Dengue

Also Know As Dengue Fever

Dengue

Dengue fever is an arboviral illness which afflicts millions of people worldwide every year. Most cases are recorded in the tropics and subtropics usually with outbreaks in the rainy season. No specific medicine is used to treat it and at present, no vaccines are available. Prevention is mainly thru control or eradication of the mosquitoes which transmit the virus. ^{[1] [2] [3]}

Epidemiology

50-100 million people worldwide are estimated to have the disease annually with the incidence noted to be increasing for the past 50 years. Mortality is mostly recorded among pediatric patients. Both genders are equally affected. People of all ages and of any race can be infected. ^[1]

Causes

The disease is caused by an RNA virus called dengue virus (DENV) classified under the family Flaviviridae. The mosquito that transmits it is called Aedes aegypti which is a dark mosquito with prominent white markings and banded legs. When the mosquito bites an infected person, it gets the virus and transmits it to another individual through a bite. Thus, the disease is not contagious as it needs a vector to be effectively passed on. ^{[2] [3][4]}

Symptoms

The incubation period is 3-14 days which means that a person only develops signs and symptoms days after being bitten. On the average, it takes about 4 days to 1 week before an individual notices any symptom. Dengue fever classically starts with abrupt onset of fever (may reach up to 41°C), chills, headache and pain behind the eyes. The fever typically lasts 2 to 7 days which may be accompanied by joint and muscle pain, skin rash and vomiting. Rashes often become visible on day 3 and are present for 2 to 3 days. The fever frequently subsides for a day then comes back again. This pattern is more commonly seen in children. A second rash may appear.

The more severe form is called Dengue hemorrhagic fever which manifests with the above stated symptoms plus signs of plasma leakage and hemorrhage including small pinpoint rashes or petechiae, gum or nose bleeding, reddish urine, black stools, abdominal pain and easy bruising.  If proper medical intervention is not done, dengue shock syndrome may occur ^{[1] [3]}

Diagnosis

Diagnosis can be confirmed after isolation of the dengue virus or demonstration of antigen or antibody titers. Other laboratory tests that are often performed in patient monitoring are complete blood count, liver panel and metabolic panel. ^[1]

Treatment

Dengue fever often resolves on its own. Acetaminophen, fluid replacement and bed rest are usually enough. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen must be avoided. More severe forms need hospitalization as patients need closer observation and intravenous fluid administration. ^[1]

References:

1.      http://emedicine.medscape.com/article/215840-overview

2.      http://www.nlm.nih.gov/medlineplus/dengue.html

3.      http://www.medicinenet.com/dengue_fever/article.htm

4.      http://medent.usyd.edu.au/photos/aedes%20aegypti.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Uncaria Tomentosa Plant (Cats Claw Herb) [1, 2]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. 

Recommendation: Weakly in favor (Early studies show that cats claw herb may be beneficial to those with dengue. More studies are needed)

Grade of Evidence: Low quality of evidence

Tawa-Tawa Herb [3, 4]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. 

Recommendation: Weakly in favor (Early studies show that tawa-tawa herb may be beneficial to those with dengue. More studies are needed)

Grade of Evidence: Low level of evidence

Sweet Potato Juice:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. 

Recommendation: No recommendation (There is insufficient evidence to support claims that sweet potato juice is beneficial to those that have dengue)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. www.laht.com/article.asp?CategoryId=14090&ArticleId=322156

2. http://www.ncbi.nlm.nih.gov/pubmed/18279801

3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765846/

4. http://www.pchrd.dost.gov.ph/index.php/news/dengue-updates/2631-tawa-tawa-contains-active-ingredients-that-may-help-dengue-hemorrhagic-fever-dhf-patients-study

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