Acetaminophen 

is an analgesic used to temporarily relieve minor aches and pains

due to headache, muscular aches, backache, minor pain of arthritis, the common
cold, toothache, and premenstrual and menstrual cramps. Acetaminophen is also
used to temporarily reduce fever.

Mild dengue fever causes a high fever, rash, and muscle and joint pain. A severe
form of dengue fever, also called dengue hemorrhagic fever, can cause severe
bleeding, a sudden drop in blood pressure (shock) and death.

IV fluids replace the fluids that are lost to the body due to sweating, vomiting, and

frequent urination. Not maintaining enough fluid hinders wound healing,
immunity, concentration and digestion. ... "Saline, which contains 0.9% sodium
chloride, is one of the most common IV fluids, used especially for dehydration.”

Dengvaxia successfully completes its two parallel Phase 3 clinical studies, which

compare the safety and effectiveness of the new treatment.

The development of a vaccine for dengue fever began as early as 1929, but has
been hindered first by incomplete knowledge of the disease pathogenesis, and later
by the need to simultaneously create a stable immunity against all four dengue
serotypes.

Reports of alleged deaths due to Dengvaxia have spawned a vaccination scare that
led to a drop in immunization coverage in the country to 40 percent last year, from
an average 70 percent in recent years.
Several cases have also been filed over the deaths of some who were injected with
Dengvaxia, but it has not been established whether the fatalities were caused by the
vaccine.
Death: 144 people (141 children and 3 adults) (as of August 12, 2019)
Dengvaxia is a vaccine used to help protect
against dengue disease. Dengue disease is a mosquito-borne tropical disease
caused by the dengue virus leading to mild, flu-like symptoms in most
people. ... Dengvaxia must only be given to people who have had a positive test
result showing a previous infection with dengue virus.

Dengue hemorrhagic fever (DHF): A syndrome due to the dengue virus that

tends to affect children under 10, causing abdominal pain, hemorrhage (bleeding)
and circulatory collapse (shock).

The Dengue Shock Syndrome (DSS) is characterized by bleeding that may appear
as tiny spots of blood on the skin (petechiae) and larger patches of blood under the
skin (ecchymoses). Minor injuries may cause bleeding (see figure 4). Shock may
cause death within 12 to 24 hours. Patients can recover following appropriate
medical treatment.
The progress towards DHF or DSS occur after 3-5 days of fever (see figure 3). At
this time, fever has often come down. This may mislead many of us to believe that
the patient is heading towards recovery. In fact, this is the most dangerous period
that requires high vigilance from care-givers.

1. Dengue fever, also known as breakbone fever, is a mosquito-borne infection

that can lead to a severe flu-like illness. It is caused by four different viruses
and spread by Aedes mosquitoes.

2. A typical person has a platelet count of between 150,000 and 250,000 per
microlitre of blood. About 80 to 90 per cent of patients with dengue will
have levels below 100,000, while 10 to 20 per cent of patients will see
critically low levels of 20,000 or less.

Thrombocytopenia is a condition in which you have a low blood platelet

count. Platelets (thrombocytes) are colorless blood cells that help blood clot. ...
Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia
or an immune system problem. Or it can be a side effect of taking certain
medications.

3. But in some people, it can also cause small blood vessels to leak,

which can lead to failure of the circulatory system, shock, and death. Severe
disease can happen with any dengue infection but is more common on
the second

4. But in some people, it can also cause small blood vessels to leak,

which can lead to failure of the circulatory system, shock, and death. Severe
disease can happen with any dengue infection but is more common on
the second
-Dengue should be suspected when you have sudden onset of fever. ...
The fever lasts for 5-7 days. In some patients, fever comes down on 3rd or
4th day but comes back. All the above symptoms and signs may not be
present in the patient.
-How dengue infection hits harder the second time around. ... One of the
most vexing challenges in the battle against dengue virus, a potentially fatal
mosquito-borne virus, is that getting infected once can put people at greater
risk for a more severe infection down the road.

5. It is concluded that Carica papaya leaf extract increases the platelet

count in dengue fever without any side effect and prevents the complication
of thrombocytopenia. So, it can be used in dengue fever with
thrombocytopenia patients. It is concluded that Carica papaya leaf
extract increases the platelet count in dengue fever without any side effect
and prevents the complication of thrombocytopenia. So, it can be used in
dengue fever with thrombocytopenia patients.
6. The elderly are at higher risk of developing severe dengue.

SUDDEN DEATHS
 The patient was a child aged 2 years and a member of the Tremembé ethnic
group indigenous to northeastern Brazil. In August 2013, the patient, who
was living in the State of Ceará and was previously healthy with no
complaints, suddenly presented intense crying, precordial pain and general
malaise. A few minutes after these non-specific symptoms, the patient
started tonic–clonic convulsions and had cyanosis, a substantial increase in
body temperature to the touch, cold sudoresis, sphincter relaxation, and
unconsciousness. This situation remained for 15 minutes, progressing to
respiratory insufficiency, with consequent absence of peripheral pulses as
the patient was on the way to the hospital.
At the emergency room in a local hospital, after resuscitation maneuvers
without success and without any biotic response, death was confirmed,
approximately 40 minutes after the first symptoms. Because the child was
under medical supervision by the Indigenous Health team and was
apparently healthy, without any evidence of violence, poisoning or previous
diseases, the family was consulted about the necessity to submit the body to
autopsy. After documented authorization, the Death Verification Service
(DVS) received the case.
During the anamnese, the family said to the DVS pathologist that the child
had presented cold-like symptoms.
Autopsy was performed under usual techniques. The pericardium was cut
and the aorta punctured for blood sample collection. A total of 10 mL of
blood was collected with a sterilized syringe and needles, without the use of
anticoagulant. The skullcap was removed, the dura mater was removed and
2 mL of cerebrospinal fluid (CSF) was collected from the subdural space.
For this procedure, all materials were sterilized. Samples of brain, heart,
lungs, liver, and spleen (1–2 cm wide) were collected in situ with sterilized
equipment (tweezers and scalpel). The fragments were preserved in two
sterile plastic bottles, with and without formaldehyde.
Considering that the death occurred during the major seasonal period for
dengue fever, samples without formaldehyde were sent for molecular
analysis, and samples with formaldehyde were sent for histological
techniques and immunohistochemistry for dengue diagnosis. All samples
without formaldehyde were sent to Central Public Health Laboratory of
Ceará (LACEN-CE) to perform diagnostic tests for anti-dengue IgM
antibody, non-structural 1 (NS1) antigen, viral isolation, and real time PCR
(RT-PCR). All tests were negative for IgM antibody, NS1 antigen, viral
isolation and RT-PCR. The sample for immunohistochemistry was sent to
the national reference laboratory at the Evandro Chagas Institute for further
analysis.
 The autopsy showed a male child, eutrophic, well nourished, presenting
cyanosis on the lips and nails, with nasal white secretion compatible with
food debris. The brain showed a slight flattening of spins and herniation of
the cerebellar tonsils (weight: 1.3 kg), and the lungs were aerated with small
purplish areas. The heart was slightly smooth and pale. The liver, spleen,
kidneys, and adrenal glands contained congested aspects.
Under microscopic examination, perivascular edema and interstitial edema
were revealed in all organs; however, they were more pronounced in the
meninges, brain, and the muscle fibers of the myocardium (Figure 1A, B).
Focal microhemorrhages were shown in the perivascular space, mainly in
the cerebral stem and basal ganglia, lymph nodes of mediastinum, thymus
capsule, and myocardium (Figure 2A, B, C, D). The alveolar septum of both
lungs was slightly thickened by capillary congestion and lymphocyte
infiltration. Flaking pneumocytes mixed with erythrocytes and edema fluids
were identified inside the alveolar spaces; however, these alterations were
focal. Mononuclear cells with large and irregular nuclei were visualized in
alveolar septa (Figure 3A, B, C, D). Accumulation of intracellular fluid,
represented by hydropic degeneration of hepatocytes, was seen diffusely in
the liver sections. Focal segmental tubular necrosis and scanty eosinophilic
material within Bowman’s space was found in both kidneys.
Immunohistochemistry showed a positive result for dengue, with micro
perivascular edema and cerebral hemorrhage.
 Dengue has become very prevalent in tropical and subtropical regions,
affecting hundreds of thousands people [10]. Early diagnosis and prevention
of dengue fever is essential for the appropriate supportive treatment and
management and can improve the patient survival [5,18]. Cardiac
dysfunctions, and consequently other physiological system complications
(pulmonary disorders), may have a contributing role in the pathogenesis of
shock and could also influence the outcome of the dengue, despite the
mechanism leading to the development of shock is complex and remains
largely unknown [5]. If significant cardiac involvement and failure is
present, preventive management strategies and advanced life support should
be applied to prevent mortality and morbidity by dengue. However, lung
abnormalities are not common in dengue infection and probably reflect
increased vascular permeability due to cardiac dysfunction.
 An 8-month-old male infant was found unresponsive during a nap in his
nursery school in Malaysia. The baby was quickly taken to the hospital by
ambulance, but was declared dead on arrival at the hospital. The body was
cold. The police took information from the nursery school teacher. Three
hours prior to death, she had given the baby plain water from a bottle before
putting him to sleep on a mattress on the floor; the baby frequently slept in
prone position. The nursery school had been taking care of the infant since
the age of 3 months. There was a history of mild fever in the weeks before
death and he had been treated with antipyretic drugs. The prosecutor began
an investigation of the nursery school, so the autopsy on the body was
arranged.
The infant was well hydrated and well nourished, with body length of 68 cm
and weight of 6920 g. He was pale and mild peripheral cyanosis was
observed. A faint lividity was noticeable on the frontal part of the body.
There was blood-stained fluid oozing out of the nostrils and mouth on
turning the body. There were no rashes or petechial hemorrhages on the
skin. Ophthalmoscopic examination did not show retinal hemorrhage. No
signs of external injury were detected, with the exception of puncture marks
on the dorsum of both hands as a result of attempts at resuscitation. All the
internal organs were congested. Pleural cavities contained 12 mL of yellow
fluid. The upper airways were filled with froth mixed with blood-stained
fluid. The lungs were edematous and congested; the entire lower lobes were
consolidated. The pericardial cavity contained 2 mL of yellow fluid. The
heart showed a few epicardial petechiae. The abdominal cavity contained 15
mL of yellow fluid. The stomach was empty. The liver was congested and
had a beefy appearance on cut sections. Other organs were unremarkable
except for edema. Serologic dengue screening using Captured Enzyme-
Linked Immunosorbent Assay was positive for IgM but negative for IgG.
A routine microscopic histopathologic study was performed on all samples
collected during autopsy using hematoxylin-eosin staining. Histopathologic
examination of heart samples showed foci of early coagulative
myocytolysis, mild and sparse perivascular and interstitial infiltration of
lymphocytes, monocytes and plasma cells without necrosis of myocells. The
lungs presented alveolar septa mildly thickened by edema and capillary
congestion; alveolar edema; lymphocytes, monocytes and plasma cells
infiltrated septa and bronchial walls in other sections obtained from the
pulmonary bases. In some fields, numerous endoalveolar erythrocytes were
observed. In liver, kidneys and spleen samples, there was perivascular
mononuclear cells infiltration. In addition, an immunohistochemical
investigation of lungs, heart, spleen, liver and kidney tissue samples was
performed using antibodies such as anti-CD45, CD3, CD4, CD8, CD15,
CD20, CD68 and dengue for the detection of DENV 1, 2, 3 and 4.
CD3, CD8 and CD68 intense positive reactions in lung, liver and
myocardium samples were detected. Viral antigens were demonstrated in
Kupffer and sinusoidal endothelial cells of the liver; macrophages,
multinucleated cells and reactive lymphoid cells in the spleen; macrophages
and vascular endothelium in the lung and kidney tubules (Fig. 1).