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HOT ISSUE: DENGUE WAR
QUIT SMOKING CLINIC
DRUG COMPARISON: B COMPLEX, NEURO- BION & MECOBALA- MIN IN NERVE RE-
QUMC IN PKDMT 19
TRUTH @ MYTHS:
STEVIA - A HEALTHY ALTERNATIVE SWEETENER?
I S S U E 1 Y E A R 2 0 1 6
PKD MELAKA TENGAH
Editorial Board Advisor: Dr. Rusdi bin Abd. Rahman Chief Editor: Mardhiah binti Amir- uddin Editor: Chew Poh Chiong Contributors: Michelle Lim Bee Ping Noorafinah Mohd Zudin Foo Swee Yen Nursyahirah binti Abd Raof
Dengue is a mosquito-borne viral disease that has rapidly spread in many regions
of the world. Dengue is found especially in tropical and subtropical regions of the
world. The geographical distribution of dengue is linked within the temperature
range where the mosquito species Aedes that transmits the disease can be found.
Dengue fever is caused by 4 closely related virus types, which is called serotypes.
The 4 Dengue Virus (DENV) serotypes are DENV-1, DENV-2, DENV-3 and
DENGUE WAR By : Lee Ai Wei
Epidemiology of dengue worldwide
The incidence of dengue has grown dramatically around the world in recent dec-
ades. Up to 3.6 billion people are estimated to now live in tropical and subtropi-
cal areas where the den-
gue viruses have the po-
tential to be transmitted.
Globally it is estimated
that approximately 50
million to 200 million
deng ue i n f e c t ion s ,
500,000 cases of severe
dengue, and over 20,000
dengue related deaths
Epidemiology of dengue in Malaysia
In Malaysia, dengue is predominantly an urban disease due to the abundance of the principle vec-
tor Aedes aegypti which is at a close proximity to high densities of susceptible hosts. The states of
Selangor, Wilayah Persekutuan Kuala Lumpur and Johor are the areas that have been largely af-
fected by the disease and are reporting high numbers of cases.
TRANSMISSION OF DENGUE
Spread through a human-to-mosquito-to-human cycle of transmission.
The two Aedes mosquito species that transmits the disease are Aedes aegypti, which is the
primary mosquito vector, and Aedes albopictus, which is the secondary mosquito vector.
When a dengue mosquito bites someone who is sick with dengue fever, that mosquito is
infected and becomes a carrier of the virus.
Mosquitoes are capable of spreading the disease within 8-12 days after biting infected person.
The virus will multiply in the salivary glands of the mosquito and then transferred into a
healthy human body during mosquito bites.
Female mosquitoes infected with dengue virus can also transfer the virus to infect its eggs
next newly hatched mosquito.
Once the mosquito is infected by the dengue virus, the mosquito is a carrier of the virus for
life and it can spread the virus to other people by biting them.
The dengue virus does not spread directly from person to person. Once inside the human
body, the virus takes 3-14 days to develop before the symptoms of dengue fever.
Differences between Aedes aegypti and Aedes albopictus
Has bright silvery lyre-shaped dorsal pattern and white banded legs
Has a single longitudinal silvery dorsal stripe and white banded legs
Occupies urban areas with or without vege- tation
Associated with thickets and arboreal vegetation
Bites, rests, and lays eggs both indoors and outdoors
Mostly an outdoor (garden) mosquito
Sneaky biter Aggressive biter
High preference for taking blood meals from humans and to lesser extent from domestic mammals, which makes it a very capable vector of dengue viruses
Bites humans but also a variety of available domestic and wild vertebrates that do not carry the dengue viruses, which lowers its capacity to transmit them
Main dengue vector worldwide Main dengue vector in some areas but is mostly a secondary vector
The major production places are human- made containers, tree holes and bamboo internodes holding water
Shows preference for tree holes and bam- boo internodes with water but can also uti- lize human-made containers for its imma- ture development
SIGNS & SYMPTOMS
Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the
following symptoms: severe headache
pain behind the eyes
muscle and joint pains
Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from
an infected mosquito.
MANAGEMENT OF DENGUE
No specific vaccine or medication to prevent or treat dengue fever currently.
Treatment is purely concerned with relief of the symptoms (symptomatic).
Rest and adequate hydration is important.
Paracetamol can be taken to reduce fever and relieve pain.
Avoid aspirin in children under the age of 12 years.
The use of antibiotics is not indicated in dengue infection.
HOT ISSUE CLINICAL COURSE OF DENGUE INFECTION
After the incubation period, the illness begins abruptly and will be followed by 3 phases.
High grade fever (usually last
for 2-7 days)
Accompanied by facial flush-
ing, rash, generalized body
ache, vomiting and headache
Mild haemorrhagic manifesta-
tions may be seen
Enlarged and tender liver
Progressive decrease in
total white cell count fol-
lowed by platelet reduction
Occurs after third day of fever (may
Lasts about 24- 48 hours
Rapid drop in temperature
Patient may deteriorate and manifest
third space plasma leakage or organ
In more severe forms of plasma leakage,
patient may develop compensated and
Thrombocytopenia and haemoconcen-
tration are usually detectable in this
Leucopenia with relative lymphocytosis,
clotting abnormalities, elevation of
transaminases, hypoproteinaemia and
hypoalbuminaemia are usually observed.
Plasma leakage stops fol-
lowed by reabsorption of
Patient’s general well being
May have a classical rash of
“isles of white in the sea of
red” with generalized
Haematocrit level stabilises
and drops further due to
haemodilution following re-
absorption of extravascular
Recovery of platelet count is
preceded by recovery of
white cell count
WHO DENGUE CLASSIFICATION
USE OF PAPAYA LEAF EXTRACT IN DENGUE FEVER Papaya leaf extract is now being widely used as a treatment for dengue fever in
many countries and in some with the approval of their health authorities. Papaya leaf extracts have been
shown to have many beneficial effects, including reduction in the duration of fever, duration of illness,
hospital stay, rapid elevation of white blood cells and platelet counts. Randomised controlled trial has
been done by Institute for Medical Research (IMR) and Tengku Ampuan Rahimah Hospital, results
showed that there was a significant increase in platelet count among dengue patients administered with
50gm of fresh papaya leaf juice for three consecutive days.
Certain parties stated that papaya leaves contain a dangerous chemical known as cyanogenic glycoside
which could cause liver, kidney or heart failure and ultimately death. However, content of the deadly
chemical are very small (0.02 mg in every four leaves). A 60kg person would need to consume 12,000
papaya leaves at once to cause any acute poisoning. According to Health director-general Datuk Dr
Noor Hisham Abdullah, papaya leaf juice has been shown to increase blood platelet count and assist in
the recovery of those with lesser complications, and is unlikely to cause liver, kidney or heart failure.
PREVENTION & CONTROL
Main method is to combat vector
(prevent mosquitoes from ac
cessing egg-laying habitat)
Improving community partici-
pation and mobilization for
sustained vector control;
Active monitoring and surveil-
lance of vectors
REFERENCES 1. Ministry of Health Malaysia. Statistik denggi. Av