Dengue Fever –Myths and Realities

“Ignorance is the most serious disease of mankind and is the cause of all its ills. Healing is achieved through knowledge”-Buddha.

Tremendous pressure builds upon  individual the  moment one  develops a high grade temperature and all hell breaks loose when some abnormality in platelet counts is seen.Thanks to half baked knowledge provided by electronic and print media or by information on the Internet ,credentials of health professional treating the patient are doubted ,many irrelevant questions are asked ,interference with treatment,irrational use of platelet transfusions are sorted and what not.Unfortunately many medicos also don’t have that kind of proper knowledge/way to treat. I have tried my best to debunk myths of dengue fever.

Some facts about Dengue.

1. It is not a contagious disease.
2. Cannot spread by human contacts,human or animal bites.
3. Dengue is a febrile illness caused by a flavivirus(dengue virus)  has four strains-DEN1,2,3 and 4, out of which 2 and 4 are dangerous.
4. Dengue has now become an epidemic covering more than 100 countries in tropical and subtropical areas, causing more than 50 million infections worldwide,it is ignorance  than disease which is more harm full.
5. Serious and dangerous manifestations of dengue are seen if one develops DHS-Dengue Hemorrhagic Syndrome or DSS-Dengue Shock Syndrome or what in layman language ,when one starts to bleed.This is actually a secondary infection of a different viral strain of the original infecting virus.Ignorance and late medical attention are responsible for a number of fatal complications and reported deaths in countries like India,Pakistan and some countries in the African Subcontinent where multiple strains float simultaneously and timely medical intervention is available to a fortunate few.
6. Recommendations of injecting vitamin K1 should be done only in cases of severe liver abnormalities or prolong the prothrombin time (something used to calculate blood clotting time).
7. Individuals with dengue fever should be warned to maintain proper hydration by adequate fluid intake and should take only paracetamol for fever,headache and other myalgia.Aspirin or any other Non steroidal anti inflammatory drugs(NSAIDS) like diclofenac ,should be avoided as these may precipitate internal bleeding.
8. For God sake avoid self treatment and advices of non medicos,it could be fatal.Timely intervention and proper compliance are the only key to faster and uncomplicated recovery.

Symptoms of Dengue fever:

• High grade fever(sudden onset) generally 3 to 8 days after infection.
• Nausea/Vomiting
• Headache and mild to severe pain behind eye balls.
• Joint and muscle pain.
• Body aches.
• Generalized weakness.
• Loss of Appetite.

The Dengue Skin rash is mild,may appear initially over chest ,upper or lower extremities or even spread to most of the body 2 – 5 days after the fever starts. A second rash, which looks like the measles, appears later . Infected people may have increased skin sensitivity and are very uncomfortable.

Generally admissions in dengue are unwarranted but there are certain conditions where patients are advised admission .To make it easy I have divided such patients into few groups.

• Individuals with initial symptoms or alarm signs of Severe abdominal pain or tenderness or guarding,repeated episodes of nausea or vomiting,abnormal body temperature pattern,mental disorientation ,bleeding from mucosa or any other part of  the body,blood with stools ,etc.
• Individuals with hypotension of <80-90/60 or a fall in blood pressure by more than 20,difference of blood pressure between upper and lower  extremities by less than 20,platelets counts less than 20000,rise in pulse by 20,any direct or indirect evidence of bleeding.
• Individuals with prior- existing conditions like Diabetes,kidney failure or some  hematological ailments,pregnancy,infancy,old age, obesity and  immuno compromised cases, are high risk cases and are generally hospitalized to avoid complications of developing severe dengue or /and its management.
• Another risk zone is of Alcoholics or drug addicts who generally have liver or hematological abnormalities.
• A phase of developing critical dengue, i.e. shock, is between third and seventh day of illness which unfortunately coincides with decrease or no temperature  giving false hope of timely recovery.Symptoms of Plasma leakage or shock are evident 24 hours before and after defervescence( The abatement of a fever as indicated by a decrease in bodily temperature).

Myth about insecticide spray:

• Insecticides spray in response to dengue outbreaks are not very effective as the mosquito A .aegypti breeds inside the home, on fresh but stagnant water.
• General and community based awareness by way street serials,educational advertisements in electronic or print media or in fact a compulsory chapter in classes can be promising in efforts of reducing dengue breeding areas like discarded tires,water coolers,unclean tanks and ponds or any other place where water is stored/stagnated.

Dengue fever and Dengue Hemorrhagic fever are same.

• No they are not.Though Dengue fever and Dengue Hemorrhagic fever are caused by same Dengue Virus but the latter has more severe symptoms and complications ,usually difficult to treat.

Prophylactic Platelet transfusion will retain platelet counts

• Some Hospitals and Doctors recommend  platelet transfusion,believe me research have proved that they cannot stop or prevent Thrombocytopenia but are only warranted in cases where platelets are less than 10000.(1.5 to 4 lacks is the normal range) Prophylactic transfusions have no role in treatment rather they may complicate things.

Treatment of Dengue:

• Like the other viral diseases, Dengue also doesn’t have any sure shot cure.There is no treatment of Dengue Fever,it is treated symptomatically.

Dengue Fever Vaccines :

• Numerous trials had been conducted worldwide,few have given some results but a definitive vaccine is still nowhere .
• The only immunity against Dengue Fever is infection by a particular Dengue Virus Strain,It won’t infect again but other strains may infect .

Test and Investigations :

• CBC with differential.
• Dengue PCR-done in early stages for the first five days,the test is 80-90 % sensitive.Particular strain of dengue virus can be isolated.
• MAC- ELISA for Dengue, In primary dengue infection IgM antibody is the first immunoglobulin Isotype to appear while the test may be reported as positive but has a limitation to identify strain of dengue fever virus due to cross reactivity with other viruses circulating in the body.
• IgG –ELISA  for Dengue,Anti-dengue IgG is detectable at the end of the first week of dengue fever and slowly increases. Positive results indicate past Dengue fever infections,Reports suggesting negative IgG in the acute phase and a positive IgG in the convalescent phase of the infection are primary dengue infections. Reports suggesting  positive IgG in the acute phase and a 3-4 fold rise in IgG levels in the convalescent phase is a secondary dengue infection.
• NS 1-Dengue NS1 Antibody.The most sensitive and specific test,this test can differentiate the strain of Dengue fever virus.  NS1 can be detected between day1 and day18 of post dengue fever symptoms.
• PRNT – Few institutions use this investigation also but it again lacks the differentiation power to isolate the particular strain of dengue fever.

I would like to end this article by a very famous line -“Half of the secret of resistance to disease is cleanliness; the other half is dirtiness”.