Dengue Fever Decoded
What is Dengue Fever?
Dengue fever is an acute febrile disease, endemic in tropics, caused by four closely related Dengue viruses 1,2,3,4. It is transmitted to humans by the Aedes Aegypti mosquito, which unlike the malaria causing mosquito Anopheles feeds only during the day. The disease is now spreading internationally. Dengue is not contagious. It spreads only through the bite of an infected mosquito.
How does one recognize Dengue illness?
Dengue presents with sudden onset of fever, severe headache, muscle and joint pains (severe pain that gives it the nick-name break-bone fever) and rash on body. There may also be gastritis with abdominal pain, nausea, vomiting, or diarrhea.
The period to be really watchful is after the first 2-4 days called the critical phase as the fever reduces. That is when shock develops . Shock occurs as the fluid portion of the blood (plasma) leaks into the abdomen, lung spaces etc. This fluid leak apart from causing shock can cause abdominal distension and respiratory problems. Bleeding can also occur if the shock is undetected or not treated appropriately. Low platelet count per se does not cause bleeding.
During the recovery phase a red itchy rash can develop on the legs
What are the warning signs to look?
It is important to remember that the risk period is especially high in the first 1-2 days after the fever subsides. This is known as the critical period. Admit immediately if any of these signs occur
- Refusing to accept oral fluids or vomiting
- Sleepy or restless
- Bleeding of the nose and gums, especially gastro-intestinal bleeding with fresh or old blood in the vomit or stool. Old blood in the vomit looks like ground coffee ground; in the stool may be black like coal tar.
- Abdominal pain
- Skin mottling, cold sweating skin or cold hands and feet.
- Absence of urine in the last 6 hours
What is the treatment of Dengue, Is it curable?
Like most viral infections there is no specific treatment for Dengue, only simple supportive care with fluids. No antibiotics are needed to treat this viral infection.
Bring the temperature down. A very high temperature can be dangerous and can cause fits in young children known as febrile convulsions. To bring down high fever to below 39 deg C, gently sponge the child with cloth soaked in water and give paracetamol. Avoid certain drugs, for example, aspirin, NSAIDs (not steroidal inflammatory drugs such as ibuprofen) which can worsen platelet problems and also cause gastritis leading to bleeds.
The mainstay of treatment is timely supportive therapy with fluids, oral or Intravenous route. Shock can be detected clinically by the degree of rise in hemoglobin as the fluid leaks into body spaces.
Increased oral fluid intake is recommended. Always use oral fluids if one is able to drink.
Supplementation with intravenous fluids may be necessary if the patient is unable to maintain oral intake and / or is in shock.
Close monitoring in this critical period is crucial.
Blood products will be needed only if the patient is bleeding, usual site of bleed is the gut.
The platelet count is the last to recover. Doctors are not unduly concerned by the low platelet count and platelet transfusions are not needed for just a low platelet count if there is no bleeding or shock.
Can Dengue fever be treated at home?
Yes, if there are no warning signs and one is able to take fluids well orally.
What tests will be done to detect Dengue?
Your doctor will order repeated tests of platelets, hemoglobin, coagulation profile, liver enzymes. and some specific tests to detect Dengue
Can one get another episode of Dengue infection?
Yes, unfortunately from one of the the other dengue viruses and the second attack is generally more severe than the first. However in infants the first attack itself can be severe.
Can one get infected with the Dengue virus and not have any problems?
There are many who get the virus but do not become unwell. Children, elders however are most vulnerable.
Are there any vaccines to prevent Dengue?
There are no vaccines to prevent Dengue
How do we reduce the Dengue menace?
Keep mosquitoes away, using window nets, Remember; unlike malaria, the mosquitoes that spread dengue bites during the day. Make sure you use mosquito repellants. Avoid open storage of water as this mosquito lays eggs only in clear stagnant water, etc.
Early diagnosis, Early treatment with fluids and Close monitoring ensures a good outcome.
DR. INDRA JAYAKUMAR
UPDATED ON 31/01/2023