Importance and epidemiology of dengue disease:
Spread of the disease throughout the world has been concidareble during the last decades , especially in tropical and subtropical areas.
More than half of the world's population lives in areas where the disease is possible
Before 1970, Outbreak of the disease has been reported only in 9 countries and now is endemic in 100 countries like America, Africa, East Mediterranean, Southeast Asia and West Pacific ocean, particularly Malaysia, Thailand, Afghanistan, Pakistan, India, Singapore, Saudi Arabia (Jeddah).
The number of cases has reached from 1.2 million in 2008 to 3.2 million in 2010. Alone in 2010, 1.6 million cases of the disease have been reported in the United States. 49 thousand of cases were severe dengue.
Dengue virus infected more than 100 million people within a year
Around Half a million people are diagnosed with the severe form of the disease and are hospitalized. Most cases involve children. Approximately two and a half percent of the cases lose their lives.
Not only the disease is spreading, but also their annual outbreak has been reported in various parts of the world.
No vaccine has been identified yet.
The disease-carrying mosquitoes have been identified in Iran.
So far no specific treatment is known. Taking care of patients in the intensive care unit is the most important step. With respect to appropriate actions, the mortality rate will be reduced from 20% to 1%.
Despite the high Damages to the health and economies of the countries, still is considered as a neglected disease in the world.
The World Health Organization's message in 2014 is "small bite, big threat". This message indicates the priority and importance of this disease.

Dengue disease Transmission routes:
A. aegypti mosquitoes become infected after biting infected people
The incubation period of the disease is four to ten days after the bite of an infected mosquito.

Dengue disease clinical symptoms:
Sudden onset of high fever with at least two of the following symptoms:
Severe headache, Pain behind the eyeball
Muscle pain, especially in the back and joints. Another name for this disease is a bone-breaking fever.
Nausea, vomiting
Swollen lymph nodes
Maculopapular rash, palate vesicles and Scleral hyperemia

Laboratory symptoms:
Thrombocytopenia, leukopenia, neutropenia, increas in serum aminotransferas
Its symptoms usually take 7-3 days

Severe dengue:
Previously stated as Dengue Hemorrhagic Fever (DHF)/ Dengue shock syndrome (DSS):
Body temperature reduction below 38 ° C, severe abdominal pain, persistent vomiting, rapid breathing, nose and gums bleeding, anorexia, fatigue, lethargy, and Hemoptysis, Central cyanosis, Hyperhidrosis and cold with moist skin 
If appropriate remedial action is not done, it will be fatal after 48-24 hours.


The following symptoms are fatal:
Increasing capillary permeability, accumulation of fluid in the interstitial space, respiratory distress and severe bleeding and tissue destruction

Dengue disease without warning symptoms:
Fever with at least two of the following symptoms:
Nausea, vomiting
Rush
Bone and joint pain
Decrease in white blood cells
Positive tourniquet test

Dengue disease with warning symptoms:
Abdominal pain or abdominal tenderness
Persistent vomiting
Fluid accumulation
Mocusal bleeding
Drowsiness, restlessness
Enlargement of the liver, more than 2 cm below the rib edges

Laboratory findings:
The rapid increase in hematocrit and decreased platelet count

 Severe Dengue:
Dangue disease with at least one of the following symptoms:
Severe plasma leakage leading to one of the following:
Dengue shock syndrome (DSS)
Fluid accumulation with respiratory distress
Massive hemorrhage
Severe involvement of organs
Liver: ALT or AST ≥ 1000
Central Nervous System: Impaired consciousness
 Heart failure or other organs' failure

Definitive diagnosis of dengue infection:
Positive IgM antibody
Proving existence of the virus in the serum
 4 times inrease in acute and convalescence period period in IgG

Treatment:
Anti-virus treatment is not known so far and principles of treatment are as following: preservative treatment with accurate calculation, prescribtion of suitable fluids with careful control of urine and patient weight, In case of necessity the blood product should be prescribed.

Disease Control:
At the present time, confronting with mosquitoes is one of the most effective ways to control the disease
Evacuating water from cooling equipment like ventilation, & air conditioning, tanks, jars, bucket, barrels and …
Accurate collecting of garbage, establishing appropriate systems of collecting sewage
The lid of water tanks should always be closed.
Garbage that can gather water like; bottles, plastic containers, old tires and etc must be destroyed.
Use of the completely covered clothes with long sleeves
Using anti-mosquito products such as insecticide spray and pills especially for children and elderly people
Using poisonous mosquito net during the rest and curtains can be covered with insecticides.
All the patients should be protected against the bite.