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). This is the fourth time I have written about this disease, and at this time next year I will write about it again, and again and so on. Why? To make absolutely sure that everyone gets the message. We must never become complacent about Dengue fever. I so often hear people, including medical practitioners, make comments like “Oh, you’ll be ok. You’ll feel lousy and your platelets (blood clotting factor) might fall, but then on day 5 or 6 it will come back up again, it always does.”
WRONG! In most people this might be true, but there are enough cases where the platelet count just continues to fall, putting the patient in a life threatening situation. Unlike other diseases that are more prevalent in the lower socioeconomic groups, Dengue fever has no prejudice and is just as much at home in the “villa” set as in a village “kampung”.
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.
- Difficulty 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 asses the thrombocyte count twice a day until it begins to rise. Many local clinics will asses 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!
