As the COVID-19 pandemic winds down, it leaves behind a sense of unease and worries among the general population and the medical fraternity alike. More and more clinicians are reporting seeing flu-like symptoms in their clinics or OPDs but there is confusion around the diagnosis.
While the symptoms seem to suggest a flu-like/ viral illness, it is not attributable to a single cause. Influenza A and C, H1N1 (swine flu), common tropical infections, monsoon-related illnesses, and dengue are all presenting in a similar fashion. Of these, dengue is of special concern as the number of cases being reported in recent years has been significant across the country. 2021 witnessed approximately 2 lakh dengue cases, a 4-fold rise over 2012 numbers. Dengue is a viral illness transmitted through the bite of the Aedes mosquitoes. These mosquitoes bite during the day so simple protective measures like using mosquito nets at night are of little value in prevention. When a mosquito bites a patient and then bites a normal individual, the infection gets transmitted.
There are 4 types of dengue-causing virus serotypes. In most cases, dengue is a self-limiting illness but in case a person gets bitten a second time and infected with a different viral serotype, the disease can have severe morbidity and mortality (as much as 20%). In such cases, dengue haemorrhagic fever and dengue shock syndrome can occur, manifesting with bleeding, severe plasma leakage from the blood, liver failure, and altered sensorium.
It is hence, important to understand how dengue could be suspected and detected early. After a bite from an infected mosquito, it could take between 4-10 days for the first symptoms to show up. High-grade fever (up to 104o F), chills, skin rash, facial flushing, retro-orbital (behind the eyes) headache, joint pains, nausea, vomiting, easy bruising of the skin, etc. could all be indicators of dengue infection. Bleeding from the gums and gastrointestinal tract could happen in dengue haemorrhagic fever and can be fatal if not diagnosed and treated in time.
A thorough clinical history suggestive of travel to a dengue endemic area guides the clinical suspicion which can be confirmed by serological blood tests. The results of these are likely to show a 4-fold increase in plasma proteins called immunoglobulins. Dengue antigen determination is confirmatory. Along with serology, complete blood counts are critical, especially platelet estimation. Dengue can cause a drop in platelet count and it is this drop that results in easy skin bruising and bleeding, as platelets control blood clotting. A platelet level below 100,000 is considered abnormal and about 20% of patients will have a count as low as 30,000. Platelet estimation needs to be repeated daily from day 3 of the illness and should continue till the platelet levels are restored to normal levels, accompanied by a complete recovery.
No specific antiviral drug is available to treat dengue. Supportive treatments like oral rehydration, antipyretics to control fever, etc. are important. Patients showing more aggressive symptoms including those with suspected haemorrhagic fever are best treated in a hospital. Elderly dengue patients may present atypically and are at higher risk of haemorrhagic fever and shock. Aside from dengue severity, age and presence of co-morbid conditions are associated with prolonged hospital admissions.
Recovery happens gradually. It is essential that patients do not immediately resume all activities and only do so over a period of time. This may have implications for employees and employers as there may ban e increase in extended leave requests. A thorough workplace assessment of common and currently prevalent infectious diseases can guide infection prevention, control, and management strategies.
A vaccine for dengue has been developed but is not universally available for general use. Its use remains limited to those who are at high risk for reinfection. Individuals, organizations, vector-control agencies, and health authorities must work in coordination to ensure the prevention of dengue. What is needed on a war footing is:
• Increased surveillance and heightened public awareness
• Regular spraying / fogging of mosquito breeding areas and avoiding water stagnation
• Use of protective / barrier clothing, along with repellents
• Avoiding outdoor exposure as much as possible during daytime
The only way to actually prevent dengue is to avoid being bitten by mosquitoes carrying the virus. Staying updated with credible information and remaining vigilant are the cornerstones of conquering dengue and other viral illnesses.
Content By: Dr. Vikram Vora, Medical Director, India Subcontinent, International SOS
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