Dengue fever (Definition, causes, symptoms, diagnosis, treatment, complications and prevention)

Definition of Dengue Fever

Dengue fever (DHF) is a disease caused by the Dengue virus which is transmitted through mosquito bites. This disease causes symptoms of high fever, headache, and bone and muscle aches. If not handled properly, dengue fever is life threatening.

Dengue fever can affect both children and adults. This disease is transmitted when a mosquito bites a DHF sufferer, then bites a healthy person. This disease is commonly found in tropical climates, including Indonesia, and the incidence of this disease usually increases during the rainy season.

Based on the level of severity, dengue fever is divided into three types, namely:

• Dengue fever (dengue fever), the symptoms tend to be mild and without signs of bleeding
• Dengue hemorrhagic fever (DHF), which is dengue fever with severe symptoms and signs of bleeding, such as nosebleeds or bleeding gums
• Shock syndrome due to dengue (dengue shock syndrome or DSS), namely severe dengue with a high mortality rate, which is usually characterized by symptoms of weakness or unconsciousness, cold sweat, vomiting of blood, or shortness of breath

Causes of Dengue Fever

Dengue fever is caused by the dengue virus. This virus is divided into 4 strains, namely dengue virus (DENV) 1, 2, 3, and 4. This virus strain is thought to affect the severity of DHF. However, this still needs further research.

Someone who recovers from DHF due to one of the virus strains will get immunity against that virus strain. For example, patients who recover from dengue due to the DENV-1 virus will be immune to the virus.

However, if the DENV-1 virus survivor is exposed to other strains of dengue virus, for example DENV-3, the risk of experiencing more severe symptoms will be greater.

The dengue virus is spread by Aedes aegypti and Aedes albopictus mosquitoes, which are usually active and bite in the morning and evening. This mosquito lives in stagnant water that is calm and basically clean, such as puddles in car tires, plastic waste or animal drinking places.

Symptoms and Complications of Dengue Fever

In general, the DHF phase is shaped like a horse's saddle cycle, which begins with a sudden fever on the first day until the third day of this disease phase. Fever can reach temperatures of 39−40°C, which is difficult to reduce even though the patient has taken antipyretic drugs.

Fever may be accompanied by other symptoms, such as:

• Terrible headache
• Pain behind the eye
• Muscle and joint pain
• Loss of appetite
• Weak
• Nausea and vomiting
• Skin rash occurs

Furthermore, DHF will continue to a critical phase, namely on day 4 to day 6. In this phase, the fever goes down but bleeding symptoms, such as nosebleeds or vomiting blood, occur easily. Platelets that have decreased drastically can also occur in this critical phase.

If not handled properly, patients with dengue fever in the critical phase can experience complications in the form of accumulation of fluid in the chest or abdominal cavities, severe bleeding, and failure of blood flow to vital organs (shock).

If handled quickly and appropriately, DHF sufferers will recover within 1-2 weeks.

When to See a Doctor

Check with your doctor if you experience the symptoms of DHF as mentioned, especially if people around you have been diagnosed with this disease.

Medical treatment in the emergency room needs to be done immediately for DHF sufferers with the following symptoms:

• Appears limp or dazed
• Skin feels wet and cold
• Severe stomach ache
• Severe vomiting, especially if it is accompanied by blood
• Hard to breathe
• Nosebleeds and bleeding gums
• Black or bloody stools
• Treatment and Prevention of Dengue Fever

There is no drug that can kill the dengue virus. Even so, there are treatments that can be done to relieve symptoms and avoid complications. Thus, it is hoped that the virus can be eradicated by the patient's immune system.

Dengue fever patients can be treated at home and are advised to undergo blood tests every day on the 4th to 7th day since the fever appears. During the treatment process, patients are advised to drink, eat and rest enough, as well as apply compresses and take fever-reducing drugs if necessary.

Patients are also advised to go to the emergency room immediately if the condition worsens even though the fever has gone down.

Meanwhile, patients with dengue fever are advised to undergo hospitalization. This is so that DHF complications can be detected earlier so that they can be treated immediately.

Treatment given at the hospital is in the form of:

• Fluid infusion
• Fever-reducing drugs, such as paracetamol or ibuprofen
• Blood transfusion in case of severe bleeding complications
• To speed up the healing process, make sure to get enough rest, drink lots of water, and eat nutritious food.

Prevention of DHF can be done by undergoing a dengue vaccine. In addition, mosquito nest eradication activities (PSN) must be carried out regularly. The goal is to create an environment that is clean and free from mosquitoes that cause dengue fever.

Causes of Dengue Fever

Dengue fever or DHF is caused by the Dengue virus. This virus is carried by the Aedes aegypti and Aedes albopictus mosquitoes, which usually bite in the morning and evening. The virus enters the bloodstream through the mosquito bite.

Dengue virus transmission occurs when an infected person is bitten by an intermediary mosquito. The virus from an infected person will be carried by the mosquito, then infects other people who are bitten by the mosquito. Even so, this virus is only transmitted through mosquitoes and not from person to person.

Dengue virus is divided into four types, namely DENV-1, DENV-2, DENV-3, and DENV-4. When a person infected with one type of dengue virus recovers, their body will form immunity against that type of virus.

However, immunity to one virus does not rule out the possibility of infection with other types of dengue virus. Someone who has been infected with the dengue virus is even more at risk of being infected again with more severe symptoms.

Dengue fever is also more at risk for infants, children, the elderly, and people with weak immune systems.

Symptoms of Dengue Fever

Based on the severity of the symptoms, dengue fever can be divided into dengue fever (dengue fever) and dengue hemorrhagic fever (dengue hemorrhagic fever). The following is an explanation:

Dengue fever

Dengue fever is a mild form of dengue virus infection. The symptom is a fever that starts from the 4th to the 7th day after being bitten by a mosquito (DHF incubation period). These fever symptoms generally subside in less than 1 week, but can also last up to 10 days.

Symptoms of dengue fever include:

• Fever 40°C or more
• Severe headache
• Pain in joints, muscles and bones
• Loss of appetite
• Pain behind the eye
• Nausea and vomiting
• Swollen lymph nodes
• Red rash (appears about 2–5 days after fever)
• Dengue hemorrhagic fever (Dengue hemorrhagic fever)

Dengue hemorrhagic fever (DHF) is a worsening condition of dengue fever, or also called the critical phase. Generally, this phase occurs between day 3 and day 7 after symptoms appear.

In the critical phase, the temperature of a patient with dengue fever can drop below 38°C for 1 day, then will rise again the next day. This pattern is known as saddleback fever.

Many think that a decrease in fever is a sign of recovery. In fact, sufferers must be monitored more closely in this phase, because they can experience bleeding and blood vessel leaks.

The following are signs of dengue hemorrhagic fever to watch out for:

• Unbearable stomach pain
• Throws up
• Bleeding, such as bleeding gums or nosebleeds
• There is blood in the urine, stool, or vomit
• Bleeding under the skin that looks like a bruise
• Short or rapid breaths
• Weak or tired
• Nervous

Diagnosis of Dengue Fever

The doctor will ask about the patient's symptoms and history of dengue fever where the patient lives. If signs are found that point to dengue fever, the doctor will proceed with a physical examination.

A thorough physical examination is carried out to look for signs such as a rash, enlarged lymph nodes, or enlarged liver.

Doctors can also do a tourniquet test with a blood pressure meter. The goal is to see how fragile the patient's blood vessels are for bleeding.

Doctors can also carry out further tests on patients with dengue fever, such as:

• Complete blood count in the first 1-3 days, to determine the levels of white blood cells, platelets, and hematocrit levels in the blood which can be a sign of blood vessel leaks
• Examination of the NS1 antigen on days 0–7 since symptoms appear, to detect the presence of the Dengue virus
• IgG and IgM serological examination, which is usually done 4–5 days after symptoms appear, to detect antibodies to Dengue virus
• Liver function tests, to determine whether dengue infection causes complications in the liver

Treatment of Dengue Fever

Based on the severity of dengue fever, the treatment given to patients can be divided into two, namely:

Treatment of dengue fever

There is no specific method for dealing with dengue fever. Treatment is aimed at relieving symptoms and preventing the viral infection from getting worse.

The doctor will advise the patient to do the following:

• Inadequate body fluids with lots of drinking to avoid dehydration.
• Meet nutritional needs with healthy foods to support the healing process.
• Enough rest.
• Take paracetamol to relieve fever. However, avoid using aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), especially in children, because they can make bleeding worse or trigger Reye's syndrome.
• Avoid mosquito bites to reduce the risk of further transmission.
• Use insect repellent lotion or mosquito nets in the room.
• Treatment of dengue hemorrhagic fever

If dengue fever develops into DHF, the patient needs to be referred to the hospital for intensive care. The doctor will give intravenous fluids and carry out close monitoring, starting from the pulse, blood pressure, to the amount of urine excreted by the patient.

Dengue Fever Complications

Dengue fever that is not treated can cause serious complications in the form of dengue shock syndrome (DSS). This condition is characterized by:

• Blood pressure drops
• The skin is wet and feels cold
• Irregular breaths
• Dry mouth
• Weak pulse
• The amount of urine decreases

In this condition, blood flow to all body tissues will decrease resulting in a lack of oxygen (hypoxia). This can cause seizures, damage to the liver, heart, brain and lungs, blood clots, and even death.

Prevention of Dengue Fever

There are several ways you can do to prevent dengue fever, namely:

Dengue vaccine

Severe dengue fever that causes dengue shock syndrome can be prevented by administering a dengue vaccine. This vaccine can be given to children and adults aged 9–45 years 3 times 6 months apart.

Dengue vaccine contains 4 types of dengue viruses. Therefore, vaccines are still given to people who have already been infected. This is to form immunity against different types of dengue virus.

It is important to remember that the dengue vaccine should not be given to people who have never been diagnosed with dengue fever, because it can increase the risk of developing severe symptoms if the person is infected. Vaccination is also not recommended for children under 9 years of age, especially in the 2–5 year age group.

Eradication of Mosquito Nests

In addition to vaccines, dengue fever can be prevented through eradicating mosquito nests (PSN). PSN is carried out in two insecticide fumigations or fogging in 1 week intervals. Fumigation twice aims to kill mosquito larvae that cannot be eradicated during the first smoking.

Another PSN method is to run 3M-Plus regularly, especially during the rainy season. The 3M steps in question are:

• Drain water reservoirs, such as bathtubs or drains, at least once a week
• Close the water reservoir tightly
• Recycle items that have the potential to become breeding grounds for Aedes aegypti mosquitoes, such as used tires that can collect rainwater

In addition, also do the Plus steps to help prevent. The Plus Steps in question include:

• Set enough light in the house
• Installing mosquito nets in the ventilation of the house
• Sprinkle larvicidal powder (abate) on water reservoirs that are difficult to drain
• Use mosquito nets while sleeping
• Plant mosquito repellent plants
• Stop the habit of hanging clothes

In addition to the methods above, wearing loose clothing can also prevent mosquito bites. This is because mosquito bites can penetrate tight clothing. For added protection, use a mosquito repellent lotion that contains N-diethylmetatoluamide (DEET).