Dr Tasaduq Itoo
Dengue fever is a viral infection transmitted by two specific types of mosquitoes, the Aedes aegypti and the Aedes albopictus species. The number of people that develop dengue fever each year has reached global proportions to high extent. As per a recent global estimate, provided by the World Health Organization- as many as 400 million new cases occur every year across the world and as many as 500,000 people, mostly children, develop the more severe form of dengue fever that requires hospitalization. Sadly, about 12,500 of those people die.
The problem is now becoming a growing public health concern in India as well. In Jammu and Kashmir state, there is emergence of dengue infection to a concerning extent. Many cases are being received in primary, secondary and territiary care hospitals on day-to-day basis from various areas of the state. At Narayana Hospital, we receive multiples of them. As per experts in medical sciences, the primary goal of treatment is on supportive measures with emphasis on recognizing the more severe forms of the infection in order to promptly seek medical attention.
Recognizing symptoms of Dengue fever
Expect an incubation period of four to seven days. Once you are bitten by a mosquito that is carrying dengue fever, the average time for symptoms to begin is four to seven days. While the average incubation period is from four to seven days, you may experience symptoms as early as three days or as late as two weeks after being bitten.
Take your temperature. A high fever is the first symptom to appear. Fevers with dengue fever are high, ranging from 102°F to 105°F (38.9°C to 40.6°C). The high fever lasts for two to seven days, returns to normal or even a little below normal, then can rebound. You may develop a high fever again that can last for several more days.
Watch for flu-like symptoms. The initial symptoms that develop after the fever begins are generally non-specific, and are described as flu-like in nature. Common symptoms that occur after the fever begins include severe frontal headache, pain behind the eyes, severe joint and muscle pain, nausea and vomiting, fatigue, and a rash. Dengue fever was once called “break-bone fever” due to the severe pain that is sometimes felt in the joints and muscles.
Monitor for symptoms of unusual bleeding. Other common symptoms caused by the virus can create hemodynamic changes, or changes that alter the flow of blood in the body. Examples of blood flow changes seen with dengue fever include nosebleeds, bleeding from the gums, and areas of bruising. Additional symptoms related to changes in blood flow may be evident by reddened areas in the eyes and a sore or inflamed throat.
Evaluate the rash. The rash usually begins three to four days after you developed the fever, can get better for one to two days, but then can come back. The initial rash often involves the facial area, and can appear as flushed skin or spotty and reddened areas. The rash does not itch. The second rash begins on the trunk area, then spreads to the face, the arms, and the legs. The second rash can last from two to three days. In some cases, a rash that is made of small dots, called petechiae, may appear anywhere on the body as the fever subsides. Other rashes that sometimes occur include an itchy rash on the palms of the hands and the soles of the feet.
Diagnosing Dengue fever
See your doctor. If you have symptoms consistent with dengue fever, see your doctor as soon as possible to determine the diagnosis.Blood tests are available that can help your doctor to determine if you have been exposed to dengue fever. Your doctor will do blood work that helps to identify the presence of antibodies to dengue fever. It does take several weeks to get the full results of the blood tests. Changes in your platelet count can be checked to help verify the diagnosis. People that are infected with dengue fever have lower than normal platelet counts. An additional test called the tourniquet test can help with the diagnosis by providing your doctor with information about the condition of your capillaries. This test is not conclusive, but can be used to help with the diagnosis. Research is underway to develop new tests that confirm the diagnosis of dengue fever, including some that are point-of-care tests. Point-of-care tests can be performed at the doctor’s office or in a hospital setting and provide quick confirmation of the infection. Your signs and symptoms are often enough for your doctor to determine that you have been infected with dengue fever, start supportive treatment, and monitor your progress.
Treating Dengue fever
Seek medical attention as soon as possible. While there is no specific treatment for dengue fever, the risks of developing bleeding problems caused by the infection warrant medical care. Most people get better in about two weeks with general supportive care.
Follow recommended treatments. The most common methods of treating dengue fever is to take steps to allow your body to heal. Get plenty of bed rest.Drink lots of fluids.Take medicine to control your fever. Acetaminophen is recommended in treating your fever and the discomforts caused by dengue fever.
Avoid aspirin products. Due to the risk of bleeding, aspirin products are not to be taken to treat the pain or fever associated with dengue fever. Ask your doctor about taking over-the-counter anti-inflammatory agents. Medications like ibuprofen and naproxen can help reduce the fever and treat discomfort. In some cases, ibuprofen or naproxen may not be appropriate if you are taking prescription medications that are similar, or if there is a reason to think you may be susceptible to GI bleeding these agents can sometimes cause. Follow the directions on the label of the product you are using. Do not take more than the amount recommended. Talk to your doctor if you are taking any medications for pain, or agents that work to thin your blood, before you take additional over-the-counter products.
Expect several weeks to recover. Most people recover from dengue fever in about two weeks. Many people, especially adults, continue to feel tired, and somewhat depressed, for several weeks to months following an infection with dengue fever.
Seek emergency medical attention. If your symptoms persist or you develop any signs of bleeding contact your doctor immediately or seek emergency medical care. Some symptoms to watch that are warning signs indicating your body may be having trouble maintaining the integrity of your blood vessels include the following: Persistent nausea and vomiting. Vomiting up blood or coffee-ground material. Blood in your urine. Abdominal pain. Difficulty breathing. Trouble with nosebleeds or bleeding gums. Bruising easily. Emergency medical care will likely result in hospitalization. Once you are hospitalized you will be treated with supportive care that can be life-saving. Examples of care that can be provided include- fluid and electrolyte replacement, and treatment for prevention of shock.
Monitoring for possible complications
Continue your medical care. Stay in contact with your doctor and report any changes you may experience as you recover from dengue fever, or if symptoms recur or worsen.Your doctor will know how to intervene should your condition deteriorate into either dengue hemorrhagic fever or dengue shock syndrome.
Watch closely for persistent symptoms. If symptoms persist beyond seven days, involve problems with continued vomiting, vomiting up blood, severe abdominal pain, difficulty breathing, purplish areas under the skin similar to bruises, and continued problems with nosebleeds or bleeding gums, then you should seek immediate medical attention. You may be developing dengue hemorrhagic fever, which is a serious and life-threatening medical condition. If you develop those symptoms, then you are in a 24 to 48 hour window where your capillaries, which are the tiniest blood vessels in your body, become more permeable, or leak. The leaky capillaries allow fluid to leak from your blood vessels and accumulate in your chest and abdominal cavity, causing conditions medically termed as ascites and pleural effusions. Your body is experiencing circulatory system failure which leads to shock. If not immediately reversed, death is likely.
Seek emergency medical attention. If you are showing any signs of dengue hemorrhagic fever or dengue shock syndrome, then you need immediate hospitalization and medical attention. This condition is life-threatening. This is a medical emergency. Dengue shock syndrome is recognized by early symptoms that include a decrease in appetite, continued fever, continued vomiting, and persistent symptoms associated with dengue fever. The maximum risk of shock is between the third and seventh day of illness.If left untreated, internal hemorrhaging will continue. Symptoms of hemorrhaging include bleeding under the skin, persistent bruising and purplish rashes, worsening of symptoms, abnormal bleeding, cold and clammy arms and legs, and sweating. Symptoms like this indicate the person is in, or will quickly be in, a state of medical shock. Dengue shock syndrome can be fatal. If the person survives, they may experience brain disease, loss of brain function, liver damage, or seizures. Treatment for dengue shock syndrome will include controlling the loss of blood, fluid replacement, attempts to establish a normal blood pressure, oxygen, and possibly a transfusion to restore platelets and provide fresh blood to vital organs.
Preventing Dengue fever
Avoid mosquitoes. Mosquitoes that carry dengue fever most often feed during the day, usually in the early morning and late afternoon hours. Stay indoors during those times, keep the air conditioning on, and keep screen doors and windows closed. Travel during the times of day when the mosquitoes are less active.
Take steps to cover your skin. Wear full-bodied clothing. Even if it is hot, try to wear long sleeves, long pants, socks and shoes, and even work gloves, when you need to be outside during the times of day when the mosquitoes are more active.Sleep under mosquito netting.
Apply a topical mosquito-repellant product. Products that contain DEET are reported to be effective. Other insect-repellant products that may be helpful include those that contain picaridin, oil of lemon eucalyptus.
Inspect your property. Mosquitoes that carry dengue fever are most often found close to dwellings. They like to breed in water that is held in artificial containers, like gallon drums, flower pots, pet dishes, or old tires. Get rid of any standing water containers that are not needed. Check for hidden sources of standing water. Clogged drains or gutters, wells, manholes, and septic tanks may have areas of standing water. Clean these areas or repair them so they no longer hold unwanted water. Eliminate containers that hold standing water around or near the outside of your home. Clean flower pot saucers, birdbaths, fountains, and pet dishes at least once a week to get rid of any larva. Maintain swimming pools and put mosquito-eating fish in small ponds. Make sure doors and windows have screens that fit tightly, and all doors and windows close properly.
(The author is Medical Practioner/ Motivational Speaker/Activist /Columnist/ Journalist/ Educator at Unacademy)
Dr Tasaduq Itoo