eMedinewS Editorial

Health Care 45 Comments

Dengue Watch (CW Games update)

  1. Dengue is a notifiable illness. The local municipal body must be notified. If dengue is reported in one house it becomes customary for the State Health Department to search for the breeding sites around 100 houses so that the disease can be curtailed there and then.
  2. There are four different types of dengue fever: Den 1, Den 2, Den 3, and Den 4. A person during his life can have dengue 4 times. Same dengue virus cannot infect again. Infection from one virus produces life long immunity only for that strain. Second dengue is usually more serious than the first one.
  3. A person can suffer from undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome (four dengue-related illnesses).
  4. Retro-orbital pain presenting as pain in the eyes or pressure on eye movement is characteristic of dengue-related fever. Other features are unexplained itching, nausea and vomiting suggestive of gall bladder inflammation or liver inflammation.
  5. Presence of restlessness (oxygen deficiency in the brain), abdominal pain (indicating internal hemorrhage) and black stools (GI bleeding) signifies urgency. The two dangerous clinical signs are falling systolic (upper) blood pressure and fall in pulse pressure.
  6. The mortality for dengue hemorrhagic fever and dengue shock syndrome is around 1%. There is no mortality seen in undifferentiated fever and dengue fever.
  7. During epidemics, people of all ages are involved otherwise the disease is more common in children.
  8. Dengue and malaria are not the indices of the hygiene status of a city. Cholera and typhoid represent the hygiene indices.
  9. The dengue mosquito, aedes, grows in fresh water collected in any place within or outside the house. Dengue mosquito is a day biter, prefers to bite before breakfast and after lunch, prefers human sites below elbow and below knee. Unlike anopheles (mosquito causing malaria) which bites every 3rd day, a dengue mosquito bites 4–5 times in a day. While anopheles infects one person in 3 days, aedes mosquito can infect 15 persons in 3 days.
  10. IgM blood test may take 5 days to become positive. Therefore in the first 5 days, all dengue tests may be negative.
  11. A platelet count of less than one lakh signifies dengue hemorrhagic fever or dengue shock syndrome.
  12. Do not give aspirin in a suspected case of dengue as it can further disturb the platelet functions.
  13. Never panic. There is no need for platelet transfusion unless platelet count is less than 10,000 or there is presence of spontaneous bleeding.
  14. The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever.
  15. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after fever is over. Often people insist on a discharge from the hospital when the fever is over or do not want to get admitted once the fever is over.
  16. Physicians should remember the formula of 20 and that is rise in pulse by more than 20, fall of BP by more than 20, difference between lower and upper BP less than 20, platelet count less than 20 thousand and presence of more than 20 hemorrhages of blood on the arm after tourniquet test suggests high risk people who need medical attention. The treatment is 20 ml/kg body weight of fluid replacement every hour.

Dr KK Aggarwal
Editor in Chief