Dengue fever- Symptoms, Examination, and Treatment
( Modern science and Acu therapy)
Causes-
Dengue fever is caused by any one of four types of dengue viruses. You can't
get dengue fever from being around an infected person. Instead, dengue fever
is spread through mosquito bites.
The two types of mosquitoes that most often spread the dengue viruses are
common both in and around human lodgings. When a mosquito bites a person
infected with a dengue virus, the virus enters the mosquito. Then, when the
infected mosquito bites another person, the virus enters that person's
bloodstream and causes an infection.
After you've recovered from dengue fever, you have long-term immunity to
the type of virus that infected you — but not to the other three dengue fever
virus types. This means you can be infected again in the future by one of the
other three virus types. Your risk of developing severe dengue fever increases
if you get dengue fever a second, third or fourth time.
Symptoms-
• Dengue should be suspected when a high fever (40°C/104°F) is
accompanied by 2 of the following symptoms during the febrile phase
(2-7 days):
• Bone level fever (gM~Mh rksM+ cq[kkj)
• Nausea
• Vomiting
• Rashes on skin
• Muscles and joints pains
• Pain behind the eyes
• Swollen glands
• Chills
• Less sweating
• Severe headache
• Cutting pain
• Altered Hot and cold sensation
• Hemorrhagic condition
• Low platelets
• Constipation
• Diarrhea
• Nausea
• Vomiting
• Rashes on skin
Dengue/ viral diseases esa antibiotic medicines dk;Z ugh djrh gSA buesa anti-
inflammatory drugs vR;ar [krjukd gks ldrh gSA
Fever de gksus ij Hkh xgu monitoring j[ksa]vU;Fkk internal hemorrhagic condition dh
fLFkfr esa Hkh rkieku de gks ldrk gSA
Complications-
Severe dengue fever can cause internal bleeding and organ damage. Blood
pressure can drop to dangerous levels, causing shock. In some cases, severe
dengue fever can lead to death.
Women who get dengue fever during pregnancy may be able to spread the
virus to the baby during childbirth. Additionally, babies of women who get
dengue fever during pregnancy have a higher risk of pre-term birth, low birth
weight, or fetal distress.
Severe Dengue-A patient enters what is called the critical phase normally
about 3-7 days after illness onset. During the 24-48 hours of critical phase, a
small portion of patients may manifest sudden deterioration of symptoms. It is
at this time, when the fever is dropping (below 38°C/100°F) in the patient, that
warning signs associated with severe dengue can manifest. Severe dengue is a
potentially fatal complication, due to plasma leaking, fluid accumulation,
respiratory distress, severe bleeding, or organ impairment.
Warning signs that we should look for include:
• severe abdominal pain
• persistent vomiting
• rapid breathing
• bleeding gums or nose
• fatigue
• restlessness
• liver enlargement
• blood in vomit or stool.
If patients manifest these symptoms during the critical phase, close
observation for the next 24–48 hours is essential so that proper medical care
can be provided, to avoid complications and risk of death. Close monitoring
should also continue during the convalescent phase.
Examination:
Virus Isolation method-
RT- PCR (Reverse transcriptase-polymerase chain reaction)-
The virus may be isolated from the blood during the first few days of infection.
Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods
are available and are considered the gold standard. However, they require
specialized equipment and training for staff to perform these tests.
Dengue Virus Antigen Detection (NS1)-
The virus may also be detected by testing for a virus-produced protein, called
NS1. There are commercially-produced rapid diagnostic tests available for this,
and it takes only ~20 mins to determine the result, and the test does not
require specialized laboratory techniques or equipment.
NS1 is detectable during the acute phase of dengue virus infections. NS1 tests
is sensitive during the first 0-7 days of symptoms. After day 7, NS1 tests are not
recommended.
Combined testing with a NS1 and IgM antibody test can usually provide a
diagnostic result during the first 1-7 days of illness, a second, convalescent
phase specimen should be obtained and tested for IgM when both antigen and
antibody tests are negative.
Serological Methods-
Serological methods, such as enzyme-linked immunosorbent assays (ELISA),
may confirm the presence of a recent or past infection, with the detection of
anti-dengue antibodies. IgM antibodies are detectable ~1 week after infection
and remain detectable for about 3 months. The presence of IgM is indicative of
a recent DENV infection. IgG antibody levels take longer to develop and remain
in the body for years. The presence of IgG is indicative of a past infection.
Coombs test or antiglobulin test (AGT)-
The Coombs test checks your blood for antibodies that attack red blood cells. It
can help prevent and diagnose problems.
Coombs tests are based on anti-human antibodies binding to human
antibodies, commonly IgG or IgM. These anti-human antibodies are produced
by plasma cells of non-human animals after immunizing them with human
plasma. Additionally, these anti-human antibodies will also bind to human
antibodies that may be fixed onto antigens on the surface of red blood
cells (RBCs). In the appropriate test tube conditions, this can lead
to agglutination of RBCs and allowing for visualisation of the resulting clumps
of RBCs. If clumping is seen, the Coombs test is positive; if not, the Coombs
test is negative.
CBC Examination-
Platelet count de gksus yxrk gSA
Total WBC count 4000 ls de gks ldrk gSA WBC ds 5 segments esa Lymphocytes,
Neutrophil normal fey ldrs gSa] ijUrq Monocytes vf/kd gks ldrk gSA
Neutrophil vkSj lymphocytes dh % value normal gks ldrh gS] ijUrq ba udk absolute
count de gks ldrk gSA
MPV (Mean Platelet volume) eku de feysxkA
Peripheral Blood smear or GBP- blesa Platelets dh la[;k de feysxh] rFkk lkFk esa
Giant cells Hkh fey ldrs gSA
Treatment-
Take more fluids in the form of water and juices.
F.No. 1 to 6 – 3/4 LHM- 2,3,4 ↓ 5,6 ↑ 0 ↑ 9 ↓
Lt Thumb all LVM- 0 ↑ 9 ↓ (Black colour)
Lt RF 0 Spm- 3,4 ↓ 5,6 ↑
RT RF 9 Spm- 3,4 ↓ 5,6 ↑
Both MM * 1,4,5 ↑ 3,6,8 ↓
Add for-
Chills-
F.No. 1 to 6 – 3rd Spm- 2,3,4 ↓ 5,6 ↑
F.No. 1 to 4 – 4th Spm- 2,4 ↓ 3,6 ↑
Increased or reduce WBC-
Rt IF 9th Spm- 4,5 ↓ 3,6 ↑
LT IF 0 Spm- - 4,5 ↓ 3,6 ↑
RT RF 0 Spm- - 4,5 ↓ 3,6 ↑
Severe headache-
F.No. 1 to 8 – 3/4 LHM- 2,3,4 ↓ 5,6 ↑ 0 ↑ 9 ↓
High fever (Temp. 1040 F or 1050 F)-
F.No. 0 to 9 – 3/4 LHM- 2,3,4 ↓ 5,6 ↑ 0 ↑ 9 ↓
Special Note:
There is no specific treatment for dengue fever. Patients should rest, stay
hydrated and seek medical advice. Depending on the clinical manifestations
and other circumstances, patients may be sent home, be referred for in-
hospital management, or require emergency treatment and urgent referral
Supportive care such as fever reducers and painkillers can be taken to control
the symptoms of muscle aches and pains, and fever.
• The best options to treat these symptoms are acetaminophen or
paracetamol.
• NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and
aspirin should be avoided. These anti-inflammatory drugs act by thinning
the blood, and in a disease with risk of hemorrhage, blood thinners may
exacerbate the prognosis.
