Yes it’s that time of year again. The wet season is
well and truly here, and along with it come the mosquitoes
and the associated diseases like Dengue Fever (DF). But what’s
different about this year’s Dengue Fever threat? First
of all, last years season of DF never really finished. We
have been seeing cases of DF all throughout 2006 at a steady
rate. Secondly this coming year is predicted to be the fifth
year in the cycle of a disease that delivers a “megademic”
every four to five years. So watch out!
What Is Dengue Fever?
Dengue fever is a serious viral illness, transmitted by the
Aedes Aegypti (Tiger) Mosquito. Dengue occurs in two forms,
Dengue Fever (DF), and the more severe Dengue Hemorrhagic
Fever (DHF). Dengue fever is a severe flu like illness that
causes fever, headaches and bone pain. 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. Muscle & joint pain.
- Rash.
- Loss of appetite. Nausea / vomiting.
D.H.F:
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).
Change in level of consciousness (Drowsy, fainting).
Restlessness. Inconsolable crying in children/babies.
Excessive thirst. Rapid, weak pulse.
lDifficulty in breathing.
PERSONS EXHIBITING ANY OF THE ABOVE SYMPTOMS MUST SEEK MEDICAL
ATTENTION IMMEDIATELY.
Treatment
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.
Pitfalls in Diagnosis
Dengue fever can be quite a difficult disease to diagnose.
A lot of people will try to self- diagnose by going off to
a lab and having a “Dengue fever test” (Anti Dengue
IgM). But please be aware that a negative test does not mean
that you do not have the disease. The Dengue antibody can
take up to 10 days (usually 3 – 4 days) to show positive
on a blood sample.
Another difficulty that arises is that during the peak Dengue
season the laboratories often run out of the reagent to test
for the disease! So then what? Basically we look at the patients
symptoms and take a simple routine blood test (CBC) to watch
for the platelet level (thrombocytes or clotting factor in
the blood). If this level starts to fall, along with suggestive
symptoms we usually make the assumption that the patient does
have Dengue Fever. Once someone is diagnosed with DF, we need
to assess the thrombocyte count twice a day until it begins
to rise. Many local clinics will assess this once a day or
every several days. This is not enough.
As the symptoms for DF are very similar to other fever based
illnesses we usually test for other diseases as well, such
as Typhoid fever. This can also be a tricky assessment as
Typhoid fever is often diagnosed if a “WIDAL”
blood test shows a positive reading. Unfortunately the WIDAL
is not 100% accurate, and can show a false positive reading
in DF patients. I often hear people say they had Dengue AND
Typhoid. This is often just a case of the treating doctor
not knowing how to read a WIDAL.
For full info in DH, DHF, and mosquito control please go to
the previous articles on Dengue at the BA website. Meantime
SWAT that MOSSIE!
“Kim Patra is a qualified Registered Nurse and Midwife
that has been living and working in Bali for almost twenty
years. She now runs her own private practice and medical referral
service from her Kuta office. Kim is happy to discuss any
health concerns with you and she may be contacted via e-mail
at info@chcbali.com or Hp. 081 2366 0000”.
