Dengue fever is more difficult to treat in patients with pre existing lifestyle diseases

Oct 3, 2015

Extra care must be taken in individuals who are suffering from pre-existing conditions such as diabetes, hypertension, heart disease and obesity 

The National Capital is witnessing chaos and disorder amid the present dengue outbreak. Fatalities are being recorded despite the best efforts of the medical fraternity to save lives. The primary reason for this is the spread of Type 4 dengue in the Capital at such a large scale for the first time. What complicates the situation is pre-existing lifestyle disorders that deter proper treatment and increase the severity of the symptoms. It is believed that at the rate at which lifestyle disorders such as obesity, hypertension, diabetes and heart disease are plaguing the 21st century Indians, soon the treatment of seasonal diseases such as dengue will only become more complex. Hypertension, for instance, is characterized by blood pressure higher than the normal range. If a hypertensive patient suffers from dengue, a disease characterized by a drop in the blood pressure of the body, warning signs of complications may go un-noticed since his BP will still be within the normal range. In addition to this, if a dengue patient suffers from obesity, he runs a higher risk of capillary leakage as compared to a person with a normal body mass index. 
Speaking about this Padma Shri Awardees Dr. A. Marthanda Pillai, National President Indian Medical Association (IMA) and Dr K. K Aggarwal – Honorary Secretary General IMA and President HCFI said, “Dengue is of two types, dengue fever, and severe dengue. While dengue fever can mostly be managed on an outpatient basis through the administration of adequate fluids, severe dengue occurs when there is capillary leakage. In a situation where the body fluid leaks from the blood vessels into the surrounding tissues, extra care must be maintained, and regular monitoring is required. Patients who are obese, are on heart medications are more prone to capillary leakage. Heart patients on low-dose aspirin must stop its consumption immediately and consult their physician because of its anti-platelet effect. 

Patients on hypertension medication might often not be aware that their medicine may contain a combination of aspirin, a statin and a blood pressure lowering agent, which may be life-threatening if taken when suffering from dengue. 
"All patients who are suffering from lifestyle diseases must take extra care and consult their doctor for advice if they are suffering from fever for over 24 hours to rule out dengue. Instead of panicking, one must be aware of all facts and seek timely intervention and treatment. Only 1% of the dengue cases are life-threatening, and if managed properly, fatality can be eliminated", they further added. 
People suffering from diabetes must also keep their insulin in check since dengue can cause a fluctuation in the sugar levels. Most dengue patients can be managed on an outpatient basis and do not need hospitalization. Being in constant touch with one's doctor is important. 

An easy to apply ‘Formula of 20’ that can be used to identify high risk patients with Dengue fever
•    Rise in pulse by 20
•    Fall in upper blood pressure by more than 20
•    Rise in haematocrit by more than 20 percent
•    Rapid fall in platelets to less than 20,000
•    More than 20 haemorrhagic spots on the arm in one inch after tourniquet test
•    Difference between upper and lower blood pressure is less than 20
If the condition arise, there is need to start fluid replacement at 20 ml/kg/hour immediately in such patients, and shift to nearest medical centre for observation.