Download National Guideline 2018 for Dengue Fever

Dengue fever is now the talk of the country. As the death toll is rising day by day yet, the city corporation is taking not enough precautions lately. So far Institute of Epidemiology Disease Control And Research (IEDCR) has reported 7,450 dengue fever cases and at least 17 fatalities in Bangladesh. But the real number is higher. I have observed the death of a mother within 24 hours after the elective caesarian section due to Dengue as dengue was not diagnosed before the procedure. She left a triplet, so unfortunate. And I have treated a few cases of my relatives from Dengue. I have talked with the senior professors regarding the presentation of Dengue. They have assured me that its sign symptoms have changed, and a lot of new patterns are arising. Children are more suffering from dengue because of their weak immunity. I have suffered from Dengue last year. I had severe abdominal pain and diarrhea. I thought it was Typhoid, but later in CBC, there was a low platelet count. Then I suspected Dengue. I had done NS1 for Dengue, and It came positive.

Chikungunya is also affecting, but Dengue is more dangerous because of the chance of death.


How to know if its Dengue or Chikungunya Fever?

As Chikungunya and dengue viruses transmitted by the same mosquitoes, sometimes it is difficult to distinguish chikungunya and dengue based on clinical findings alone. The joint pain feature is more prominent in Chikungunya fever.
Blood Report: Complete Blood Count (CBC) can be done, which costs 250 takas only.

Chikungunya virus is more likely to cause high fever, severe polyarthralgia, arthritis, rash, and lymphopenia.

Dengue virus is more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death.

Patients with suspected chikungunya should be managed as dengue until dengue has been ruled out.

IAMAT guideline for Dengue: For travelers to visit Bangladesh, here is the guideline by the International Association for Medical Assistance to Travellers.

National Guideline 2018 for Dengue Fever

Download National Guideline 2018 for Dengue Fever (1)

Directorate General Of Health Services under Ministry Of Health And Family Welfare Bangladesh has published the National Guidelines for the Management of Dengue fever. The 3rd Edition was published in 2013. It was very necessary as the death toll is rising due to dengue.

The Chief advisor is Prof. Dr. Abul Kalam Azad, Director General of Directorate General of Health Services.
Editor in Chief is Prof. Quazi Tarikul Islam, Professor of Medicine, Popular Medical College and Former Member, Regional Technical Advisory Group for Dengue, SEARO-WHO.

Introduction: Dengue is a disease caused by an arbovirus, which has four related virus serotypes. It is the most important arthropod transmitted human viral disease and constitutes an important worldwide health problem, including Bangladesh. Dengue is a systemic and dynamic infectious disease. The infection may be asymptomatic or present itself with a broad clinical spectrum that includes both severe and non-severe clinical manifestations. After the incubation period (4 to 10 days), the illness begins abruptly and is followed by three phases—febrile, critical, and recovery.

There are four dengue virus serotypes, which are designated as DENV-1, DENV-2, DENV-3, and DENV-4. Previously only Den-1 and Den-2 were prevalent in Bangladesh. Now, Den-3 and Den-4 have been found in Bangladesh. Secondary infection with another serotype increases the chances of occurring more severe forms of diseases.

Aedes aegypti and Aedes albopictus are the two most important vectors of dengue, but Aedes aegypti is highly domesticated and strongly anthropophilic.

Sign Symptoms of Dengue Fever:

The following features are usually observed in addition to Fever: Fever is usually high grade in the first days. Fever may subside and appear a few days later. Which is more dangerous. A rash may or may not appear.
• Retro-orbital pain on eye movement or eye pressure
• Photophobia
• A backache, and pain in the muscles and joints/bones.
• The other common symptoms include anorexia and altered taste sensation, constipation, colicky pain, and abdominal tenderness
That these symptoms and signs of DF vary markedly in frequency and severity.

Laboratory Investigations for Dengue Virus:

The management of Dengue fever is more clinical than investigations reports. Few investigations may help in the course of treatment and evaluation.

  1. Complete Blood Count: There is usually Leucopenia, low platelet count  rising hematocrit (HCT)
  2. NS1 antigen (non-structural protein 1) for Dengue.

For the clinical purpose, Complete blood count, NS1 antigen, and SGOT (AST)and or SGPT (ALT) done within three days will confirm the diagnosis and guides for monitoring and management. These two investigations are very basic. Many diseases can be identified here. Other available investigations for severe and hospital admitted patients are:

  1. Serum AST(SGOT) and ALT (SGPT)
  2. Coagulation profile.
  3. Serum Electrolyte.
  4. Urine R/M/E

Specific Diagnosis of Dengue:

NS1 antigen: Positive from Day 1 of starting symptoms and becomes negative after 4-5 days.

Dengue IgM /IgG test: IgM is positive from day five onwards. IgG will be positive for the previous dengue.

Treatment of Dengue Fever:

First of all, Seek the advice of an MBBS doctor, at least. Don’t take medicines from the local pharmacy.

  1. Adequate bed rest
  2. Adequate fluid intake (> 6 glasses for an average-sized adult, or accordingly in children) – e.g., milk, fruit juice, oral rehydration solution (ORS) or barley/rice water/coconut water, Plain water alone may cause electrolyte imbalance. SO DO NOT TAKE JUST WATER ALONE.
  3. Take paracetamol only for fever.
  4. Tepid sponging with lukewarm water.
  5. Look for mosquito breeding places in and around the home and eliminate them.
  6. Avoid NSAID, Steroids, Aspirin, Anti-biotics, etc. without the advice of registered Doctors.
  7. Look for danger signs.

Do you know your Blood group? If not, it is high time You did your blood group, Make a list of Donor ready for you in an urgent situation.

Dengue Vaccine:

The Dengue vaccine is available. The name is Dengvaxia, developed by Sanofi Pasteur. It can be used for the persons of 9-45 years of age. The vaccine had proved to be very effective in those who had dengue once. The dengue vaccine is not yet imported in Bangladesh. So not available in our country till now. A more clinical trial is needed.


How to Prevent Dengue Fever?

  1. Wear protective clothing such as full sleeved shirts and full pants during day time.
  2. Use of mosquito coils, aerosols, mats, etc.
  3. Use of mosquito net
  4. Use of repellents and creams during the day
  5. Clean and cover water storage, keeping surroundings clean, improving basic sanitation measures.

And many others you can find in Newspapers, TV, etc.

Download National Guideline 2018 for Dengue

Google Drive Link

Media Fire Link

To read more in Bangla: Facebook posts a child Doctor Sayed Muhammad Tawhid.[Backup]

Additional Readings:

WHO Dengue

Thank, everyone. Take care.

About Dr. Alamgir Hossain Shemul 94 Articles
Passionate about Child Health and Well Being. MD Resident of Pediatric Hematology and Oncology in BSMMU. Passed MBBS from Rajshahi Medical College. Completed FCPS Part 1 in Paediatrics. Ex-Honorary Medical Officer at Dhaka Medical College Hospital and NICU Medical officer at Anwer Khan Modern Hospital, Dhaka.

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