Living in a tropical country, it is impossible to avoid the omnipresent mosquito.

An even bigger impossibility is to prevent get bitten by these blood suckers. Despite the abundant repellents available in the market there never seems to be a dearth in the population of these lean mean biting machines. The most dreaded infections caused by them are Malaria, Dengue and Chikungunya whose symptoms are so much alike that even the experts sometimes find it difficult to arrive at the precise diagnose before it threatens the patients life. Here are some brief guidelines to differentiate the symptoms of the three. - Generally Dengue and Chikungunya are caused by infected Aedes Agypti (also Aedes Albopictus for chikungunya) which is active during the day and loves to breed as close to us as mosquitoly possible (open, clean water storage areas at home) whereas Malaria is caused by Anopheles which is prevalent during the night (even at dusk/dawn). - Dengue takes 3 to 4 days for symptoms to set in and generally lasts for a week, whereas Chikungunya takes a week for symptoms to set in. In Malaria, the symptoms start after 2 weeks of mosquito bite. - In all 3 cases body temperature is above 102 F and common symptoms are sudden high fever, pain behind the eyes, severe headache, muscle, joint pain, vomiting, nausea, anemia, general weakness/dizziness. - Dengue is differentiated by fever subside and reappear with skin rashes. Bleeding is also common in the cases of dengue hemorrhagic fever. It also shows relatively low WBC and platelet count. - Chikungunya has intense joint pain (when compared to dengue). Unlike dengue there is no bleeding in chikungunya. - Malaria includes fever which keeps reoccurring in shorter duration accompanied by chills, heat and sweating which follows one after the other. Malaria is tested by microscopic examination of the sample and there are very effective anti malarial drugs available. Testing for Dengue involves virus isolation in cell cultures, nucleic acid detection by PCR, viral antigen detection or specific antibodies (serology) like IgG and IgM ( this may not be evident at the early onset of the infection) . There are no vaccines or specific medicines available for Dengue or Chikungunya as yet. Only symptoms can be treated with the available general medicines. Chikungunya is diagnosed by virus isolation test, antibody testing of IgM as well as by genetic identification of virus gene structures. Detection of either C or E1 genome indicates positive result. It is always safe to keep the house and surrounding area clean, free from unwanted waste, stagnant or open water sources either clean or dirty. Ensure the house is well protected with detachable mesh and repellents. Once you are infected, make sure you are well hydrated, drink only boiled water and rest well.

Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus serotypes Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity to only that serotype of life, to a person living in a Dengue-endemic area can have more than one Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes are maintained in the cycle which involves humans and Aedes aegypti or Aedes

albopictus mosquito through the transmission of the viruses to humans by the bite of an infected mosquito. The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue and after a week it can transmit the virus while biting a healthy person. Dengue cannot be transmitted or directly spread from person to person. Aedes aegypti is the most common aedes specie which is a domestic, day-biting mosquito that prefers to feed on humans. INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days

PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when virus is still present in the blood CLINICAL MANIFESTATIONS: First 4 days: >febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis 4th to 7th day: >toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure and shock; death may occur; vasomotor collapse th 7 to 10th day: >convalescent or recovery stage --- generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable MODE OF TRANSMISSION: Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing and blood feeding of transmitting the virus to susceptible individuals for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission. Humans are the main amplifying host of the virus. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time as they have fever. Aedes mosquito may have acquired the virus when they fed on an individual during this period. Dengue cannot be transmitted through person to person mode. CLASSIFICATION: 1. Severe, frank type >flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death 2. Moderate >with high fever but less hemorrhage, no shock present 3. Mild

>with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of invest or typical cases GRADING THE SEVERITY OF DENGUE FEVER: Grade 1: >fever >non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain >absence of spontaneous bleeding >positive tourniquet test Grade 2: >signs and symptoms of Grade 1: plus >presence of spontaneous bleeding: mucocutaneous, gastrointestinal Grade 3: >signs and symptoms of Grade 2 with more severe bleeding: plus >evidence of circulatory failure: cold, clammy skin, irritability, weak to compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold extremities, mental confusion Grade 4: >signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS) SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE: >all persons are susceptible >both sexes are equally affected >age groups predominantly affected are the pre-school age and school age >adults and infants are not exempted >peak age affected: 5-9 years old DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June November). Peak months are September October. It occurs wherever vector mosquito exists. DIAGNOSTIC TEST: Tourniquet test >Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. >Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. >Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand, but today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in several of them.