Dos and don’ts during dengue

Parvinder Chawla

Dengue is caused by a virus transmitted to humans by mosquitoes. The mosquito causing dengue (and chikungunya) breeds in stagnant water around habitations and bites in the daytime, particularly early morning, or late evening. The infection can evolve rapidly into an epidemic during the mosquito-breeding season.

Symptoms

Chills, fatigue, fever, loss of appetite, nausea, vomiting, body rash, aches and pains, including eye pain (typically behind the eyes), muscle, joint, or bone pain. Dengue is also called ‘break bone fever’.

Not all infected patients develop symptoms of dengue. In fact, most are asymptomatic. Among those who do develop symptoms, many can mimic other viral infections i.e. fever, headache and body aches. Most improve within a few days without needing any aggressive treatment apart from fever-lowering medicines, rest and a liberal intake of fluids.

Be on guard

• Symptoms can mimic other viral fevers
• Sometime when fever breaks, often other symptoms can worsen
• Monitor haemoglobin & haematocrit

A typical patient goes through three phases: febrile, critical and recovery. In the initial febrile phase, fever, headache and body pain are the major symptoms. Fever-reducing medicines (paracetamol) and plenty of fluids are required. Most patients usually go into recovery without developing an overt critical phase.

Some patients, however, develop critical symptoms that require hospitalisation and close monitoring. The warning signs include vomiting, abdomen pain, severe headache, persisting body pain, bleeding from any site and the inability to have liquids. Presence of any of these indicates a critical situation and the patient needs close monitoring for 48-72 hours in a hospital setting.

Monitoring haemoglobin and haematocrit (ratio of the volume of red blood cells to the total blood volume) is more important than even monitoring of platelet count in dengue. These two values need to be checked on the second/third day of fever. These results would serve as the baseline values for the patient and should be closely monitored if symptoms persist or worsen. Sometimes, when the patient’s fever breaks, often other symptoms worsen, indicating the beginning of the critical phase. Any abnormal rise (>20 per cent) in haemoglobin and haematocrit beyond baseline values indicates the need for hospitalisation.

A sharp fall in haemoglobin and haematocrit levels from the baseline values along with clinical deterioration is even more serious and suggests internal bleeding that requires urgent blood transfusion. A slight decrease in these two parameters along with improvement in symptoms indicates recovery.

A falling platelet count alone (unless it is drastically low) usually doesn’t need hospitalisation. Platelets need to be transfused only if the count is below 10,000/cmm or there is evidence of active bleeding. For most critical patients, guarded intravenous fluids suffice to tide over the crisis.

No vaccine is available at present. Prevention of mosquito breeding and protection from mosquito bite are the only preventive steps. Simple measures can help. Do not let water collect in pots or discarded containers, remove mosquito breeding sites around houses, use repellents and wear appropriate clothing.

— The writer is consultant,

internal medicine, Fortis, Mohali

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