Dengue

• Dengue [DEN-ghee] is a flu-like viral disease spread by the bite of infected mosquitoes.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue.
• Dengue occurs in most tropical areas of the world. Most U.S. cases occur in travelers
returning from abroad, but the dengue risk is increasing for persons living along the
Texas-Mexico border and in other parts of the southern United States.
• There is no specific treatment for dengue.
• Prevention centers on avoiding mosquito bites in areas where dengue occurs or might
occur and eliminating breeding sites.

What is dengue fever? What is dengue hemorrhagic fever?

Dengue fever is a flu-like illness spread by the bite of an infected mosquito.

Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.

What is the infectious agent that causes dengue?

Dengue and dengue hemorrhagic fever are caused by any of the dengue family of viruses.
Infection with one virus does not protect a person against infection with another.

How is dengue spread?

Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting
an infected person and then biting someone else.

Where is dengue found?

Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the
Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most
common in cities but can be found in rural areas. It is rarely found in mountainous areas above
4,000 feet.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower
pots, old oil drums, and water storage containers close to human dwellings. Unlike the
mosquitoes that cause malaria, dengue mosquitoes bite during the day.

What are the signs and symptoms of dengue fever and dengue hemorrhagic
fever?

Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the
eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name
"breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3
to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can
take as long as a month. Older children and adults are usually sicker than young children.

Most dengue infections result in relatively mild illness, but some can progress to dengue
hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause
bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body.
Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock
syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among
children and young adults.

How soon after exposure do symptoms appear?

The time between the bite of a mosquito carrying dengue virus and the start of symptoms
averages 4 to 6 days, with a range of 3 to 14 days. An infected person cannot spread the infection
to other persons but can be a source of dengue virus for mosquitoes for about 6 days.

How is dengue diagnosed?

Dengue is diagnosed by a blood test.

Who is at risk for dengue?

Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue
hemorrhagic fever include a person's age and immune status, as well as the type of infecting
virus. Persons who were previously infected with one or more types of dengue virus are thought
to be at greater risk for developing dengue hemorrhagic fever if infected again.
What is the treatment for dengue and dengue hemorrhagic fever?

There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty
of fluids. They should be kept away from mosquitoes for the protection of others. Dengue
hemorrhagic fever is treated by replacing lost fluids. Some patients need transfusions to control
bleeding.

How common is dengue?

In tropical countries around the world, dengue is one of the most common viral diseases spread
to humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of
thousands of cases of dengue hemorrhagic fever occur each year.

In the United States, approximately 100 cases of dengue are reported each year in travelers
returning from tropical areas. Many more cases probably go unreported. A few persons have
become infected with dengue while living in the United States. Aedes mosquitoes are found in
Texas, Florida, and other southern states, and locally acquired dengue has been reported three
times since 1980 in southern Texas.

Is dengue an emerging infectious disease?

Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent
epidemics, especially in cities in the tropics. The emergence of dengue as a major public health
problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic
levels in Central America and is threatening the United States.

Several factors are contributing to the resurgence of dengue fever:

• No effective mosquito control efforts are underway in most countries with dengue.
• Public health systems to detect and control epidemics are deteriorating around the world.
• Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and
substandard sanitation, allowing more mosquitoes to live closer to more people.
• The increase in non-biodegradable plastic packaging and discarded tires is creating new
breeding sites for mosquitoes.
• Increased jet air travel is helping people infected with dengue viruses to move easily from
city to city.

Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more
forms of dengue virus are at greater risk for the more severe disease. With the increase in all
types of virus, the occurrence of dengue hemorrhagic fever becomes more likely.
How can dengue be prevented?

There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when
traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-
Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is
another key prevention measure.

Avoid mosquito bites when traveling in tropical areas:

• Use mosquito repellents on skin and clothing.

• When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long
pants tucked into socks.
• Avoid heavily populated residential areas.
• When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are
not screened or air-conditioned.
• If you have symptoms of dengue, report your travel history to your doctor.

Eliminate mosquito breeding sites in areas where dengue might occur:

• Eliminate mosquito breeding sites around homes. Discard items that can collect rain or
run-off water, especially old tires.
• Regularly change the water in outdoor bird baths and pet and animal water containers.

What is Dengue Fever (DF)?

Dengue fever is an infection caused by a virus. It occurs commonly as dengue fever.

Occasionally a patient suffering form dengue may develop bleeding. Common sites for bleeding
are the nose, gums and skin. Sometimes, the patient may have coffee-ground vomiting or black
stools. This indicates bleeding in the intestines. The patient with dengue fever who develops
bleeding has dengue hemorrhagic fever (DHF).

How does dengue spread?

Dengue fever is transmitted to people by the bite of an Aedes mosquito that is infected with the
dengue virus. The mosquito becomes infected with dengue when it bites a person who has
dengue fever or DHF. Dengue fever cannot be spread directly from person to person.

When should I suspect Dengue?

Dengue should be suspected when you have sudden onset of high fever, 39-40°C, accompanied
with severe headache, pain behind the eyes, body aches, rashes on the skin and nausea or
vomiting. The fever lasts for 5-7 days. In some patients, fever comes down on the third or fourth
day but it recurs.
Can dengue fever be treated at home?

Most patients with dengue fever can be treated at home. They should take rest, drink plenty of
fluids and eat nutritious food. Whenever available, Oral Rehydration Salt (commonly used in
treating diarrhea) should be used. Sufficient fluid intake is very important. Generally the
progression towards dengue hemorrhagic fever or dengue shock syndrome occurs after 3-5 days
of fever. At this time, fever has often come down. This may mislead many of us to believe that
the patient is heading towards recovery. This is the most dangerous period that requires high
vigilance. It is best to consult a physician. Indications for hospitalization are persistent vomiting,
inability to take oral fluids, persistent abdominal pain, restlessness, or bleeding from any site
(nose, gums, passage of black stools).

What is the treatment?

Like most viral diseases there is no specific cure for dengue fever. Antibiotics do not help.
Paracetamol is the drug of choice to bring down fever and joint pain. Aspirin and Ibuprofen
should be avoided since they can increase the risk of bleeding.

Can people die from dengue fever?

People who suffer from dengue fever have no risk of death but some of them develop Dengue
Hemorrhagic Fever or Dengue Shock Syndrome. In some of these cases death can occur. With
proper treatment, the patients with these conditions can recover fully. Proper treatment provided
in time can save lives.

Is there a vaccine to prevent dengue fever?

A vaccine has been developed to prevent dengue fever but it is still under trial. It is not yet
available in the market.

How can the multiplication of mosquitoes be reduced?

Dengue mosquitoes breed in stored, exposed water collections. To prevent the mosquitoes from
multiplying, drain out the water from tanks, barrels, drums, buckets, etc. Remove all objects
containing water (e.g. plant saucers) from the house. Collect and destroy discarded containers
where water can collect, e.g., bottles, plastic bags, cans, tires, etc. If storage of water can't be
helped, the container should be covered with a tight fitting lid.

How can I prevent mosquito bites?

Dengue mosquitoes bite during the day time. The highest biting intensity is about 2 hours after
sunrise and before sunset. Wear full sleeves clothing and long dresses to cover as much of your
body as possible. Use repellents but be careful in using them in young children and the elderly.
Use mosquito coils and electric vapor mats during daytime. Use mosquito nets to protect
children, old people and others who nap during the day.
What can the community do to prevent dengue?

The main strategy in the prevention and control of dengue is source reduction, or prevention of
breeding places. Every household can undertake simple measures to prevent existing water
collections from becoming breeding places of Aedes aegypti. House cleaning by all members of
the community will ensure that no breeding places exist, preventing dengue form occurring.
The kidneys are paired organs seen in many types of animals, including vertebrates and some
invertebrates. Part of the urinary system, they are responsible for urine production as well as a
number of other homeostatic functions. These include regulation of electrolytes, acid-base
balance, and blood pressure; excretion of wastes such as urea and ammonium; reabsorption of
glucose and amino acids; and production of hormones including vitamin D and erythropoietin.

Located behind the abdominal cavity in the retroperitoneum, the kidneys receive blood from the
paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a
ureter, itself a paired structure that empties into the urinary bladder.

Renal physiology is the study of kidney function, while nephrology is the medical specialty
concerned with diseases of the kidney. Diseases of the kidney are diverse, but individuals with
kidney disease frequently display characteristic clinical features. Common clinical presentations
include the nephritic and nephrotic syndromes, acute kidney failure, chronic kidney disease,
urinary tract infection, nephrolithiasis, and urinary tract obstruction.[1]

Anatomy
[edit] Location

In humans, the kidneys are located behind the abdominal cavity, in a space called the
retroperitoneum. There are two, one on each side of the spine; they are approximately at the
vertebral level T12 to L3.[2] The right kidney sits just below the diaphragm and posterior to the
liver, the left below the diaphragm and posterior to the spleen. Above each kidney is an adrenal
gland (also called the suprarenal gland). The asymmetry within the abdominal cavity caused by
the liver typically results in the right kidney being slightly lower than the left, and left kidney
being located slightly more medial than the right.[citation needed] The upper (cranial) parts of the
kidneys are partially protected by the eleventh and twelfth ribs, and each whole kidney and
adrenal gland are surrounded by two layers of fat (the perirenal and pararenal fat) and the renal
fascia. Each adult kidney weighs between 125 and 170 g in males and between 115 and 155 g in
females.[2] The left kidney is typically slightly larger than the right.[citation needed]
[edit] Structure

1. Renal pyramid • 2. Interlobar artery • 3. Renal artery • 4. Renal vein • 5. Renal

hilum • 6. Renal pelvis • 7. Ureter • 8. Minor calyx • 9. Renal capsule • 10. Inferior
renal capsule • 11. Superior renal capsule • 12. Interlobar vein • 13. Nephron •
14. Minor calyx • 15. Major calyx • 16. Renal papilla • 17. Renal column

Bean-shaped structures, each kidney has concave and convex surfaces. The concave surface, the
renal hilum, is the point at which the renal artery enters the organ, and the renal vein and ureter
leaves. The kidney is surrounded by tough fibrous tissue, the renal capsule, which is itself
surrounded by perinephric fat, renal fascia (of Gerota), and paranephric fat. The anterior (front)
border of these tissues is the peritoneum, while the posterior (rear) border is the transversalis
fascia.

The substance, or parenchyma, of the kidney is divided into two major structures: superficial is
the renal cortex and deep is the renal medulla. Grossly, these structures take the shape of 8 to 18
cone-shaped renal lobes, each containing renal cortex surrounding a portion of medulla called a
renal pyramid (of Malphigi).[2] Between renal pyramids, which are composed of medulla, are
projections of cortex called renal columns (of Bertin). Nephrons, the urine-producing functional
structures of the kidney, span the cortex and medulla. The initial filtering portions of the
nephron, the renal corpuscles, are located in the cortex and each sends a renal tubule that passes
from the cortex deep into the medullary pyramids. Part of the renal cortex, a medullary ray is a
collection of renal tubules that drain into a single collecting duct.

The tip, or papilla, of each pyramid empties urine into a minor calyx, minor calyces empty into
major calyces, and major calyces empty into the renal pelvis and ultimately the ureter and
urinary bladder. These urine-filled spaces comprise the renal sinus.[2]
[edit] Blood supply

The kidneys receive blood from the renal arteries, left and right, which branch directly from the
abdominal aorta. Despite their relatively small size, the kidneys receive approximately 20% of
the cardiac output.[2]

Each renal artery branches into segmental arteries, dividing further into interlobar arteries which
penetrate the renal capsule and extend through the renal columns between the renal pyramids.
The interlobar arteries then supply blood to the arcuate arteries that run through the boundary of
the cortex and the medulla. Each arcuate artery supplies several interlobular arteries that feed
into the afferent arterioles that supply the glomeruli.

After filtration occurs the blood moves through a small network of venules that converge into
interlobular veins. As with the arteriole distribution the veins follow the same pattern, the
interlobular provide blood to the arcuate veins then back to the interlobar veins which come to
form the renal vein exiting the kidney for transfusion for blood.

[edit] Histology

Microscopic photograph of the renal medulla.

Microscopic photograph of the renal cortex.

Renal histology studies the structure of the kidney as viewed under a microscope. Various
distinct cell types occur in the kidney, including:
 • Kidney glomerulus parietal cell
• Kidney glomerulus podocyte
• Kidney proximal tubule brush border cell
• Loop of Henle thin segment cell
• Thick ascending limb cell
• Kidney distal tubule cell
• Kidney collecting duct cell
• Interstitial kidney cell

[edit] Embryology
Main article: Kidney development

The mammalian kidney develops from intermediate mesoderm. Kidney development, also called
nephrogenesis, proceeds through a series of three successive phases, each marked by the
development of a more advanced pair of kidneys: the pronephros, mesonephros, and
metanephros.[3]

[edit] Evolutionary adaptation

Kidneys of various animals show evidence of evolutionary adaptation and have long been
studied in ecophysiology and comparative physiology. Kidney morphology, often indexed as the
relative medullary thickness, is associated with habitat aridity among species of mammals.[4]

[edit] Etymology

Medical terms related to the kidneys commonly use terms such as renal and the prefix nephro-.
The adjective renal, meaning related to the kidney, is from the Latin rēnēs, meaning kidneys; the
prefix nephro- is from the Ancient Greek word for kidney, nephros (νεφρός).[5] For example,
surgical removal of the kidney is a nephrectomy, while a reduction in kidney function is called
renal dysfunction.

[edit] Diseases and disorders

Main article: Nephropathy

[edit] Congenital

• Congenital hydronephrosis
• Congenital obstruction of urinary tract
• Duplicated ureter
• Horseshoe kidney
• Polycystic kidney disease
• Renal agenesis
• Renal dysplasia
• Unilateral small kidney
• Multicystic dysplastic kidney
• Parenchyma
[edit] Acquired

Drawing of an enlarged kidney by John Hunter.

• Diabetic nephropathy
• Glomerulonephritis
• Hydronephrosis is the enlargement of one or both of the kidneys caused by
obstruction of the flow of urine.
• Interstitial nephritis

• Kidney stones (nephrolithiasis) are a relatively common and particularly

painful disorder.
• Kidney tumors
o Wilms tumor
o Renal cell carcinoma
• Lupus nephritis
• Minimal change disease
• In nephrotic syndrome, the glomerulus has been damaged so that a large
amount of protein in the blood enters the urine. Other frequent features of
the nephrotic syndrome include swelling, low serum albumin, and high
cholesterol.
• Pyelonephritis is infection of the kidneys and is frequently caused by
complication of a urinary tract infection.
• Renal failure
o Acute renal failure
o Stage 5 Chronic Kidney Disease

[edit] Kidney failure

Main article: Renal failure

Generally, humans can live normally with just one kidney, as one has more functioning renal
tissue than is needed to survive. Only when the amount of functioning kidney tissue is greatly
diminished will chronic kidney disease develop. Renal replacement therapy, in the form of
dialysis or kidney transplantation, is indicated when the glomerular filtration rate has fallen very
low or if the renal dysfunction leads to severe symptoms.

[edit] History
[edit] Human thought about kidneys

The Latin term renes is related to the English word "reins", a synonym for the kidneys in
Shakespearean English (eg. Merry Wives of Windsor 3.5), which was also the time the King
James Version was translated. Kidneys were once popularly regarded as the seat of the
conscience and reflection[6][7], and a number of verses in the Bible (eg. Ps. 7:9, Rev. 2:23) state
that God searches out and inspects the kidneys, or "reins", of humans. Similarly, the Talmud
(Berakhoth 61.a) states that one of the two kidneys counsels what is good, and the other evil.

[edit] Animal kidneys as food

Hökarpanna, Swedish pork and kidney stew

The kidneys of animals can be cooked and eaten by humans (along with other offal).

Kidneys are usually grilled or sautéed, but in more complex dishes they are stewed with a sauce
that will improve their flavor. In many preparations kidneys are combined with pieces of meat or
liver, like in mixed grill or in Meurav Yerushalmi. Among the most reputed kidney dishes, the
British Steak and kidney pie, the Swedish Hökarpanna (pork and kidney stew), the French
Rognons de veau sauce moutarde (veal kidneys in mustard sauce) and the Spanish "Riñones al
Jerez" (kidneys stewed in sherry sauce), deserve special mention.[8]