syndrome (DSS)

This is the most severe form and is characterized by:

  • Shock: Rapid and severe drop in blood pressure, leading to organ failure if not treated promptly.
  • Cold and Clammy Skin: Often accompanied by a weak pulse.
  • Altered Mental State: Confusion, irritability, and sometimes loss of consciousness.

Other Atypical Symptoms

Some patients also report:

  • Sore Throat: In some cases, patients have a sore throat and may even experience difficulty swallowing.
  • Abdominal Pain: Intense abdominal cramps or pain may also be present.
  • Diarrhea: Although less common, some people may experience diarrhea.

Dengue Diagnostic Tests:

Accurate and timely diagnosis of dengue fever is crucial for proper clinical management and outbreak control. Diagnostic tests for dengue fever can be broadly categorized into virological tests, serological tests, and molecular tests. Here is an overview of the various diagnostic tests available for dengue:

Virological Tests

Dengue NS1 Antigen Test

  • Type: Immunoassay
  • Timeframe: Best within the first 1-5 days of symptom onset.
  • Advantage: High sensitivity in early-stage disease.
  • Limitation: Cannot differentiate between dengue serotypes.

Serological Tests

IgM ELISA (Enzyme-Linked Immunosorbent Assay)

  • Type: Immunoassay
  • Timeframe: Effective after day 5 of symptom onset, peak at 10-14 days.
  • Advantage: Relatively easy to perform and interpret.
  • Limitation: Cross-reactivity with other flaviviruses like Zika and Yellow Fever.

IgG ELISA

  • Type: Immunoassay
  • Timeframe: Peaks in the second week but can be detected for months or years.
  • Advantage: Useful for determining past infections.
  • Limitation: Cannot diagnose acute infections.

Hemagglutination Inhibition Test (HI)

  • Type: Serological
  • Timeframe: Effective after several days of infection.
  • Advantage: Good for epidemiological studies.
  • Limitation: Requires specialized equipment and expertise.

Molecular Tests

RT-PCR (Reverse Transcription Polymerase Chain Reaction)

  • Type: Molecular
  • Timeframe: Effective in the first 1-5 days of symptom onset.
  • Advantage: High specificity, can differentiate between dengue serotypes.
  • Limitation: Requires specialized equipment and skilled technicians.

qRT-PCR (Quantitative Reverse Transcription Polymerase Chain Reaction)

  • Type: Molecular
  • Timeframe: Effective in the first 1-5 days.
  • Advantage: Provides viral load quantification.
  • Limitation: Requires specialized laboratory conditions.

Integrated Platforms

Dengue Duo or Combo Tests

  • Type: Rapid Diagnostic Tests
  • Timeframe: Varies, but usually effective from day 1 to beyond week 2.
  • Advantage: Quick results, typically incorporating NS1 and IgM/IgG tests.
  • Limitation: May have lower sensitivity and specificity compared to laboratory tests.

Interpretation and Clinical Relevance

  • Single Positive Test: A positive NS1, IgM, or RT-PCR alone is generally considered confirmatory for dengue infection.
  • Serial Testing: In some cases, serial tests may be needed to confirm the diagnosis.
  • Epidemiological Context: Results should always be interpreted in the context of the patient’s clinical presentation and epidemiological setting.

Given the various stages and presentations of dengue fever, no single test is definitive for all cases. Often, a combination of tests is used for a conclusive diagnosis. Early diagnosis and proper clinical management are essential for reducing morbidity and mortality associated with dengue fever.

Dengue Treatment

Dengue fever is primarily managed symptomatically, as there is no specific antiviral treatment. Key treatment strategies include:

  • Fluid Management: Oral or intravenous fluids to manage dehydration.
  • Analgesics: Pain management is critical but aspirin should be avoided as it may exacerbate hemorrhagic tendencies.
  • Monitoring: Regular hematocrit and platelet counts.

For severe cases like DHF and DSS, intensive medical intervention is needed, often requiring hospitalization.

Mild Dengue Fever

Symptomatic Relief

  • Antipyretics: Acetaminophen or paracetamol is recommended for fever and pain relief.
    • Note: Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided due to their anticoagulant properties, which may exacerbate hemorrhagic symptoms.
  • Hydration: Oral rehydration with fluids like water, herbal teas, and electrolyte solutions.

Monitoring

  • Outpatient Care: Usually sufficient for mild cases.
  • Clinical Assessment: Regular monitoring of fever, blood pressure, and hydration status.

Dengue Hemorrhagic Fever (DHF) & Dengue Shock Syndrome (DSS)

Hospitalization

  • Immediate hospitalization is often required for severe dengue manifestations.

Intravenous Fluids

  • Fluid replacement to counteract dehydration and maintain blood pressure is critical. This often includes the use of isotonic fluids like Ringer’s lactate or Normal Saline.

Blood Transfusions

  • In cases of severe hemorrhage or shock, blood or platelet transfusions may be required.

Hemodynamic Monitoring

  • Close monitoring of vital signs, hematocrit, and platelet count.

Intensive Care

  • For severe cases of DSS, intensive medical care, including mechanical ventilation or inotropic support, may be necessary.

Preventive Measures

  • Rest: Patients are often advised to rest to aid the body’s immune response.
  • Vector Control: Elimination of breeding sites, use of insecticides, and community engagement.
  • Personal Protective Measures: Use mosquito repellents, bed nets, and long clothing.
  • Vaccination: Dengvaxia, a vaccine, has been approved in some countries but has limitations including reduced efficacy for those not previously exposed to the virus.

Dengue – Ayurvedic View

Dandaka jwara is a condition in Ayurveda that can be correlated with dengue fever. This is explained in one of the chapters of Madhava Nidana, an Ayurvedic treatise. The condition is not explained as an independent disease. The etiology of dandaka jwara and jwara are same.

The symptoms of dandaka jwara are seen in a condition called Sannipatika jwara. Agnimandya (impaired digestion), aruchi (anorexia), asthi-sandhi-shiro ruja (pain in joint-head-bones), raktapitta stheevana (blood in the vomiting) kasa (cough), shwasa (difficulty in breathing), mandala utpatti (skin rashes), bhrama (giddiness) etc.

The treatment for dandaka jwara is langhana (fasting therapy), ushnodaka (lukewarm water drinking), jwarahara aushadha (medicines that are explained in fever), mrudu swedana (mild sudation).

Ayurvedic Medicines for Dengue

Ayurvedic medicines for dengue are selected depending on the severity of the disease and the patient’s condition. Below are the few commonly used ayurvedic medicines in treating dengue fever.

  1. Abhaya pippalimuladi Kashaya
  2. Amruthothara Kashaya
  3. Bharangyadi Kashaya
  4. Drakshadi Kashaya
  5. Guluchyadi Kashaya
  6. Pachanamruatam Kashayam
  7. Shadangam Kashayam
  8. Amrutashadanga Kashaya
  9. Amrutarishta
  10. Sudarshanarishta
  11. Sudarshana Choorna
  12. Anandabhairava Rasa
  13. Jayamangala Rasa
  14. Jwarankusha Gulika
  15. Tribhuvanakeeri Rasa

Diet and Lifestyle

Light, easily digestible foods, drinking plenty of water, fresh fruit juices, fresh coconut water, eating plenty of green leafy vegetables either cooked or in the form of soup, dal-rice, khichadi, spices like basil, ginger, garlic, coriander, lemon can be useful. Juice of papaya leaves, whole fruits, and goat’s milk help during dengue fever.

  • Avoid heavily populated areas
  • Use mosquito repellent on the body indoors and outdoors
  • Use window and door screens
  • Wear clothes that cover the body
  • Use air-conditioning instead of opening windows
  • Use mosquito nets
  • Remove any stagnant water around the home
  • Avoid camping near still water
  • Check if drains, plant pots, or any other things do not collect water
  • Avoid being outside at dawn, dusk, and early evening
  • Adequate rest
  • Avoid spicy, oily, fried food items, and chilled water

Home Remedies for Dengue

  • Fenugreek seeds: The seeds are soaked in hot water and allowed to cool. This water can be used to drink two times a day
  • Guava: One cup of guava juice two times a day as a drink is beneficial
  • Papaya leaf: Crush some papaya leaves and make juice out of them. A small amount of juice twice a day is helpful in dengue fever
  • Giloy: A few stems of the giloy plant are taken and boiled in water. This water can be taken twice a day
  • Dry ginger and giloy: Two grams of dry ginger powder and five grams of giloy powder are added to 100 ml of boiled water and mixed thoroughly. This water is allowed to cool and then taken internally with one teaspoon of honey added to it
  • Ten to fifteen basil leaves and 10-5 grams of coriander powder are added to one liter of water and boiled. This water is taken at an interval of 3-4 hours in a day.
  • Cardamom and clove water are beneficial  

Conclusion

Dengue fever is caused by one of the four dengue viruses and occurs in tropical areas. The condition occurs due to the bite of the mosquito Aedes agypti. Oral rehydration is of prime importance as a remedy for dengue fever. In later stages, bleeding gums and nose, blood in vomiting and stools are the matter of concern. Low platelet count, and reduced white blood cells are key factors in blood investigations. Dandaka jwara in Ayurveda has similar symptoms to that of dengue fever. Plenty of water, papaya leaf juice, other fresh fruit juices, and easily digestible foods are the important diet. The use of mosquito nets, and mosquito repellants, avoiding water from stagnating are some of the lifestyles to be followed during dengue fever.  


10 frequently asked questions (FAQs) about dengue:

  1. What is dengue fever?
    • Dengue fever is a viral illness caused by the dengue virus, which is transmitted to humans through the bite of infected mosquitoes, primarily the Aedes species.
  2. What are the common symptoms of dengue fever?
    • Common symptoms include high fever, severe headache, joint and muscle pain, rash, and mild bleeding from the nose or gums. In severe cases, dengue can lead to dengue hemorrhagic fever or dengue shock syndrome.
  3. How is dengue fever diagnosed?
    • Dengue fever is diagnosed through blood tests that detect the presence of the virus or its antibodies. These tests help determine the specific type of dengue virus infection.
  4. Can dengue be fatal?
    • Yes, dengue can be fatal, especially in severe cases where it progresses to dengue hemorrhagic fever or dengue shock syndrome. Timely medical intervention is crucial to prevent complications and fatalities.
  5. Where is dengue commonly found?
    • Dengue is prevalent in tropical and subtropical regions around the world, especially in areas with high populations of Aedes mosquitoes. Countries in Southeast Asia, Latin America, and the Caribbean are often affected.
  6. How is dengue fever treated?
    • There is no specific antiviral treatment for dengue. Treatment mainly involves managing symptoms and providing supportive care, such as fluids and pain relievers. Severe cases may require hospitalization and close monitoring.
  7. How can dengue fever be prevented?
    • Prevention involves reducing mosquito exposure. This can be achieved by using mosquito repellents, wearing protective clothing, and eliminating mosquito breeding sites by removing standing water in and around homes.
  8. Can a person get dengue more than once?
    • Yes, it is possible to contract dengue multiple times. There are four different serotypes of the dengue virus, and immunity to one serotype does not provide protection against the others. In fact, subsequent infections with different serotypes can increase the risk of severe dengue.
  9. What is dengue hemorrhagic fever?
    • Dengue hemorrhagic fever is a severe form of dengue characterized by increased vascular permeability, which can lead to plasma leakage, internal bleeding, and shock. It requires prompt medical attention and hospitalization.
  10. Is there a vaccine for dengue?
    • Yes, there are vaccines available to prevent dengue. However, the availability and usage of these vaccines vary by country. It’s important to consult with healthcare professionals to determine if the vaccine is recommended in your area and for your specific circumstances.

Remember that information about diseases can change over time, so it’s always a good idea to stay updated with the latest guidelines and recommendations from reputable health organizations.

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Ayurvedic Treatment for Fever
NOTE: “This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on this website. If you think you may have a medical emergency, immediately call or visit your doctor.” 
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References

  1. https://en.wikipedia.org/wiki/Dengue_fever
  2. https://www.webmd.com/a-to-z-guides/dengue-fever-reference
  3. https://www.healthline.com/health/dengue-fever
  4. https://my.clevelandclinic.org/health/diseases/17753-dengue-fever
  5. https://www.medicalnewstoday.com/articles/179471
  6. https://www.wjpmr.com/download/article/71082020/1598855894.pdf
  7. http://www.iamj.in/posts/images/upload/2858_2863.pdf
  8. https://www.researchgate.net/publication/342234120_DENGUE_AND_ITS_MANAGEMENT_THROUGH_AYURVEDA
  9. https://vikaspedia.in/health/diseases/vector-borne-diseases/dengue

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