Dengue season is here. While prevention is key, seeking medical help on time once you notice symptoms, prompt diagnosis and treatment, and understanding warning signs play a crucial role in management of the vector-borne disease.
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Data updated till September 17 on the National Centre for Vector Borne Diseases Control website shows the country reported 94,198 cases of dengue and 91 deaths. Kerala, Karnataka and Maharashtra reported the most cases.
“We look for classic symptoms. If they seek treatment during the acute viremic phase - one to three days - we do not admit them,” says E. Theranirajan, dean, Rajiv Gandhi Government General Hospital (RGGGH), in Chennai. “We inform them of the warning signs and when to seek medical help. If they come to the hospital at the end of the third or fourth day, we admit them unless they are stable or have primary dengue. This is because day four to six is the critical phase in dengue and they need to be closely monitored. Their vital signs and haematocrit levels are closely watched,” he adds.
In dengue, day one to three are called the acute viremic phase, while day four to six are the critical phase followed by recovery, he added.
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What are the symptoms? Three days of continuous fever, with temperatures more than 101 degrees Fahrenheit - a high-grade fever that does not respond to routine paracetamol - is one the main symptoms, he said. “Patients will experience varying levels of headache, severe myalgia and maculopapular rash that typically begins on the third day,” he said.
Fever and two of the following - nausea and vomiting, rash, aches and pains, positive tourniquet test, leukopenia, any warning signs and laboratory-confirmed dengue - are probable dengue. The warning signs are intense abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy and restlessness, liver enlargement and laboratory findings of increase in haematocrit with concurrent rapid decrease in platelet count, he explains.
Dr. Theranirajan, who is a paediatrician, says parents must take children to the healthcare facility if they notice any of the following: poor appetite for food or water, less urine than usual, abdominal pain, bleeding in any form, inability to sit up or dizziness in older children, irritability, drowsiness, restlessness and if the feeling of sickness does not improve. “Frequent vomiting during the first one or two days of fever and low white cell blood count on day two are pointers for early diagnosis of dengue fever,” he added.
He stressed early recognition of the disease and careful monitoring of IV fluids from the beginning. Healthcare personnel need to familiarise themselves with the three main demarcated phases of dengue - febrile, critical and recovery.
“In the critical phase, there will be capillary leakage during which fluid collects in the pleural space around the lungs, abdomen and liver,” he said.
He added: “The critical phase is the golden period. There needs to be close monitoring on fluid management. Haematocrit level is the best indicator to assess hydration status. Platelet levels fall as the dengue virus produces anti-platelet antibodies. Dengue has no specific treatment but a supportive line of management.”
Absence of fever for 24 hours without the use of antipyretics, return of appetite that dwindled on the fourth or fifth day, visible improvement in the clinical picture, stable haematocrit, three days after recovery from shock, platelet count greater than 50,000 and rising are criteria for discharge.
Dengue prevention
Dengue is spread through the bite of Aedes aegypti. “It usually bites from 5 a.m. to 7 a.m. and from 5 p.m. to 7 p.m.; hence it is important to wear full-sleeved clothes, use mosquito nets and repellants. Check for mosquito breeding sources once every week, clear water stagnations and check the refrigerators trays,” he added.
Do not take antibiotics, steroids and non-steroidal anti-inflammatory drugs, and intramuscular injections, he said.
