"Dengue Fever: Symptoms, Severity, and Treatment"

What is Dengue?

Dengue Fever is quite common in tropical and subtropical regions. Dengue viruses are transmitted to humans when they get bitten by mosquitoes infected with the Aedes species (Ae. aegypti or Ae. albopictus). Centers for Disease Control and Prevention (CDC) approximately 4 billion people, nearly half of the world's population, reside in regions where the risk of dengue is prevalent. It's particularly prevalent in places like Southeast Asia, the Western Pacific Islands, Latin America, and Africa. Even in Bangladesh cases tend to increase during the pre-monsoon and monsoon seasons, with the transmission rate being highest from March to June and peaking in April. It usually starts to go down from June to July. Dengue Fever has spread to southern parts of Europe and the United States too. Every year, millions of people get infected worldwide, and depending on the time and place, it can even turn into an epidemic. Scary stuff!

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The thing is, Dengue can be tricky to diagnose because not everyone shows specific symptoms. But if it's caught early and you get the right medical care, you can totally recover from it, even at home. Of course, in more serious cases, hospitalization might be needed, but most patients recover in about 1-2 weeks.

The World Health Organization (WHO) classifies Dengue into three main forms:

1.      Dengue Fever (DF): This is the most common form of Dengue and is characterized by symptoms such as high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding. Dengue Fever is usually not life-threatening, and with proper medical care and rest, most patients recover within a couple of weeks.

2.      Dengue Hemorrhagic Fever (DHF): DHF is a more severe form of Dengue that can be life-threatening. It presents with symptoms similar to Dengue Fever but may progress to more serious complications, including bleeding, plasma leakage, and organ impairment. Prompt medical attention is crucial for managing DHF, and hospitalization is often necessary for close monitoring and supportive care.

3.      Dengue Shock Syndrome (DSS): DSS is the most severe form of Dengue and is characterized by symptoms of DHF along with shock, which can lead to organ failure and potentially death. In DSS, the blood pressure drops significantly, and medical intervention, such as intravenous fluids and careful monitoring, is critical to stabilize the patient.

Admission to the hospital is generally recommended for patients with Dengue when they show signs of severe Dengue, specifically Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). These severe forms of Dengue can be life-threatening and require close monitoring and specialized medical care. Here are some guidelines on when hospital admission is typically advised:

1.      Dengue Hemorrhagic Fever (DHF):

• Severe abdominal pain.

• Bleeding from the nose, gums, or under the skin (petechiae).

•  Blood in vomit, stools, or urine.

• Rapid breathing or difficulty breathing.

• Fatigue or restlessness.

2.      Dengue Shock Syndrome (DSS):

•    Symptoms of DHF (persistent vomiting, severe abdominal pain, bleeding, rapid breathing).

•   Cold, clammy skin.

• Weak but rapid pulse.
•  Low blood pressure (signs of shock).

• Rapid development of organ failure.

The common symptoms of dengue include:

•  High fever (40°C/104°F)
  

• Intense headache

•  Pain behind the eyes

• Joint and bone pain

•    Nausea and vomiting

•   Swollen lymph nodes

•  Skin rashes in various parts of the body

•  Persistent vomiting

These symptoms are usually observed within 4 to 10 days of contracting the infection. Generally, the symptoms persist for about 2 to 7 days. If someone gets infected with dengue for the second time, the severity of the disease may increase. Therefore, individuals who have previously had dengue are advised to be extra cautious.
 
The severe symptoms of dengue include:

• Intense abdominal pain

• Progressive vomiting

•  Bleeding from the mouth or nose

•   Bleeding with urine and stool

•  Uncontrolled shaking

• Bleeding under the skin (which may look like bruises)

• Rapid and shallow breathing

•  Fatigue

• Irritability and restlessness

The dengue virus affects the blood vessels in the human body, leading to the formation of clots and the reduction of platelets (blood cells responsible for clotting). As a result, the body can experience internal bleeding, bleeding from different parts, and injury to any organ, eventually leading to death in severe cases. If any of these severe symptoms are observed in a person, it is crucial to immediately contact a doctor or admit the patient to the nearest hospital. Otherwise, the patient's life could be at risk.

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"What is the usual platelet count in Dengue?"

The normal platelet count in a healthy adult human is typically between 150,000 to 450,000 platelets per microliter of blood. In cases of severe dengue infection, this count can drop below 20,000 platelets. At this point, the risk of bleeding is significantly increased. For moderately severe cases, the platelet count may be in the range of 21,000 to 40,000 platelets per microliter of blood. However, dengue infection can often lead to rapid changes in the platelet count. When the platelet count is low and symptoms of bleeding appear, platelet transfusion may be required. Otherwise, our body can naturally increase the platelet count as the infection decreases by consuming foods rich in vitamin C, vitamin E, vitamin K, folate, and potassium.

Treatment for Dengue: As of now, there is no specific medicine or vaccine available for the treatment of dengue. Researchers are continuously working on it. In most cases, dengue infection can be managed through home-based care. Doctors often control the fever and discomfort using medications like paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs) are avoided to reduce the risk of bleeding. If the severity of the disease increases significantly, the patient may need to be admitted to the hospital, and close medical attention becomes essential. In the hospital, dengue patients are given intravenous (IV) electrolyte (salt) solutions, which help maintain the necessary fluid and salt balance in the body.

Diet for Dengue Patients For individuals affected by dengue fever, certain nutritional elements can be especially beneficial, such as:

•  Vitamin C (found in citrus fruits, berries, and leafy vegetables)

•  Zinc (found in seafood, peas, and almonds)

•  Iron (found in meat and peas)

• Oatmeal (important for easy digestion and fiber)

• Papaya

•  Coconut water

• Plenty of water to stay hydrated.

Inappropriate Foods for Dengue Patients Dengue patients should avoid foods that are difficult to digest, such as:

•  Meat dishes

•  Fatty foods

• Oily foods

•  Fried and spicy foods.

Medications that should not be taken:

When you have Dengue fever, you can take Paracetamol. An adult of normal weight can take up to four tablets of Paracetamol per day. The maximum daily dose of Paracetamol is three to four grams, depending on body weight.

However, if a person has complications related to the liver, heart, or kidneys, they must consult a doctor before taking Paracetamol.

Avoid taking Aspirin or any painkiller for body pain when affected by Dengue fever. Taking Aspirin during Dengue can lead to bleeding.

When should the Dengue test be conducted?

The Dengue test (Dengue Test) should be done after the onset of fever. In this case, the first test to be done is the Dengue NS1 Antigen test, which can be done from the first day of fever. This test is available in all places. It must be done within the first four days of fever; otherwise, it may come out as negative.

Subsequently, you can also take:

IGM Dengue Antibody: This test can come out positive in the patient's body from the fifth day of fever, so it should be done from the fifth day of fever. Some other essential tests should also be done from the beginning, such as CBC, SGPT. If other symptoms are observed along with fever, the doctor may suggest some additional tests.

Precautions for Dengue at Home Dengue is a mosquito-borne disease. Therefore, protect yourself and your family from mosquito bites.

• Do not allow water to stagnate around your home, as mosquitoes breed in stagnant water. Regularly inspect places where water might accumulate and get rid of it.  Wear long-sleeved clothing and use mosquito repellent during the early morning and evening when mosquitoes are most active.
  

• Use mosquito nets while sleeping.

• Use mosquito-repellent chemicals like permethrin.

• Stay extra cautious during peak mosquito activity hours.

Conclusion:  Dengue fever is a common disease, but if neglected, it can become severe. The outbreak is more common in urban areas. Therefore, city residents need to be more vigilant and aware. Especially those who have had dengue before should remain extra cautious. Second-time dengue infections can be fatal. Stay conscious, stay healthy, and take care. Consult your doctor if necessary.

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References:

1. WHO
2. The Calcutta Medical Research Institute (CMRI)
3. BBC News
4. Centers for Disease Control and Prevention(CDC)