LETTER TO THE EDITOR
Dengue: A Brief Insight
Sharmin Sultana1, *, Faisal Muhammad1, 2, 3, ABM Alauddin Chowdhury1, Nadira Mehriban1, Salim Khan4
Identifiers and Pagination:Year: 2023
E-location ID: e187494452305081
Publisher ID: e187494452305081
Article History:Received Date: 05/01/2023
Revision Received Date: 02/04/2023
Acceptance Date: 10/04/2023
Electronic publication date: 22/06/2023
Collection year: 2023
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Dengue is the second most dangerous vector-borne disease worldwide in terms of incidence and mortality rate . Many nations are experiencing dengue outbreaks, including the Americas, Africa, the Middle East, Asia, and the Pacific Islands . Dengue, also known as dengue fever (DF), is a viral disease that is carried and spread by female mosquitos, mostly Aedes aegypti and to a lesser extent, Aedes albopictus. The virus belongs to the Flaviviridae family and has four separate but closely related serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) . Whilst there are four types of the dengue virus, it is still possible to be re-infected as the immune system only becomes immune to one serotype at a time.
Dengue is widespread and particularly found in tropical and subtropical climates. Urban and semi-urban regions present increased case numbers. Mosquito bites are more prevalent in early mornings and early evenings, particularly near still water in built-up areas . Around 100 to 400 million infections are thought to occur annually, with more than 80% being minor and asymptomatic .
Approximately 380, 171 dengue virus cases and 113 deaths were reported worldwide between January 1st to 9th March, 2023. Most cases were reported from Brazil (240, 482), Bolivia (31, 283), Peru (20, 022), Colombia (15, 972), and Nicaragua (13, 187). Most deaths were reported in Bolivia (26), Peru (26), Brazil (24), Sudan (14), and Bangladesh (9) .
Bangladesh, a country in South Asia, has a lower seroprevalence of dengue than other nations in Southeast Asia , but conditions are changing quickly. The country is in tropical and subtropical zones and presents a favorable environment for the dengue vector and its accelerated spread . In 2023, Bangladesh reported the highest case of DF in Asia . A previous study in 2019 estimated that dengue affected on average 2.4 million people annually in Bangladesh, with concentrations being higher in major cities, including the capital Dhaka . In addition, men were found to be more susceptible to infection as they have increased incidence rates which may be attributed to increased frequency of travel and exposure to external environments . Mortality levels, however, do not relate to infection rates as more women die from the mosquito-borne viral disease . Furthermore, a study in India (2022) found a high incidence of DF in children aged 5 to 10 years  and determined that this age range was a risk factor.
Symptoms of DF include a high temperature or feeling hot and shivery. In addition, severe headaches, pain behind the eyes, muscle and joint pain, feeling sick, and the presence of a widespread rash. Other symptoms include hepatomegaly, abdominal pain, and oliguria. Moreover, impaired awareness upon hospital admission was also frequently noticed, particularly in those who succumbed to DF .
DF can range from asymptomatic or self-limiting to severe, characterized by plasma leakage (dengue hemorrhagic fever, DHF) and dengue shock syndrome (DSS). Dengue Shock Syndrome is a severe complication caused by an overreaction of the body's immune system to the virus. Mortality is linked to DSS and is approximately 50 times higher compared to those without DSS .
Several studies have also reported excessive menstrual bleeding in dengue-infected adolescents [12, 13]. In pregnancy, dengue is associated with preterm birth and low birth weight . Other obstetrical pathologies include premature labor, particularly if infection occurs in the last trimester ; increased risk of miscarriage and hemorrhaging [16-18]; and potential congenital abnormalities in the newborn . One cohort study found that dengue increased the risk of maternal death 3-fold, and DHF increased the risk of maternal death by 450 times when compared to mortality rates of pregnant women not infected with dengue .
Although the primary mode of dengue transmission between humans involves mosquito vectors, maternal transmission to infants is also possible , in addition to the virus being sexually transmissible for a brief period after acute DF, and known to cause reversible changes in sperm .
It is well known that dengue infection affects the body's central nervous system [22, 23] and may result in psychological manifestations [24, 25]. Several studies have revealed DF to be significantly associated with depression, anxiety, and distress [26-28]; these are more prevalent in females [29-31] and infected children who demonstrated irritable mood, visual hallucination, agitation, and aggressiveness . Moreover, transient myocardial depression is not uncommon in DSS patients  and may affect their clinical severity and level of fluid overload .
Dengue is a serious public health issue . There is no specific treatment for the disease, only the symptoms can be relieved until the immune system can resolve the infection. Antipyretic treatment with paracetamol to relieve pain and fever is advised. Nonsteroidal anti-inflammatory medications (ibuprofen) and aspirin should be avoided as these can cause further bleeding problems in people with dengue. Fluid intake is important to prevent dehydration, particularly if vomiting or diarrhoea occurs. In cases of severe dengue (DHF), symptoms such as vomiting repeatedly; vomiting blood; breathing difficulties; cold clammy skin; weak fast pulse; or drowsiness/loss of consciousness warrant urgent medical assistance .
Currently, five different dengue vaccines are being investigated: a live attenuated vaccine, inactivated vaccine, a recombinant subunit vaccine, a viral vector vaccine, and a DNA vaccine . The vaccines primarily work by enhancing immune responses against the E protein and non-structural protein 1 of the DENV . Dengvaxia, a live-attenuated dengue vaccine is approved by the U.S. Food and Drug Administration and recommended for use .
Without a suitable cure for dengue, contact between people and vector is key to preventing infections. Several environmental, chemical, biological, and genetic approaches are also being used or developed to control mosquito populations and prevent dengue infections .In addition, it is imperative that health educators and health promotion practitioners further increase awareness of dengue risk factors, particularly in countries with increased prevalence.
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or otherwise.
|||World Health Organization (WHO). Vector-borne diseases. 2020. Available From: https://www.who.int/news-room/fact-sheets/detail/ vector-borne-diseases|
|||Centers for Disease Control and Prevention (CDC). Dengue Areas of Risk Around the World. 2021. Available From: https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html|
|||World Health Organization (WHO). Dengue and severe dengue. 2022. Available From: https://www.who.int/news-room/fact-sheets/detail/ dengue-and-severe-dengue|
|||European Centre for Disease Prevention and Control (ECDC). Dengue worldwide overview. 2023. Available From: https://www.ecdc.europa.eu/en/dengue-monthly#:~:text=Americas%20and%20the%20Caribbean,and%20Nicaragua%20(13%20187)|
|||Sharmin S, Viennet E, Glass K, Harley D. The emergence of dengue in Bangladesh: Epidemiology, challenges and future disease risk. Trans R Soc Trop Med Hyg 2015; 109(10): 619-27.
|||Mutsuddy P, Tahmina Jhora S, Shamsuzzaman AKM, Kaisar SMG, Khan MNA. Dengue situation in Bangladesh: An epidemiological shift in terms of morbidity and mortality. Can J Infect Dis Med Microbiol 2019; 2019: 1-12.
|||Henrik S, Kishor KP, Repon P, et al. Nationally-representative serostudy of dengue in Bangladesh allows generalizable disease burden estimates. Elife 2019; 8: e42869.
|||bdnews24.com. Women dying more from dengue but disease afflicting more men in Bangladesh. 2019. Available From: https://bdnews24.com/health/women-dying-more-from-dengue-but-disease-afflicting-more-men-in-bangladesh|
|||Sinha B, Goyal N, Kumar M, et al. Incidence of lab-confirmed dengue fever in a pediatric cohort in Delhi, India. PLoS Negl Trop Dis 2022; 16(4): e0010333.
|||Pothapregada S, Kamalakannan B, Thulasingham M. Risk factors for shock in children with dengue fever. Indian J Crit Care Med 2015; 19(11): 661-4.
|||Huy NT, Van Giang T, Thuy DHD, et al. Factors associated with dengue shock syndrome: A systematic review and meta-analysis. PLoS Negl Trop Dis 2013; 7(9): e2412.
|||Tangnararatchakit K, Chuansumrit A, Chaiyaratana W, et al. Excessive menstrual bleeding in adolescents with dengue infection. Pediatr Infect Dis J 2010; 29(1): 92-3.
|||Jain M, Sehgal A. Dengue fever as a cause of menorrhagia. Int J Gynaecol Obstet 2011; 113(3): 247-8.
|||Paixão ES, Teixeira MG, Costa MCN, Rodrigues LC. Dengue during pregnancy and adverse fetal outcomes: A systematic review and meta-analysis. Lancet Infect Dis 2016; 16(7): 857-65.
|||Alvarenga CF, Silami VG, Brasil P, et al. Dengue during Pregnancy: A study of thirteen cases. 2009. Am J Infect Dis 2009; 5(4): 288-93.
|||Pouliot SH, Xiong X, Harville E, et al. Maternal dengue and pregnancy outcomes: A systematic review. Obstet Gynecol Surv 2010; 65(2): 107-18.
|||Basurko C, Carles G, Youssef M, Guindi WEL. Maternal and foetal consequences of dengue fever during pregnancy. Eur J Obstet Gynecol Reprod Biol 2009; 147(1): 29-32.
|||Dale Carroll I, Toovey S, Gompel AV. Dengue fever and pregnancy—A review and comment. Travel Med Infect Dis 2007; 5(3): 183-8.
|||Paixão ES, Teixeira MG, Costa MCN, Barreto ML, Rodrigues LC. Symptomatic dengue during pregnancy and Congenital Neurologic Malformations. Emerg Infect Dis 2018; 24(9): 1748-50.
|||Paixao ES, Harron K, Campbell O, et al. Dengue in pregnancy and maternal mortality: A cohort analysis using routine data. Sci Rep 2018; 8(1): 9938.
|||Mons J, Mahé-Poiron D, Mansuy JM, et al. Effects of acute dengue infection on sperm and virus clearance in body fluids of men. Emerg Infect Dis 2022; 28(6): 1146-53.
|||Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health 2007; 12(9): 1087-95.
|||Pawaria A, Mishra D, Juneja M, Meena J. Atypical manifestations of dengue fever. Indian Pediatr 2014; 51(6): 495-6.
|||Mushtaq M, Zahir M. Depression, anxiety, stress and their effect upon the self- efficacy in dengue patients. J Postgrad Med Inst 2016; 3(1)|
|||Jhanjee A, Bhatia MS, Srivastava S, Rathi A. A study of psychiatric symptomatalogy in dengue patients. Delhi Psychiatry J 2013; 16(1): 21-3.|
|||Gunathilaka N, Chandradasa M, Champika L, Siriwardana S, Wijesooriya L. Delayed anxiety and depressive morbidity among dengue patients in a multi-ethnic urban setting: First report from Sri Lanka. Int J Ment Health Syst 2018; 12(1): 20.
|||Hashmi AM, Butt Z, Idrees Z, et al. Anxiety and depression symptoms in patients with dengue fever and their correlation with symptom severity. Int J Psychiatry Med 2012; 44(3): 199-210.
|||Khan MA, Ahmad M, Mir S, et al. Anxiety and depression in patients of dengue fever. Rawal Med J 2012; 37: 239-42.|
|||Sultana S, Zaman S, Chowdhury ABMA, et al. Prevalence and factors associated with depression among the mothers of school-going children in Dhaka city, Bangladesh: A multi stage sampling-based study. Heliyon 2021; 7(7): e07493.
|||Sultana S, Muhammad F, Abm AC. Child-related factors associated with depressive symptoms among mothers in urban Bangladesh: A Cross-Sectional Study. Res Sqr 2022. preprint
|||Sultana S, Muhammad F, Abm AC. Women’s depression: Before or after marriage, When women are more depressed?. 2023 Open Psychol J 2023; 16(1)|
|||Herbuela VRDM, de Guzman FS, Sobrepeña GD, et al. Depressive and anxiety symptoms among pediatric in-patients with dengue fever: A case-control study. Int J Environ Res Public Health 2019; 17(1): 99.
|||Khongphatthanayothin A, Lertsapcharoen P, Supachokchaiwattana P, et al. Myocardial depression in dengue hemorrhagic fever: Prevalence and clinical description. Pediatr Crit Care Med 2007; 8(6): 524-9.
|||Darvin Scott Smith. Dengue Medication. 2022. Available From: https://emedicine.medscape.com/article/215840-medication|
|||Yauch LE, Shresta S. Dengue virus vaccine development. Adv Virus Res 2014; 88: 315-72.
|||Liu Y, Liu J, Cheng G. Vaccines and immunization strategies for dengue prevention. Emerg Microbes Infect 2016; 5(1): 1-6.
|||Centers for Disease Control and Prevention (CDC). For healthcare providers: A dengue vaccine can protect your patients. 2022. Available From: https://www.cdc.gov/dengue/vaccine/hcp/index.html|