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Dengue Fever

Definition
Dengue fever is a disease caused by one of a number of viruses that are carried by mosquitoes. These mosquitoes then transmit the virus to humans.

Description
The virus that causes dengue fever is called an arbovirus, which stands for arthropod-borne virus. Mosquitoes are a type of arthropod. In a number of regions, mosquitoes carry this virus and are responsible for passing it along to humans. These regions include the Middle East, the far East, Africa, and the Caribbean Islands. In these locations, the dengue fever arbovirus is endemic, meaning that the virus naturally and consistently lives in that location. The disease only shows up in the United States sporadically. In order to understand how dengue fever is transmitted, several terms need to be defined. The word "host" means an animal (including a human) that can be infected with a particular disease. The word "vector" means an organism that can carry a particular disease-causing agent (like a virus or bacteria) without actually developing the disease. The vector can then pass the virus or bacteria on to a new host. Many of the common illnesses in the United States (including the common cold, many viral causes of diarrhea, and influenza or "flu") are spread because the viruses that cause these illness can be passed directly from person to person. However, dengue fever cannot be passed directly from one infected person to another. Instead, the virus responsible for dengue fever requires an intermediate vector, a mosquito, that carries the virus from one host to another. The mosquito that carries the arbovirus responsible for dengue fever is the same type of mosquito that can transmit other diseases, including yellow fever. This mosquito is called Aedes egypti. The most common victims are children younger than 10 years of age.

Causes and symptoms


Dengue fever can occur when a mosquito carrying the arbovirus bites a human, passing the virus on to the new host. Once in the body, the virus travels to various glands where it multiplies. The virus can then enter the bloodstream. The presence of the virus within the blood vessels, especially those feeding the skin, causes changes to these blood vessels. The vessels swell and leak. The spleen and lymph nodes become enlarged, and patches of liver tissue die. A process called disseminated intravascular coagulation (DIC) occurs, where chemicals responsible for clotting are used up and lead to a risk of severe bleeding (hemorrhage). After the virus has been transmitted to the human host, a period of incubation occurs. During this time (lasting about five to eight days) the virus multiplies. Symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints. This initial period of illness lasts about two or three days. After this time, the fever drops rapidly and the patient sweats heavily. After about a day of feeling relatively well, the patient's

temperature increases again, although not as much as the first time. A rash of small red bumps begins on the arms and legs, spreading to the chest, abdomen, and back. It rarely affects the face. The palms of the hands and the soles of the feet become swollen and turn bright red. The characteristic combination of fever, rash, and headache are called the "dengue triad." Most people recover fully from dengue fever, although weakness and fatigue may last for several weeks. Once a person has been infected with dengue fever, his or her immune system keeps producing cells that prevent reinfection for about a year. More severe illness may occur in some people. These people may be experiencing dengue fever for the first time. However, in some cases a person may have already had dengue fever at one time, recovered, and then is reinfected with the virus. In these cases, the first infection teaches the immune system to recognize the presence of the arbovirus. When the immune cells encounter the virus during later infections, the immune system over-reacts. These types of illnesses, called dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), involve more severe symptoms. Fever and headache are the first symptoms, but the other initial symptoms of dengue fever are absent. The patient develops a cough, followed by the appearance of small purplish spots (petechiae) on the skin. These petechiae are areas where blood is leaking out of the vessels. Large bruised areas appear as the bleeding worsens and abdominal pain may be severe. The patient may begin to vomit a substance that looks like coffee grounds. This is actually a sign of bleeding into the stomach. As the blood vessels become more damaged, they leak more and continue to increase in diameter (dilate), causing a decrease in blood flow to all tissues of the body. This state of low blood flow is called shock. Shock can result in damage to the body's organs (especially the heart and kidneys) because low blood flow deprives them of oxygen.

Diagnosis
Diagnosis should be suspected in endemic areas whenever a high fever goes on for two to seven days, especially if accompanied by a bleeding tendency. Symptoms of shock should suggest the progression of the disease to DSS. The arbovirus causing dengue fever is one of the few types of arbovirus that can be isolated from the serum of the blood. The serum is the fluid in which blood cells are suspended. Serum can be tested because the phase in which the virus travels throughout the bloodstream is longer in dengue fever than in other arboviral infections. A number of tests are used to look for reactions between the patient's serum and laboratory-produced antibodies. Antibodies are special cells that recognize the markers (or antigens) present on invading organisms. During these tests, antibodies are added to a sample of the patient's serum. Healthcare workers then look for reactions that would only occur if viral antigens were present in that serum.

Treatment
There is no treatment available to shorten the course of dengue fever, DHF, or DSS. Medications can be given to lower the fever and to decrease the pain of muscle aches and headaches. Fluids are given through a needle in a vein to prevent dehydration. Blood transfusions may be necessary if severe hemorrhaging occurs. Oxygen should be administered to patients in shock.

Prognosis

The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients fully recover. However, as many as 6-30% of all patients die when DHF occurs. The death rate is especially high among the youngest patients (under one year old). In places where excellent medical care is available, very close monitoring and immediate treatment of complications lowers the death rate among DHF and DSS patients to about 1%.

Prevention
Prevention of dengue fever means decreasing the mosquito population. Any sources of standing water (buckets, vases, etc.) where the mosquitoes can breed must be eliminated. Mosquito repellant is recommended for those areas where dengue fever is endemic. To help break the cycle of transmission, sick patients should be placed in bed nets so that mosquitoes cannot bite them and become arboviral vectors.

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Health: Dengue Fever
Dengue is a disease carried and spread by the female Aedes mosquito. It is sometimes called breakbone fever. The Aedes mosquito is quite slow moving and has striped black and white legs and bites during daylight hours. The incubation period (time from the bite of an infected mosquito to symptoms appearing) is 3-14 days (average 4-7 days).
Symptoms

Adults and older children: The main symptoms in adults and older children are:

Mild or high fever (usually for 2-10 days) Severe headache Pain behind the eyes Aching muscles and joints Skin rash Nausea and vomiting Tingling in the hands or feet

Young children and infants: The symptoms in younger children tend to be more mild:

Mild fever Skin rash Runny nose

Diagnosis

It is difficult to definitively diagnosis dengue fever. The diagnosis is usually made by looking at the symptoms. A blood test can be taken to measure the platelet levels and white blood cells in the blood. Generally the white cell count would be low if there was dengue fever and there would be a drop in the blood platelet levels (below 150,000). Usually a second blood test would be carried out two weeks after the first to determine whether the levels are increasing or decreasing. A tourniquet test (TT) has been determined by the World Health Organization as necessary for a diagnosis of dengue fever. In a TT a blood pressure cuff is put on the arm, inflated and left in place for 5 minutes. The test is positive for dengue fever if there are 10 or more little red or purple spots or bruising (petechiae) per square inch in the area where the cuff was, and positive for dengue haemorrhagic fever (see below) if there are 20 or more petechiae per square inch. Reduced platelet levels (thrombocytopaenia) are found in 50% of cases of dengue fever. Reduced white blood cell levels are found in about 60-70% of patients with dengue fever. A TT is accurate in diagnosing dengue fever in 50-60% of cases. However, if the TT and the white blood cell levels are taken together the accuracy for diagnosis increases to 85%. The hematocrit can also be measured through a blood test if it shows an increase of more than 20% this is an indication of a decrease in the blood volume and usually indicates that a patient is about to go into circulatory shock (see dengue haemorrhagic fever below). There is a test to see whether a person has antibodies to dengue but this is not always accurate and can take some time before the results are available. About 5% of patients with dengue fever will not show any antibodies int their blood test. The presence of antibodies can usually be detected about 2 days after the first symptoms appear although the antibody levels may be slower to rise in a second or subsequent infection. If you are being treated at home and not hospitalized you can arrange for blood tests to be taken in your own home rather than having to visit a clinic. Contact Prodia to arrange a home visit (for a low fee) and they will send someone to your home to take blood and then contact you with the results.
Complications

Dehydration: Dehydration is one of the most common complications of dengue fever. Symptoms of dehydration include:

Dry mucous membranes (the inside of a childs cheeks and their gums will feel more dry than usual) Sunken fontanelles in an infant Lack of skin tone (if you pinch the skin on the back of the hand it will take a few seconds to spring back to shape)

Dehydration can develop into a serious complication, especially in children and infants, if it is left untreated. Often a person with dehydration will not feel thirsty. It is important to keep up the fluid intake in a person with a fever, even a mild fever. Plain water is helpful at preventing dehydration although replacing lost fluids with a drink that contains electrolytes is more effective. If a patient with dengue is admitted to hospital they will usually be placed on an intravenous (IV) drip that contains water and electrolytes. Rehydration salts can be purchased in the pharmacy in Bali. Homemade rehydration fluids should be avoided as it is very easy to give too much salt, especially in young children. Coconut water has been found to be effective in rehydrating however there have only be a small number of scientific studies. It can cause nausea although if it is enriched with sodium this appears to be helpful in preventing nausea. Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS): In most cases dengue fever is a self-limiting illness without serious health problems. In some cases though it can develop into DHF or the more severe form of the illness, DSS, both of which can be life threatening. DHF and DSS are found more commonly in children under 10 years of age, the very old or people whose immune system is already compromised. The symptoms of DHF and DSS usually appear between 2-6 days after symptoms of dengue fever first appear, with the most critical day being day 5 or 6. The symptoms of DHF and DSS include:

Sudden rise in temperature Facial flush Skin rash or bruising Possible liver pain on the right of the abdomen, just under the ribs Bleeding from the nose or gums Blood in the stool or urine Vomiting Abdominal pain

The high fever with DHF and DSS usually lasts 2-7 days and can be as high as 41C (106F). It may be accompanied by convulsions or fits. In dengue fever or moderate DHF the symptoms will all ease once the fever reduces. If the symptoms suddenly become worse after a few days of fever this can be life threatening. The patient might show signs of circulatory shock. Circulatory shock results from the body being low on blood volume in the case of DSS this is because of internal bleeding resulting from a serious drop in platelet levels. The reduced blood volume means there is not enough blood, and therefore not enough oxygen, to adequately nourish the body. The symptoms of circulatory shock include:

Fast pulse that is weak (difficult to feel) Cool clammy skin Rapid and shallow breathing Altered consciousness

A patient can rapidly deteriorate in as little as 24 hours so when signs of DHF or DSS appear it is important to be having medical care and likely hospitalization to prevent circulatory shock.

DHF and DSS are more commonly seen if the infection is not the first time a person has had dengue fever. In the case of DHF the hematocrit should be measured every 24 hours. In the case of DSS the hematocrit should be measured every 3-4 hours. The platelet levels are usually less than 100,000 cells/mm3 if DHF is present and should be monitored every 24 hours. Blood products may be needed if a patient develops DHF or DSS. In Bali there is a blood bank but it may be difficult to find the right blood type, particularly if your blood type is rare. In cases where blood is needed for a patient expatriates have commonly sent messages through their telephones around the island to find volunteers to provide blood that is urgently required.
Treatment

There is no specific treatment for dengue fever. In cases of DHF, IV fluids would be given to prevent circulatory shock. Without treatment DHF has a mortality rate as high as 20%. With treatment this can be reduced to 1%. If you want to use pain relieving or fever reducing medication only paracetamol (brand name Panadol) should be used. Do not give ibuprofen or aspirin as these both can cause bleeding. There is a lot of controversy over using fever reducing medication in the case of infective illness. Raising the temperature is the bodys way of killing viruses. When you reduce the temperature with medication you limit the ability of the body to heal itself. There has been some research in this area in particular looking at whether fever reducing medication has a negative or positive impact on recovery from malaria. In one study they found that the patients who were given antipyretics (fever reducing medication) took longer to clear the malaria parasite from their system with no beneficial effects. At this point though the studies carried out have been small so it is difficult to draw any conclusions and none, as far as we are aware, looked specifically at dengue. Anti-pyretics do not cure illness or kill viruses all they will do is reduce fever, and in the case of paracetamol, reduce pain. In the case of young children and infants, a very high temperature can lead to a seizure. If you prefer not to use anti-pyretics you can help reduce the temperature enough to make the patient more comfortable by using cool sponging. In serious cases of dengue you may want to consider being medically evacuated to Singapore where the hospitals offer a high standard of medical care. There are public hospitals in Singapore but as a visitor you would need to seek out private medical hospitals. These can be very expensive so you may want to consider health insurance that covers the cost of medical evacuation if you are going to be in Bali for an extended period.
Recovery

The recovery period for dengue can be long and challenging. Depression and lethargy are common for several months after an infection with dengue. It is important to build the immune system and rest as much as possible during this time. If you prefer to use natural treatments there are a number of naturopaths living in Bali who have extensive experience with dengue fever. Eating foods that are rich in iron and other nutrients can be beneficial in helping the body to recover. Red rice, for example, is very high in iron.

Dengue can have a detrimental effect on the immune system for several weeks after an infection. You may find that you are more susceptible to colds and that injuries such as cuts and scrapes take longer to heal. Increasing garlic in your diet, taking additional vitamins in the form of fresh vegetables and fruit or supplements, and rest can all be beneficial during this stage.
Immunization

There is no vaccine for preventing dengue or DHF.


Immunity and Recurrence

There are four different strains of dengue fever, all carried by the Aedes mosquito. Once you have had an infection from one strain you can never catch that strain again you have lifelong immunity. However, you are not protected against the other strains. In a second infection with dengue the immune system will be activated as if you were being infected by the first strain that you previously had. The antibodies produced by the immune system will attempt to kill the virus but will not be able to inactivate it as it is a different strain. The immune system attracts white blood cells to attempt to fight the virus but because the new strain cannot be inactivated these white blood cells then become infected with the virus, often resulting in the symptoms being more serious than the previous infection was. If you have previously had dengue fever and then acquire a second or subsequent infection you are at increased risk of developing DHF or DSS. This is particularly the case in young children experiencing their second or subsequent infection of dengue fever.
Risk Factors

Several research papers have looked at risk factors and whether there are certain conditions that make an individual more susceptible to dengue fever, or the more serious forms of DHF and DSS. It does appear that Caucasians are more susceptible to DHF and DSS than Africans. Chinese men were also more susceptible than Malay men in a study carried out in Malaysia. Blood group may affect susceptibility although the research here is very limited. In one study of Thai children, those with blood group AB were more likely to develop DHF in a second infection and DSS than those with blood groups A, O or B.
Pregnancy

There is some evidence that dengue fever can be transmitted from mother to child during pregnancy although there have been very few studies that have looked at this and it is not known whether there are particular periods during pregnancy where the developing baby is more susceptible.
Prevention

The only way to prevent dengue is to eliminate the mosquitoes which transmit the virus, and to avoid being bitten. The mosquito needs water to breed this is where they lay their eggs. They

prefer to lay their eggs in artificial containers the sort that are often found around homes. Commonly they will choose places like the base of a flower pot, buckets, and drains blocked with leaves. Keeping these clear can go a long way in preventing mosquitoes near your home. Teach your children and your staff to turn containers upside down to stop water accumulating in them.If you have a pond fill it with fish that will eat the larvae, and ensure that the water is moving rather than still as the mosquito cannot lay eggs in moving water. You can reduce the risk of your children being bitten during the day with natural mosquito repellents that are available in shops such as Bali Buddha.

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Dengue and dengue haemorrhagic fever
Fact sheet N117 March 2009

Key facts

Dengue is a mosquito-borne infection that causes a severe flu-like illness, and sometimes a potentially lethal complication called dengue haemorrhagic fever. Global incidence of dengue has grown dramatically in recent decades. About two fifths of the world's population are now at risk. Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semiurban areas. Dengue haemorrhagic fever is a leading cause of serious illness and death among children in some Asian countries. There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue haemorrhagic fever. The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes.

Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region. There are four distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that virus but confers only partial and transient protection against subsequent infection by the other three viruses. There is good evidence that sequential infection increases the risk of developing DHF.
Global burden of dengue

The incidence of dengue has grown dramatically around the world in recent decades. Some 2.5 billion people two fifths of the world's population are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year. In 2007 alone, there were more than 890 000 reported cases of dengue in the Americas, of which 26 000 cases were DHF. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific are the most seriously affected. Before 1970 only nine countries had experienced DHF epidemics, a number that had increased more than four-fold by 1995. Not only is the number of cases increasing as the disease is spreading to new areas, but explosive outbreaks are occurring. In 2007, Venezuela reported over 80 000 cases, including more than 6 000 cases of DHF. Some other statistics:

During epidemics of dengue, infection rates among those who have not been previously exposed to the virus are often 40% to 50%, but can reach 80% to 90%. An estimated 500 000 people with DHF require hospitalization each year, a very large proportion of whom are children. About 2.5% of those affected die. Without proper treatment, DHF fatality rates can exceed 20%. Wider access to medical care from health providers with knowledge about DHF - physicians and nurses who recognize its symptoms and know how to treat its effects - can reduce death rates to less than 1%.

The spread of dengue is attributed to expanding geographic distribution of the four dengue viruses and their mosquito vectors, the most important of which is the predominantly urban species Aedes aegypti. A rapid rise in urban mosquito populations is bringing ever greater numbers of people into contact with this vector, especially in areas that are favourable for mosquito breeding, e.g. where household water storage is common and where solid waste disposal services are inadequate.

DengueNet: WHO surveillance

Transmission

WHO/TDR/Stammers

Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission.
Characteristics

Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment (see below).
Treatment

There is no specific treatment for dengue fever.

For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives - decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's circulating fluid volume is the central feature of DHF care.
Immunization

There is no vaccine to protect against dengue. Although progress is underway, developing a vaccine against the disease - in either its mild or severe form - is challenging.

With four closely related viruses that can cause the disease, the vaccine must immunize against all four types to be effective. There is limited understanding of how the disease typically behaves and how the virus interacts with the immune system. There is a lack of laboratory animal models available to test immune responses to potential vaccines.

Despite these challenges, two vaccine candidates have advanced to evaluation in human subjects in countries with endemic disease, and several potential vaccines are in earlier stages of development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation.

More on vaccine research

Prevention and control

At present, the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes. In Asia and the Americas, Aedes aegypti breeds primarily in man-made containers like earthenware jars, metal drums and concrete cisterns used for domestic water storage, as well as discarded plastic food containers, used automobile tyres and other items that collect rainwater. In Africa the mosquito also breeds extensively in natural habitats such as tree holes, and leaves that gather to form "cups" and catch water.

WHO/TDR/Crump

In recent years, Aedes albopictus, a secondary dengue vector in Asia, has become established in the United States, several Latin American and Caribbean countries, parts of Europe and Africa. The rapid geographic spread of this species is largely attributed to the international trade in used tyres, a breeding habitat. Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal and improved water storage practices, including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes. The application of appropriate insecticides to larval habitats, particularly those that are useful in households, e.g. water storage vessels, prevents mosquito breeding for several weeks but must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success. During outbreaks, emergency vector control measures can also include broad application of insecticides as space sprays using portable or truck-mounted machines or even aircraft. However, the mosquito-killing effect is transient, variable in its effectiveness because the aerosol droplets may not penetrate indoors to microhabitats where adult mosquitoes are sequestered, and the procedure is costly and operationally difficult. Regular monitoring of the vectors' susceptibility to widely used insecticides is necessary to ensure the appropriate choice of chemicals. Active monitoring and surveillance of the natural mosquito population should accompany control efforts to determine programme effectiveness.

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Denggi

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Apa itu denggi? Mungkin masih ramai yang tidak mengetahui lebih mendalam tentang penyakit ini. Penyakit denggi merupakan penyakit berjangkit yang berbahaya dan boleh membawa maut kerana sehingga hari ini belum ada ubat atau penawar untuk mengubati penyakit ini. Denggi boleh terjadi di kalangan orang dewasa dan kanak-kanak akibat daripada gigitan nyamuk aedes. Penyakit ini biasanya berlangsung selama sepuluh hari dan kadangkala mengambil masa lama untuk pulih sepenuhnya. Penyakit ini kerap berlaku di

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kawasan bandar berbanding dengan luar bandar. Penyakit denggi disebabkan oleh sejenis kuman virus yang dipanggil virus denggi. Virus ini tergolong di dalam keluarga togaviridae. Ia merupakan virus yang berkembang biak dalam serangga. Terdapat 4 jenis serotype virus yang telah dikenalpasti iaitu den 1, den 2, den 3 dan den 4. Semua jenis serotype ini boleh merangsang pembentukan antibodi yang berbeza-beza. Namun begitu, kekebalan yang dihasilkan oleh pertahanan badan tidak menyeluruh terhadap semua jenis virus denggi. Ia akan hanya melindungi individu untuk jenis virus tersebut sahaja. Virus ini masuk ke dalam peredaran darah manusia melalui gigitan nyamuk aedes dan boleh didapati dalam tempoh yang singkat sahaja iaitu 4-5 hari pada tahap awal penyakit. Nyamuk aedes merupakan pembawa bagi kuman virus denggi. Gigitan nyamuk merupakan satu cara penyebaran virus denggi dari seorang ke seorang yang lain. Daripada satu gigitan ia boleh menghisap darah sebanyak dua hingga empat miligram darah iaitu 1.5 kali berat badannya. Nyamuk aedes ini boleh dikenali dengan tanda belang hitam dan putih di kaki.Terdapat dua jenis nyamuk aedes yang membawa virus denggi iaitu: 1. Aedes aegypti. Ciri-ciri nyamuk ini ialah tanda putih-perak bentuk kecapi di kepala. Nyamuk aedes aegypti berterbangan di sekitar rumah dan tinggal di tempat-tempat gelap di dalam rumah. Ia bertelur dan berkembang biak di dalam bekas buatan di dalam dan di luar rumah. 2. Aedes albopictus. Ciri-ciri nyamuk ini pula ialah terdapat garisan putihperak disepanjang pertengahan kepala dan badan. Nyamuk albopictus pula terdapat di kawasan perumahan di bandar, kebun dan juga di hutan. Ia biasa terdapat di luar rumah pada tumbuh-tumbuhan dan menggigit manusia di luar rumah. Kadang-kadang ia memasuki rumah untuk menggigit manusia. Disamping bekas buatan nyamuk ini juga boleh berkembang biak dalam berbagai-bagai bekas alamiah seperti lubang pada pokok, tunggul pokok, buluh, ketiak daun seperti daun pandan dan nenas dan tempat air bertakung. Jarak terbang kedua-dua jenis nyamuk ini biasanya tidak melebihi 350 meter. Cara jangkitan: Manusia dijangkiti kuman virus denggi melalui gigitan nyamuk. Virus denggi ini hidup dan berkembang biak di dalam air liur nyamuk. Ia memerlukan masa pengeraman selama lapan hingga sepuluh hari untuk berkembang biak dan terkumpul di dalam air liur nyamuk. Nyamuk yang telah dijangkiti akan terus membawa virus denggi sepanjang hidupnya. Apabila nyamuk aedes betina menggigit manusia atau haiwan ia akan memasukkan sekali virus denggi yang ada terdapat dalam air liurnya ke dalam sistem aliran darah manusia. Apabila nyamuk aedes betina menghisap darah manusia yang mengandungi virus denggi ia akan melengkapi kitaran hidup virus tersebut dan menyebarkan kepada orang lain. Penularan virus denggi boleh juga terjadi apabila nyamuk aedes betina sedang menghisap darah orang yang dijangkiti virus denggi diganggu dan

nyamuk itu dengan segera menggigit orang lain pula. Ini akan menyebabkan virus yang terdapat dalam belalai nyamuk tersebut akan masuk ke dalam peredaran darah orang kedua tanpa memerlukan masa pengeraman. Cara ini dipanggil penularan mekanikal. Selain itu, jangkitan virus denggi boleh juga berlaku melalui penularan transovari di mana ia merupakan suatu proses penularan agen penyakit daripada serangga betina melalui telur, jentik-jentik hingga kepada serangga dewasa generasi berikutnya. Penularan transovari sangat penting bagi virus denggi kerana proses ini membolehkan virus tersebut berkekalan di persekitaran. Melalui proses penularan ini nyamuk bukan sahaja berperanan sebagai agen pembawa tetapi juga sebagai perumah kepada agen penyakit. Tempat pembiakan: Nyamuk aedes membiak di dalam takungan air jernih sama ada di dalam dan luar rumah tetapi tidak boleh membiak di dalam air yang kotor. Bahagian dalam rumah ia dapat membiak di piring alas pasu bunga, tadahan air seperti kolah mandi, tempayan atau baldi dan perangkap semut. Manakala di luar rumah seperti di dalam tayar buruk, saluran air hujan, tin-tin kosong, kawasan pembinaan, cawan getah, lubang pokok, tungguk buluh, ketiak daun seperti, daun pandan dan nanas. Terdapat dua jenis penyakit denggi iaitu: i) Demam denggi klasikal. Pesakit menunjukkan gejala demam, ruam, sakit badan, sakit sendi dan sakit otot. Gejala penyakit ini biasanya tidak teruk dan jarang menyebabkan kematian. Demam jenis ini juga pernah dinamakan demam patah tulang atau breakbone fever. ii) Demam denggi berdarah. Biasanya terjadi di kalangan kanak-kanak terutama dalam lingkungan umur 213 tahun. Pada tahap awal (selama 2-4 hari) gejala yang dihidapi adalah sama seperti demam denggi klasikal dan diikuti oleh tahap yang lebih teruk dengan gejala seperti tekanan darah rendah, ruam dan bintik-bintik merah di badan, perdarahan gusi, berak berdarah (najis berwarna hitam) disertai dengan sawan dan tidak sedar diri. Ia sering menyebabkan kematian jika rawatan tidak diberikan dengan segera. Ia juga dipanggil sebagai demam berdarah Filipina. Tanda-tanda atau gejala: 1. Demam denggi klasikal Tanda-tanda demam denggi ini bergantung kepada usia pesakit tersebut. Bagi bayi atau kanak-kanak ciri utama ialah ruam yang disertai oleh demam panas. Manakala orang dewasa dan remaja pula demam kuat yang muncul dengan tiba-tiba yang berlangsung selama 2-7 hari, sakit kepala, sakit di belakang mata, sakit otot dan sendi yang diikuti oleh ruam yang timbul pada hari ketiga hingga keempat. Bintik-bintik merah di bawah kulit juga boleh didapati. Dan hasil daripada ujian makmal menunjukkan jumlah leukosit dan platlet dalam darah menurun.

2. Demam denggi berdarah Demam denggi berdarah mempunyai 4 ciri klinikal utama seperti demam yang sangat panas, perdarahan, pembesaran hati dan kegagalan sistem peredaran darah. Perdarahan yang berlaku adalah seperti bintik-bintik merah di bawah kulit, perdarahan hidung, gusi, darah dalam najis(najis berwarna hitam), kencing berdarah dan kadang kala mendapat haid yang berlebihan. Pembesaran hati terjadi pada peringkat awal penyakit. Pembesaran hati ini boleh mencapai dua hingga empat sentimeter di bawah tulang rusuk kanan. Kegagalan atau gangguan peredaran ditunjukkan melalui tanda-tanda seperti kesejukan dan kongesti kulit, kebiruan dan peningkatan kadar nadi. Mereka juga kelihatan resah dan lemah dan kemudian dengan cepat mengalami renjatan atau sawan. Keadaan ini juga dipanggil sebagai Dengue Shock Syndrome (DSS). Setakat ini tiada rawatan yang spesifik bagi membunuh virus denggi. Namun begitu antara rawatan yang biasa dilakukan untuk membantu pesakit deman denggi ialah: Rawatan demam denggi klasikal: Rawatan yang diberi adalah untuk menstabilkan pesakit bergantung kepada keadaan pesakit iaitu mengurangkan demam(suhu badan) dan mengelakkan dari perdarahan berlaku. Rawatan demam denggi berdarah: Demam yang sangat panas, kehilangan selera makan dan muntah menyebabkan dehidrasi. Pesakit digalakkan supaya minum air lebih banyak. Demam yang sangat panas juga meningkatkan risiko terjadinya sawan, oleh itu demam patut dikawal dengan antipiretik. Selain itu, pesakit akan diawasi supaya gejala perdarahan dan sawan dapat dikesan awal. Dan masa yang paling genting ialah pada hari ketiga hingga hari ketujuh. Maka pemberian aliran intravena perlu jika sekiranya kiraan hematokrit meningkat kerana ini menggambarkan darjah kehilangan plasma. Oleh hal yang demikian, orang ramai perlu lebih peka terhadap kawasan sekitar tempat tinggal mereka agar nyamuk ini tidak dapat membiak dengan membersihkan kawasan rumah dan membuang segala sampah sarap yang mungkin menjadi sarang nyamuk ini melakukan proses pembiakkan malah pihak berkuasa juga perlu memastikan setiap premis bebas daripada denggi

Demam Denggi merupakan sejenis penyakit yang disebabkan oleh jangkitan virus Denggi (genus Flavivirus) yang disebar oleh nyamuk Aedes betina. Cara penyebarannya ialah melalui gigitan nyamuk aedes orang yang berpenyakit virus denggi kepada orang yang sihat. Terdapat dua jenis denggi yang paling berat iaitu Demam Hemoragik Denggi (DHF) dan Sindrom Kejutan Denggi (DSS). Virus Denggi akan terpendam di dalam badan pesakit selama 3 - 14 hari (purata 4 hingga 6 hari) sebelum menunjukkan tanda-tanda. Pesakit mungkin akan mengalami demam mengejut diikuti dengan berbagai-bagai tanda dan gejala tidak khusus. Denggi dan denggi berdarah merupakan penyakit febril akut (acute febrile), dijumpai di kawasan tropika, dengan taburan geografi serupa dengan malaria. Disebabkan oleh satu daripada empat virus serotype yang berkait rapat dari genus Flavivirus, famili Flaviviridae, setiap serotype cukup berbeza menjadikan tiadanya perlindungan bertindan (cross-protection) dan wabak denggi yang disebabkan oleh pelbagai serotype (hyperendemicity) boleh berlaku. Denggi disebarkan kepada manusia oleh nyamuk Aedes aegypti (hanya kadang-kala oleh Aedes albopictus).

Isi kandungan
[sorokkan]

1 Tanda dan gejala 2 Diagnosis 3 Rawatan 4 Epidemiologi 5 Pencegahan 6 Wabak terkini 7 Mengenal pasti demam denggi 8 Bagaimana demam denggi berjangkit 9 Pautan luar

[sunting] Tanda dan gejala


Demam denggi bermula dengan demam mengejut, dengan sakit kepala teruk, sakit di belakang bebola mata, sakit sendi dan otot (myalgias dan arthralgias, sakit pinggang yang teruk menyebabkan ia juga digelar demam tulang-pecah - break-bone fever) dan gatal-gatal. Ciri-ciri keradangan demam denggi adalah bintik-bintik merah terang, dan biasanya muncul di anggota bahagian bawah - pada sesetengah pesakit, ia merebak hampir kepada keseluruhan tubuh. Tanda pada kulit yang klasik ialah seluruh kulit tubuh bertukar kemerahan diselangi dengan tompoktompok kulit warna yang normal (island of white in a sea of red). Kemungkinannya terdapat gastritis dengan gabungan sakit perut, mual, muntah atau cirit-cirit. Pesakit juga boleh mendapat radang hati, radang otak (lebih pada kanak-kanak) dan juga dalam kes luarbiasa radang otot jantung (cardiomyopathy).

Demam denggi klassik berlarutan selama enam hingga tujuh hari dengan demam kembali memuncak pada akhir demam (dikenali sebagai pola biphasic). Secara klinikal bilangan sel darah pembeku (platelet) akan turun sehingga hilang demam diikuti dengan kehilangan bendalir plasma darah dari salur darah ke dalam tisu perantara atau ruang ke tiga (third space loss di antara selaput paru-paru, ruang peritoneum dan sebagainya), kerana kapilari darah menjadi rapuh (capillary fragillity). Pada peringkat ini pesakit terdedah kepada renjatan dan risiko perdarahan. Kes DHF juga menunjukkan demam tinggi, fenomena pendarahan, trombositopenia (thrombocytopenia) dan haemoconcentration. Sebahagian kecil kes membawa kepada sindrom kejutan denggi (dengue shock syndrome) atau DDS yang mempunyai kadar kematian yang tinggi.

[sunting] Diagnosis
Diagnosis denggi kebiasaannya dibuat secara klinikal. Gambaran klasik adalah demam tanpa sumber jangkitan tempatan, bintik-bintik gatal dengan thrombocytopenia dan kemungkinan leukopenia. Kajian serologi dan PCR (polymerase chain reaction) digunakan bagi mengesahkan diagnosa denggi sekiranya diperlukan secara klinikal.

[sunting] Rawatan
Rawatan utama adalah terapi sokongan. Pesakit digalakkan untuk mengekalkan makan, terutamanya minum air. Sekiranya pesakit tidak mahu / mampu minum, tambahan melalui cecair intravena mungkin diperlukan untuk menghalang kekeringan dan hemoconcentration teruk. Pemindahan darah mungkin diperlukan sekiranya bilangan platelet turun dengan banyaknya.Cara yang lain untuk mencegah penyakit ini juga pesakit perlu bersenam pada waktu pagi atau berjoging dan beriadah.Minum air paling penting dalam hidupan harian kita.Minum air mineral sekurang-kurangnye 8 gelas sehari atau selebih-lebihnya pun hanya maksimum 16 gelas sehari.

[sunting] Epidemiologi
Wabak pertama berlaku hampir serentak, di Asia, Afrika, dan Amerika Utara pada tahun 1780an, penyakit tersebut dikenal pasti dan diberi nama pada 1779. Pada awalnya ia tidak merbahaya. Wabak sejagat meletus di di Asia Tenggara sekitar 1950-an, dan pada 1975 DHF telah menjadi sebab utama kematian dikalangan kanak-kanak dikebanyakan negara dikawasan tersebut. Wabak denggi menjadi kebiasaan semenjak 1980-an, pada akhir 1990s denggi merupakan penyakit virus bawaan nyamuk paling utama menjangkiti manusia selepas malaria, terdapat 40 juta kes demam denggi dan beberapa ratus ribu demam denggi berdarah setiap tahun. Pada Februari 2002 terdapat wabak teruk di Rio De Janeiro, membabitkan satu juta penduduk tetapi hanya mengakibatkan enam belas kematian. Wabak teruk demam denggi biasanya berlaku setiap lima atau enam tahun. Terdapat kecenderungan bahawa sebahagian besar penduduk mudah dijangkiti walaupun berlaku wabak

sebelumnya kerana terdapat empat jenis virus denggi dan mereka yang baru memasuki penduduk sasaran, samaada melalui kelahiran atau immigrasi. Penyakit Demam Denggi mula dilaporkan di Malaysia pada tahun 1902 lagi. Pada tahun 1962, wabak pertama demam denggi berdarah berlaku di Georgetown, Pulau Pinang dan Kuala Lumpur pada tahun 1973. Semenjak itu, penyakit demam denggi dan demam denggi berdarah telah dikesan berlaku di seluruh negara. Semenjak penyakit demam denggi mula dikesan, ia telah menunjukkan peningkatan yang seiring dengan pertambahan kawasan bandar, pembangunan dan peningkatan kepadatan penduduk. Pada tahun 1991, sebanyak 6628 kes demam denggi dilaporkan di seluruh Malaysia. Pada tahun 1998, sebanyak 27,373 kes demam denggi dilaporkan iaitu peningkatan sebanyak 4 kali ganda dari tahun 1991. Di Singapura, terdapat 4-5000 kes dilaporkan berkaitan dengan demam denggi atau demam denggi berdarah setiap tahun. Pada tahun 2003, terdapat 6 kematian disebabkan sindrom kejutan denggi. Ia dipercayai bahawa kes demam denggi yang dilapurkan adalah rendah kerana ia tidak mengendahkan kes subklinikal dan kes di mana pesakit tidak hadir untuk rawatan perubatan. Kadar kematian disebabkan denggi oleh itu dianggarkan kurang daripada 1 dari 1000 kes.

[sunting] Pencegahan
Pada masa kini tidak terdapat vaksin siap untuk demam denggi flavivirus. Cara mencegah denggi yang utama adalah menghapuskan atau mengurangkan vektor nyamuk pembawa denggi. Langkah menghapuskan takungan air (seperti dalam bekas bunga) terbukti berkesan bagi mengawal penyakit bawaan nyamuk. Pengunaan ubat jentik-jentik juga berkesan untuk menghapuskan jentik-jentik, manakala penggunaan kelambu dan juga semburan (fogging) juga boleh membantu.

[sunting] Wabak terkini


Di Asia Tenggara:

Indonesia (2006): 114,656 kes dilaporkan dengan 1,196 kes kematian. Malaysia (2006): 34,386 kes dikesan dengan 70 kematian. Thailand (2006): 20,000 dijangkiti dengan 23 kematian. Filipina (2006): 16,929 kes dengan 324 kematian. Singapura (2006): 3,051 kes dikesan. Thailand (2006): 20,00 kes dikesan dan 23 kematian. Myanmar (2006): 11,383 kes dikesan dan 128 kematian. Vietnam (2006): 77,800 kes dikesan dan 68 kematian.

[sunting] Mengenal pasti demam denggi


Demam denggi adalah sejenis penyakit berjangkit berbahaya yang disebabkan oleh virus denggi dan dibawa oleh nyamuk aedes.

Pada masa ini, tiada ubat khusus untuk merawat penyakit itu kecuali aktiviti pencegahan adalah amat penting. Antara tanda-tanda demam denggi ialah:
1. 2. 3. 4. 5. 6. 7. 8. 9. Demam kuat yang mengejut dan berterusan Bintik merah pada kulit Sakit teruk pada tulang-tulang, otot-otot, sendi-sendi, biji mata dan kepala Berdarah pada badan, hidung dan mulut Hilang selera makan Muntah-muntah Sakit perut rasa pahit pada lidah lemah dan tidak bermaya

[sunting] Bagaimana demam denggi berjangkit


1. 2. 3. 4. Nyamuk aedes membawa kuman deman denggi Seorang yang sihat digigit oleh nyamuk aedes Pesakit demam denggi mengandungi kuman denggi di dalam badannya. Nyamuk aedes menggigit pesakit denggi

KKM
Demam Denggi
Pengenalan Demam denggi adalah sejenis penyakit jangkitan virus yang merebak melalui gigitan nyamuk Aedes aegypti yang telah dijangkiti. Terdapat empat (4) jenis virus yang boleh menyebabkan demam denggi (DEN 1, DEN 2, DEN 3 dan DEN 4) Jangkitan oleh salah satu jenis virus akan memberikan imuniti terhadap virus jenis itu sahaja, jika individu tinggal di kawasan jangkitan denggi, mereka boleh di jangkiti lebih dari sekali seumur hidupnya. Lebih 100 negara di Asia selatan, Asia Tenggara, Afrika, Amerika Timur Mediterranean dan Pasifik Barat mengalami masalah denggi. Tanda-tanda dan gejala

Kebiasaannya demam akan terjadi pada hari ke tiga (3) hingga ke empat belas (14) selepas digigit oleh nyamuk yang dijangkiti, kebiasaannya di antara 4 hingga 7 hari. Selalunya ia akan bermula dengan demam kuat yang mengejut, , sakit kepala yang teruk/kuat, sakit pada bahagian belakang mata serta otot-otot dan sendi-sendi. Ruam merah di kulit juga boleh terjadi. Demam ini boleh mencapai suhu 40 - 41 C, dan selalunya akan berlarutan selama 2 hingga 7 hari. Ia juga boleh menyebabkan serangan sawan di kalangan kanak-kanak di bawah umur 6 tahun. Sakit teruk pada tulang-tulang, otot-otot dan sendi-sendi. Demam denggi ini juga dikenali sebagai "breakbone fever". Ruam selalunya akan tumbuh pada hari ke 3 dan 4 selepas bermulanya demam. Muntah dan kurang selera makan.

Pemastian Diagnosa Penyakit Antibodi akan dikesan di dalam darah (Dengue IgM) (Antibodi yang dihasilkan oleh sistem pertahanan badan untuk melawan jangkitan). Ujian PCR (kaedah mengesan genetik virus) boleh mengesan virus denggi di dalam darah dan nyamuk. Rawatan

Segera berjumpa dengan doktor kerana tiada ubat yang khusus untuk merawat demam denggi Rehat dan banyakkan minum air masak. Ubat paracetamol boleh diambil untuk menurunkan demam dan mengurangkan kesakitan Elakkan ubat aspirin bagi kanak-kanak di bawah umur 12 tahun

Demam Denggi Berdarah Merupakan Demam Denggi yang teruk disebabkan oleh jangkitan virus denggi. Kebiasaan tanda sakit adalah sama dengan demam denggi. Pesakit akan menjadi teruk disebabkan oleh radangan di salur darah. Tanda-tanda yang biasa termasuklah muntah, pitam dan sakit di bahagian abdomen. Salur darah di dalam badan boleh mengalami kebocoran dan menyebabkan isi padu darah berkurangan. Ini boleh menyebabkan pesakit mengalami renjatan (shock) dan akhirnya boleh menyebabkan kematian. Tiada ubatan yang khusus untuk merawat demam denggi. Pesakit perlu dimasukkan ke wad bagi rawatan demam denggi berdarah. Rawatan awal boleh mengelakkan kematian dengan kadar kurang daripada 1%. Pesakit akan diberikan rehidrasi untuk memastikan beliau tidak mengalami renjatan. Faktor Penyumbang Intravena:

Pembangunan yang pesat di bandar-bandar terutama di Negara Tropika menyebabkan kepadatan penduduk tinggi dan tapak binaan yang banyak Peningkatan penggunaan bahan plastik dan pembuangan tayar lama boleh menyebabkan pembiakan nyamuk yang baru Pergerakan manusia dari satu tempat ke tempat yang lain menyebabkan penularan berlaku dengan cepat

Pencegahan Pada masa sekarang tiada vaksin untuk mengubati demam denggi. Walau bagaimanapun usahausaha sedang dijalankan untuk menghasilkan vaksin tersebut. Elakkan gigitan nyamuk dengan:
Gunakan ubat nyamuk Gunakan kelambu semasa tidur. Gunakan ?repellent? jika perlu Elakkan aktiviti semasa nyamuk aktif menggigit (5.30 pagi ? 8.00 pagi dan 5.30 petang-8.00 malam) Pakai pakaian berlengan panjang dan seluar panjang bila keluar rumah Pasang jaring halus (mosquito mesh) di tingkap dan pintu Menghapuskan tempat-tempat pembiakan nyamuk: Menghapuskan tempat pembiakan nyamuk di sekeliling rumah. Musnahkan semua bekas yang boleh menakung air hujan atau lebihan air, terutamanya di besin, tayar lama, bekas bunga, bekas plastik dan tong. Jika tidak boleh dimusnahkan, letakkan bahan pembunuh jentik-jentik di bekas tersebut Kerap tukar air di bekas minuman haiwan peliharaan

Mungkin masih ramai yang tidak mengetahui lebih mendalam tentang penyakit ini. Penyakit denggi merupakan penyakit berjangkit yang berbahaya dan boleh membawa maut kerana sehingga hari ini belum ada ubat atau penawar untuk mengubati penyakit ini. Denggi boleh terjadi di kalangan orang dewasa dan kanak-kanak akibat daripada gigitan nyamuk aedes. Penyakit ini biasanya berlangsung selama sepuluh hari dan kadangkala mengambil masa lama untuk pulih sepenuhnya. Penyakit ini kerap berlaku di kawasan bandar berbanding dengan luar bandar. Penyakit denggi disebabkan oleh sejenis kuman virus yang dipanggil virus denggi. Virus ini tergolong di dalam keluarga togaviridae. Ia merupakan virus yang berkembang biak dalam serangga. Terdapat 4 jenis serotype virus yang telah dikenalpasti iaitu den 1, den 2, den 3 dan den 4. Semua jenis serotype ini boleh merangsang pembentukan antibodi yang berbeza-beza.

Namun begitu, kekebalan yang dihasilkan oleh pertahanan badan tidak menyeluruh terhadap semua jenis virus denggi. Ia akan hanya melindungi individu untuk jenis virus tersebut sahaja. Virus ini masuk ke dalam peredaran darah manusia melalui gigitan nyamuk aedes dan boleh didapati dalam tempoh yang singkat sahaja iaitu 4-5 hari pada tahap awal penyakit. Nyamuk aedes merupakan pembawa bagi kuman virus denggi. Gigitan nyamuk merupakan satu cara penyebaran virus denggi dari seorang ke seorang yang lain. Daripada satu gigitan ia boleh menghisap darah sebanyak dua hingga empat miligram darah iaitu 1.5 kali berat badannya. Nyamuk aedes ini boleh dikenali dengan tanda belang hitam dan putih di kaki.Terdapat dua jenis nyamuk aedes yang membawa virus denggi iaitu: 1. Aedes aegypti. Ciri-ciri nyamuk ini ialah tanda putih-perak bentuk kecapi di kepala. Nyamuk aedes aegypti berterbangan di sekitar rumah dan tinggal di tempat-tempat gelap di dalam rumah. Ia bertelur dan berkembang biak di dalam bekas buatan di dalam dan di luar rumah. 2. Aedes albopictus. Ciri-ciri nyamuk ini pula ialah terdapat garisan putih-perak disepanjang pertengahan kepala dan badan. Nyamuk albopictus pula terdapat di kawasan perumahan di bandar, kebun dan juga di hutan. Ia biasa terdapat di luar rumah pada tumbuh-tumbuhan dan menggigit manusia di luar rumah. Kadang-kadang ia memasuki rumah untuk menggigit manusia. Disamping bekas buatan nyamuk ini juga boleh berkembang biak dalam berbagai-bagai bekas alamiah seperti lubang pada pokok, tunggul pokok, buluh, ketiak daun seperti daun pandan dan nenas dan tempat air bertakung. Jarak terbang kedua-dua jenis nyamuk ini biasanya tidak melebihi 350 meter. Cara jangkitan: Manusia dijangkiti kuman virus denggi melalui gigitan nyamuk. Virus denggi ini hidup dan berkembang biak di dalam air liur nyamuk. Ia memerlukan masa pengeraman selama lapan hingga sepuluh hari untuk berkembang biak dan terkumpul di dalam air liur nyamuk. Nyamuk yang telah dijangkiti akan terus membawa virus denggi sepanjang hidupnya. Apabila nyamuk aedes betina menggigit manusia atau haiwan ia akan memasukkan sekali virus denggi yang ada terdapat dalam air liurnya ke dalam sistem aliran darah manusia. Apabila nyamuk aedes betina menghisap darah manusia yang mengandungi virus denggi ia akan melengkapi kitaran hidup virus tersebut dan menyebarkan kepada orang lain. Penularan virus denggi boleh juga terjadi apabila nyamuk aedes betina sedang menghisap darah orang yang dijangkiti virus denggi diganggu dan nyamuk itu dengan segera menggigit orang lain pula. Ini akan menyebabkan virus yang terdapat dalam belalai nyamuk tersebut akan masuk ke dalam peredaran darah orang kedua tanpa memerlukan masa pengeraman. Cara ini dipanggil penularan mekanikal. Selain itu, jangkitan virus denggi boleh juga berlaku melalui penularan transovari di mana ia merupakan suatu proses penularan agen penyakit daripada serangga betina melalui telur, jentik-

jentik hingga kepada serangga dewasa generasi berikutnya. Penularan transovari sangat penting bagi virus denggi kerana proses ini membolehkan virus tersebut berkekalan di persekitaran. Melalui proses penularan ini nyamuk bukan sahaja berperanan sebagai agen pembawa tetapi juga sebagai perumah kepada agen penyakit. Tempat pembiakan: Nyamuk aedes membiak di dalam takungan air jernih sama ada di dalam dan luar rumah tetapi tidak boleh membiak di dalam air yang kotor. Bahagian dalam rumah ia dapat membiak di piring alas pasu bunga, tadahan air seperti kolah mandi, tempayan atau baldi dan perangkap semut. Manakala di luar rumah seperti di dalam tayar buruk, saluran air hujan, tin-tin kosong, kawasan pembinaan, cawan getah, lubang pokok, tungguk buluh, ketiak daun seperti, daun pandan dan nanas. Terdapat dua jenis penyakit denggi iaitu: i) Demam denggi klasikal. Pesakit menunjukkan gejala demam, ruam, sakit badan, sakit sendi dan sakit otot. Gejala penyakit ini biasanya tidak teruk dan jarang menyebabkan kematian. Demam jenis ini juga pernah dinamakan demam patah tulang atau breakbone fever. ii) Demam denggi berdarah. Biasanya terjadi di kalangan kanak-kanak terutama dalam lingkungan umur 2-13 tahun. Pada tahap awal (selama 2-4 hari) gejala yang dihidapi adalah sama seperti demam denggi klasikal dan diikuti oleh tahap yang lebih teruk dengan gejala seperti tekanan darah rendah, ruam dan bintik-bintik merah di badan, perdarahan gusi, berak berdarah (najis berwarna hitam) disertai dengan sawan dan tidak sedar diri. Ia sering menyebabkan kematian jika rawatan tidak diberikan dengan segera. Ia juga dipanggil sebagai demam berdarah Filipina. Tanda-tanda atau gejala: 1. Demam denggi klasikal Tanda-tanda demam denggi ini bergantung kepada usia pesakit tersebut. Bagi bayi atau kanakkanak ciri utama ialah ruam yang disertai oleh demam panas. Manakala orang dewasa dan remaja pula demam kuat yang muncul dengan tiba-tiba yang berlangsung selama 2-7 hari, sakit kepala, sakit di belakang mata, sakit otot dan sendi yang diikuti oleh ruam yang timbul pada hari ketiga hingga keempat. Bintik-bintik merah di bawah kulit juga boleh didapati. Dan hasil daripada ujian makmal menunjukkan jumlah leukosit dan platlet dalam darah menurun. 2. Demam denggi berdarah Demam denggi berdarah mempunyai 4 ciri klinikal utama seperti demam yang sangat panas, perdarahan, pembesaran hati dan kegagalan sistem peredaran darah. Perdarahan yang berlaku

adalah seperti bintik-bintik merah di bawah kulit, perdarahan hidung, gusi, darah dalam najis(najis berwarna hitam), kencing berdarah dan kadang kala mendapat haid yang berlebihan. Pembesaran hati terjadi pada peringkat awal penyakit. Pembesaran hati ini boleh mencapai dua hingga empat sentimeter di bawah tulang rusuk kanan. Kegagalan atau gangguan peredaran ditunjukkan melalui tanda-tanda seperti kesejukan dan kongesti kulit, kebiruan dan peningkatan kadar nadi. Mereka juga kelihatan resah dan lemah dan kemudian dengan cepat mengalami renjatan atau sawan. Keadaan ini juga dipanggil sebagai Dengue Shock Syndrome (DSS). Setakat ini tiada rawatan yang spesifik bagi membunuh virus denggi. Namun begitu antara rawatan yang biasa dilakukan untuk membantu pesakit deman denggi ialah: Rawatan demam denggi klasikal: Rawatan yang diberi adalah untuk menstabilkan pesakit bergantung kepada keadaan pesakit iaitu mengurangkan demam(suhu badan) dan mengelakkan dari perdarahan berlaku. Rawatan demam denggi berdarah: Demam yang sangat panas, kehilangan selera makan dan muntah menyebabkan dehidrasi. Pesakit digalakkan supaya minum air lebih banyak. Demam yang sangat panas juga meningkatkan risiko terjadinya sawan, oleh itu demam patut dikawal dengan antipiretik. Selain itu, pesakit akan diawasi supaya gejala perdarahan dan sawan dapat dikesan awal. Dan masa yang paling genting ialah pada hari ketiga hingga hari ketujuh. Maka pemberian aliran intravena perlu jika sekiranya kiraan hematokrit meningkat kerana ini menggambarkan darjah kehilangan plasma. Oleh hal yang demikian, orang ramai perlu lebih peka terhadap kawasan sekitar tempat tinggal mereka agar nyamuk ini tidak dapat membiak dengan membersihkan kawasan rumah dan membuang segala sampah sarap yang mungkin menjadi sarang nyamuk ini melakukan proses pembiakkan malah pihak berkuasa juga perlu memastikan setiap premis bebas daripada denggi.

Dengue Fever
Definition
Dengue fever is a disease caused by one of a number of viruses that are carried by mosquitoes. These mosquitoes then transmit the virus to humans.

Description
The virus that causes dengue fever is called an arbovirus, which stands for arthropod-borne virus. Mosquitoes are a type of arthropod. In a number of regions, mosquitoes carry this virus and are responsible for passing it along to humans. These regions include the Middle East, the far East, Africa, and the Caribbean Islands. In these locations, the dengue fever arbovirus is endemic, meaning that the virus naturally and consistently lives in that location. The disease only shows up in the United States sporadically. In order to understand how dengue fever is transmitted, several terms need to be defined. The word "host" means an animal (including a human) that can be infected with a particular disease. The word "vector" means an organism that can carry a particular disease-causing agent (like a virus or bacteria) without actually developing the disease. The vector can then pass the virus or bacteria on to a new host. Many of the common illnesses in the United States (including the common cold, many viral causes of diarrhea, and influenza or "flu") are spread because the viruses that cause these illness can be passed directly from person to person. However, dengue fever cannot be passed directly from one infected person to another. Instead, the virus responsible for dengue fever requires an intermediate vector, a mosquito, that carries the virus from one host to another. The mosquito that carries the arbovirus responsible for dengue fever is the same type of mosquito that can transmit other diseases, including yellow fever. This mosquito is called Aedes egypti. The most common victims are children younger than 10 years of age.

Causes and symptoms


Dengue fever can occur when a mosquito carrying the arbovirus bites a human, passing the virus on to the new host. Once in the body, the virus travels to various glands where it multiplies. The virus can then enter the bloodstream. The presence of the virus within the blood vessels, especially those feeding the skin, causes changes to these blood vessels. The vessels swell and leak. The spleen and lymph nodes become enlarged, and patches of liver tissue die. A process called disseminated intravascular coagulation (DIC) occurs, where chemicals responsible for clotting are used up and lead to a risk of severe bleeding (hemorrhage). After the virus has been transmitted to the human host, a period of incubation occurs. During this time (lasting about five to eight days) the virus multiplies. Symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints. This initial period of illness lasts about two or three days. After this time, the fever drops rapidly and the patient sweats heavily. After about a day of feeling relatively well, the patient's temperature increases again, although not as much as the first time. A rash of small red bumps begins on the arms and legs, spreading to the chest, abdomen, and back. It rarely affects the face. The palms of the hands and the soles of the feet become swollen and turn bright red. The characteristic combination of fever, rash, and headache are called the "dengue triad." Most people recover fully from dengue fever, although weakness and fatigue may last for several

weeks. Once a person has been infected with dengue fever, his or her immune system keeps producing cells that prevent reinfection for about a year. More severe illness may occur in some people. These people may be experiencing dengue fever for the first time. However, in some cases a person may have already had dengue fever at one time, recovered, and then is reinfected with the virus. In these cases, the first infection teaches the immune system to recognize the presence of the arbovirus. When the immune cells encounter the virus during later infections, the immune system over-reacts. These types of illnesses, called dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), involve more severe symptoms. Fever and headache are the first symptoms, but the other initial symptoms of dengue fever are absent. The patient develops a cough, followed by the appearance of small purplish spots (petechiae) on the skin. These petechiae are areas where blood is leaking out of the vessels. Large bruised areas appear as the bleeding worsens and abdominal pain may be severe. The patient may begin to vomit a substance that looks like coffee grounds. This is actually a sign of bleeding into the stomach. As the blood vessels become more damaged, they leak more and continue to increase in diameter (dilate), causing a decrease in blood flow to all tissues of the body. This state of low blood flow is called shock. Shock can result in damage to the body's organs (especially the heart and kidneys) because low blood flow deprives them of oxygen.

Diagnosis
Diagnosis should be suspected in endemic areas whenever a high fever goes on for two to seven days, especially if accompanied by a bleeding tendency. Symptoms of shock should suggest the progression of the disease to DSS. The arbovirus causing dengue fever is one of the few types of arbovirus that can be isolated from the serum of the blood. The serum is the fluid in which blood cells are suspended. Serum can be tested because the phase in which the virus travels throughout the bloodstream is longer in dengue fever than in other arboviral infections. A number of tests are used to look for reactions between the patient's serum and laboratory-produced antibodies. Antibodies are special cells that recognize the markers (or antigens) present on invading organisms. During these tests, antibodies are added to a sample of the patient's serum. Healthcare workers then look for reactions that would only occur if viral antigens were present in that serum.

Treatment
There is no treatment available to shorten the course of dengue fever, DHF, or DSS. Medications can be given to lower the fever and to decrease the pain of muscle aches and headaches. Fluids are given through a needle in a vein to prevent dehydration. Blood transfusions may be necessary if severe hemorrhaging occurs. Oxygen should be administered to patients in shock.

Prognosis
The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients fully recover. However, as many as 6-30% of all patients die when DHF occurs. The death rate is especially high among the youngest patients (under one year old). In places where excellent

medical care is available, very close monitoring and immediate treatment of complications lowers the death rate among DHF and DSS patients to about 1%.

Prevention
Prevention of dengue fever means decreasing the mosquito population. Any sources of standing water (buckets, vases, etc.) where the mosquitoes can breed must be eliminated. Mosquito repellant is recommended for those areas where dengue fever is endemic. To help break the cycle of transmission, sick patients should be placed in bed nets so that mosquitoes cannot bite them and become arboviral vectors.

6
Dengue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic morbilliform skin rash. In a small proportion of cases the disease develops to the life-threatening dengue hemorrhagic fever (bleeding, low levels of blood platelets and blood plasma leakage) and dengue shock syndrome (circulatory failure). Dengue is transmitted by several species of mosquito within the Aedes genus, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type is believed to increase the risk of severe complications. As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites. Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. The incidence of dengue fever has increased dramatically over the last 50 years, with around 50100 million people infected yearly. Dengue is currently endemic in more than 110 countries. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a worldwide problem since the Second World War.

Signs and symptoms


People infected with dengue virus are commonly asymptomatic or only have mild symptoms such as an uncomplicated fever. Others have more severe illness, and in a small proportion it is life-threatening. The incubation period (time between exposure and onset of symptoms) ranges from 314 days, but most often it is 47 days. This means that travellers returning from endemic areas are unlikely to have dengue if fever or other symptoms start more than 14 days after arriving home. Children often experience symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea), but are more susceptible to the severe complications.

Clinical course
The characteristic symptoms of dengue are: a sudden-onset fever, headache (typically behind the eyes), muscle and joint pains, and a rash. The alternative name for dengue, "break-bone fever", comes from the associated muscle and joints pains. The course of infection is divided into three phases: febrile, critical, and recovery. The febrile phase involves high fevers, frequently over 40 C (104 F) and is associated with generalized pain and a headache; this usually lasts two to seven days. Flushed skin and some small red spots called petechiae, which are caused by broken capillaries, may occur at this point, as may some mild bleeding from mucous membranes of the mouth and nose. The critical phase, if it occurs, follows the resolution of the high fever and typically lasts one to two days. During this phase there may be significant fluid accumulation in the chest and abdominal cavity due to increased capillary permeability and leakage. This leads to depletion of fluid from the circulation and decreased blood supply to vital organs. During this phase, organ dysfunction and severe bleeding (typically from the gastrointestinal tract) may occur. Shock and hemorrhage occur in less than 5% of all cases of dengue, however those who have previously been infected with other serotypes of dengue virus ("secondary infection") have an increased risk. The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream. This usually lasts two to three days. The improvement is often striking, but there may be severe itching and a slow heart rate. It is during this stage that a fluid overload state may occur, which if it affects the brain may reduce the level of consciousness or cause seizures.

Associated problems
Dengue may occasionally affect several other body systems. This may be either in isolation or along with the classic dengue symptoms. A decreased level of consciousness occurs in 0.56% of severe cases. This may be caused by infection of the brain by the virus or indirectly due to impairment of vital organs, for

example, the liver. Other neurological disorders have been reported in the context of dengue, such as transverse myelitis and Guillain-Barr syndrome. Infection of the heart and acute liver failure are among the rarer complications of dengue.

Virology

Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus Flavivirus. Other members of the same family include yellow fever virus, West Nile virus, St. Louis encephalitis virus, Japanese encephalitis virus, tick-borne encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus. Most are transmitted by arthropods (mosquitoes or ticks), and are therefore also referred to as arboviruses (arthropod-borne viruses). The dengue virus genome (genetic material) contains about 11,000 nucleotide bases, which code for the three different types of protein molecules that form the virus particle (C, prM and E) and seven other types of protein molecules (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5) that are only found in infected host cells and are required for replication of the virus. There are four strains of the virus, which are called serotypes, and these are referred to as DENV-1, DENV-2, DENV-3 and DENV-4. All four serotypes can cause the full spectrum of disease. Infection with one serotype is believed to produce lifelong immunity to that serotype but only short term protection against the others. The severe complications on secondary infection seem to occur particularly if someone previously exposed to serotype DENV-1 then contracts serotype DENV-2 or serotype DENV-3, or if someone previously exposed to type DENV-3 then acquires DENV-2.

Transmission

Dengue virus is primarily transmitted by Aedes mosquitoes, particularly A. aegypti. These mosquitoes usually live between the latitudes of 35 North and 35 South below an elevation of 1000 metres (3,280.8 ft). They bite primarily during the day. Other mosquito speciesAedes albopictus, A. polynesiensis and several A. scutellarismay also transmit the disease. Humans are the primary host of the virus, but it may also circulate in nonhuman primates. An infection may be acquired via a single bite. A mosquito that takes a blood meal from a person infected with dengue fever becomes itself infected with the virus in the cells lining its gut. About 810 days later, the virus spreads to other tissues including the mosquito's salivary glands and is subsequently released into its saliva. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Aedes aegypti prefers to lay its eggs in artificial water containers and tends to live in close proximity to humans, and prefers to feed off people rather than other vertebrates. Dengue may also be transmitted via infected blood products and through organ donation. In countries such as Singapore, where dengue is endemic, the risk is estimated to be between 1.6 and 6 per 10,000 transfusions. Vertical transmission (from mother to child) during pregnancy or at birth has been observed. Other person-to-person modes of transmission have been reported, but are very unusual.

Predisposition
Severe disease is more common in babies and young children, and in contrast to many other infections it is more common in children that are relatively well nourished. Women are more at risk than men. Dengue may be life-threatening in people with chronic diseases such as diabetes and asthma. It is thought that polymorphisms (normal variations) in particular genes may increase the risk of severe dengue complications. Examples include the genes coding for the proteins known as TNF, mannanbinding lectin, CTLA4, TGF, DC-SIGN, and particular forms of human leukocyte antigen. A common genetic abnormality in Africans, known as glucose-6-phosphate dehydrogenase deficiency, appears to increase the risk. Polymorphisms in the genes for the vitamin D receptor and FcR seem to offer protection.

Mechanism
When a mosquito carrying DENV bites a person, the virus enters the skin together with the mosquito's saliva. It binds to and enters white blood cells, and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing a number of signalling proteins (such as interferon) that are responsible for many of the symptoms, such as the fever, the flu-like symptoms and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow) can be affected, and fluid from the bloodstream leaks through the wall of small blood vessels into body cavities. As a result, less blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue.

Viral reproduction
After entering the skin, DENV binds to Langerhans cells (a population of dendritic cells in the skin that identifies pathogens). The virus enters the cells through binding between viral proteins and membrane proteins on the Langerhans cell, specifically the C-type lectins called DC-SIGN, mannose receptor and CLEC5A. DC-SIGN, a non-specific receptor for foreign material on dendritic cells, seems to be the main one. The dendritic cell moves to the nearest lymph node. Meanwhile, the virus genome is replicated in membrane-bound vesicles on the cell's endoplasmic reticulum, where the cell's protein synthesis apparatus produces new viral proteins, and the viral RNA is copied. Immature virus particles are transported to the Golgi apparatus, the part of the cell where the some of the proteins receive necessary sugar chains (glycoproteins). The now mature new viruses bud on the surface of the infected cell and are released by exocytosis. They are then able enter other white blood cells (such as monocytes and macrophages). The initial reaction of infected cells is to produce the interferon, a cytokine that raises a number of defenses against viral infection through the innate immune system by augmenting the production of a large group of proteins (mediated by the JAK-STAT pathway). Some serotypes of DENV appear to have mechanisms to slow down this process. Interferon also activates the adaptive immune system, which leads to the generation of antibodies against the virus as well as T cells that directly attack any cell infected with the virus. Various antibodies are generated; some bind closely to the viral proteins and target them for phagocytosis (ingestion by specialized cells) and destruction, but some bind the virus less well and appear instead to deliver the virus into a part of the phagocytes where it is not destroyed but is able to replicate further.

Severe disease

It is not entirely clear why secondary infection with a different strain of DENV places people at risk of dengue hemorrhagic fever and dengue shock syndrome. The most widely accepted hypothesis is that of antibody-dependent enhancement (ADE). The exact mechanism behind ADE is unclear. It may be caused by poor binding of non-neutralizing antibodies and delivery into the wrong compartment of white blood cells that have ingested the virus for destruction. There is a suspicion that ADE is not the only mechanism underlying severe dengue-related complications, and various lines of research have implied a role for T cells and soluble factors (such as cytokines and the complement system). Severe disease is marked by two problems: dysfunction of endothelium (the cells that line blood vessels) and disordered blood clotting. Endothelial dysfunction leads to the leakage of fluid from the blood vessels into the chest and abdominal cavities, while coagulation disorder is responsible for the bleeding complications. Higher levels of virus in the blood and involvement of other organs (such as the bone marrow and the liver) are associated with more severe disease. Cells in the affected organs die, leading to the release of cytokines and activation of both coagulation and fibrinolysis (the opposing systems of blood clotting and clot degradation). These alterations together lead to both endothelial dysfunction and coagulation disorder.

General
Abdominal pain Ongoing vomiting Liver enlargement Mucosal bleeding High hematocrit with low platelets Lethargy

The diagnosis of dengue is typically made clinically, on the basis of reported symptoms and physical examination; this applies especially in endemic areas. Early disease can however be difficult to differentiate from other viral infections. A probable diagnosis is based on the findings of fever plus two of the following: nausea and vomiting, rash, generalized pains, low white blood cell count, positive tourniquet test, or any warning sign (see table) in someone who lives in an endemic area. Warning signs typically occur before the onset of severe dengue. The tourniquet test, which is particularly useful in settings where no laboratory investigations are readily available, involves the application of a blood

pressure cuff for five minutes, followed by the counting of any petechial hemorrhages; a higher number makes a diagnosis of dengue more likely. It may be difficult to distinguish dengue fever and chikungunya, a similar viral infection that shares many symptoms and occurs in similar parts of the world to dengue. Often, investigations are performed to exclude other conditions that cause similar symptoms, such as malaria, leptospirosis, typhoid fever, and meningococcal disease. The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis. In severe disease, plasma leakage may result in hemoconcentration (as indicated by a rising hematocrit) and hypoalbuminemia. Pleural effusions or ascites may be detected by physical examination when large, but the demonstration of fluid on ultrasound may assist in the early identification of dengue shock syndrome. The use of ultrasound is limited by lack of availability in many settings.

Classification
The World Health Organization's 2009 classification divides dengue fever into two groups: uncomplicated and severe. This replaces the 1997 WHO classification, which needed to be simplified as it had been found to be too restrictive, but the older classification is still widely used. The 1997 classification divided dengue into undifferentiated fever, dengue fever, and dengue hemorrhagic fever. Dengue hemorrhagic fever was subdivided further into four grades (grade IIV). Grade I is the presence only of easy bruising or a positive "tourniquet test" (see below) in someone with fever, grade II is the presence of spontaneous bleeding into the skin and elsewhere, grade III is the clinical evidence of shock, and grade IV is shock so severe that blood pressure and pulse cannot be detected. Grades III and IV are referred to as "dengue shock syndrome".

Virology and serology


Dengue fever may also be diagnosed by microbiological laboratory testing. This can be done by virus isolation in cell cultures, nucleic acid detection by PCR, viral antigen detection or specific antibodies (serology). Virus isolation and nucleic acid detection are more accurate than antigen detection, but these tests are not widely available due to their greater cost. All tests may be negative in the early stages of the disease. Apart from serology, laboratory tests are only of diagnostic value during the acute phase of the illness. Tests for dengue virus-specific antibodies, types IgG and IgM, can be useful in confirming a diagnosis in the later stages of the infection. Both IgG and IgM are produced after 57 days. The highest levels (titres) of IgM are detected following a primary infection, but IgM is also produced in secondary and tertiary infections. The IgM becomes undetectable 3090 days after a primary infection, but earlier following re-infections. IgG, by contrast, remains detectable for over 60 years and, in the absence of symptoms, is a useful indicator of past infection. After a primary infection the IgG reaches peak levels in

the blood after 1421 days. In subsequent re-infections, levels peak earlier and the titres are usually higher. Both IgG and IgM provide protective immunity to the infecting serotype of the virus. In the laboratory test the IgG and the IgM antibodies can cross-react with other flaviviruses, such as yellow fever virus, which can make the interpretation of the serology difficult. The detection of IgG alone is not considered diagnostic unless blood samples are collected 14 days apart and a greater than fourfold increase in levels of specific IgG is detected. In a person with symptoms, the detection of IgM is considered diagnostic.

Prevention

There are currently no approved vaccines for the dengue virus. Prevention thus depends on control of and protection from the bites of the mosquito that transmits it. The World Health Organization recommends an Integrated Vector Control program consisting of five elements: (1) Advocacy, social mobilization and legislation to ensure that public health bodies and communities are strengthened, (2) collaboration between the health and other sectors (public and private), (3) an integrated approach to disease control to maximize use of resources, (4) evidence-based decision making to ensure any interventions are targeted appropriately and (5) capacity-building to ensure an adequate response to the local situation. The primary method of controlling A. aegypti is by eliminating its habitats. This may be done by emptying containers of water or by adding insecticides or biological control agents to these areas. Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effect from insecticides and greater logistical difficulties with control agents. People may prevent mosquito bites by wearing clothing that fully covers the skin and/or the application of insect repellent (DEET being the most effective).

Management
There are no specific treatments for the dengue fever virus. Treatment depends on the symptoms, varying from oral rehydration therapy at home with close follow-up, to hospital admission with administration of intravenous fluids and/or blood transfusion. A decision for hospital admission is typically based on the presence of the "warning signs" listed in the table above, especially in those with preexisting health conditions.

Intravenous hydration is usually only needed for one or two days. The rate of fluid administration is titrated to a urinary output of 0.51 mL/kg/hr, stable vital signs and normalization of hematocrit. Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial punctures are avoided, in view of the bleeding risk. Acetaminophen may be used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding. Blood transfusion is initiated early in patients presenting with unstable vital signs in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined "transfusion trigger" level. Packed red blood cells or whole blood are recommended, while platelets and fresh frozen plasma are usually not. During the recovery phase intravenous fluids are discontinued to prevent a state of fluid overload. If fluid overload occurs and vital signs are stable, stopping further fluid may be all that is needed. If a person is outside of the critical phase, a loop diuretic such as furosemide may be used to eliminate excess fluid from the circulation.

Epidemiology

Most people with dengue recover without any ongoing problems. The mortality is 15% without treatment, and less than 1% with adequate treatment. Severe disease carries a mortality of 26%. Dengue is believed to infect 50 to 100 million people worldwide a year with half a million lifethreatening infections requiring hospitalization, resulting in approximately 12,50025,000 deaths. The burden of disease from dengue is estimated to be similar to other childhood and tropical diseases, such as tuberculosis, at 1600 disability-adjusted life years per million population. It is the most common viral disease transmitted by arthropods. As a tropical disease it is deemed only second in importance to malaria. It is endemic in more than 110 countries. The World Health Organization counts dengue as one of sixteen neglected tropical diseases. The incidence of dengue increased 30 fold between 1960 and 2010. This increase is believed to be due to a combination of urbanization, population growth, increased international travel, and global warming. The geographical distribution is around the equator with 70% of the total 2.5 billion people living in endemic areas from Asia and the Pacific. In the United States, the rate of dengue infection among those who return from an endemic area with a fever is 2.98.0%, and it is the second most

common infection after malaria to be diagnosed in this group. Until 2003, dengue was classified as a potential bioterrorism agent, but subsequent reports removed this classification as it was deemed too difficult to transfer and only caused hemorrhagic fever in a relatively small proportion of people.

Etymology
The origins of the word "dengue" are not clear, but one theory is that it is derived from the Swahili phrase Ka-dinga pepo, which describes the disease as being caused by an evil spirit. The Swahili word dinga may possibly have its origin in the Spanish word dengue, meaning fastidious or careful, which would describe the gait of a person suffering the bone pain of dengue fever. However, it is possible that the use of the Spanish word derived from the similar-sounding Swahili. Slaves in the West Indies having contracted dengue were said to have the posture and gait of a dandy, and the disease was known as "dandy fever". The term "break-bone fever" was first applied by physician and Founding Father Benjamin Rush, in a 1789 report of the 1780 epidemic in Philadelphia. In the report he uses primarily the more formal term "bilious remitting fever". The term dengue fever came into general use only after 1828. Other historical terms include "breakheart fever" and "la dengue". Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever".

Discovery
The first record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (265420 AD) which referred to a "water poison" associated with flying insects. There have been descriptions of epidemics in the 17th century, but the most plausible early reports of dengue epidemics are from 1779 and 1780, when an epidemic swept Asia, Africa and North America. From that time until 1940, epidemics were infrequent. In 1906, transmission by the Aedes mosquitoes was confirmed, and in 1907 dengue was the second disease (after yellow fever) that was shown to be caused by a virus. Further investigations by John Burton Cleland and Joseph Franklin Siler completed the basic understanding of dengue transmission. The marked rise of spread of dengue during and after the Second World War has been attributed to ecologic disruption. The same trends also led to the spread of different serotypes of the disease to different areas, and the emergence of dengue hemorrhagic fever, which was first reported in the Philippines in 1953. In the 1970s, it became a major cause of child mortality. Around the same time it emerged in the Pacific and the Americas. Dengue hemorrhagic fever and dengue shock syndrome were

first noted in Middle and Southern America in 1981, as DENV-2 was contracted by people who had previously been infected with DENV-1 several years earlier.

Research
Current research efforts to prevent and treat dengue have included different means of vector control, vaccine development, and antiviral drugs. With regards to vector control, a number of novel methods have been used to reduce mosquito numbers with some success including the placement of the fish Poecilia reticulata or copepods in standing water to eat the mosquito larva. There are ongoing programs working on a dengue vaccine to cover all four serotypes. One of the concerns is that a vaccine may increase the risk of severe disease through antibody-dependent enhancement. The ideal vaccine is safe, effective after one or two injections, covers all serotypes, does not contribute to ADE, is easily transported and stored, and is both affordable and cost-effective. A number of vaccines are currently undergoing testing. It is hoped that the first products will be commercially available by 2015. Apart from attempts to control the spread of the Aedes mosquito and work to develop a vaccine against dengue, there are ongoing efforts to develop antiviral drugs that might be used to treat attacks of dengue fever and prevent severe complications. Discovery of the structure of the viral proteins may aid the development of effective drugs. There are several plausible targets. The first approach is inhibition of the viral RNA-dependent RNA polymerase (coded by NS5), which copies the viral genetic material, with nucleoside analogs. Secondly, it may be possible to develop specific inhibitors of the viral protease (coded by NS3), which splices viral proteins. Finally, it may be possible to develop entry inhibitors, which stop the virus entering cells, or inhibitors of the 5' capping process, which is required for viral replication

Demam Denggi Demam Denggi ialah penyakit akut(teruk) yang disebabkan oleh virus dan disebarkan melalui gigitan nyamuk Aedes betina (vektor). Nyamuk Aedes terdiri dari Aedes aegypti dan Aedes albopictus. Denggi terbahagi kepada 2 jenis i) Demam Denggi biasa (DD) ii) Demam Denggi Berdarah atau Sindrom Renjatan Denggi (DDB/SRD) Virus Denggi dari famili Flaviviridae.Terdiri dari 4 serotype iaitu Den1,Den2,Den3 dan Den4 Kesemua serotype ini boleh menyebabkan DD dan DDB di Malaysia. Virus denggi berkembang biak dalam badan nyamuk dan nyamuk yang mengandungi virus mampu menjadi sumber jangkitan disepanjang hayatnya. Virus ini juga boleh dipindahkan kepada telurnya.Proses ini disebut transmisi transovari. Seekor nyamuk dewasa hasil dari telur ini akan mengandungi virus di dalam badannya walau pun ia tidak pernah menggigit pesakit denggi sebelum ini. Pada masa ini tiada ubat khusus untuk merawat penyakit ini. Oleh itu pencegahan amat penting. TANDA-TANDA Demam panas yang teruk secara mengejut dan berterusan. Petekia (bintik-bintik merah pada kulit) Sakit teruk pada tulang-tulang, otot-otot,sendi-sendi, biji mata dan kepala Pesakit DD memerlukan pengawasan kerana ada kalanya mereka turut mengalami pendarahan di hidung dan gusi serta kencing berdarah. Pesakit DD perlu diawasi agar tidak berubah menjadi DDB/SRD.

Demam Denggi Berdarah Empat tanda utama ialah pendarahan,demam panas,pembesaran hati dan kegagalan sistem perdedaran darah.

Gejala yang mungkin terjadi ialah muntah-muntah,sakit kepala dan sakit perut. Tanda-tanda pendarahan ialah kelebaman di kulit,hidung berdarah,gusi berdarah,petekia dan pemeriksaan darah menunjukkan berlaku trombositipenia,leukopenia dan peningkatan aras hematokrit. Jika setelah beberapa hari demam,pesakit kelihatan semakin parah dan menunjukkan gejala kegagalan sistem peredaran darah seperti kulit yang lembab dan dingin,bibir yang lebam kebiruan,denyutan nadi yang cepat tetapi lemah dan hipotensi menandakan berlakunya sindrom renjatan denggi (SRD)

senang dikenali dengan belang hitam dan putih di badan dan kakinya. biasanya menggigit pada awal pagi dan awal senja Virus akan membiak di dalam kalenjar air liur nyamuk (proses pengeraman) selama 8-10 hari. Selepas tempoh ini nyamuk menjadi infektif dan mampu menyebar virus. Selepas gigitan virus akan membiak di dalam badan manusia.Tanda-tanda klinikal akan timbul dalam masa 4-6 hari. Virus denggi hanya hidup selama 5-7 hari sahaja di dalam badan manusia kerana badan akan bertindakbalas dengan membentuk dan mengeluarkan antibodi. Kitaran hidup dari telur hingga menjadi dewasa mengambil masa lebih kurang seminggu. Nyamuk dewasa (betina dan jantan) akan bersenyawa dan sperma jantan akan disimpan dalam nyamuk betina.Untuk menghasilkan telur yang hidup,nyamuk betina perlukan darah. Nyamuk bertelur di dalam takungan air jernih di dalam dan di luar rumah.Sebanyak 60100 biji telur dikeluarkan pada setiap kali bertelur.Nyamuk betina mampu bertelur 10 kali semasa hayatnya selama 30 hari. Selepas 1-3 hari telur nyamuk akan matang dan menetas mengeluarkan larva ( jentik-jentik) Selepas 5-7 hari larva akan bertukar menjadi kepompong dan selepas 1-2 hari nyamuk dewasa akan terbang meninggalkan kepompong.