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  Fever & Infection

December 2009
A Lowdown On Dengue
Dr Syamasis Bandyopadhyay
 
The feared Aedes Aegypti's claim to fame is shocking – they torment the lives of nearly two fifth of global population! According to the World Health Organisation, 2.5 billion people are at risk of suffering from dengue fever. Aedes Aegypti, by the way, is a not a cult or mafia organisation: it is a species of mosquito...
 
Dengue is a mosquito-borne infection that causes typical flu-like illness. Sometimes it causes potentially lethal complications like Dengue Hemorrhagic Fever (DHF) and dengue shock syndrome. It is commonly seen in tropical and sub tropical countries

Getting Infected
Dengue is spread when the female Aedes Aegypti bites an infected person - and then bites a healthy individual. These mosquitoes are smaller in size and live within 90 mts of human dwelling place so that their food is assured. The Aedes Aegypti mosquito can be recognised by white markings on its legs and a marking of the form of a lyre on the thorax.

Complications
Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are complications of dengue where the platelet or clotting factor of the blood reduces at an alarming level, resulting in bleeding. Along with all the other symptoms of dengue, there occurs bleeding from nose, gums and other openings of the body, and bruising or appearance of bluish red marks as a sign of internal bleeding. As the DHF progresses, the body loses the circulating blood volume and goes into a serious condition called Dengue Shock Syndrome (DSS) where the patient has weak pulse, extreme weakness, altered level of consciousness, bleeding with stool (melena), vomiting, nose bleed, abdominal pain etc. The risk of DHF and DSS increase with subsequent dengue infections.

Dengue Diagnosis
Anyone presenting with the symptoms of high fever, severe joint pains and rash should be screened for dengue. Especially after visiting a dengueinfested zone, any fever should raise a high suspicion. Blood works remain the cornerstone for dengue diagnosis. There is a delay in between the infection and development of dengue antibody. So the dengue test done three to four days after manifestation of symptoms yields appropriate result. There may be changes in white cell count as well. Since this is a mosquito-borne infection, malaria should also be ruled out.

 
Dengue Symptoms
  1. High fever often shooting up to 104◦F and more
  2. Rashes all over the body, mainly the arms
  3. Pain behind the eyes and headache
  4. Severe pain in bones and joints (no wonder dengue is also called break bone fever)
  5. Transient flushing pink colour on face
  6. Swelling up of glands in the neck and groin
The fever and other symptoms of dengue rise rapidly, and last about four days. Thereafter there is an abrupt drop in temperature and sweating, followed by a period of normal temperature and an apparent feeling of wellbeing for a day. The temperature shoots up again, and characteristic rash appears. The palms and soles appear bright red and swollen up.

Taking Care of Dengue
In most cases, uncomplicated cases of dengue can be well-managed at home, provided the treatment is carried under expert medical supervision. There are no specific vaccines for dengue. It is treated symptomatically. The principal aim is to control the abrupt temperature fluctuation, maintain adequate hydration and provide relief from joint pain and abstinence from exertion.
  1. Patients should have plenty of fluids like water, fresh fruit juice, coconut water, light soup, ORS solution etc. It is better to avoid cola and other fizzy drinks, which may contain harmful chemicals.
  2. Since dengue is a viral illness, antibiotics are of no use. But doctors may prescribe it if there are signs of secondary bacterial infection.
  3. Paracetamol can be taken to bring down fever and provide relief from debilitating joint pain.
  4. Aspirin and non steroidal anti inflammatory medicines like Ibuprofen should not be taken since they increase the risk of bleeding.
  5. Patients should be kept within mosquito net to avoid the risk of mosquito bite and spreading of infection.
  6. Infants, children, elderly and those with low immunity should stay away from the dengue patient till the infection is cleared.
  7. Sufficient rest facilitates rapid recovery.
When to Rush to the Hospital
In case the patient develops any symptom of DHF or DSS, they should be rushed to the hospital. A delay in treatment leads to significant mortality. Once in hospital, immediate fluid replacement will be done to prevent hypovolemic shock (acute condition due to low volume of blood circulating in the body) along with other supportive treatments. In most cases, patient recovers rapidly once the shock is reversed although they may need a few days of hospitalisation. If platelet count is very low, infusion of platelet is done and in case of severe blood loss, transfusion of whole blood is given. Once at home, the fluid level maintenance and rest is very important.

Can Dengue Recur?
Yes, with four subtypes of the virus prevalent, dengue can recur and the risk increases for those with weak general health. Balanced nutritious diet, regular exercises to increase stamina and general well being and steps to avoid infection reduces the chance of recurrence.

Dengue Prevention
The key to preventing dengue lies in preventing the breeding of mosquitoes. Aedes Aegypti lays eggs in clean, stagnant water. So never allow water to stagnate in and around your house. Unused tyres, construction sites, water tanks, even the household flower vase are favourite breeding ground for these mosquitoes. Make sure the water tank is cleaned at least once in a fortnight; flower vase water is frequently changed. It is wise to keep buckets and other water containers upturned when not in use. Use mosquito nets and repellents. Electronic machines are safer than coils (which may cause respiratory distress). Reduce furniture clutter to minimise the chance of being bitten. Involve your community in the mosquito-eradication drive as well.
Dr Syamasis Bandyopadhyay is Consultant Internal Medicine & Rheumatologist at Apollo Gleneagles Hospitals, Kolkata

    
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