DENGUE
PRESENTED BY
CINDY & MARY
CONTENTS
Introduction
Morphology
Pathogenesis
Transmission
Antigenic and genomic properties
Clinical syndrome
Lab Diagnosis
Treatment
Prophylaxis
Epidemiology
Prevention and control
INTODRUCTION
Dengue is one of the most important virus
transmitted to humans by the bite of the
infected Aedes mosquitoes. The virus
responsible for causing dengue is called
dengue virus.
Dengue is a member of the flavoviridae family
Dengue can cause a range of illness with
different severities, from asymptomatic, to
mild dengue fever, to severe dengue
hemorrhagic fever (DHF) or dengue shock
syndrome (DSS).
The name dengue is derived from Swahiti-word Ki-dinga-pepo
meaning a sudden seizure by a demon.
The earliest known documentation of symptom of dengue-like
illness was described in Chinese Encyclopedia during 265 AD.
In 1780, Rauss coined the term “break-bone fever” based on
description of symptom reported by patient during Philadelphia
epidemics of probably dengue fever.
The first epidemic of dengue hemorrhagic fever was described
in 1963 in Manila.
In 1979-1980, the first report outbreak of dengue fever
occurred simultaneously in Asia, Africa and North America.
MORPHOLOGY
Dengue virus is a small spherical and enveloped
virus. It is a flavivirus having cubic symmetry and
measures 40-50nm in in diameter.
It is a single stranded RNA virus of 11Kb size.
It has an icosahedral nucleocaspid and is covered
by a lipid envelope.
The virus is inactivated by diethyl ether and bile
salts such as sodium deoxycholate.
PATHOGENESIS
TRANSMISSION
ANTIGENIC AND GENOMIC PROPERTIES
Dengue virus has four distinct closely related serotypes:
a) Dengue-1 (DEN-1)
b) Dengue-2 (DEN-2)
c) Dengue-3 (DEN-3)
d) Dengue-4 (DEN-4)
The speciation was done by Albert Sabine in 1944.
Each serotypes is known to have several different
genotypes.
CLINICAL SYNDROME
The major symptoms of dengue fever include sudden high
fever, chills, severe headache (usually behind the eye),
muscle ache and joint pain, nausea, vomiting, flushed skin
and in some cases, a skin rash similar to meales.
The disease may occur in three forms; classical dengue
fever and dengue in more serious forms with hemorrhagic
fever and dengue shock syndrome.
CLASSIC DENGUE FEVER
This usually affect older children and adult. It
has relatively benign course with fever,
headache and pain in muscle and bones.
The incubation period varies from 2 to 7 days.
The onset of the disease is sudden, which begin
as influenza-like illness manifesting as fever,
malaise, cough and headache.
The fever is typically biphasic (saddle
back),which may be as high as 41C ,begins on
third day and last for 5 to 7 days.
A maculopapular rash
generally appears on 3rd or
4th day.
The febrile illness lasts for
about 10 days after which
recovery is generally
completed.
It is rarely fatal.
DENGUE HEMORRHAGIC FEVER
It is most severe manifestation of the disease.
The initial classic phase of dengue hemorrhagic fever is
similar to that of dengue fever and other febrile and viral
illness. But, subsequently, the condition of the patient
suddenly worsens with shock and hemorrhage, especially
into the GI tract and Skin.
The hemorrhagic manifestation include bleeding
from from nose or gums, melena and
hematemesis.
This condition shows a high fatality rate as high
as 10%.
It occurs in children with passively acquired
maternal antibodies. It may also occur in a
person previously infected with a different
serotypes of the virus, showing non- neutralising
heterologous antibodies in the serum.
DENGUE SHOCK SYNDROME
It is the most severe form of the disease caused by
dengue virus.
This is most commonly seen in untreated cases of dengue
hemorrhagic fever.
The common symptoms include abdominal pain, muscle
pain, nausea, headache and restlessness and finally,
the patient may die of circulatory failure and shock.
When treated dengue hemorrhagic fever has a mortality
rate of 5%. If left untreated, the condition has a
mortality rate a high as 50%.
LAB DIAGNOSIS
a) Specimens
For antibody detection
Serum
For antigen detection
Serum
For isolation of virus and PCR
Serum
Plasma
Whole blood(washed buffy coat)
Autopsy tissues
Mosquito collected in nature
Blood collected during 3 to 5 days of illness is useful for
isolation of virus and serum is useful for serological tests.
b) Haematological diagnosis
-thrombocytopenia(100,000cells or less per mm 3 )
- haemoconcentration (>20% rise in haematocrit)
c) Microbiological diagnosis
isolation of the virus is difficult but serology plays a major role in
diagnosis
Detection of the antibody
Demonstration of IgM antibody in serum provides early diagnosis.
IgM antibody appears 5 days after onset of symptoms and persits for
one to three months.
IgG antibody appears laters than IgM antibody. Detection of four
fold rise in IgG titre in paired sera taken at an interval of 10 days or
more is confirmatory. ELISA is used for detection of IgM and IgG
antibodies.
Detection of NSI antigen
It is a rapid test and detects antigen on the first
day of fever before antibodies appear. It can be
detected upto 7-10 days. Test results are
available in about 15 minutes.
Isolation of virus:
Virus isolation can be done by inoculating clinical
specimen into mosquitoes , mosquitoes cell lines
(c6\36 or AP-61 cells .)or suckling mice.
Further identification is done by using fiuorescent
antibody test.
Polymerase Chain Reaction (PCR)
Viral RNA van be detected in clinical specimens
by reverse transcriptase polymerase chain
reaction (RTPCR). Viral genomic sequences can
also be detected.
TREATMENT
There is no specific treatment for dengue fever.
Antipyretic such as Paracetamol, fluid and electrolyte
replacement and platelet infusion when Platelet count are
10,000 or less
Aspirin or Ibuprofen should not be used as these may lead
to Platelets dysfunction and severe bleeding.
PROPHYLAXIS
Control measures include elimination of
mosquitoes. WHO has approved and launched a
dengue vaccine in some South American
countries. In India, the vaccine is not available.
PREVENTION
EPIDEMIOLOGY
Dengue virus is distributed worldwide. Dengue
hemorrhagic fever is primarily a disease of
children and a leading cause of death in South
East Asia.
Geographical distribution:
An estimate 3 billion people living in
approximately 110 countries world wide are at
risk of dengue infection.
Reservoir and source and transmission:
Humans are reservoir of transmission. The human host
serves as source of viral amplification. The infection is
transmitted by the bite of A. aegypti mosquitoes . The
mosquitoes are vectors as well as sources of viral
amplification. A. aegypti are small and highly
domesticated mosquitoes , which breed on artificial water
sources , and they preffered to bite human typically at
human of the neck and at the ankle
Dengue has been spreading from South east Asia to three
sub-tropical and tropical Asian countries, Indian sub-
continent including India, Sri Lanka, Philippines, New
Guinea, Australia and several pacific island
Dengue was initially restricted to east cost of India.
Subsequently, the virus has affected most part of India.
Reports of dengue have been documented of various parts
of India. The higher incidence of dengue has been
reported in children younger than 8 years.
Major outbreak of dengue was observed in western India
during Oct 2002 to Dec 2003.
REFERENCES
Textbook of microbiology by C.P Baveja
Textbook of microbiology and Immunology by
Subash Chandra Parija.