Dengue Fever

It is estimated that one-third of the world's population is at risk of infection with the Dengue virus. The virus is spread by blood-feasting organisms, such as mosquitoes [FIGURE 6], ticks and fleas." The type of mosquito that is the main cause of transmission of the virus is present in nearly every tropical country, which explains the fact that 50-100 million people each year acquire Dengue fever (DF). Of these millions, 500,000 go on to suffer the severe forms of the disease known as Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS).3z There is currently no vaccine available for DF, although some pharmaceutical companies, including GSK, are at an advanced stage of clinical testing of a vaccine that may prevent the disease.

FIGURE 6. DENGUE FEVER IS ENDEMIC WHEREVER BLOOD-FEASTING ORGANISMS, SUCH AS MOSQUITOES, LIVE

Many cases of infection result in no clinically apparent symptoms, but the classic sign of infection is fever, from which nearly all patients recover. However, the disease is usually more severe if a person is infected for a second time when the risk of DHF and DSS is 15-80 times higher."
Signs, symptoms and natural course of the disease

The vast majority (95%) of DF cases occur in children under the age of 15 years, with at least 5% of these cases in infants. 12 The virus has an incubation period of 7-10 days after which the signs and symptoms of DF include a fever that lasts for 2-7 days, with two or more of the following symptoms:"

• Headache.
• Retro-orbital pain (pain behind the eye).
• Muscle/joint pain.
• Rash.
• Pinpoint, un-raised, round red spots under the skin caused by bleeding, known as petechiae.
• Low white blood-cell count.

 

Progression to DHF is indicated by:
• Petechiae or larger, blue-red bruise-like lesions on the skin that are also caused by bleeding.
• Bleeding from the nose, gums, injection sites or other sites.
• Vomiting of blood or the passing of dark, tarry stools containing blood.
• Low blood platelet count.
• Leakage of blood plasma from the capillaries, indicated by abnormal levels of red blood cells or excessive fluid in the abdominal or lung cavities.

 

In DSS, the symptoms are the same as DHF, but signs such as a rapid/weak pulse, low blood pressure, restlessness and cold, clammy skin will also be present.

 

Complications of Dengue Fever
The percentage of Dengue-infected patients who die as a result of DF, DHF or DSS is estimated at between 0.5% and 3.5%.34 The complications of DHF include liver failure, swelling of the brain and inflammation of the heart muscle leading to abnormal heart function."

Efficacy of paracetamol in the treatment of Dengue fever
WHO guidelines recommend that the treatment of DF be based on the relief of the various types of fever and pain symptoms and patient support." Paracetamol is one of the antipyretics/analgesics recommended for DF, as both aspirin and ibuprofen increase the risk of gastrointestinal bleeding."
WHO recommends a paracetamol dose of between 60 and 240 mg not more than 4 times a day, depending on the age of the child." Fluid intake is required to combat dehydration caused by vomiting and high temperature." DHF and DSS require specialised treatment based on fluid and electrolyte replacement therapy."," However, even in cases of DHF, paracetamol can be used to control fever."

 

 

DENGUE FEVER SUMMARY,
• 50-100 million people each year acquire Dengue fever (DF).
• 95% of DF cases occur in children <15 years of age.
• Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) are severe forms of this disease.
• Fever is one of the classic signs of Dengue infection.
• Paracetamoi is one of the antipyretics/analgesics recommended for DF.

 

Colds and coughs, and other viral infections

 

Viruses are responsible for a range of common childhood ailments, many of which are self-limiting. Common viral ailments of this sort include coughs and colds, measles, rubella (German measles) and chicken pox (varicella). However, complications of viral diseases can occur, especially in children who are malnourished or have co-existing conditions that weaken the immune system. As discussed below, these complications can include blindness, encephalitis (inflammation of the brain) and pneumonia. Furthermore, rubella is associated with birth defects, still birth and a condition of the new born known as congenital rubella syndrome (CRS, see Rubella section). These complications are the reason why widespread immunisation programmes have emerged.

While the body can usually deal with the infectious agent, the natural course of the disease is often accompanied by symptoms such as fever, sore throat and aching limbs, the role of Paracetamol Calpol® in treating children with these viral diseases is to relieve these symptoms.

Colds and coughs
It is estimated that an otherwise healthy 3-year old living in the developed world will suffer 6-10 colds per year" and this can lead to up to 140 days of cold symptoms per year."
Signs, symptoms and natural course of a cold

The 'common cold', of which cough is often a symptom, is specifically a viral upper-respiratory tract infection (URTI) that is associated with a range of symptoms [TABLE ].

TABLE 1. SIGNS AND SYMPTOMS OF A COMMON COLD"

• Nasal discharge                                      • Mild fever (<39°C)
• Nasal congestion/ obstruction                 • Muscle pain
• Scratchy/sore throat                               • Irritability
• Malaise                                                    • Decreased sleep
• Runny nose                                             • Conjunctivitis
• Headache                                                • Sore throat
• Cough                                                      • Watery eyes
• Sneezing                                                 • Fatigue
• Decreased appetite                                 • Hoarseness

 

It is thought that there are over 100 different types of virus that can cause a cold." The largest concentrations of these viruses are found in the nose and they are passed on primarily by contamination of hands and objects by excretions from the nose. Therefore, sneezing, nose blowing, nose wiping and other methods of spreading nasal secretions can spread the infection. In contrast, saliva does not contain a high level of viruses and coughing is not a major source of transmission of infection." After the virus has been introduced into the nasal passages of the child, it infects the lining of the nose and airways. The typical increase in the amount and thickness of nasal secretions is part of the body's mechanisms for fighting the infection.

The virus can infect the child for 1-5 days before symptoms become apparent and in most cases the infection has been eradicated from the body in 10-14 days.

Complications of a cold
Complications of a cold can include ear infections (otitis media - earache and ear infection) and sinus infection. Another important aspect of a cold is its ability to trigger asthma in children who are susceptible to the condition.

Managing coughs and colds in children
In most cases, the management of coughs and colds is based on relief of the symptoms until the  disease has run its course . There is good evidence that analgesics such as Paracetamol can provide relief of aches and pains and mild fever.

COLDS AND COUGHS SUMMARY
• Over 100 different types of virus can cause a old.
• Healthy 3 year olds can suffer 6-10 colds per year.
• Cough is often a symptom of the 'common cold'.
• Ear infections (otitis media) and sinus infections can occur as complications of a cold.
• Paracetamol Calpol® can provide relief of some of the symptoms of a cold including aches and pains and mild fever.