Deciphering Dengue: A Problem-Based Learning Approach to Understanding and Addressing the Threat
Acharya Laxman , Aalam Sajid , Acharya Anurag , Banmala Bishal , Bhandari Shristi , Baral Binayak , Baral Ashish , Basel
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Prashant , Bhandari Suyog , Belbase Abhilekh , Adhikari Sameer , Alam Prabej , Basel Raj , Acharya Keshav
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*Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
CASE SUMMARY CLINICAL MANIFESTATIONS
A 38-year-old male, working as a farmer, presented to Manipal Teaching Hospital in • Variable clinical presentation
Pokhara with a one-week history of fever, headache, and muscle pain. The patient • From asymptomatic to life-threatening
reported experiencing high-grade intermittent fever accompanied by rigors and • Incubation period: 3 to 14 days
chills for the past five days. He also complained of sore throat, chest pain, • Three Phases of Infection
shortness of breath, vomiting, abdominal pain, burning urination, and occasional Febrile Phase
gum bleeding. Additionally, he had reddish-colored urine with clots for two days. Critical phase
Upon physical examination, the patient appeared stable but had mild conjunctival Recovery Phase
pallor. Skin examination revealed multiple purpura and petechiae on various parts
of his body. His body temperature was 41.5°C, pulse rate was 92/min, breath rate
DIAGNOSIS
was 24/min, and blood pressure was 100/70 mmHg. Dry lips and tongue were
• Antibody Detection : ELISA (Anti-dengue IgM),
observed. Systemic examination did not reveal any significant findings. The patient
ICT
was admitted to the Medicine ward for further diagnosis and management.
• Antigen Detections : ELISA (Dengue specific
NS1), ICT
INTRODUCTION • Neutralization: Plaque Reduction Test, Micro
Dengue fever is a disease caused by a family of viruses transmitted by mosquitoes. Neutralization Test
Dengue virus, a member of the Flaviviridae family, causes the most widespread • Viral Isolations : Mosquito cell lines https://www.researchgate.net/figure/Graphical-representation-of-the-
kinetics-of-dengue-NS1-antigen-and-IgM-IgG-and-IgA_fig1_225086700
mosquito-borne viral infection in humans. Dengue can affect anyone but tends to be
more severe in people with compromised immune systems. Dengue hemorrhagic fever TREATMENT
is a more severe form of a viral illness. Symptoms include headache, fever, rash, and • No specific viral therapy
evidence of bleeding (hemorrhage) in the body. • Conservative management of the case such as :
Pain relief: Acetaminophen 1g 3 times a day
Replacement of plasma losses
DENGUE VIRUS Proper fluid balance
Dengue virus, Flaviviridae family, is characterized by Platelet Rich Plasma (PRP) infusion - if required
• Enclosed by an envelope.
• Single-stranded RNA genome.
• E Protein: Viral attachment and entry.
• M Protein: Envelope structure and shape. EPIDEMIOLOGY IN NEPAL
• Capsid Protein: Stability and replication assistance. https://www.genetex.com/Research/Overview/
infectious_diseases/dengue_virus
Between January and 28 September 2022,
• Non-structural proteins( NS1, NS2a ) : Immune evasion. a total of 28,109 suspected and confirmed
cases of dengue fever including 38 confirmed
PATHOGENESIS deaths have been reported from all seven
provinces of Nepal. Bagmati province has
Bite of Aedes Aegypti reported the highest number of cases (78.2%) and
deaths (68.4%).
https://cdn.who.int/media/images/default-source/emergencies/disease-
The virus infects and replicates inside the Langerhans cell outbreak-news/map_dengue_nepal.jpg?sfvrsn=8020401f_3
Langerhans cells release interferons [to limit the spread of infections]
Infected Langerhans cells go to the lymphatic system to alert immune PREVENTION
• Vaccination : Live attenuated (CYD-TDV) - 3 inj s.c at 6 months interval
Then goes to circulation
• Vector control activities :
Results in viremia-high levels of virus in the bloodstream Covering, Draining and Cleaning household water storage.
Spraying insceticides.
Activation of immune response-increases lymphocyte
• Personal protective equipments during outdoor activities :
Release of pyrogen causes fever and increased blood pressure in Skin repellent.
vessels causes rashes Long sleeves shirts and trousers.
REFERENCES :
• Essential of Medical Microbiology - 3rd edition, Sastri Apurva
• Dengue Fever: An Overview, Ramalingam Kothai and Balasubramanian Arul
• WHO 10th Oct, 2022 - Disease Outbreak News; Dengue Fever Nepal
• Commercial Dengue Rapid Diagnostic Tests for Point-of-Care Application: Recent Evaluations and Future Needs?, Stuart BlacksellUniversity of Oxford
