add these basic exercises

8/4/2019 Add These Basic Exercises

1/38

Add These Basic Exercises

to Your Fitness Plan

No time to exercise? Start off witha few minutes of these basic

exercises and calisthenics, just a couple of times per week, and watch your fitnessroutine grow over time and your body fat shrivel away.

This page was designed for people like me: Those that want simple (not to beconfused with easy) exercises that will tone their bodys primary muscles and build

strength for endurance sports without any fancy equipment.

I had to give up my weight bench years ago when my Me Room became our son'snursery. Today, I dont miss the weight equipment at all. I can do my strength

workouts almost anywhere and exercise almost every muscle in my body. Most of

these exercises are probably familiar to you, but Ive included explanations andpictures to guide you through the motions. Ive also listed the muscle groups

(laymans terms) that youll be working with each exercise.

These basic exercises will really tone your body and build more muscle. Add them to

your weekly routine and stick to them. If you can start doing some push-ups andcrunches just 3 times a week, this will greatly enhance your fitness plan. As you

become comfortable with that, add another exercise in a month.

If you prefer going to the gym, by all means, use the weights and machines. These

exercises can enhance your gym workout, or provide for a good substitute when youcant get to a gym. These exercises will burn calories both in the workout themselves

and in the raised metabolism youll gain with more lean muscle. I log this activity onmy workout log under calisthenics. Good luck!

PUSH UPS

Push-ups are a great resistance exercise, which primarily build your chest andshoulders. The triceps and back also get a fair workout. Start with your hands

shoulder-width apart; keep your back straight (i.e. dont stick your butt into the air);

and lower yourself towards the ground until your upper arms are parallel with thefloor. Push up and exhale as you do. Do enough to 'feel it', but dont push yourself toexhaustion. Remember: Youre building long-term habits.


2/38

CRUNCHES

There are numerous variations of crunches, each targeting a different part of your

abdominal muscles (abs). I like the crunches with my feet of the ground (eitherstraight up, or knees bent as shown). Raise your upper back a few inches off the

floor while slowly exhaling. You can take your right elbow to left knee and vice-versato target the oblique abdominals (side of your abs). The key with these is to make

sure that your abs are doing the work. Dont pull your neck your hands should beplaced on the side of your head. Tuck your chin to your chest, if you find yourself

pulling your neck. Like all of these exercises, you will get used to doing them withtime. Were shifting your comfort zone, one step (or crunch) at a time!


3/38

CALF RAISES

Slowly raise yourself up on your toes and lower heels back down. Do enough

repetitions to feel it, but dont over-due it or the stairs will be an obstacle tomorrow


4/38

morning. As these get easier over time (and they will as you keep doing them), doone leg at a time with the other leg bent at the knee and behind you.

SQUATS

The Squat is an important basic exercise and works a large muscle group that weoften overlook. Squats workout your hamstrings, quadriceps, and gluteal muscles.

Keep your back straight, hands at your side and slowly lower your weight by bendingyour knees. Raise yourself and exhale. Feet should be approximately shoulder-width

apart. As these get easier over time, do them on one leg (put the other leg straightout in front of you, suspended in the air).


5/38

PULL UPS / CHIN UPS

For pull-ups and chin-ups you may need to install a bar or improvise (not your pipes

at home, though!). This basic exercise works out your back, chest, and arm muscles.

It also strengthens your grip. The wider grip will work more back and lat muscles,while the narrow grip will work the tricep muscles. Start with a few sets of amanageable number of repetitions. Chin-ups (palms inward) will also build the bicep

muscles.


6/38

These basic exercises are a great foundation to a solid strength-building plan. A

strengthening program can really be enhanced with a proper stretching routine, aswell. Look into the benefits of stretchingand some basic stretches to increase both

your flexibility and strength.

To calculate the calories you burn during the above basic exercises and other

workouts, check out the calories-burned calculator.
http://www.the-fitness-motivator.com/benefits-of-stretching.htmlhttp://www.the-fitness-motivator.com/stretches.htmlhttp://the-fitness-motivator.com/calories-burned.htmlhttp://www.the-fitness-motivator.com/benefits-of-stretching.htmlhttp://www.the-fitness-motivator.com/stretches.htmlhttp://the-fitness-motivator.com/calories-burned.html


7/38

Effects of physical activity

heart rate

fatigue

benefits

o

flexibilityo strength

o endurance

o cardiovascular fitness

o increased self-esteem

o increased motivation

o decreased risk of illness

o reflexes

o balance

o coordination

o activity specific (skill)

riskso injury

Further/ongoing screening

during community activity program

after completion of community activity program

at regular intervals to ensure safety and benefits of community activity program

are maximised

Movement terminology

planes of movement

o frontal

o lateral

o horizontal

levers types

movement description

o flexion

o extension

o adduction

o abduction

o rotationo circumduction

o pronation

o supination

correct muscle names

Other relevant stakeholders


8/38

individual or group funding the community activity program, eg, local council

individual or group who initiated the community activity program

Pre-activity

prior to first implementing of community activity program

Precautions for participation

illness or sickness

disease

disorder

complaint

weakness

may involve but is not limited to

o acute inflammations, eg, signs and symptoms of bursitis and tendonitis

o

infections, eg, fever, temperature, rednesso fractures

o recent muscle injury, eg, hamstring tear

o haematoma, ie, bruising or the potential bruising

o torn ligaments, ie, joint instability

o acute and/or sudden joint swelling

o neck soreness/strain that result in symptoms of neurological origin in the

arms and/or restriction of spinal movemento pain on movement of any body part

o inability to bear weight through a limb

o people with medical problems who are not currently seeking medical

treatmento heart conditions

o open wounds

Range of people

screened, with no identified health risks

participants in community activity program

a range of

o ages that reflect normal fitness participants, usually over 10 years

o males and females

o fitness levelso experience levels in physical activities

Report

written

content

o satisfaction with the facilities


9/38

o satisfaction with community activity program outcome

o effectiveness of the community activity program

o monitoring and recording of individual responses to the various activities

demonstrated through

program record cards

screening records

Screening

height

weight

body mass index

girths

waist/hip ratio

strength

flexibility

for precautions to participation in physical activity includingo illness or sickness

o disease

o disorder

o complaint

o weakness

may involve but is not limited to

o acute inflammations, eg, signs and symptoms of bursitis and tendonitis

o infections, eg, fever, temperature, redness

o fractures

o recent muscle injury, eg, hamstring tear

o haematoma, ie, bruising or the potential bruisingo torn ligaments, ie, joint instability

o acute and/or sudden joint swelling

o neck soreness/strain that result in symptoms of neurological origin in the

arms and/or restriction of spinal movement

o pain on movement of any body part

o inability to bear weight through a limb

o people with medical problems who are not currently seeking medical

treatmento heart conditions

o open wounds

o medication use

Evidence Guide

Critical aspects of evidence to be considered


10/38

Assessment must confirm the ability integrated demonstration of all elements of

competency and their performance criteria, in particular the ability to

o explain basic principles of exercise science to program participants

o communicate precautions to participants

o deliver under supervision a community activity program in a range of

environments using a range of community recreation industry equipmentand venues

Interdependent assessment of units

This unit must be assessed after attainment of competency in the following unit(s)

o Nil

This unit must be assessed in conjunction with the following unit(s)

o Nil

For the purpose of integrated assessment, this unit may be assessed in conjunctionwith the following unit(s)

o SRCCAP002A Promote the benefits of healthy eating to participantso SRCCAP003A Demonstrate basis of body functioning to an activity group

o SRCCAP004A Support delivery of a group activity

o SRCCAP005A Perform warm-up stretching and cool-down techniques

before and after participation in an activity

Required knowledge and skills

Required knowledge

o Nil

Required skills

o Nil

Resource implications

Physical assessment - assessment of this competency requires access to

o a real or simulated work environment

o appropriate documentation and resources normally used in the workplace

o a work environment with clients

Human resources - assessment of this competency will require human resourcesconsistent with those outlined in the Assessment Guidelines. . That is, assessors

(or persons within the assessment team) should

o be competent in this unit but preferablyo be current in their knowledge and understanding of the industry through

provision of evidence of professional activity in the relevant area

o have attained the National Competency Standards for Assessment:

BSZ401A, BSZ402A and BSZ403A

Consistency in performance


11/38

Competence in this unit must be assessed over a period of time in order to ensure

consistency of performance over the Range Statements and contexts applicable to

the work environment

Context for assessment

This unit of competency must be assessed in the context of community recreation

in Australia. For valid and reliable assessment the community recreation activity

should closely replicate the work environment. The environment should be safe,with the hazards, circumstances and equipment likely to be encountered in a real

workplace

This unit of competence should be assessed through the observation of processes

and procedures, oral and/or written questioning on required knowledge and skillsand consideration of required attitudes

Where performance is not directly observed and/or is required to be demonstrated

over a "period of time" and/or in a "number of locations", any evidence should be

authenticated by colleagues, supervisors, clients or other appropriate persons


12/38

Basic hygiene lies at the heart of infection

control in the community: a pioneering

role in community infection control atCapital and Coast District Health

Board is removing fear from health

care workers and helping break the

chain of infection

by Anne Manchester

Infection control is just good basic hygiene, according to Capital and Coast District

Health Board's (DHB) community-based infection control facilitator Suzanne Miller. Shebelieves it's no coincidence that the Greek goddess of health was named Hygieia, from

which our word hygiene comes. In ancient Greek understanding, however, health was

only understood in relation to a life lived without indulgence or excess. It wasn't until theearly 1800s that scientists realty understood the links between micro-organisms and

disease, and the importance of prevention through hygiene.

Miller's community-based role is a year old now and remains a unique position among

DHBs. In the United Kingdom, this role is much more common. The position at Capital

and Coast was first proposed by a locum infection control nurse at the hospital, VivMurray. A business plan was prepared by the infection control team, which had been

receiving an increasing number of requests for infection control support and advice fromthe primary sector. Other changes occurring at that time were shorter patient stays, a

reduction in the number of hospital beds, and the consequent increase in care being

delegated to health care workers in the community. The challenge for the team was toensure that both caregivers and clients in the community stayed healthy.

Personal, domestic andcommunity hygieneGood hygiene is an important barrier to many infectious diseases,including


13/38

the faecaloral diseases, and it promotes better health and well-being.

To achieve the greatest health benefits, improvements in hygieneshould bemade concurrently with improvements in the water supply and

sanitation,and be integrated with other interventions, such as improvingnutrition andincreasing incomes. The next sections discuss how to improvepersonal andcommunity hygiene practices that help to prevent the spread offaecaloraldiseases.If wastewater is not disposed of effectively it can serve as abreedingground for mosquitoes. People may also slip and fall in muddypuddles, andchildren may play in them and risk waterborne illness.

8.1 Personal and domestic hygiene8.1.1 HandwashingProper handwashing is one of the most effective ways of preventingthespread of diarrhoeal diseases. Pathogens cannot be seen on hands,and wateralone is not always sufficient to remove them. Soap and wood ashare both

cleansing and disinfecting agents when used with water and can beused tokill pathogens on hands and utensils. The most important times thathandsshould be washed with soap and water are: After defecating. After cleaning a child who has defecated. Before eating or handling food.Promoting good personal hygiene often requires that communitymembersare mobilized towards this goal and awareness is raised about howto achieveit. It is important that hygiene education programmes do more thansimplytell people that if they do not wash their hands they will becomesick becauseof pathogens they cannot see. This rarely works. Instead, educationprogrammes


14/38

should try different methods to maximize community participation66 HEALTHY VILLAGES: A GUIDE FOR COMMUNITIES AND COMMUNITYHEALTH WORKERS

in the programmes and to encourage people to promote goodhygiene. Some

methods for promoting hygiene and health are discussed in the nextchapter.To encourage handwashing to become part of the daily routine,suitablefacilities must be located near to places such as latrines andkitchens, wherethey will be needed. If running water is available, the facilitiesshould includea tap and a sink as well as soap. Hands may also be washed at a tapstandas shown in Figures 8.1 and 8.2. If running water is not available, an

oil canor bucket fitted with a tap is a simple way of providing handwashingfacilities;the larger the container, the less frequently it will need filling. Somecontainersare mounted on stands with a ledge for soap. Aleaking container(suchas a tin can with holes in its base) can also be used to scoop waterfrom thewater storage container and provide a stream of running water for

handwashing.Another approach involves a suspended container that, whentipped, pours water onto the hands of the user. The system caneasily bemade from plastic cooking oil containers. Soap itself can be keptclean by suspendingit above the ground on a string.8.1.2 BathingRegular bathing and laundering are important for cleanliness andgood personalappearance. They also prevent hygiene-related diseases such as

scabies,ringworm, trachoma, conjunctivitis and louse-borne typhus.Educational andpromotional activities can encourage bathing and laundering, butincreasingthe number of washing facilities and locating them convenientlymay be more


15/38

effective. Bathing with soap is an important means of preventingthe transmissionof trachomaan illness that can cause blindness and other eyesightproblems. Childrens faces in particular should be washed regularlyand thoroughly.

If a child has trachoma, a special towel or tissue should be used towipe or dry the childs face; the towel should never be used forother childrenbecause of the risk of transmitting the disease. Ideally, programmesthatpromote bathing should be combined with a programme to reducethenumbers of flies, which spread trachoma and other diseases, and toimprovesanitation.For people to bathe thoroughly they must use sufficient water, but itmaybe difficult to promote the use of more water for washing if watersuppliesare distant and water must be collected by hand. Moreover, manytraditionalbathing practices do not use water efficiently and ensuringcleanliness maybe difficult. By modifying existing practices, such as by encouragingthe useof water containers with taps, it may be possible to improve the

efficiency ofwater use. Community shower units, with separate facilities for menandwomen, can also become income-generating enterprises in largervillages, butthe facilities require careful maintenance and must be convenientlylocated.Operators should also allay concerns about voyeurism, which maybeCHAPTER 8. PERSONAL, DOMESTIC AND COMMUNITY HYGIENE 67

Figure 8.1 Handwashing using a tap

Figure 8.2 Handwashing at a standpost68 HEALTHY VILLAGES: A GUIDE FOR COMMUNITIES AND COMMUNITYHEALTH WORKERS

particularly important to women. Such problems are best resolvedthroughdiscussion within the community.8.1.3 Laundering


16/38

To promote laundering of clothes and bedding, laundry slabs orsinks can beconstructed near water points. They should be large enough towash beddingand other bulky items and be situated so that water drains away

from thelaundry area and away from the water source. Locating laundryplaces innatural water bodies, streams and irrigation canals is best avoided ifpossible,since this practice can contribute to the transmission ofschistosomiasis.

8.2 Community hygieneSome health measures can be undertaken only by the communityas awhole; these include water source protection, proper disposal ofsolid wasteand excreta, wastewater drainage, controlling animal rearing andmarkethygiene. Some of these issues have been described in earliersections.Individual community members play an important role incommunityhygiene, and have a responsibility to their neighbours and to thecommunityto promote good health and a clean environment. For example,

everyone inthe village must keep their houses and compounds clean, becauseone dirtyhouse can affect many conscientious neighbours and contribute tothe spreadof disease. Community leaders can promote cleanliness in the homeby regularlychecking on village households and by using by-laws to encouragehousehold maintenance.8.2.1 MarketsMarkets often represent a health hazard because foodstuffs may notbe storedproperly and because the markets may lack basic services, such aswatersupply, sanitation, solid waste disposal and drainage. Ideally,markets shouldhave several taps to provide traders and customers with readyaccess to safe


17/38

water for drinking and washing. Many vegetable and fruit sellersregularlysprinkle their produce with water, and it is important that they haveaccessto clean water for this. The sanitation facilities should also be

appropriate forthe number of people who will visit the market, with separatefacilities formen and women. Water and sanitation facilities for a market areoften relativelyeasy to support by charging a small user fee, or by using part of themarket fee to pay for such services. If people are charged a fee touse the facilities,discounts can be offered to traders who already support thefacilitiesthrough their market fee.CHAPTER 8. PERSONAL, DOMESTIC AND COMMUNITY HYGIENE 69

Foodstuffs sold at the market should be inspected daily by healthofficials.

This is particularly important for meat and fish, which should beinspectedbefore sale to ensure that they have been prepared according tonationalregulations and that they do not contain pathogens or othercontaminants.Markets usually generate a lot of solid waste and it is important that

it is disposedof properly, to prevent vermin such as rats and insects from feedingand breeding among it. The layout of market stalls should thus alloweasyaccess for vehicles that collect waste and clean the area. Solidwaste shouldbe collected and disposed of daily, and preferably more often.Strategicallylocated waste bins (often concrete bunkers) can make this moreeffective.Market areas should also be properly drained to prevent flooding

and insectbreeding.Successful refuse collection in west AfricaIn one west African market, refuse collection was effective because therewereenough disposal points, and because the market was closed for a short timeeach


18/38


19/38

drinking-water sources, since their excreta contain pathogens thatcan contaminatefood and water. Preferably, animals should be kept in compounds atleast 100 metres from water sources and 10 metres from houses.Animal waste

should be disposed of properly, away from homes and watersources, or beused as a fertilizer. It is also best that animals are slaughtered awayfromhouseholds and water sources, since the offal and wastes mayintroduce contamination.Slaughtering must be carried out by qualified individuals whofollow the country laws governing slaughter practices..Some disease vectors prefer animal hosts to humans. Pigs, forexample,can be reservoirs of Japanese encephalitis, dogs can be reservoirs ofleishmaniasis,and some mosquitoes prefer to feed on cattle rather than humans.Placing animal shelters between mosquito breeding places and thevillagemay therefore provide some protection against malariatransmission.

8.3 Food hygieneContaminated food represents one of the greatest health risks to apopulationand is a leading cause of disease outbreaks and transmission. Food

that iskept too long can go bad and contain toxic chemicals or pathogens,and foodstuffsthat are eaten raw, such as fruits or vegetables, can becomecontaminatedby dirty hands, unclean water or flies. Improperly prepared food canalso cause chemical poisoning: cassava leaf that has not beenproperlypounded and cooked, for example, may contain dangerous levels ofcyanide.

To promote good health, therefore, food should be properly storedand prepared.Ways in which communities can prevent health risks from food arediscussed in the following sections.8.3.1 Food preparation in the homeAs most food is likely to be prepared in the home, it is importantthat families


20/38

understand the principles of basic hygiene and know how to preparefoodsafely. Before preparing food, hands should be washed with soap orash. Rawfruit and vegetables should not be eaten unless they are first peeled

or washedwith clean water. It is also important to cook food properly,particularly meat.Both cattle and pigs host tapeworms that can be transferred tohumansthrough improperly cooked meat; for this reason, raw meat shouldnever beeaten. Eggs, too, must be cooked properly before eating, since theymaycontain salmonella, a virulent pathogen. The kitchen itself should bekeptclean and waste food disposed of carefully to avoid attractingvermin, suchas rats and mice, that may transmit disease. Keeping foodpreparation surCHAPTER8. PERSONAL, DOMESTIC AND COMMUNITY HYGIENE 71

faces clean is critical, because harmful organisms can grow onthese surfacesand contaminate food.Fresh meat should be cooked and eaten on the same day, unless itcan be

stored in a refrigerator; if not, it should be thrown away. Cookedfood shouldbe eaten while it is still hot and should not be left to stand at roomtemperaturefor long periods of time, since this provides a good environment forpathogens to grow. Food that is ready to eat should be covered asshown inFigure 8.3 to keep off flies and should be thrown away if not eatenwithin1216 hours. If food must be stored after cooking, it should be keptcovered

and in a cool place, such as a refrigerator. If a refrigerator is notavailable,food can be stored on ice blocks or in a preservative such aspickling vinegaror salt. Food that is already prepared, or food that is to be eatenraw, must


21/38

not come into contact with raw meat as this may contain pathogensthat cancontaminate the other foods (particularly if slaughtering was notcarried outhygienically).

8.3.2 Eating-housesIn many rural communities food is bought and consumed at eating-houses(cafes, restaurants or cantinas). If basic health and safety rules forstoring,preparing and handling food are not followed in the eating-houses,theseplaces will represent a health hazard for the customers and maycause seriousdisease outbreaks. The most important aspects of food hygiene intheseestablishments relate to sanitation, water supply and personalcleanliness:Figure 8.3 Storing food properly72 HEALTHY VILLAGES: A GUIDE FOR COMMUNITIES AND COMMUNITYHEALTH WORKERS

Eating-houses should have clean water for washing and drinking,andseparate sanitation facilities, away from the kitchen area, forcustomers,cooks and food-handlers.

The staff should have clean uniforms each day and have regularmedicalcheck-ups. Food should be freshly prepared daily and any that is spilled or notused should be disposed of. The kitchens and eating areas must be kept clean and free ofverminand insects. Eating-houses should also be well-ventilated, with adequatelighting,and have procedures for dealing with fires and accidents. For

example,the eating area should not be too crowded, to allow customers easyexitin the event of a fire.Most countries have legislation covering eating-houses and theiroperation.


22/38

As a rule, eating-houses require official approval before they canoperate andare subject to regular checks. These checks are likely to beincreased in timesof epidemics. The community should recognize that eating-houses

must beproperly run and maintained to ensure that they do not become asource ofdisease. Eating-houses should be periodically checked, for exampleby healthofficials, to make sure that the establishments do not pose healthrisks. If acommunity member suspects an eating-house of posing a healthhazard,he/she should request an inspection by the appropriate local healthauthorities.8.3.3 Street food-vendorsStreet food-vendors are common in urban and periurban areas, buttheyalso operate in rural areas, particularly if there is a market orcommunityfair with bars and other drinking establishments. Although peopleenjoyfood from these vendors, in many cases the food is of poor qualityand itrepresents a serious health risk. A study in one African city, for

example,found that 98% of the street vendors had faecal contamination ontheir handsand food, a situation that is likely to be the same for food vendors inothercities and villages. In part, this is because the street vendors havelittle orno access to safe water supplies or sanitation facilities, and theycommonlycook and handle food with dirty hands. Raw foodstuffs, too, cannotbekept in safe storage places and are easily contaminated by verminand insects.Moreover, the street vendors often keep cooked food at ambient(environmental)temperatures for prolonged periods of time and may heat the foodonly slightly before serving. All these factors may make the foodfrom street


23/38

vendors dangerous.CHAPTER 8. PERSONAL, DOMESTIC AND COMMUNITY HYGIENE 73

Where street food-vendors are legal, they should be regulated bythe healthauthorities. Often they are not legal, however, and in these cases

steps shouldbe taken to promote their safe management of food and, wherenecessary, toprevent them from selling their food. This may be difficult if thedemand forstreet food is high, and it may be necessary to work closely withlocal healthauthorities. Street vendors should be encouraged to locate close towater pointsand sanitation facilities where they can keep hands and food clean.Community

members can also work with vendors to ensure that food isprepared andeaten immediately, rather than being kept unrefrigerated for longperiods.8.3.4 Promoting nutritionA healthy and well-balanced diet is essential for good health. Whenthere isnot enough food, or if the diet does not contain the right balance offoodstuffs,people become more prone to illness and may become

undernourishedor malnourished. Children, in particular, are vulnerable to poornutrition.Undernourishment and malnourishment can lower their resistanceand makethem more likely to suffer from infectious diseases. Often, childrenwill eatonly small amounts of food if it is spicy, even if it is nutritious, and itis importantto make childrens food less spicy than adult food. Also, becausetheir

stomachs are small, children can eat only small portions and needto be fedmore frequently than healthy adults. It is also important thatchildren are fednot just foods high in starch or carbohydrate (for instance rice orcassava).


24/38

Although these foods can quickly make a child feel full, he or shemay becomemalnourished if other key foodstuffs are not eaten. A well-balanceddietusually has a mixture of food with protein (for example beans, peas,

meat,fish or eggs), carbohydrates (such as maize, potatoes, cassava, riceand manyother staple foods), vitamins (such as vegetables, fish, fruits ormilk), andsome fats or oils (such as cooking oil). Sometimes not all thesefoods are availableand it is important that community members ask health workershow tomake best use of available foods for a balanced diet.In many situations, nutrition can be improved by changingagricultural orgardening practices. Often, even small plots of land can providenutritiousfood provided that the right crops are grown. Health workers oragriculturalextension workers can be asked for advice about which crops togrow toprovide community members with well-balanced diets. It is notpossible hereto give a full discussion of the nutritional value of foods, or of what

constitutesa well-balanced diet. This is an enormous subject and is covered inmoredetail in materials developed by other programmes andorganizations.However, it is important that communities request advice andsupport forimproving nutrition. Many organizations that provide advice andsupport tonutrition programmes are listed in Annex 1.


25/38

Dengue fever

From Wikipedia, the free encyclopedia

Jump to: navigation,searchFor other uses, seeDengue fever (disambiguation).

Dengue fever

Classification and external resources

The typical rash seen in dengue fever

ICD-10 A90.

ICD-9 061

DiseasesDB 3564

MedlinePlus 001374

eMedicine med/528

MeSH C02.782.417.214
http://en.wikipedia.org/wiki/Dengue_fever#mw-head%23mw-headhttp://en.wikipedia.org/wiki/Dengue_fever#mw-head%23mw-headhttp://en.wikipedia.org/wiki/Dengue_fever#p-search%23p-searchhttp://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/List_of_ICD-10_codeshttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://apps.who.int/classifications/apps/icd/icd10online/?ga00.htm+a90http://apps.who.int/classifications/apps/icd/icd10online/?ga00.htm+a90http://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=061http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb3564.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/001374.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/med/topic528.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?mode=&term=Dengue&field=entry#TreeC02.782.417.214http://en.wikipedia.org/wiki/File:Denguerash.JPGhttp://en.wikipedia.org/wiki/Dengue_fever#mw-head%23mw-headhttp://en.wikipedia.org/wiki/Dengue_fever#p-search%23p-searchhttp://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/List_of_ICD-10_codeshttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://apps.who.int/classifications/apps/icd/icd10online/?ga00.htm+a90http://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=061http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb3564.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/001374.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/med/topic528.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?mode=&term=Dengue&field=entry#TreeC02.782.417.214


26/38

Dengue fever (UK:/de/, US: /di/), also known as breakbone fever, is aninfectious tropical disease caused by the dengue virus. Symptoms include fever,

headache, muscle andjoint pains, and a characteristic skin rash that is similar to measles.

In a small proportion of cases the disease develops into the life-threatening dengue

hemorrhagic fever, resulting inbleeding,low levels of blood platelets and blood plasma

leakage, or into dengue shock syndrome, where dangerously low blood pressureoccurs.

Dengue is transmitted by several species ofmosquito within theAedesgenus, principallyA. aegypti. The virus has four different types; infection with one type usually gives

lifelongimmunity to that type, but only short-term immunity to the others. Subsequent

infection with a different type increases the risk of severe complications. As there is no

vaccine, prevention is sought by reducing the habitat and the number of mosquitoes andlimiting exposure to bites.

Treatment of acute dengue is supportive, using either oral or intravenous rehydrationfor

mild or moderate disease, andintravenous fluids andblood transfusion for more severe

cases. The incidence of dengue fever has increased dramatically since the 1960s, witharound 50100 million people infected yearly. Early descriptions of the condition date

from 1779, and its viral cause and the transmission were elucidated in the early 20th

century. Dengue has become a worldwide problem since theSecond World Warand isendemic in more than 110 countries. Apart from eliminating the mosquitoes, work is

ongoing on a vaccine, as well as medication targeted directly at the virus.

Contents

[hide]

1 Signs and symptomso 1.1 Clinical course

o 1.2 Associated problems

2 Causeo 2.1 Virology

o 2.2 Transmission

o 2.3 Predisposition

3 Mechanism

o 3.1 Viral reproduction

o 3.2 Severe disease

4 Diagnosis

o 4.1 Classification

o 4.2 Laboratory tests

5 Prevention

6 Management

7 Epidemiology 8 History

o 8.1 Etymology
http://en.wikipedia.org/wiki/Wikipedia:IPA_for_Englishhttp://en.wikipedia.org/wiki/Wikipedia:IPA_for_Englishhttp://en.wikipedia.org/wiki/Wikipedia:IPA_for_Englishhttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Genushttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Dengue_fever#%23http://en.wikipedia.org/wiki/Dengue_fever#Signs_and_symptoms%23Signs_and_symptomshttp://en.wikipedia.org/wiki/Dengue_fever#Clinical_course%23Clinical_coursehttp://en.wikipedia.org/wiki/Dengue_fever#Associated_problems%23Associated_problemshttp://en.wikipedia.org/wiki/Dengue_fever#Cause%23Causehttp://en.wikipedia.org/wiki/Dengue_fever#Virology%23Virologyhttp://en.wikipedia.org/wiki/Dengue_fever#Transmission%23Transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#Predisposition%23Predispositionhttp://en.wikipedia.org/wiki/Dengue_fever#Mechanism%23Mechanismhttp://en.wikipedia.org/wiki/Dengue_fever#Viral_reproduction%23Viral_reproductionhttp://en.wikipedia.org/wiki/Dengue_fever#Severe_disease%23Severe_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#Diagnosis%23Diagnosishttp://en.wikipedia.org/wiki/Dengue_fever#Classification%23Classificationhttp://en.wikipedia.org/wiki/Dengue_fever#Laboratory_tests%23Laboratory_testshttp://en.wikipedia.org/wiki/Dengue_fever#Prevention%23Preventionhttp://en.wikipedia.org/wiki/Dengue_fever#Management%23Managementhttp://en.wikipedia.org/wiki/Dengue_fever#Epidemiology%23Epidemiologyhttp://en.wikipedia.org/wiki/Dengue_fever#History%23Historyhttp://en.wikipedia.org/wiki/Dengue_fever#Etymology%23Etymologyhttp://en.wikipedia.org/wiki/Wikipedia:IPA_for_Englishhttp://en.wikipedia.org/wiki/Wikipedia:IPA_for_Englishhttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Genushttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Dengue_fever#%23http://en.wikipedia.org/wiki/Dengue_fever#Signs_and_symptoms%23Signs_and_symptomshttp://en.wikipedia.org/wiki/Dengue_fever#Clinical_course%23Clinical_coursehttp://en.wikipedia.org/wiki/Dengue_fever#Associated_problems%23Associated_problemshttp://en.wikipedia.org/wiki/Dengue_fever#Cause%23Causehttp://en.wikipedia.org/wiki/Dengue_fever#Virology%23Virologyhttp://en.wikipedia.org/wiki/Dengue_fever#Transmission%23Transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#Predisposition%23Predispositionhttp://en.wikipedia.org/wiki/Dengue_fever#Mechanism%23Mechanismhttp://en.wikipedia.org/wiki/Dengue_fever#Viral_reproduction%23Viral_reproductionhttp://en.wikipedia.org/wiki/Dengue_fever#Severe_disease%23Severe_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#Diagnosis%23Diagnosishttp://en.wikipedia.org/wiki/Dengue_fever#Classification%23Classificationhttp://en.wikipedia.org/wiki/Dengue_fever#Laboratory_tests%23Laboratory_testshttp://en.wikipedia.org/wiki/Dengue_fever#Prevention%23Preventionhttp://en.wikipedia.org/wiki/Dengue_fever#Management%23Managementhttp://en.wikipedia.org/wiki/Dengue_fever#Epidemiology%23Epidemiologyhttp://en.wikipedia.org/wiki/Dengue_fever#History%23Historyhttp://en.wikipedia.org/wiki/Dengue_fever#Etymology%23Etymology


27/38

9 Research

10 Notes

11 References

12 External links

[edit] Signs and symptoms

Schematic depiction of the symptoms of dengue fever

Typically, people infected with dengue virus are asymptomatic (80%) or only have mildsymptoms such as an uncomplicated fever.[1][2][3]Others have more severe illness (5%),

and in a small proportion it is life-threatening.[1][3] The incubation period (time between

exposure and onset of symptoms) ranges from 314 days, but most often it is 47 days. [4]

Therefore, travelers returning from endemic areas are unlikely to have dengue if fever or

other symptoms start more than 14 days after arriving home.[5] Children often experience

symptoms similar to those of the common cold and gastroenteritis (vomiting anddiarrhea),[6] but are more susceptible to the severe complications.[5]

[edit] Clinical course

The characteristic symptoms of dengue are sudden-onset fever, headache (typically

located behind the eyes), muscle and joint pains, and a rash. The alternative name fordengue, "break-bone fever", comes from the associated muscle and joint pains.[1][7] The

course of infection is divided into three phases: febrile, critical, and recovery.[8]

The febrile phase involves high fever, often over 40 C (104 F), and is associated with

generalized pain and a headache; this usually lasts two to seven days.[7][8] At this stage, arash occurs in approximately 5080% of those with symptoms.[7][9]It occurs in the first or

second day of symptoms as flushed skin, or later in the course of illness (days 47), as a
http://en.wikipedia.org/wiki/Dengue_fever#Research%23Researchhttp://en.wikipedia.org/wiki/Dengue_fever#Notes%23Noteshttp://en.wikipedia.org/wiki/Dengue_fever#References%23Referenceshttp://en.wikipedia.org/wiki/Dengue_fever#External_links%23External_linkshttp://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=1http://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-2%23cite_note-Euro10-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-2%23cite_note-Euro10-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-2%23cite_note-Euro10-2http://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-3%23cite_note-Gubler379-3http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-8%23cite_note-Fitz2009-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-8%23cite_note-Fitz2009-8http://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/Dengue_fever#Research%23Researchhttp://en.wikipedia.org/wiki/Dengue_fever#Notes%23Noteshttp://en.wikipedia.org/wiki/Dengue_fever#References%23Referenceshttp://en.wikipedia.org/wiki/Dengue_fever#External_links%23External_linkshttp://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=1http://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-2%23cite_note-Euro10-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-2%23cite_note-Euro10-2http://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-3%23cite_note-Gubler379-3http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-8%23cite_note-Fitz2009-8http://en.wikipedia.org/wiki/Erythema


28/38

measles-like rash.[9][10] Somepetechiae(small red spots that do not disappear when the

skin is pressed, which are caused by broken capillaries) can appear at this point,[8] as may

some mild bleeding from the mucous membranesof the mouth and nose.[5][7]The feveritself is classicallybiphasic in nature, breaking and then returning for one or two days,

although there is wide variation in how often this pattern actually happens.[10][11]

In some people, the disease proceeds to a critical phase, which follows the resolution of

the high fever and typically lasts one to two days.[8] During this phase there may besignificant fluid accumulation in the chest and abdominal cavity due to increased

capillary permeability and leakage. This leads to depletion of fluid from the circulation

anddecreased blood supply to vital organs.[8] During this phase, organ dysfunction andseverebleeding, typically from the gastrointestinal tract, may occur.[5][8]Shock(dengue

shock syndrome) and hemorrhage (dengue hemorrhagic fever) occur in less than 5% of

all cases of dengue,[5] however those who have previously been infected with otherserotypesof dengue virus ("secondary infection") are at an increased risk.[5][12]

The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream.[8] This usually lasts two to three days.[5] The improvement is often striking, but there may

be severe itchingand a slow heart rate.[5][8] During this stage, a fluid overload state mayoccur; if it affects the brain, it may cause areduced level of consciousness orseizures.[5]

[edit] Associated problems

Dengue can occasionally affect several otherbody systems,[8] either in isolation or along

with the classic dengue symptoms.[6] A decreased level of consciousness occurs in 0.56% of severe cases, which is attributable either toinfection of the brain by the virusor

indirectly as a result impairment of vital organs, for example, the liver.[6][11]

Other neurological disorders have been reported in the context of dengue, such as

transverse myelitisand Guillain-Barr syndrome.[6]Infection of the heart andacute liverfailureare among the rarer complications.[5][8]

[edit] Cause

[edit] Virology

Main article: Dengue virus
http://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-8%23cite_note-Fitz2009-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-9%23cite_note-ER2010-9http://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-9%23cite_note-ER2010-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-9%23cite_note-ER2010-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=3http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Hepatic_encephalopathyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndromehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=5http://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-8%23cite_note-Fitz2009-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-9%23cite_note-ER2010-9http://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-9%23cite_note-ER2010-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=3http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Hepatic_encephalopathyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndromehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-7%23cite_note-WHOp25-7http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=4http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=5http://en.wikipedia.org/wiki/Dengue_virus


29/38

A TEMmicrographshowing dengue virusvirions (the cluster of dark dots near the

center)

Dengue fever virus (DENV) is an RNA virus of the familyFlaviviridae; genus

Flavivirus. Other members of the same family includeyellow fever virus, West Nilevirus, St. Louis encephalitis virus, Japanese encephalitis virus,tick-borne encephalitis

virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus.[11] Most are

transmitted by arthropods (mosquitoes orticks), and are therefore also referred to asarboviruses(arthropod-borne viruses).[11]

The dengue virus genome(genetic material) contains about 11,000 nucleotide bases,

whichcode for the three different types of protein molecules (C, prM and E) that form

the virus particle and seven other types of protein molecules (NS1, NS2a, NS2b, NS3,NS4a, NS4b, NS5) that are only found in infected host cells and are required for

replication of the virus.[12][13]There are four strains of the virus, which are called

serotypes, and these are referred to as DENV-1, DENV-2, DENV-3 and DENV-4.[2]

Allfour serotypes can cause the full spectrum of disease.[12]Infection with one serotype is

believed to produce lifelong immunity to that serotype but only short term protection

against the others.[2][7]

The severe complications on secondary infection occurs particularly if someonepreviously exposed to serotype DENV-1 then contracts serotype DENV-2 or serotype

DENV-3, or if someone previously exposed to type DENV-3 then acquires DENV-2.[13]
http://en.wikipedia.org/wiki/Transmission_electron_microscopyhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/Transmission_electron_microscopyhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12


30/38

[edit] Transmission

The mosquitoAedes aegyptifeeding off a human host

Dengue virus is primarily transmitted byAedes mosquitoes, particularlyA. aegypti.[2]

These mosquitoes usually live between thelatitudesof 35 North and 35 South below an

elevation of 1,000 metres (3,300 ft).[2] They bite primarily during the day.[14] Other

mosquito speciesAedes albopictus,A. polynesiensisand severalA. scutellarisalsotransmit the disease.[2] Humans are the primary host of the virus,[2][11] but it also circulates

in nonhumanprimates.[15] An infection can be acquired via a single bite.[16] A female

mosquito that takes a blood meal from a person infected with dengue fever becomes itselfinfected with the virus in the cells lining its gut. About 810 days later, the virus spreads

to other tissues including the mosquito'ssalivary glands and is subsequently released into

its saliva. The virus seems to have no detrimental effect on the mosquito, which remains

infected for life.Aedes aegypti prefers to lay its eggs in artificial water containers, to livein close proximity to humans, and to feed off people rather than other vertebrates.[17]

Dengue can also be transmitted via infectedblood products and through organ donation.[18][19]

In countries such as Singapore, where dengue is endemic, the risk is estimated to bebetween 1.6 and 6 per 10,000 transfusions.[20]Vertical transmission (from mother tochild) during pregnancy or at birth has been reported. [21] Other person-to-person modes of

transmission have also been reported, but are very unusual. [7]

[edit] Predisposition

Severe disease is more common in babies and young children, and in contrast to many

other infections it is more common in children that are relatively well nourished. [5]

Women are more at risk than men. [13] Dengue can be life-threatening in people with

chronic diseasessuch as diabetes and asthma.[13]

Polymorphisms (normal variations) in particulargeneshave been linked with an

increased risk of severe dengue complications. Examples include the genes coding for the

proteins known as TNF,mannan-binding lectin,[1]CTLA4, TGF,[12]DC-SIGN, and

particularforms ofhuman leukocyte antigen.[13]A common genetic abnormality inAfricans, known as glucose-6-phosphate dehydrogenase deficiency, appears to increase

the risk.[22]Polymorphisms in the genes for thevitamin D receptorandFcRseem to

offer protection against severe disease in secondary dengue infection.[13]
http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=6http://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-13%23cite_note-WHOp59-13http://en.wikipedia.org/wiki/Asian_tiger_mosquitohttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-14%23cite_note-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-15%23cite_note-Yellow10-15http://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-16%23cite_note-16http://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-17%23cite_note-17http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18%23cite_note-18http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18%23cite_note-18http://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Blood_transfusionshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-19%23cite_note-19http://en.wikipedia.org/wiki/Dengue_fever#cite_note-19%23cite_note-19http://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-20%23cite_note-pmid20130380-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Polymorphism_(biology)http://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/Transforming_growth_factor_betahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=6http://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-13%23cite_note-WHOp59-13http://en.wikipedia.org/wiki/Asian_tiger_mosquitohttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-1%23cite_note-WHOp14-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-10%23cite_note-Gould-10http://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-14%23cite_note-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-15%23cite_note-Yellow10-15http://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-16%23cite_note-16http://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-17%23cite_note-17http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18%23cite_note-18http://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Blood_transfusionshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-19%23cite_note-19http://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-20%23cite_note-pmid20130380-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-6%23cite_note-Chen-6http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-4%23cite_note-Peads10-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Polymorphism_(biology)http://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/Transforming_growth_factor_betahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12


31/38

[edit] Mechanism

When a mosquito carrying dengue virus bites a person, the virus enters the skin together

with the mosquito's saliva. It binds to and enters white blood cells, and reproduces insidethe cells while they move throughout the body. The white blood cells respond by

producing a number of signaling proteins, such as interferon, which are responsible formany of the symptoms, such as the fever, the flu-like symptoms and the severe pains. Insevere infection, the virus production inside the body is greatly increased, and many more

organs (such as the liverand thebone marrow) can be affected, and fluid from the

bloodstream leaks through the wall of small blood vessels into body cavities. As a result,

less blood circulates in the blood vessels, and the blood pressure becomes so low that itcannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone

marrow leads to reduced numbers of platelets, which are necessary for effective blood

clotting; this increases the risk of bleeding, the other major complication of dengue.[22]

[edit] Viral reproduction

Once inside the skin, dengue virus binds toLangerhans cells (a population ofdendritic

cells in the skin that identifies pathogens).[22] The virusenters the cells through binding

between viral proteins and membrane proteinson the Langerhans cell, specifically the C-type lectins called DC-SIGN, mannose receptorandCLEC5A.[12] DC-SIGN, a non-

specific receptor for foreign material on dendritic cells, seems to be the main point of

entry.[13]The dendritic cell moves to the nearest lymph node. Meanwhile, the virusgenome is replicated in membrane-bound vesicles on the cell's endoplasmic reticulum,

where the cell's protein synthesis apparatus produces new viral proteins, and the viral

RNA is copied. Immature virus particles are transported to the Golgi apparatus, the partof the cell where some of the proteins receive necessary sugar chains (glycoproteins). The

now mature new viruses bud on the surface of the infected cell and are released byexocytosis. They are then able to enter other white blood cells, such asmonocytes and

macrophages.[12]

The initial reaction of infected cells is to produce interferon, acytokine that raises a

number of defenses against viral infection through theinnate immune system by

augmenting the production of a large group of proteins mediated by the JAK-STATpathway. Some serotypes of dengue virus appear to have mechanisms to slow down this

process. Interferon also activates the adaptive immune system, which leads to the

generation ofantibodies against the virus as well as T cells that directly attack any cell

infected with the virus.[12]Various antibodies are generated; some bind closely to the viral

proteins and target them forphagocytosis (ingestion by specialized cellsand destruction),but some bind the virus less well and appear instead to deliver the virus into a part of the

phagocytes where it is not destroyed but is able to replicate further.[12]

[edit] Severe disease

Further information:Antibody-dependent enhancement
http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=8http://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Interferonhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=9http://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Golgi_apparatushttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Interferonhttp://en.wikipedia.org/wiki/Interferonhttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=10http://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=8http://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Interferonhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=9http://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Golgi_apparatushttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Interferonhttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=10http://en.wikipedia.org/wiki/Antibody-dependent_enhancement


32/38

It is not entirely clear why secondary infection with a different strain of dengue virus

places people at risk of dengue hemorrhagic fever and dengue shock syndrome. The most

widely accepted hypothesis is that ofantibody-dependent enhancement (ADE). The exactmechanism behind ADE is unclear. It may be caused by poor binding of non-neutralizing

antibodies and delivery into the wrong compartment of white blood cells that have

ingested the virus for destruction.[12][13]

There is a suspicion that ADE is not the onlymechanism underlying severe dengue-related complications,[1] and various lines of

research have implied a role forT cells and soluble factors such as cytokinesand the

complement system.[22]

Severe disease is marked by two problems: dysfunction ofendothelium (the cells that lineblood vessels) and disorderedblood clotting.[6] Endothelial dysfunction leads to the

leakage of fluid from the blood vessels into the chest and abdominal cavities, while

coagulation disorder is responsible for the bleeding complications. Higher viral load inthe blood and involvement of other organs (such as thebone marrowand the liver) are

associated with more severe disease. Cells in the affected organs die, leading to the

release of cytokines and activation of both coagulation andfibrinolysis(the opposingsystems of blood clotting and clot degradation). These alterations together lead to bothendothelial dysfunction and coagulation disorder.[22]

[edit] Diagnosis

Warning signs[23]

Abdominal pain

Ongoing vomiting

Liver enlargement

Mucosal bleedingHigh hematocritwith lowplatelets

Lethargy

The diagnosis of dengue is typically made clinically, on the basis of reported symptoms

andphysical examination; this applies especially in endemic areas.[1] However, early

disease can be difficult to differentiate from otherviral infections.[5] A probable diagnosisis based on the findings of fever plus two of the following:nauseaand vomiting, rash,

generalized pains,low white blood cell count, positivetourniquet test, or any warning

sign (see table) in someone who lives in anendemicarea.[23] Warning signs typicallyoccur before the onset of severe dengue.[8] The tourniquet test, which is particularly

useful in settings where no laboratory investigations are readily available, involves theapplication of ablood pressure cufffor five minutes, followed by the counting of anypetechialhemorrhages; a higher number makes a diagnosis of dengue more likely.[8]It

can be difficult to distinguish dengue fever and chikungunya, a similar viral infection that

shares many symptoms and occurs in similar parts of the world to dengue.[7] Often,

investigations are performed to exclude other conditions that cause similar symptoms,such as malaria, leptospirosis, typhoid fever, and meningococcal disease.[5]
http://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-11%23cite_note-Life10-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-12%23cite_note-Guzman10-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Complement_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-5%23cite_note-India10-5http://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-21%23cite_note-Martina09-21http://en.wikipedia.org/w/index.php?title=Dengue_fever&action=edit&section=11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-22%23cite_note-WHOp10-22http://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-0%23cite_note-White10-0http://en.wikipedia.org/wiki/Viral_infectionshttp://en.wikipedia.

add these basic exercises

Documents