Dengue fever: Check for the symptoms

When dengue advances into the critical stage it can result in bleeding, low levels of blood platelets or dangerously low blood pressure.

Liji Varghese The death of legendary filmmaker Yash Chopra on October 21, 2012 left the entire country sad and grieving. At the same time it also surprised and shocked many when the cause of the veteran filmmaker’s death was revealed - dengue. The filmmaker who rewrote romance on the celluloid had all the riches in the world –the most upscale areas to live in, to the best of food and healthcare. Then how could he succumb to an illness most often referred to as the poor man`s diseases? The diseases that had already infected over 600 people in the national capital itself for once has sent the authorities into a tizzy, with the state and the municipal bodies trying to put the blame on one another. The death of the ace filmmaker has forced the authorities into taking up concrete steps and implementing concentrated vector-control activities in various areas on a war footing. The authorities, who suspect that the filmmaker may have been infected due to a few mosquito-breeding sites in his own studio have however, asked Lilavati hospital to provide them a copy of the death certificate to ascertain the cause of his demise. As the state and the municipal authorities fight it out on who is more responsible for the health scare looming large in the country, here is a look at the cause, symptoms and the preventive measures to be taken to tackle the vector-borne infection. CAUSE Dengue, also known as break bone fever, due to the extreme pain caused in bones and muscles, is a mosquito-borne infection transmitted through the bite of an infected female Aedes aegypti mosquito. The mosquitoes which acquire the virus from already infected humans – also known to be the primary host of the virus – are capable of transmitting the virus for the rest of their life after 4-10 days of virus incubation. These mosquitoes breed in tropical and sub-tropical climates worldwide. There is no direct human to human transmission of the virus. However, dengue can be transmitted via infected blood transfusion and organ donation. Aedes aegypti which primarily bites during the day time breeds mostly in man-made containers. They bite multiple people during each feeding period and peak biting periods are early in the morning and in the evening before dusk. There are four serotypes of the virus that cause dengue - DEN-1, DEN-2, DEN-3 and DEN-4. Having recovered from one virus strain provides lifelong immunity against that particular serotype, but cross-immunity i.e. being infected by a different serotype increases risk of developing severe dengue which can be fatal. According to WHO, the number of dengue cases reported has increased predominantly in urban and semi-urban areas and has become a major international public health concern. SYMPTOMS Dengue in its initial stage is not deadly. However, ignoring symptoms or being infected again by a different serotype of virus or having another chronic disease can up complication risks and may result in dengue hemorrhagic fever or dengue shock syndrome. Symptoms usually last for 2–7 days, after an incubation period of 4–10 days. The characteristic symptoms of dengue include: i) Sudden-onset of fever (40°C/ 104°F). Fever is usually biphasic in nature, breaking and then returning for one or two days ii) Headache, pain behind the eyes iii) Muscle and joint pains iv) Swollen glands or skin rash that is similar to measles v) Nausea, vomiting When dengue advances into the critical stage it can result in bleeding, low levels of blood platelets in case of hemorrhagic fever, or dangerously low blood pressure in case of dengue shock syndrome. The critical stage can lead to:

i) Fluid accumulation in the chest and abdominal cavity due to increased capillary permeability and leakage, which leads to depletion of fluid from the circulation and decreased blood supply to vital organs ii) Organ dysfunction and severe bleeding, typically from the gastrointestinal tract iii) Respiratory distress, rapid breathing, fatigue, restlessness iv) Severe abdominal pain v) Persistent vomiting or blood in vomit TREATMENT There is no known vaccine to treat dengue; prevention is the only way to keep away from the virus. Hospitals offer only supportive care in order to maintain the body fluid levels and platelet transfusion in case it drops to extremely low. (A normal platelet count in a healthy individual is between 150,000 and 450,000 per microlitre of blood). PREVENTION AND CONTROL Prevention is the only way to combat the mosquito-borne disease. Prevent measures include: i) These mosquitoes breed in accumulated water and unhygienic conditions. The best way is to eliminate all the possible breeding grounds for the mosquitoes ii) Regular cleaning, emptying and covering of water storage containers iii) Using mosquito repellents, nets iv) Wear long-sleeved clothesv) Active monitoring and surveillance of vectors WHAT TO DO INCASE DIGANOSED WITH DENGUE Hospitalization is not required until one is suffering from severe dengue or has preexisting health conditions. It can be well managed at home as hospitals provide only supportive care. 1. Take all preventive measure as being infected with another stereotype of dengue when already diagnosed with one can be fatal 2. Try to maintain body fluid level, with ample intake of water and oral rehydration solution in short intervals. 3. Though there is no specific diet for dengue patients it is important to avoid spicy and oily food. Eat food that can be easily digested like boiled vegetables, rice gruel, porridge, soup, toast, apples, and bananas. Crushed juice of two fresh papaya leaves is a good home remedy for dengue fever. Chymopapin and papin - enzymes in the papaya leaf - help revive platelet count. 4. Paracetamol is used to bring down fever, however, painkiller like ibuprofen and aspirin should be avoided as they reduce platelet count and increase risk of bleeding. 5. Go for blood test, monitor BP regularly and follow up the condition with the doctor. According to WHO, over 2.5 billion people – over 40% of the world`s population – are now at risk from dengue. In Delhi, as on November 4, dengue cases in the capital rose to 1,161, with 36 people testing positive for the mosquito-borne disease, shows civic agency data. Two people have died of dengue-related complications in the national capital this year. In 2011, a total of 829 cases were reported. This year, 1,161 cases have already been reported, and the number of those infected continues to rise, even as the temperature has begun to drop. In 2010, a total of 5,649 dengue cases were recorded in Delhi.