Toxoplasmosis (Toxoplasma infection)

Toxoplasmosis Frequently Asked Questions (FAQs)

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What is toxoplasmosis?

A single-celled parasite called Toxoplasma gondii causes a disease known as toxoplasmosis. While the parasite is found throughout the world, more than 60 million people in the United States may be infected with the Toxoplasma parasite. Of those who are infected, very few have symptoms because a healthy person's immune system usually keeps the parasite from causing illness. However, pregnant women and individuals who have compromised immune systems should be cautious; for them, a Toxoplasma infection could cause serious health problems.


How do people get toxoplasmosis?

A Toxoplasma infection occurs by:

  • Eating undercooked, contaminated meat (especially pork, lamb, and venison).
  • Accidental ingestion of undercooked, contaminated meat after handling it and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin).
  • Eating food that was contaminated by knives, utensils, cutting boards and other foods that have had contact with raw, contaminated meat.
  • Drinking water contaminated with Toxoplasma gondii.
  • Accidentally swallowing the parasite through contact with cat feces that contain Toxoplasma. This might happen by
    1. cleaning a cat's litter box when the cat has shed Toxoplasma in its feces
    2. touching or ingesting anything that has come into contact with cat feces that contain Toxoplasma
    3. accidentally ingesting contaminated soil (e.g., not washing hands after gardening or eating unwashed fruits or vegetables from a garden)
  • Mother-to-child (congenital) transmission.
  • Receiving an infected organ transplant or infected blood via transfusion, though this is rare.

What are the signs and symptoms of toxoplasmosis?

Symptoms of the infection vary.

  • Most people who become infected with Toxoplasma gondii are not aware of it.
  • Some people who have toxoplasmosis may feel as if they have the "flu" with swollen lymph glands or muscle aches and pains that last for a month or more.
  • Severe toxoplasmosis, causing damage to the brain, eyes, or other organs, can develop from an acute Toxoplasma infection or one that had occurred earlier in life and is now reactivated. Severe cases are more likely in individuals who have weak immune systems, though occasionally, even persons with healthy immune systems may experience eye damage from toxoplasmosis.
  • Signs and symptoms of ocular toxoplasmosis can include reduced vision, blurred vision, pain (often with bright light), redness of the eye, and sometimes tearing. Ophthalmologists sometimes prescribe medicine to treat active disease. Whether or not medication is recommended depends on the size of the eye lesion, the location, and the characteristics of the lesion (acute active, versus chronic not progressing). An ophthalmologist will provide the best care for ocular toxoplasmosis.
  • Most infants who are infected while still in the womb have no symptoms at birth, but they may develop symptoms later in life. A small percentage of infected newborns have serious eye or brain damage at birth.

Who is at risk for developing severe toxoplasmosis?

People who are most likely to develop severe toxoplasmosis include:

  • Infants born to mothers who are newly infected with Toxoplasma gondii during or just before pregnancy.
  • Persons with severely weakened immune systems, such as individuals with HIV/AIDS, those taking certain types of chemotherapy, and those who have recently received an organ transplant.

What should I do if I think I am at risk for severe toxoplasmosis?

If you are planning to become pregnant, your health care provider may test you for Toxoplasma gondii. If the test is positive it means you have already been infected sometime in your life. There usually is little need to worry about passing the infection to your baby. If the test is negative, take necessary precautions to avoid infection (See below).

If you are already pregnant, you and your health care provider should discuss your risk for toxoplasmosis. Your health care provider may order a blood sample for testing.

If you have a weakened immune system, ask your doctor about having your blood tested for Toxoplasma. If your test is positive, your doctor can tell you if and when you need to take medicine to prevent the infection from reactivating. If your test is negative, it means you have never been infected and you need to take precautions to avoid infection. (See below).


What should I do if I think I may have toxoplasmosis?

If you suspect that you may have toxoplasmosis, talk to your health care provider. Your provider may order one or more varieties of blood tests specific for toxoplasmosis. The results from the different tests can help your provider determine if you have a Toxoplasma gondii infection and whether it is a recent (acute) infection.


What is the treatment for toxoplasmosis?

Once a diagnosis of toxoplasmosis is confirmed, you and your health care provider can discuss whether treatment is necessary. In an otherwise healthy person who is not pregnant, treatment usually is not needed. If symptoms occur, they typically go away within a few weeks to months. For pregnant women or persons who have weakened immune systems, medications are available to treat toxoplasmosis.


How can I prevent toxoplasmosis?

There are several general sanitation and food safety steps you can take to reduce your chances of becoming infected with Toxoplasma gondii.

  • Cook food to safe temperatures. A food thermometer should be used to measure the internal temperature of cooked meat. Do not sample meat until it is cooked. USDA recommends the following for meat preparation.
    • For Whole Cuts of Meat (excluding poultry)
      • Cook to at least 145° F (63° C) as measured with a food thermometer placed in the thickest part of the meat, then allow the meat to rest* for three minutes before carving or consuming.
    • For Ground Meat (excluding poultry)
      • Cook to at least 160° F (71° C); ground meats do not require a rest* time.
    • For All Poultry (whole cuts and ground)
      • Cook to at least 165° F (74° C), and for whole poultry allow the meat to rest* for three minutes before carving or consuming.

    *According to USDA, "A 'rest time' is the amount of time the product remains at the final temperature, after it has been removed from a grill, oven, or other heat source. During the three minutes after meat is removed from the heat source, its temperature remains constant or continues to rise, which destroys pathogens."

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  • Freeze meat for several days at sub-zero (0° F) temperatures before cooking to greatly reduce chance of infection.
  • Peel or wash fruits and vegetables thoroughly before eating.
  • Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables.
  • Wear gloves when gardening and during any contact with soil or sand because it might be contaminated with cat feces that contain Toxoplasma. Wash hands with soap and warm water after gardening or contact with soil or sand.
  • Teach children the importance of washing hands to prevent infection.

If I am at risk, can I keep my cat?

Yes, you may keep your cat if you are a person at risk for a severe infection (e.g., you have a weakened immune system or are pregnant); however, there are several safety precautions to avoid being exposed to Toxoplasma gondii :

  • Ensure the cat litter box is changed daily. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat's feces.
  • If you are pregnant or immunocompromised:
    1. Avoid changing cat litter if possible. If no one else can perform the task, wear disposable gloves and wash your hands with soap and warm water afterwards.
    2. Keep cats indoors.
    3. Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant.
  • Feed cats only canned or dried commercial food or well-cooked table food, not raw or undercooked meats.
  • Keep your outdoor sandboxes covered.

Your veterinarian can answer any other questions you may have regarding your cat and risk for toxoplasmosis.

More on: Handwashing



Once infected with Toxoplasma is my cat always able to spread the infection to me?

No, cats only spread Toxoplasma in their feces for a few weeks following infection with the parasite. Like humans, cats rarely have symptoms when first infected, so most people do not know if their cat has been infected. The infection will go away on its own; therefore it does not help to have your cat or your cat's feces tested for Toxoplasma.

Know what, where, when, how and more about Dengue?

Q: What does "Dengue" mean?

A: Dengue is derived from Swahili word (Kadingapepo) meaning evil spirit or perhaps it originated from Spanish word dengue meaning careful.


Q: What is dengue and dengue hemorrhagic fever?

A: Dengue fever is an acute high grade febrile illness ranging to 40c or 104F, associated with severe headache especially retro orbital pain (behind the eyes), rash, joints and muscles pain, hence it's named "break bone fever". If there are all of the above signs, + associated with bleeding due to very low platelets it would be called dengue hemorrhagic fever. This is further classified by WHO from grade 1-4, if a patient looses too much blood and plasma, this leads to dengue shock with very low blood pressure and multi organ failure especially liver and kidneys failure and subsequently it would be labeled grade4.


Q: What is the history and Epidemiology of this disease?

A: It seems that it is an ancient disease, in retrospect mentioned in Chines encyclopedia from the Jin Dynasty (265-420 AD), which referred to water poison associated with flying insect. There have been reported epidemics from 1779 1797, and has affected Asia, Africa, and North America. In 1906 its vector and basic understanding of its transmission was identified, in 1907 it was the second mosquito born viral disease after yellow fever. Since 1940 epidemics were frequent perhaps due to the 2nd World War, massive army movement in different parts of the world and disruption of ecological systems. The severe form of disease was first reported in 1953 in the Philippines, since then Philippine is endemic for dengue fever. By 1970, it had become the major cause of child mortality.

Epidemiology: Most people self recover without any complications. The mortality rate is 1-5% without treatment and less than 1% with adequate treatment, however severe disease carries the mortality rate of 26%. Dengue is endemic in more than 110 countries. It infects 50 to 100 million people world wide a year, leading to half a million hospitalizations and approximate 12,500 to 25,000 deaths. Dengue is the most common viral disease transmitted by arthropods. The incidence of dengue has increased 30 fold between 1960 and 2010. Dengue fever which was once confined to Southeast Asia, has now spread to southern China, countries in the Pacific ocean and America and might pose a threat to Europe.

Pakistan epidemiology: There is a huge epidemic in Punjab province at the moment with average 4-7 deaths a day. In retrospect Pakistan first reported an epidemic in 1997 perhaps from Karachi.

In 2007 total reported cases were 3500 with 289 deaths.

In 2008 4000 cases were reported with 55 deaths.

In 2009 5500 cases were reported with 100 deaths.

In 2010 total cases 5050 of which 2350 were in Sindh,1885 punjab and 200 KPP in which 31 deaths were reported, this data is probably incorrect due to poor recording and data sharing.



Q: What causes dengue fever?

A: Dengue fever is caused by an RNA virus, family flaviviridae, genus flavivirus, which has four serotypes, the common is serotype3 (DENV1, DENV2, DENV3 and DENV4).


Q: How the virus enter to human body?

A: Dengue virus is primarily transmitted through Aedes mosquitoes, particularly Aedes aegypti which has other species, called A. albopictus, A. Polynesiensis and A. Scutellaris. Human is the primary host, as the mosquito bites an infected person and suck the virus along with blood, after 8-10 days the virus reaches to the mosquito salivary gland, once it bites another healthy person the virus is transferred to that person and hence this is a vicious cycle which goes on and on until the mosquitoes are eradicated.


Q: What is its mechanism of infection?

A: When a mosquito carrying dengue virus bites a person, the virus enter through human skin along with mosquito’s saliva. It binds to and enters white blood cells and multiply in it. White blood cells respond by producing mediator proteins which causes a lot of complications. In severe cases of this disease virus invades liver and bone marrow; thefore patient develops thrombocytopenia.



Q: What is the physical appearance of this mosquitoes?

A: They typically look like other mosquitoes, but they have white spots on their limbs, thorax and wings, so one can easily identify it.


Q: How this disease transferred from one country to another?

A: Due to modern frequent travelling from one country to another a person can pick up the disease abroad and bring it to its own country, where the vector mosquito is already present, or a vector mosquito can be transported through good such as second hand tyre import export or other goods which can harbor eggs of the mosquito in the small amount of water retaining in those objects. I believe the Pakistan epidemic started the same one way, but probably we already had the vector in Pakistan.


Q: When these mosquitoes prefer to bite?

A: They are day biters. Only female mosquito have the ability to bite because they need blood to lay viable eggs. For this purpose it might bite humans or animals.


Q: If infected mosquito bite some body, how long it takes to develop dengue fever?

A: After a mosquito bite 4-7 days are required to develop the signs and symptoms; this is called the incubation period.


Q: How to diagnose dengue or dengue hemorrhagic fever?

A: In any endemic areas of the world the doctors will suspect dengue fever if the patient comes with the above mentioned symptoms. There might also be other symptoms such as ascites, gastrointestinal upset, vomiting, diarrhea or melena.

A good history, a complete physical examination as well as signs of skin rash and liver enlargement.

In the absence of any rash you may do a tourniquet test (also known as Rumpel-Leede Capillary fragility test) which is recommended by WHO to asses the hemorrhagic tendency of the patient. To do this test simply inflate the blood pressure cup around the arm of the patient between systolic and diastolic pressure for 5 minute. If in one inch square area around cubital fossa 10 or more petechiae appeared this will be considered positive. If 20 or more petechiae are found, it is more likely the picture of dengue hemorrhagic fever. However this test is not highly specific and can be affected by other factors.

Blood tests are carried out to confirm the diagnosis. PCR amplifies the virus RNA for detection. Antibody tests like IgM, IgG, can be done to establish the acute phase of infection. Further tests for serotyping can be done once infection is confirmed.


Q: How to treat dengue fever?

A: Treatment is supportive. Until now there are no anti viral drugs recommended to be effective against this virus. However, early diagnosis, and preventing the complications are vital in recovering from this disease. Patient should be isolated in the mosquitoes net, to prevent the spread of the disease to healthy people. Adequate hydration, if at home oral, if in the hospital intravenous hydration is recommended. Need for admission depends on warning signs e. g tendency of hemorrhage high hematocrits and low platelets, abdominal pain, persistent vomiting, mucosal bleeding, enlarged liver and lethargy. As a supportive treatment paracetamol for fever and pain but no NSAIDS which includes Aspirin, Ibuprofen, Naproxen which can increase bleeding tendencies.

If the blood test shows the platelets to be less than 100,000 and the hematocrit is dropping whole blood or packed RBC are recommended while platelets, fresh frozen plasma are not. If the hematocrits drops arrange blood transfusion rather than waiting for hemoglobin to drop. Avoid invasive procedures like nasogastric tube or intramuscular injections.


Q: How to prevent dengue fever and control the vector?

A: Prevention is better than cure. There is no vaccine available at the moment. The main step to control the disease by eradicating the vector. A. aegypti lay their eggs on damp soil or in small amount of fresh water such as collection of rain in the small containers, pots, unused tyre, even big trees have some holes in their trunks to retain rain water which is the breeding grounds. We should carefully inspect our surrounding for any retaining water. Any plants growing in the pot around or in the house should be inspected for stagnant water. Alternatively if difficult to dry out those small stagnant water areas we should drop few drops of kerosene oil which makes a thin film above the surface of water and stop oxygen dissolving in water which will ultimately suffocate the mosquitoes larvae.


Q: What are the other methods of controlling the vector?

A: Biological Control Research has shown that there are other insects which can be introduced to eat the mosquitoes or larvae of the mosquitoes, also to identify some, fungi, bacteria or viruses which can destroy the adult or larvae. This would need a long term planning and research as it will depend on many biological and ecological conditions.

Chemical Control Chemical control is one of the effective ways combating the vector in the situation of an epidemic. We should avoid using chemicals if they are not effective. Remember every chemical has hazardous effects on our environment and eco system.

New Jersey agriculture for mosquito control has published insecticides for 2011:

1. Malathion, Temephos and spinosad block acetyl choline in nerves.

2. Resmethrin and Etofenprox block sodium channels in nerves.

3. Bti which destroy cell membrane

4. Methoprene is Juvinile hormone agonist

5. Thermal aerosol fogging is an effective way of controlling the adult mosquitoes once populations reach to public health or nuisance level.

We should be aware which chemical are effective against adult mosquitos or its pupae or larvae. Every insecticides available in the market should carry all this information.

The use of chemical against insects need proper training to make it more effective and less health hazardous.





Q: What are the common precautions in the situation of epidemic?

A: We should raise public awareness. We should not visit endemic areas unless it is very necessary. People who are already in endemic areas should be wearing long sleeve shirts, use mosquito repellent on all exposed areas which are vulnerable to bites. We should use mosquito nets when sleeping day or night in both cases we can prevent dengue and even malaria.



There are more than 2500 species of mosquitoes, eight of the species account for over 99% complaint from the public. All mosquitoes must have water in which to complete its life cycles. This water can range in quality from melted snow water to sewage effluent and it could be in any container imaginable. The type of water in which the mosquito larvae is found can be an aid to the identification of which species it may be. The adult mosquito choose the source and quality of water to lay their eggs. They lay their eggs in such places like tree holes that periodically hold water, tide water pools in salt marshes, sewage effluent ponds, irrigated pastures, rain water ponds, etc. Each species therefore has unique environmental requirements for the maintenance of its life cycle.

The Flight habitat of mosquitoes depends again on the species, most domestic species remain fairly close to their point of origin while some species known for their migration habits are often annoying far from their breeding place. Female fly distances perhaps searching for humans or animals to feed on blood, wind also play a role in their migration and dispersion. Most mosquitoes stay with in a mile or two of their source, however some have been recorded 75 miles from their source.

The length of life of the adult mosquito usually depend on several factors: temperature, humidity, sex of the mosquito and time of the year. Most males live very short life, about a week, and female live about a month.



The mosquitoe goes through four separate and distinct stages of their life cycle:

1.Egg: Different species lay eggs differently, one egg at a time, like A. aegypti and anopheles lay their eggs scattered, while other species collect their eggs and arrange it in a boat or raft shape, of a hundred or more eggs. Most eggs hatch in to larvae in 48 hours.

2. Larvae: The larvae live in the water come to the surface for breathing, they shed their skin four time growing larger after each molting, most larvae have siphon tubes for breathing and hang from the water surface. Anopheles larvae do not have siphons and they lay parallel to the water surface, the larvae feed on micro organism and organic matter, on the fourth molt the larva changes in to pupa.

3. Pupa: It is a resting non feeding stage. This is the time the mosquito turns into an adult. It takes about two days before the adult is fully developed. When development is complete the pupa skin splits and the mosquitoes emerges as an adult.

4. Adult: The newly emerged adult rests on the surface of the water for short time to allow itself to dry and all it parts to harden. Also the wings had spread out and dry properly before the mosquito can fly. The eggs, larvae and pupae stages depend on temperature and species characteristic as to how long it takes for development. For example Culex tarsalis might go through its life cycle in 14 days at 70F and takes only 10 days at 80F. Also some species have naturally adopted to go to their entire life cycle in as little as four days or as long as one month.








1. W
2. insects/
3. Mosquito control in New Jersy in 2011 L. B. Brattsten, professor and, G.C Hamilton, professor, Department of entomology, Rutgers, the state university of New Jersy.
4. htt:// Cycle.html
5. dengue-control-strategy-in-pakistan/


Dengue fever

 Frequently Asked Questions
Q. What is dengue?
A. Dengue (pronounced den' gee) is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, the Aedes aegypti mosquito is the most important transmitter or vector of dengue viruses, although a 2001 outbreak in Hawaii was transmitted by Aedes albopictus. It is estimated that there are over 100 million cases of dengue worldwide each year.

Q.What is dengue hemorrhagic fever (DHF)?
A.DHF is a more severe form of dengue infection. It can be fatal if unrecognized and not properly treated in a timely manner. DHF is caused by infection with the same viruses that cause dengue fever. With good medical management, mortality due to DHF can be less than 1%.

Q.How are dengue and dengue hemorrhagic fever (DHF) spread?
A. Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue virus in their blood. The person can either have symptoms of dengue fever or DHF, or they may have no symptoms. After about one week, the mosquito can then transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person.


Q.What are the symptoms of the disease?
A. The principal symptoms of dengue fever are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g., nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.

Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels into the peritoneum (causing ascites) and pleural cavity (leading to pleural effusions). This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected. In addition, the patient with DHF has a low platelet count and hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding.


Q.What is the treatment for dengue?
A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician. If they feel worse (e.g., develop vomiting and severe abdominal pain) in the first 24 hours after the fever declines, they should go immediately to the hospital for evaluation.

Q.Is there an effective treatment for dengue hemorrhagic fever (DHF)?
A. As with dengue fever, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. DHF management frequently requires hospitalization. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information.

Q. Where can outbreaks of dengue occur?
A.Outbreaks of dengue occur primarily in areas where Ae. aegypti (sometimes also Ae. albopictus) mosquitoes live. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists.

Q.What can be done to reduce the risk of acquiring dengue?
A.There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Ae. aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.

Items that collect rainwater or to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and cleaned (to remove eggs) at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.

Using air conditioning or window and door screens reduces the risk of mosquitoes coming indoors. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small. There is increased risk if an epidemic is in progress or visitors are in housing without air conditioning or screened windows and doors.

Q.How can we prevent epidemics of dengue hemorrhagic fever (DHF)?
A.The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides, and adulticides). Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue fever/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of standing water where mosquitoes can be produced.


How to reduce your risk of dengue infection?

There is no vaccine available against dengue, and there are no specific medications to treat a dengue infection. This makes prevention the most important step, and prevention means avoiding mosquito bites if you live in or travel to an endemic area.

The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels. Look for standing water indoors such as in vases with fresh flowers and clean at least once a week.

The adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect yourself, use repellent on your skin while indoors or out. When possible, wear long sleeves and pants for additional protection. Also, make sure window and door screens are secure and without holes. If available, use air-conditioning.

If someone in your house is ill with dengue, take extra precautions to prevent mosquitoes from biting the patient and going on to bite others in the household. Sleep under a mosquito bed net, eliminate mosquitoes you find indoors and wear repellent! 


Patient Education

Basic - Fact Sheet

This one-page handout is intended to be used in a clinical setting and to be given to patients / family of patients with suspected dengue to assist them in watching for warning signs that could indicate risk for severe dengue.    English Adobe PDF file [PDF - 1 page]


Protect Yourself and Your Baby from Dengue - Fact Sheet

This one page handout discusses that "a pregnant woman infected with dengue virus may infect her unborn baby or her newborn baby at birth". Read the fact sheet to learn more.

Engilsh Version Adobe PDF file [PDF - 1 page]

Symptoms and What To Do If You Think You Have Dengue

The principal symptoms of dengue are:

  • High fever and at least two of the following:
    • Severe headache
    • Severe eye pain (behind eyes)
    • Joint pain
    • Muscle and/or bone pain
    • Rash
    • Mild bleeding manifestation (e.g., nose or gum bleed, petechiae, or easy bruising)
    • Low white cell count

Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.

Watch for warning signs as temperature declines 3 to 7 days after symptoms began.
Go IMMEDIATELY to an emergency room or the closest health care provider if any of the following warning signs appear:

  • Severe abdominal pain or persistent vomiting
  • Red spots or patches on the skin
  • Bleeding from nose or gums
  • Vomiting blood
  • Black, tarry stools (feces, excrement)
  • Drowsiness or irritability
  • Pale, cold, or clammy skin
  • Difficulty breathing

Dengue hemorrhagic fever (DHF) is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, warning signs may develop. This marks the beginning of a 24 to 48 hour period when the smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels into the peritoneum (causing ascites) and pleural cavity (leading to pleural effusions). This may lead to failure of the circulatory system and shock, and possibly death without prompt, appropriate treatment. In addition, the patient with DHF has a low platelet count and hemorrhagic manifestations, tendency to bruise easily or have other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding.


There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing ibuprofen, Naproxen, aspirin or aspirin containing drugs. They should also rest, drink plenty of fluids to prevent dehydration, avoid mosquito bites while febrile and consult a physician.

As with dengue, there is no specific medication for DHF. If a clinical diagnosis is made early, a health care provider can effectively treat DHF using fluid replacement therapy. Adequately management of DHF generally requires hospitalization.

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