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Know about Dengue Fever

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Dengue is having a free run this autumn, thanks to the abundant rains, ramapant water logging and unrestricted breeding of mosquitoes. Almost every household has either had a bout of fever in the last month or is likely to in the next one.

Recognizing Dengue Fever (DF): It is a viral infection transmitted by mosquitoes and presents as a sudden febrile illness of 2-7 days’ duration, with 2 or more of the following:
  • Headache
  • Pain behind the eye balls
  • Severe body aches
  • Pain in the joints
  • Rash

One of the main concerns in Dengue is the fall in platelet counts from its normal range of above 150,000. Platelets play a vital role in preventing or stopping bleeding from small blood vessels. Infusion of platelets is required only if they drop to below 20,000 or when there is active bleeding. Remember transfusions have their own risk of transmitting other infections, of allergic reactions, and their effect lasts barely a few hours.

The other concern is shock. Dengue sometimes causes fall in blood pressure due to leakage of plasma from capillaries with loss of blood volume. The Hemoglobin level paradoxically rises and urination may become less. Some patients show liver involvement (Serum ALT/AST, Bilirubin) or kidney dysfunction (increase in serum creatinine). These usually settle down with good intake of fluids and calories.

Tests for Fever: It is important to remember that all fevers may not be due to Dengue and Enteric Fever (Typhoid), malaria, and common flu are equally ramapant these days. Further, while Dengue is a viral illness with no specific medicines, typhoid and malaria need specific medications and can be far more dangerous to life than Dengue.

If fever persists for more than 2 days and is severe, tests should include Hemoglobin, white blood cell and platelet estimations, a peripheral smear for malaria, and a serological test for Dengue. The serological test for typhoid often does not show up in the first few days of this infection and hence can be misleading if done too early.

When to worry: If you have contracted Dengue, lie in bed and take rest for atleast a week, drink lots of liquids (water, juices, soups, nimboo paani or ORS), take paracetamol tablets ( upto 3 a day), avoid aspirin and brufen as they may trigger bleeding,  apply balms on your head and listen to soothing music. Consult your family physician but do not panic. Remember that there is no specific medication for Dengue and yet recovery is the rule.

Critical phase: Contrary to popular belief, the danger phase in dengue is not the 1st 2-3 days of high fever, but around the 5th to 7th day, when the fever begins to settle. Many people who are in a hurry to get back to their normal lives often crash during this phase with low BP and shock. It is therefore crucial to relax at home for a couple of days more.

I hope employers and school principals do not sue me for this advice!

As published in HT City ( Hindustan Times) dated 8th September, 2012.
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