Definition

Dengue fever is a disease transmitted through the bite of the Aedes aegypti mosquito, which carries one of four types of dengue virus. The virus is commonly found in tropical and subtropical areas, including Central and South America, Africa, parts of Asia, and the Pacific islands. Dengue is not transmitted from one person to another except through a pregnant mother to her child.

Upon infection with one of the four dengue viruses, individuals develop lifelong immunity to that specific virus but remain susceptible to infection by the other three variants.

Causes

Dengue fever is caused by infection with one of the dengue viruses, usually transmitted through the bites of infected mosquitoes. These mosquitoes, often found in and around people's homes, can introduce the virus into the bloodstream when they bite.

Once infected, the virus replicates within the body, triggering an immune system response and leading to the onset of symptoms. The dengue virus can target components of the blood responsible for clotting and maintaining the structure of blood vessels. As a result, the virus, combined with immune system reactions, can cause blood vessels to leak, leading to internal bleeding.

Risk factor

The risk of dengue fever infection can be influenced by the following factors:

• Residence or travel to tropical areas: Living in or traveling to tropical and subtropical regions increases the likelihood of exposure to the dengue virus, raising the risk of contracting dengue fever.
• History of previous dengue fever: Individuals with a history of dengue fever are at an increased risk of experiencing more severe symptoms if they contract the virus again.

Symptoms

Symptoms of dengue fever typically manifest between days 4 and 10 after the initial infection. Sometimes, the emerging symptoms may be mistaken for flu or other infections. Children and individuals with no prior infection history may experience milder symptoms than older adults.

Common symptoms usually last for 2 to 7 days and may include:

• Sudden high fever (41 degrees Celsius)
• Headache
• Enlarged lymph nodes
• Muscle and joint pain
• Reddish skin (appearing between 2 and 5 days after the initial fever)

In severe cases, dengue fever may present symptoms including:

• Abdominal pain
• Moderate to severe vomiting (3 times in 24 hours)
• Moderate bleeding from the nose or gums
• Vomiting blood or the presence of blood in the stool
• Fatigue, exhaustion, and easy irritability

Diagnosis

The doctor will recommend a blood test to check for antibodies to the dengue virus or infection in general. They may suggest virological or serological testing. Virological testing directly examines elements of the virus. This type of testing typically requires specialized equipment and trained personnel, so it may not always be available at every hospital. Serological testing checks for antibodies in the blood to confirm a recent infection or recurrence.

If you experience symptoms of dengue fever after visiting a dengue-endemic country, it's important to see your doctor for testing to determine if you have the virus. The initial symptoms of dengue fever can last for 3 to 7 days. Some people may start to feel better after this period, but others may develop severe dengue and require medical assistance at a hospital.

Management

There's no specific treatment for dengue fever. The medication prescribed by the doctor depends on the symptoms you're experiencing. The doctor may conduct a medical examination, and you need to rest and drink plenty of fluids. You may feel uncomfortable, and symptoms may worsen in the first 24 hours. When the fever subsides, it's crucial to be taken to the hospital for further examination, especially to check for potential complications.

Most people recover from dengue fever without any other complications. If you experience symptoms of dengue fever, there's a 1 in 20 chance of developing severe dengue. If you have severe dengue and receive prompt treatment at a hospital or medical facility, you have a 99% chance of recovery.

Complications

Severe dengue fever can result in internal bleeding and organ damage. Blood pressure may suddenly drop to dangerously low levels, leading to shock. In certain instances, severe dengue fever can even be fatal.

Pregnant women who acquire dengue fever during pregnancy can transmit the virus to their fetuses. Furthermore, babies infected with the dengue virus in the womb are at a heightened risk of being born prematurely and having a low birth weight.

Prevention

The Food and Drug Administration approved a vaccine called Dengvaxia for Dengue Fever in 2019. The vaccine is available in some countries and requires three doses over six months. In Indonesia, the Indonesian Agency of Drug and Food Control (BPOM) approved a vaccine called Qdenga in 2022.

The best prevention method is avoiding mosquito bites and reducing the population. When you are in a high-risk area, it's advisable to:

• Avoid densely populated areas.
• Use mosquito repellent indoors and outdoors.
• Wear long-sleeved shirts and long pants.
• Use air conditioning instead of opening windows.
• Ensure doors and windows have screens and repair holes.
• Use mosquito nets while sleeping if the area is still unknown.

Reducing the mosquito population involves eliminating mosquito breeding sites such as bird baths, pet water bowls, empty pots, cans, and other containers.

When to see a doctor?

If you're planning to travel to or reside in a dengue-endemic country and experience symptoms of dengue fever, you must contact a doctor immediately. An early diagnosis will help in more effective treatment.

Severe dengue is a medical emergency, so you should seek medical help immediately if you have recently visited an area known for dengue fever and experience symptoms such as fever and other signs. Other symptoms include abdominal pain, vomiting, difficulty breathing, bleeding from the nose, gums, vomiting, or bowel movements.

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