DENGUE

DENGUE

Dengue is a disease caused by virus which is spread by Aedes mosquitoes which are usually white striped /dotted. They breed in clean water and usually bite during early morning and evening. Few cases have been reported where it has been spreaded by blood of infected person comming in contact of mucous membrane of healthcare worker.

The incubation period is 4-15 days. i.e the symptoms will appear after 4-15 days after being bitten by the infected mosquito.

There are 4 types of dengue viruses (Type 1 and type 3 are less severe compared to type 3 and type 4), so it is possible to be infected by dengue multiple times in a life time since at a time your body develops immunity only against the type you are infected with.

It is also known as “dandy fever” or “breakbone fever” as it causes severe joint pain and muscle pain.

Symptoms of Dengue

High fever with chills, headache (typically located behind the eyes), Joint pain , muscle pain, extreme pain in the lower back ,rashes, loss of appetite, extreme weakness, Thrombocytopenia (drop in platelets)

Often due to similarity of symptoms, it is difficult to distinguish between dengue and other diseases such as chikungunya, malaria , typhoid and influenza etc.

Dengue Fever can be classified in two types Uncomplicated Dengue Fever and Heamorrhagic Dengue Fever which may result into Dengue Heamorrhagic Shock and is a medical emergence and required immediate hospitalisation preferebly in an intensive care unit. Dengue Fever lasts for 5-7 days then there is a phase of udden drop in platelets for 2-3 days as its supposed that the antibodies driven against dengue virus also damages platelets and also there is suporession of bone marrow due to infection so the production of new platelets is arrested to certain extent for some period which causes severe fall in platelets , these 2-3 days post fever are very critical as patient seems to be out of fever but platelets falls drastically within,  the fall is severe bringing platelets down to sub 10k levels within a day or two and may progress into condition called Dengue Heamorrhagic Shock if there is external or internal heamorrhage as a result of damaged capillaries due to virus and extreme thrombocytopenia due to some ort of antibody driven immune response and suppressed marrow by virus.

A feeling of fatigue may last for weeks.

Diagnosis of Dengue

Drop in plateles count starts after 2-3 days from 1st day of fever and after last day of fever there severe drop causing thrombocytopenia.

LDH level may rise upto 1500 due to mild damages to liver.

In most cases where pt doesnt have any other disease condition in body the WBC starts increases only after 2-3 days from 1st day of fever when platelets starts falling

The Diagnosis can be confirmed by a blood test – Dengue NS1 antigen test, its positive only during first 2-5days of infection then indirect antibody test are used Dengue IgG and Dengue IgM if both these antibody are postive it indicates that person is infected second time with dengue virus. Every subsequent infection is more complicated then previous.

Treatment/Management of Dengue

There is no specific allopathic medicine available.

In homoeopathy certain medicines like Eupatorium Perfoliatum, Lachesis, Phosphorus are frequently used.

Treatment is based on symptomatic management of the patient

Drinking plenty of liquids – water , fruit juices, coconut water, Oral Rehydration Solution etc. and avoiding solid food or keeping it to minimum. atleast 3-4 liters of fluids should be consumed throughout the day, monitoring urine output and calculating fluid inpit is to output ratio and monitoring blood pressure.

Take enough rest.

Can take Paracetamol for reducing fever, Avoid other NSAIDS, avoid Aspirin for headache.

Its claimed that Papaya leaf juice/extract, Giloi, Kiwi fruit & dragon fruit helps in increasing platelet count but its role remains uncertain as per highly controled studies.

If platelets fall below 10000 and if there is active bleeding external or internal, then  Single Donor Platelets transfussion is required, otherwise platelets transfusion should b avoided as its observed that in many cases platelets transfussion has complicated the case.

If patient develops any kind of active bleeding or there is sudden drop in blood pressure or any symptoms of neurological origin its a medical emergency and can be fatal patient needs to b shifted to hospital with Intensive Care Unit and Blood Bank facility as it can lead to Dengue Heamorrhagic Shock and death.

Frequently it is accomoanied by malaria and it is a medical emergency as in such case platelets fall even faster and also there is loss of RBC due to malaria.

Many other conditions like autoimmune anaemia(Pernicious anaemia) and heamolytic conditions complicates the case and is a medical emergency as patient may require blood concerntrates and plateles transfussion.

Any other co-existing infection and ailments should be treated with its specific medication if required.

Though fall in platelets is thought to b due to immune response still use of corticosteroids is contradicted as its observed that it complicates the case.

If Menstrual bleeding appear during dengue there is no need to interfere or stop bleeding with help of medicines till the bleeding is not beyond average and vitals of patients are normal. wait for it to subside on its own and if it is prolonged beyond its normal course or there are other complications or vitals of patient are not normal it needs to be intervened.

Pt is considered out of risk if he has no fever for more than 4 days and also his platelets stops falling and increases 1.5 times of last reading and if there are no other comolications and his vital are normal.

Patient will feel weak for weeks after dengue and some patient will also have abdominal discomfort and loss of appetite and very mild swelling of extremities on dependent parts especially aroud ankle joint , it subsides on its own and if persists longer it may require medical attention.

Pt will require nutritious diet , enough of sleep for recovery after dengue. rest is recomended atleast for a week after dengue.

Prevention of Dengue

To avoid dengue protect yourself from the mosquitoes spreading them.
Keep your house and surroundings free of stagnant water where the Aedes mosquitoes generally breed.
Use mosquito repellent, use mosquito net while sleeping .
Wear full clothes.