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Home Health & Nutrition

 Doctor’s Chamber

Dengue, chikungunya and other fevers!

Published : Friday, 10 August, 2018 at 12:00 AM Count : 1105

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Medically, a person is not considered to have a significant fever until the temperature is above 100.4 F (38oC).
Fever is the result of an immune response by your body to a foreign invader. Foreign invaders include viruses, bacteria, fungi, drugs, or other toxins. These foreign invaders are considered fever-producing substances (called pyrogens), which trigger the body's immune response. Pyrogens send signal to the hypothalamus in the brain to increase the body temperature in order to help the body fight off the infection.
Dengue fever
Dengue fever is a disease caused by a family of viruses transmitted by mosquitoes. Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of five serotypes of the dengue virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular viral serotype to which the patient was exposed.
Dengue goes by other names, including "breakbone fever" or "dandy fever."
Symptoms and signs
Primary symptoms of dengue appear three to fifteen days after the mosquito bite and include the following:
*   High fever and severe headache
*    With severe pain behind the eyes that is apparent when trying to move the eyes.
Other associated symptoms are:
*    Joint pain
*    Muscle and bone pain
*    Rash
*    And mild bleeding.
Many affected people complain of lower back pain.
Treatment
Because dengue fever is caused by a virus, there are no specific antibiotics to treat it. Antiviral medications are also not indicated for dengue fever. For typical dengue, the treatment is concerned with relief of the symptoms and signs. Home remedies such as rest and fluid intake (oral rehydration) are important. Pain relievers such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) should only be taken under a doctor's supervision because of the possibility of worsening bleeding complications.
Prevention
The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer able to transmit the virus to a biting mosquito.
The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.
To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito-repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever except living in or traveling to an area where the mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors for two hours after sunrise and before sunset will help, as the Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.
Typhoid fever
Typhoid fever is an acute illness associated with fever caused by the Salmonella enterica serotype typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.
Symptoms
The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks. Symptoms include:
*    Poor appetite
*    Headaches
*    Generalized aches and pains
*    Fever as high as 104 degrees Fahrenheit
*    Lethargy
*    Diarrhea
Dr Monzur Hussain Chowdhury Medical Officer  ICDDR,B

Dr Monzur Hussain Chowdhury Medical Officer ICDDR,B

Treatment
Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.
Prevention
The following are some general rules can help to minimize the chance of typhoid infection:
*    Drink bottled water.
*    If bottled water cannot be sourced, ensure water is heated on a rolling boil for at least one minute before consuming.
*    Be wary of eating anything that has been handled by someone else.
*    Avoid eating at street food stands, and only eat food that is still hot.
*    Do not have ice in drinks.
*    Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.
Vaccination
If traveling to an area where typhoid is prevalent, vaccination is recommended.
Before traveling to a high-risk area, getting vaccinated against typhoid fever is recommended.
This can be achieved by oral medication or a one-off injection:
*    Oral: a live, attenuated vaccine. Consists of 4 tablets, one to be taken every second day, the last of which is taken 1 week before travel.
*    Shot, an inactivated vaccine, administered 2 weeks before travel.
Vaccines are not 100 percent effective and caution should still be exercised when eating and drinking.
Chikungunya
Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alpha virus genus of the family Togaviridae. The name "chikungunya" derives from a word in the Kimakonde language, meaning "to become contorted", and describes the stooped appearance of sufferers with joint pain (arthralgia). The disease mostly occurs in Africa, Asia and the Indian subcontinent.
Signs and symptoms
Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. The joint pain is often very debilitating, but usually lasts for a few days or may be prolonged to weeks.
Other common signs and symptoms are-
*    Muscle pain
*    Headache
*    Nausea
*    Fatigue and Rash
Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints.
Treatment
There is no specific antiviral drug treatment for chikungunya. Treatment is directed primarily at relieving the symptoms, including the joint pain using anti-pyretics, optimal analgesics and fluids. There is no commercial chikungunya vaccine.
Prevention and control
The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.







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