MEDICAL MANAGEMENT

Dengue fever is usually a self-limited illness. There is no specific antiviral

treatment currently available for dengue fever. The World Health Organization (WHO)
has provided the publication Guidelines for Treatment of Dengue Fever/Dengue
Haemorrhagic Fever in Small Hospitals.
Supportive care with analgesics, fluid replacement, and bed rest is usually
sufficient. Acetaminophen may be used to treat fever and relieve other symptoms.
Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be
avoided. Management of severe dengue requires careful attention to fluid management
and proactive treatment of hemorrhage.
Single-dose methylprednisolone showed no mortality benefit in the treatment of
dengue shock syndrome in a prospective, randomized, double-blind, placebo-controlled
trial. The Novartis Institute for Tropical Diseases (NITD) in Singapore is carrying out
research to find inhibitors of dengue viral target proteins to reduce the viral load during
active infection.
No specific diet is necessary for patients with dengue fever. Patients who are
able to tolerate oral fluids should be encouraged to drink oral rehydration solution, fruit
juice, or water to prevent dehydration from fever, lack of oral intake, or vomiting. Return
of appetite after dengue hemorrhagic fever or dengue shock syndrome is a sign of
recovery.
Bed rest is recommended for patients with symptomatic dengue fever, dengue
hemorrhagic fever, or dengue shock syndrome. Permit the patient to gradually resume
their previous activities, especially during the long period of convalescence.

SUMMARY
Dengue is the most important mosquito-borne viral disease affecting humans; its
global distribution is comparable to that of malaria, and an estimated 2.5 billion people
live in areas at risk for epidemic transmission (1997 numbers).
Each year, tens of millions of cases of dengue fever occur and, depending on the year,
up to hundreds of thousands of cases of DHF. The case-fatality rate of DHF in most
countries is about 5%; most fatal cases are among children and young adults.
Dengue and dengue hemorrhagic fever (DHF) are caused by one of four closely related,
but antigenically distinct, virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), of the
genus Flavivirus. Infection with one of these serotypes does not provide crossprotective immunity, so persons living in a dengue-endemic area can have four dengue
infections during their lifetimes.
Dengue is primarily a disease of the tropics, and the viruses that cause it are
maintained in a cycle that involves humans and Aedes aegypti, a domestic, day-biting
mosquito that prefers to feed on humans. Infection with dengue viruses produces a
spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal
hemorrhagic disease. Important risk factors for DHF include the strain and serotype of
the infecting virus, as well as the age, immune status, and genetic predisposition of the
patient.
CONCLUSION
History has taught us that the top down approach to Ae. aegypti control has no
lasting impact after government support is withdrawn. The bottom up approach, on the
other hand, is very slow and may take years before results are observed. It is my
opinion, therefore, that neither a top down nor a bottom up approach alone is ideal
for controlling Ae. aegypti-borne diseases in the 2000s. What we urgently need today

are integrated control strategies that utilize the best of both approaches in the initial
phase, with more emphasis directed to the community-based approach as the program
progresses. This should insure relatively rapid success, but also that the programs will
be sustainable, and that the next generation will understand and, hopefully, accept its
responsibility to help maintain Ae. aegypti control in the community. Citizens of each
community must be given more responsibility for their own health destiny.
RECOMMENDATION
There is no vaccine to prevent dengue fever. The best way to prevent the
disease is to prevent bites by infected mosquitoes, particularly if you are living in or
travelling to a tropical area. This involves protecting yourself and making efforts to keep
the mosquito population down.
To protect yourself:

Stay away from heavily populated residential areas, if possible.

Use mosquito repellents, even indoors.

When outdoors, wear long-sleeved shirts and long pants tucked into socks.

When indoors, use air conditioning if available.

Make sure window and door screens are secure and free of holes. If sleeping
areas are not screened or air conditioned, use mosquito nets.

If you have symptoms of dengue, speak to your doctor.

To reduce the mosquito population, get rid of places where mosquitoes can breed.
These include old tires, cans, or flower pots that collect rain. Regularly change the water
in outdoor bird baths and pets' water dishes.

If someone in your home gets dengue fever, be especially vigilant about efforts to
protect yourself and other family members from mosquitoes. Mosquitoes that bite the
infected family member could spread the infection to others in your home.