Expert panel to review dengue clinical norms

Doctors report unusual symptomatic manifestations

The Health Department has set up an expert committee to review the clinical management guidelines of dengue fever, after doctors from all government medical college hospitals in the State reported unusual symptomatic manifestations of dengue, rapid deterioration and death in many cases.

The State has been going through one of the worst dengue epidemics ever, chalking up over 13,000 confirmed dengue cases and 23 deaths. An additional 48,000 cases have been reported as “probable dengue” cases and 163 deaths as “probable dengue deaths”.

At a high-level meeting held here last week, attended by experts from the National Centre for Disease Control and All India Institute of Medical Science, senior virologists and faculty from various medical colleges, and doctors, had expressed much concern over the “unusual” and “unpredictable” manner in which many young dengue patients seemed to develop complications, followed by sudden death.

“The classic symptoms of dengue seem to have undergone a change, with doctors now reporting sudden hepatic failure, renal shut down, neurological involvement (encephalopathy) with stroke-like paralysis and myocarditis. Paediatric casualties too seemed unusually high this season. There were arguments that we were failing in the close monitoring of patients and that at least some doctors were deviating from the clinical guidelines,” a senior health official said.

The State is following the national guidelines for dengue management adapted from the WHO guidelines.

“When doctors talk about the aggressiveness of dengue this season, we should also remember that we do not have exact grounds for comparison with the scenarios in previous years. Because documentation or mortality analysis has not been proper and there has never been any set yardstick for assessing that this dengue epidemic is more severe than the previous year’s,” says T. K. Suma, Professor of Medicine, Alappuzha MCH, who is heading the team reviewing the clinical guidelines.

The guidelines are being reviewed to make it more doctor-friendly and to list out in a capsule form, the warning signs of complications and the deviations in classic symptoms of dengue, which many doctors in the periphery may not associate with the infection, she says.

Senior virologists have ruled out any mutations in the dengue viruses which may have contributed to the aggravation in symptoms and complications.