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Dr. Sachin Shelke
Internal Medicine


Dengue, a mosquito-borne disease, is prevalent in areas with tropical and subtropical climate. According to the Center for Disease Control and Prevention, this infection is common in more than 100 countries around the world. The estimate of this world body suggests that around 3 billion people live in dengue-prone areas. These include India and parts of South East Asia, China, Africa, Taiwan and Mexico among others. In 2019 alone, India saw more than 67,000 cases of dengue, as suggested by the figures released by the National Vector Borne Disease Control Programme (NVBDCP). This report also reveals that 2017 was the worst year for India in terms of dengue with 1.88 lakh cases and 325 deaths.

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What Is Dengue?

Dengue refers to a mosquito-borne viral infection characterised by high grade fever, headache, muscle and joint pain, and skin rashes. Transmitted through the bite of aedes mosquitoes, this infection is caused by four closely-related serotypes of a virus  of the flaviviridae family: DENV-1, DENV-2, DENV-3 and DENV-4. Though these viruses are self-limiting and don’t last for more than 10 days, the infection, in severe form, can cause dengue haemorrhagic fever (DHF). This condition leads to heavy bleeding, a sudden drop in blood pressure, a decrease in the platelet (clot-forming cells) count in the blood, and even death. Rapid and weak pule, hypotension, cold and clammy skin, undetectable blood pressure and shock represent the final stage of DHF and is known as dengue shock syndrome (DSS).In extreme cases, immediate hospitalisation is required. There is no specific treatment for dengue. The approach is that of symptomatic and therapeutic management of the patient.

Transmission of the dengue virus can take place in the following ways:

  • Transmission through the bite of an aedes mosquito

  • Transmission from the infected pregnant mother to the child

  • Transmission through infected blood transfusion

  • Transmission by sharing syringes


Dengue fever can be mild or severe. The symptoms also vary accordingly. Many, especially kids and teens, may not even experience the manifestations of dengue if it is mild. The symptoms of mild form of this condition set in in four to seven days after a person being infected and subside within a week. The symptoms include high grade fever (104°F) and at least two of the following:

  • Headache

  • Muscle, bone and joint pain

  • Nausea

  • Vomiting

  • Pain behind the eyes

  • Swollen glands

  • Rash

However, in severe cases, dengue can progress to DHF, a health emergency. In this condition, blood vessels are damaged and the platelet count in the blood drops. The symptoms of this condition include:

  • Severe abdominal pain

  • Persistent vomiting

  • Bleeding from your gums or nose

  • Blood in your urine, stools or vomit

  • Reduced flow of urine

  • Dry mouth

  • Bleeding under the skin, which might look like bruising

  • Difficult or rapid breathing

  • Cold or clammy skin (symptom of shock)

  • Fatigue

  • Irritability or restlessness

Causes And Risk Factors


As already mentioned, dengue is caused by the aedes mosquitoes. Various factors can increase your risk of being infected by this viral infection. Here, we shed light on a few of them:

  • Living in a dengue-prone area: If you live in an area infested with aedes mosquitoes, your chance of getting infected by dengue increases naturally.

  • Prior infection: Being infected by dengue doesn’t make you immune to this viral infection. In fact, it may hit you harder the next time.

  • Low immunity: People with compromised immunity are more likely to suffer from dengue. This is what makes the elderly population more vulnerable to this condition. Certain conditions like diabetes, lung diseases and cardiovascular ailments can also increase your risk.

  • Low platelet count: A severe complication of dengue is low platelet (clot-forming cells) count in the blood. So, if you already have depleted levels of platelets, you are likely to catch this infection faster than others.

Risk Factors

The risk factors associated with a dengue infection are as follows:

People residing in tropical areas are at a higher risk of contracting the dengue virus.

  • The stagnant water in and around a home serves as a breeding ground for the dengue mosquito, thereby increasing the risk for people living there.

  • People exposed to the dengue virus in the past are at risk of developing severe symptoms if infected with the disease again.

  • Pre-existing co-morbidities such as asthma and diabetes can prove fatal for people who contract the dengue infection.


In May 2019, the US Food and Drug Administration approved a dengue vaccine named Dengvaxia for use only in kids in the age bracket of 9 to 16 years with a history of the infection. However, it is not yet approved for use in India. Dengue is a communicable disease which is spread by mosquitoes to humans. The only way it can really be prevented in the absence of a vaccine is by avoiding mosquito bites. So, you have to rely on mosquito repellents, mosquito nets, net screens on your doors and windows, and clothes that cover you well (long-sleeve shirts, full-sleeve trousers, etc.). Here are some other measures you can employ:

  • Make sure all egg-laying habitats of mosquitoes, such as open and stagnant water sources, are cleaned up.

  • If there are any open water sources you cannot eliminate, cover them and apply appropriate insecticides.

  • Use air conditioners when indoors.


The diagnosis of dengue is usually done based on a patient’s symptoms and physical examination, especially in endemic areas (region where the particular disease is more prevalent). Your doctor may suggest the following tests after evaluating your symptoms:

Complete Blood Count: This test reveals your platelet count. Low count of these cells is a crucial marker of dengue.

ELISA test for dengue NS1 Ag: This is a confirmatory blood test which detects the dengue virus antigen. However, it may show negative results during the initial stages of infection. So, this test may need to be repeated if symptoms persist.

PCR for detecting viral DNA: This test can be more effective in the first 7 days of infection, when NS1 Ag test may show negative results despite the infection.

Serum IgG and IgM test: This test helps in the diagnosis of the condition at a later stage. Once the virus sneaks into the body, the immune cells start producing antibodies IgG and IgM against the dengue virus.  The level of these antibodies increases gradually.  This test is a useful indicator of a prior infection or acute infection depending on antibodies detected.


There is no specific medicine for dengue since it is a viral disease. However, your doctor may suggest a pain or fever reliever like paracetamol to control the symptoms. Another important aspect of dengue control is keeping yourself hydrated. So, drinking plenty of clean water is necessary. However, people with severe symptoms may need hospitalisation. In an extreme case, one may need intravenous fluid or electrolyte supplementation, constant blood pressure monitoring and even blood transfusion or platelets transfusion.

Drugs such as aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

Prognosis And Complications


Full recovery is seen in most patients with dengue infection. However, the risk of death increases in patients who develop dengue haemorrhagic fever or dengue shock syndrome.


If a dengue infection is severe, it can affect your lungs, liver and heart. Blood pressure can drop dangerously, triggering shock. In extreme cases, it may be fatal too. Here is what happens to the body if this infection is severe:

  • Hypotension, low blood pressure

  • Multi organ failure

  • Haemorrhages

  • Fluid accumulation in the chest, abdomen

Dengue fever can affect other organ systems and may result in complications such as myocarditis, hepatitis, glomerulonephritis and electrolyte imbalance. Routine monitoring with renal function tests, liver function tests, and echocardiography will help to identify the affected organ system at the earliest.

Lifestyle Management

A healthy, well-planned diet will help in the fast recovery from dengue fever. Make sure your meals are easy to digest as the performance of your gastrointestinal tract may be sluggish during this condition. While adding some foods to your diet may relieve symptoms some food items should be avoided.

  • Add papaya leaf juice to your diet: It can help in the healing process by increasing your platelet count and boosting your immunity. Have it twice or thrice a day with water.

  • Have coconut water: It will keep you hydrated and nourish your body. Having two glasses of coconut water will improve your overall health.

  • Include neem leaves in your meals: They come with chemicals named nimbin and nimbidin, which are endowed with anti-inflammatory, anti-pyretic and anti-microbial properties. They are also known to increase the platelet count.

  • Avoid these foods: Although there are no strict restrictions, caffeinated beverages, spicy and deep-fried foods are best avoided. Oily and spice-laden foods won’t be easy for your stomach to digest while you are suffering from dengue. Caffeinated beverages, on the other hand, will dehydrate you.


  1. Transmission [Updated on September 26, 2019]. CDC. Available at: Accessed on: March 17, 2021.

  2. Dengue fever risk factors. Wikidoc. Available at: Accessed on: March 17, 2021.

  3. Dengue fever – do’s and don’ts for dengue [Updated on July 30, 2019]. NHP. Available at: Accessed on: March 17, 2021.

  4. Treatment [Updated on May 3, 2019]. CDC. Available at: Accessed on: March 17, 2021.

  5. Dengue Fever [Updated on March 17, 2018]. Cleveland Clinic. Available at: Accessed on: March 17, 2021.

Rajapakse S, et al. Infect Drug Resist. 2012;5:103-12.


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