The monsoons are here again, and with the rains come the
diseases. One of them unfortunately, is dengue fever (“demam
berdarah”). During this past 2 –3 weeks no less
than 4 of my immediate family and friends have been diagnosed
with dengue fever, and none of these people live or work in
the same area. Dengue tends to occur in epidemics, on about
a 5-year cycle, and we had assumed that last year was the
big one. With at least 6 – 8 weeks of monsoons left
to go, this year could be even bigger than the last! Preparing
yourself with the knowledge of the early signs and symptoms
of this disease is imperative, as early diagnosis and therapy,
shows a direct relationship to the successful treatment of
this disease.
What is dengue fever?
Dengue fever is a serious viral illness, transmitted by the
Aedes Aegypti mosquito. Dengue occurs in two forms, dengue
fever, and the more severe dengue hemorrhagic fever (DHF).
Dengue fever is a severe flu like illness that causes fever
mostly in older children and adults, but rarely causes death.
DHF is a second more severe form of the disease causing bleeding
and shock. Severe cases may be fatal, particularly in children.
How does dengue fever present ?
The symptoms of dengue fever may vary according to the age,
and condition of the patient. Should you or your child present
with any of the following signs a doctor should be consulted
immediately to confirm diagnosis.
Dengue fever:
Abrupt onset of high fever (»39 c or 102 f).
Headache.
Pain behind the eyes.
Rash.
Loss of appetite.
Nausea / vomiting.
Muscle & joint pain.
DHF:
All or any of the above symptoms.
Severe stomach pains.
Pale, cold or clammy skin.
Bleeding from the nose, mouth or gums.
Bruising, or “blotchiness” under the skin.
Vomiting, with or without blood. (N.B. Vomited blood may be
red or dark brown / black in appearance).
Black stools (Digested blood).
Restlessness.
Change in level of consciousness (Drowsy, fainting).
Inconsolable crying in children / babies.
Excessive thirst.
Rapid, weak pulse.
Difficulty in breathing.
PERSONS EXHIBITING ANY OF THE ABOVE SYMPTOMS MUST SEEK MEDICAL
ATTENTION IMMEDIATELY.
What does the “Aedes Aegypti” mosquito look like
?
The Aedes Aegypti mosquito is a small black and white striped
mosquito that grows to about 5 mm in length. It tends to lurk
around lush wet garden areas, and occasionally in cupboards
and other hide aways. They tend to bite in the early mornings
and late afternoons and do not make the characteristic buzzing
noise that other mosquitos do. The mosquito breeds in water
catchments such as ponds, jars, gutters, hollow tree stumps
etc. etc. It is a myth that this creature prefers murky, stagnant,
or putrid water holes…it feels just at home bringing
its young into this world in pristine waters as it does the
murky ones!
How does the mosquito spread dengue?
Dengue fever is spread by vector transmission. It cannot be
transmitted directly from one person to the next. When an
Aedes Aegypti mozzie bites someone who is infected by dengue,
it will give the disease to the next person that it bites…and
the next, and the next…etc. Note that:
The incubation period (time from exposure or bite to the
time that the symptoms are displayed) of dengue is 5 –
7 days.
Not all A.E. mozzies are carriers of the disease. Only mosquitoes
that have been infected can infect you.
If a mosquito bites an infected human, the disease takes about
8 days to develop in the mosquito before it can pass the disease
on to humans.
How is dengue diagnosed?
This can be quite a tricky business for the clinician concerned
as the dengue fever pattern can mimic other febrile illnesses
such as typhoid fever, meningitis, Ross River virus etc. Dengue
fever is suspected if the above symptoms are apparent, in
a region where dengue is common. Blood tests for dengue fever
are imperative for a definite diagnosis.
Dengue Antibody testing - Unfortunately antibody tests for
dengue fever are more “after the fact”, as the
antibodies are not detectable for up to 5 – 10 days
after exposure.
Complete Blood Count (CBC) – This gives a picture of
certain cell counts that may indicate dengue (platelet levels,
white cell count, plasma concentration etc).
The Tourniquet test – By applying a tourniquet (tight
band) around the upper arm the physician can demonstrate any
bleeding tendencies by looking for small hemorrhages under
the skin.
So…if I do get dengue, how is it treated?
Firstly, there is no curative treatment for dengue, (i.e.
no magic pill, injection etc. that will cure it). Dengue is
treated symptomatically by reducing the fever, analgesics
for headache (Aspirin or any other NSAID painkillers must
never be given for dengue, as it will increase the bleeding
tendencies. Codiene, paracetamol or acetomenaphin are safe).
Intravenous fluids are given to treat dehydration, and in
severe cases of shock, blood transfusion may be required.
If you have suffered from dengue, you will have immunity
to the disease for approximately one year, and only against
the type of dengue that you had. (There are about 4 –
5 different serotypes of dengue fever). In some cases previous
exposure to dengue fever seems to cause a more severe form
of the disease in subsequent exposures.
How do we prevent the spread of dengue?
Firstly, don’t invite this troublesome insect into your
area by providing it with ideal breeding grounds.
Make sure that your garden and surrounding area are free
of water catchments, or that water containers are covered.
Keep larvae eating fish, such as guppies, in ponds.
Use chemical larvicides in ponds, drains or other water catchments.
Remove garbage, or unnecessary pots, bottles, cans etc from
the garden area.
Lush garden areas should be fogged regularly in the monsoon
season.
… and secondly, don’t get bitten !
Mozzie coils, or vapor mats can be used indoors in the early
mornings and late afternoons during the wetseason.
Mosquito nets, and screens can be used in problem areas. Babies
and young children should always be protected by cot, or pram
covers.
Wear long sleeved, loose light colored clothing while walking
in garden areas.
Personal repellants may be used, however, they should be used
with caution in the very young, or the elderly.
People suffering from dengue should be protected from mosquitoes,
so as the disease cannot be passed on.
Remember, dengue is a not selective for race, religion, gender,
or social status !!!!There is currently no vaccine for dengue
fever, however, promising trials are being conducted in Thailand….mean
time……..SWAT THAT MOZZIE !!!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
