Dengue is preventable and manageable
Aug, 2015
Dengue has once again made its appearance across India causing extreme chaos and panic. However most dengue cases are preventable and it is extremely essential to educate the masses about its treatment, prevention and myths.
Dengue fever is a painful mosquito-borne disease. It is caused by any one of four types of dengue virus, which is transmitted by the bite of the infected female Aedes aegypti mosquito.
Speaking about the issue, Padma Shri Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA said, “Dengue is both preventable and manageable. The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. A platelet transfusion is not needed if the platelet counts are more than 10,000. Unnecessary platelet transfusion can cause more harm than good”.
Symptoms experienced by patients suffering from Dengue
• Fever is present in 90% cases
• Headache, eye pain, body pain, and joint pain in 80% cases
• Rash in 50% cases
• Nausea or vomiting in 50 % and diarrhoea in 30% cases
• Cough, sore throat, and nasal congestion are present in 33% cases
Most dengue virus infections in adults are symptomatic (86%) and in children under the age of 15 years are asymptomatic or minimally symptomatic. Classic dengue fever is an acute febrile illness accompanied by headache, retro orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and 7 days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for five to seven days. The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches, and rash are more common in females.
Most complications of dengue occur after the fever is over. The two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar. The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications.
When suffering from dengue, one should take Paracetamol strictly but not use aspirin for fever as aspirin also has antiplatelet effects. Plasma leakage is the most specific and life-threatening feature of dengue which occurs 3 to 7 days after the onset of the illness. The presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence are the red flag symptoms and a chest x-ray and chest/abdominal ultrasound are useful for detection of plasma leakage. Taking necessary precautions and acting in a timely fashion is key to eliminate fatality in dengue cases. For all patients, staying well hydrated is strongly advised.”
In cases of plasma leakage, the increase in vascular permeability develops over a period of 24 to 48 hours. Shock may develop in patients with marked plasma leakage, especially if supportive treatment is delayed and is associated with case-fatality rate of 12 percent. Abdominal pain is also reported to precede the onset of plasma leakage in approximately 60 percent of patients with dengue.
Plasma leakage is important to manage with intravascular volume repletion to prevent or reverse hypovolemic shock. In mild cases, particularly when medical attention is received early, oral rehydration may be sufficient. However, in patients with established intravascular volume loss, intravenous fluid administration is recommended. Blood transfusion is appropriate in patients with significant bleeding or those who have low haematocrit and fail to improve despite fluid resuscitation. Platelet transfusions have not been shown to be effective at preventing or controlling haemorrhage but may be warranted in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding.
Physicians need to remember the ‘Formula of 20’ i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 haemorrhagic spots on the arm after a tourniquet test suggest a high risk situation and the person needs immediate medical attention.
The onus of preventing dengue lies with the public and not with the Government authorities. The dengue mosquitoes are found only in water collected outside the house and not in dirty water in the drains.