Dengue

Dengue is caused by an arbovirus which is transmitted by Aedes mosquitoes.It is highly seasonal in many countries in Asia and South America.The illness usually starts with an acute onset of fever which remains continuously high for 2 – 7 days.Most children recover but a small proportion go on to develop severe disease.During the recovery period a macular or confluent blanching rash is often noted.

Diagnosis

Suspect dengue fever in an area of dengue risk if a child has fever lasting more than 2 days.

Headache,pain behind the eyes,joint and muscle pains,abdominal pain,vomiting and/or  a rash may occur but are not always present.It can be difficult to distinguish dengue from other common childhood infections.

Treatment

Most children can be managed at home provided the parents have reasonable access to the hospital.

1.       Counsel the mother to bring the child back for daily follow up but to return immediately if any of the following occur : severe abdominal pain;persistent vomiting;cold ,clammy extremities;lethargy or restlessness;bleeding e.g. black stools or coffee-ground vomit.

2.       Encourage oral fluid intake with clean water or ORS solution to replace losses from fever and vomiting.

3.       Give paracetamol for high fever if the child is uncomfortable.Do not give aspirin or ibuproven as these drugs may aggravate bleeding.

4.       Follow up the child daily until the temperature is normal.Check the haematocrit daily where possible.Check for signs of severe disease.

5.       Admit any child with signs of severe disease(mucosal or severe skin bleeding,shock,altered mental status,convulsions or jaundice) or with a rapid or marked rise in haematocrit.(WHO)