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Case 41: Dengue Fever
Dr Mahesh Chevva
'Ars-alb / Rhus-tox / Nux-vom / Sul / Gels / Eup-perf / Phos

This article is put in this Online Section as it is a Current Topic (Though it does not strictly belong to a case section.)

Once again its time for us to prove ourselves. No one is spared from this virus - right from doctors, ministers to workers. Hospital admissions are increasing day by day and mortality continues to rise. We as Homoeopathic doctors have great role in prevention as well as treating this disease. We and our medicines have proved very effective in all the epidemics. (Example: Recent out break of chikungunya) Govt is realizing the importance of it and freely distributing Homoeopathic medicines-which is already started in Delhi. Now it is time for us to arise, awake till we prevent this disease. First let us understand our enemy (disease) so that we will be ready to use our weapons (medicines)

Synonyms and Related Keywords: Dengue fever, bone breaking fever- Dengue Fever, dengue virus, dengue infection, dengue hemorrhagic fever-DHF, dengue shock syndrome-DSS, dengue virus 1, DENV-1, dengue virus 2, DENV-2, dengue virus 3, DENV-3, dengue virus 4, DENV-4, Flaviviridae, Flavivirus, Aedes aegypti, A aegypti, Aedes albopictus, A albopictus, mosquitoes, viral epidemic, epidemic, saddleback fever.

History: The term "dengue" is a Spanish attempt at the SWAHILI phrase "ki denga pepo", meaning "cramp-like seizure caused by an evil spirit" It emerged during a Caribbean outbreak in 1827-1828.

Outbreaks resembling dengue fever have been reported throughout history. The first case report dates back from 1789 and is attributed to Benjamin Rush, who coined the term "breakbone fever" because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name.

Epidemiology: Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of

  • Africa
  • Southeast Asia and China
  • India
  • Middle East
  • Caribbean and Central and South America
  • Australia and the South and Central Pacific

Cause: Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3 and DEN-4. You can be infected by at least two, if not all four types at different times during your lifetime, but only once by the same type.

Dengue Mosquito

Reservoir: Humans are the only vertebrate hosts of the virus. There is a jungle cycle between monkeys and mosquitoes, but this plays no role in human disease.

Mode of Transmission: The transmission of dengue by the bite of an infected Aedes aegypti mosquito. This disease occurs more frequently in the rainy season and immediately afterwards (July to October) in India.

Period of Communicability: There is no evidence of person-to-person transmission

Spread: Just like in Malaria, Dengue fever is also spread by bites of mosquitoes. The Dengue virus is present in the blood of the patient suffering from Dengue fever. Whenever an Aedes mosquito bites a patient of Dengue fever, it sucks blood and along with it, the Dengue virus into its body. The virus undergoes further development in the body of the mosquito for a few days. When the virus containing mosquito bites a normal human being, the virus is injected into the person's body and he/she becomes infected and can develop symptoms of Dengue fever.

Incubation Period: Once inoculated into a human host, dengue has an incubation period of 3-14 days (average 4-7 d). Following incubation, a 5- to 7-day acute febrile illness ensues. Recovery is usually complete by 7-10 days. DHF or DSS usually develops around the third to seventh day of illness, approximately at the time of defervescence.

Age: Dengue affects people of all ages. DHF usually affects children younger than 15 years. DSS shows no age predilection.

Symptoms of the disease
Symptoms depend upon the type of Dengue fever. There are three types of Dengue fever:

  1. Classical (Simple) Dengue Fever
  2. Dengue Haemorrhagic Fever (DHF)
  3. Dengue Shock Syndrome (DSS)
The classical (Simple) Dengue fever is a self-limiting disease and does not kill. However, the other types (i.e. DHF and DSS) can prove fatal if prompt treatment is not started.

It is important to recognize whether Dengue Fever is Simple or DHF or DSS. The following symptoms will help in diagnosis:.

  1. Classical (Simple) Dengue Fever
    1. Sudden onset of high fever with feeling of chills
    2. Severe Headache
    3. Pains in muscles and joints.
    4. Pain behind the eyeballs especially on pressing the eyes or on moving the eyeballs.
    5. Extreme weakness, loss of appetite, feeling of nausea.
    6. Change in taste sensations in mouth.
    7. Pain in abdomen by itself or on touching.
    8. Mild pain in throat.
    9. Patient feels generally depressed and very sick.
    10. Rash on the skin: Pinkish red rash appears on the skin in the form of diffuse flushing, mottling or pinhead eruptions on the face, neck and chest. Later on, the rash may become more prominent.
    11. The entire duration of Classical Dengue fever lasts for about 5-7 days and the patient recovers.
  2. Dengue Haemorrhagic Fever - (DHF)
    It should be suspected if with above mentioned symptoms of Classical (Simple) Dengue Fever one or more of the following symptoms appear:
    Bleeding (haemorrhagic) manifestations:
    Bleeding from nose, gums, blood in the stools or in vomiting, bleeding spots on the skin which are seen as dark bluish-black, small or large patches. If a health worker carries out a Tourniquet Test, it is positive.
    Certain laboratory investigations carried out on a blood sample also confirm DHF.
  3. Dengue Shock Syndrome (DSS)
    All symptoms as mentioned above in DHF are present plus
    the patient also develops a condition called 'shock'. Symptoms of shock in a Dengue Fever cases are -
    1. The person is very restless and the skin feels cold and clammy despite high fever.
    2. The person may start losing consciousness.
    3. If you examine the pulse rate of the patient, it is weak and rapid.
    4. Similarly, blood pressure will be low.

Clinical Features accompanied by thrombocytopenia and hemoconcentration. * Dengue Shock Syndrome

Lab Studies
Complete Blood Cell count findings include the following: Leukopenia, often with lymphopenia, is observed near the end of the febrile phase of illness. Lymphocytosis, with atypical lymphocytes, commonly is seen before defervescence or shock.

A rise in hematocrit greater than 20% is a sign of hemoconcentration and precedes shock. The hematocrit level should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever (DHF) and every 3-4 hours in severe cases of DHF or dengue shock syndrome (DSS).

Thrombocytopenia has been demonstrated in up to 50% of dengue fever (DF) cases. Platelet counts of less than 100,000 are seen in DHF or DSS and occur before defervescence and the onset of shock. The platelet count should be monitored at least every 24 hours to facilitate early recognition of DHF.

Serum Specimens should be sent to the laboratory for serodiagnosis, polymerase chain reaction (PCR), and viral isolation. Because the signs and symptoms of DF are nonspecific, attempting laboratory confirmation of dengue infection is important.

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