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Dengue Fever

Dengue Fever: What it is, symptoms, treatment and prevention | KKH

Dengue Fever - What it is

What Is Dengue Fever?

Dengue fever is an illness caused by the dengue virus, which is carried and spread by the Aedes mosquitoes. These viruses cause the body to bleed easily and may affect other organ systems.​

Dengue Fever - Symptoms

​What Are The Symptoms And Signs of Dengue Fever?

The usual symptoms experienced are:

  • Fever
  • Headache
  • Muscle and joint aches
  • Rash - different types of rash, may be itchy and appears a few days after the onset of fever
  • Bleeding tendency - from nose, gums, and other parts of the body due to low platelets; platelets are one of the blood components, which help to clot and prevent excessive bleeding. Normal platelets levels are 150,000 - 450,000 per ml.
  • Bruises from minor knocks and bumps

Sometimes, dengue infection can present in the more serious form, known as Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS), whereby serious complications can occur, resulting in:

  • Widespread bleeding
  • Low blood pressure / shock due to bleeding or leaking blood vessels
  • Organ failure
  • The risk of dying from dengue complications is very low; less than 1-5% if supportive treatment is given early.

Dengue Fever - How to prevent?

Dengue Fever - Causes and Risk Factors

Dengue Fever - Diagnosis

Dengue Fever - Treatments

​How Can You And Your Child Be Managed At Home?

Majority of the cases are mild and self-limiting; requiring no hospitalization.

Bleeding Prevention & Control

Rest in bed and reduce activities like running around and avoiding sports to reduce the risk of falls and injury, thereby preventing unnecessary bleeding. Your child may also need to avoid brushing his teeth if his platelet counts are very low as this may lead to gum bleeding. Distract them from digging their noses or blowing their noses hard.

Assessment

  • Your child may require blood test to be done daily to assess the platelet level and blood concentration (as it can be normal during the first few days of fever)
  • The blood test can be done at polyclinics or GP clinics

There is no antibiotic or anti-viral medication for dengue fever. The treatment is mainly supportive and for relief of symptoms. The main components of management of dengue fever are:

Fluid / Water Replacement

  • Children about 1 year old or > 10 kg, should drink at least 1 litre of fluids a day
  • Children > 40 kg or adult, should drink at least 2 litres of fluids a day

This is because

  • Fever increases water loss from body
  • Dengue fever causes the blood vessels to be leaky and increases water loss from the blood circulation

Symptom Relief and Fever Control

  • Painkillers (e.g. paracetamol) may be given to relieve pain and control fever
  • Avoid aspirin (or other medications such as ibuprofen and diclofenac suppositories that affect the platelet functions)
  • Medications may be given for nausea and vomiting

When Do You Or Your Child Need To Return To Hospital?

  • Blood platelet count is less than 80,000
  • Bleeding from the nose or gums without any injury
  • Unwell (lethargic/ drowsy/ breathing difficulty)
  • Vomiting or poor feeding / drinking
  • Severe abdominal pain and giddiness, as these can be signs of DHF / DSS.

Hospitalisation may be considered when you or your child is presented with the above conditions.

Assessment, Observation And Treatment During Hospitalisation

  • Blood tests are done daily to assess the platelet level and blood concentration
  • Vital signs (e.g. pulse rate, blood pressure) are monitored to detect any potential complications of dengue fever mentioned earlier
  • Intravenous fluid drip may be required
  • Platelets or blood transfusion may be given if the spontaneous bleeding or if the platelets level is critically low (below 20,000 and dropping)

Dengue Fever - Preparing for surgery

Dengue Fever - Post-surgery care

Dengue Fever - Other Information

When Can You Or Your Child Go Home?

Current hospital guidelines allow patients who are well and have a rising platelet trend or platelet above 70,000 to be discharged.

After discharge, a repeat blood test (details included with discharge letter) should be done 1-2 weeks later at a polyclinic or GP to confirm that the platelet count is back to normal.

However, some patients may feel very tired and another week of rest at home is advised.

Can You Or Your Child Spread Dengue To Others?

No, it is not transmitted by direct spread from one person to another. Dengue is transmitted by infected mosquito bites. Hence, persons in the same vicinity may come down with dengue fever.

Can You Or Your Child Be Infected Again?

Yes. There are 4 strains of dengue viruses. Infection with one strain will provide protection against only that particular strain. Future infection by other strains is possible. Currently there is no vaccine available for dengue fever.

How To Reduce The Chances Of Being Infected By Dengue Fever?

Singapore is in the tropical region where Aedes aegypti mosquitoes live. The best prevention is to get rid of mosquito breeding places:

  • Change water in vases/ bowls (including pet water containers) on alternate days
  • Remove water from flowerpot plates on alternate days
  • Turn over all water storage containers
  • Cover bamboo pole holders when not in use
  • Cover rarely used gully traps
  • Add prescribed amount of Temephos sand granular insecticide in roof gutters at least once a month
  • Cover toilet bowls and floor traps when away from home for a few or more days
  • Fit all floor traps with anti-mosquito valves

Air conditioning or windows/ doors with mosquito screens can reduce the risk of being bitten by mosquitoes.

Using mosquito repellents containing DEET as the active ingredient on exposed skin and clothing can also decrease the risk of being bitten by mosquitoes.

However, it is important to note:

  • Children below 2 months old should avoid DEET mosquito repellent
  • Children below 3 years old should avoid eucalyptus oil
  • Children above 2 months old should use mosquito repellent in lower concentration of DEET between 7 - 20%
  • Pregnant women should reduce the usage of DEET mosquito repellent and apply on clothing instead
  • Mosquito repellent with DEET in concentration between 20 - 30 % is only suitable for adult

Sources:
Communicable Disease Centre, Singapore
National Environment Agency, Singapore

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