The end of the COVID-19 pandemic is leaving a sense of unease and concern among the general population and medical community alike. More and more doctors are reporting flu-like symptoms in their clinics or OPDs, but there is confusion surrounding the diagnosis.
While the symptoms may seem to indicate a flu-like/viral illness, it is not due to a single cause. Influenza A and C, H1N1 (swine flu), common tropical infections, monsoonal diseases and dengue fever all present themselves in similar ways. Of these, dengue is of particular concern as the number of reported cases has been significant across the country in recent years. There were approximately 2 lakh dengue cases in 2021, a four-fold increase from 2012 numbers. Dengue is a viral disease transmitted by the bite of the Aedes mosquito. These mosquitoes bite during the day, so simple protective measures like using mosquito nets at night to prevent them are of little value. If a mosquito bites a patient, and then bites a normal person, the infection is transmitted.
There are 4 types of dengue virus serotypes. In most cases, dengue is a self-limiting disease, but if a person is bitten a second time and infected with a different viral serotype, the disease can have severe morbidity and mortality (up to 20%). In such cases, dengue hemorrhagic fever and dengue shock syndrome can occur, which manifest with bleeding, severe plasma leakage from the blood, liver failure and altered sensorium.
Therefore, it is important to understand how to suspect and detect dengue early. After being bitten by an infected mosquito, it can take between 4 and 10 days for the first symptoms to appear. High-grade fever (up to 104°F), chills, rash, facial flushing, retroorbital (behind the eyes) headache, joint pain, nausea, vomiting, easy bruising, etc. can be signs of dengue infection. Dengue hemorrhagic fever can cause bleeding from the gums and gastrointestinal tract, which can be fatal if not diagnosed and treated early.
A thorough medical history suggesting travel to a dengue-endemic area guides clinical suspicion, which can be confirmed by serological blood tests. The results of these tests probably show a 4-fold increase in plasma proteins called immunoglobulins. Dengue antigen determination is for confirmation. In addition to serology, complete blood counts, particularly platelet counts, are critical. Dengue can cause a drop in platelet counts, and this drop makes the skin bruise and bleed easily because platelets control blood clotting. A platelet count below 100,000 is considered abnormal, and about 20% of patients have a count as low as 30,000. Platelet determination must be repeated daily from day 3 of illness and should be continued until platelet counts return to normal, accompanied by full recovery.
There is no specific antiviral drug available to treat dengue. Supportive treatments such as oral rehydration, antipyretics to reduce fever, etc. are important. Patients with more aggressive symptoms, including those with suspected hemorrhagic fever, are best treated in a hospital. Older dengue patients may present atypically and are at higher risk for hemorrhagic fever and shock. Aside from the severity of dengue fever, age and the presence of comorbidities are associated with longer hospitalizations.
Recovery is gradual. It is important that patients do not resume all activities immediately, but only do so over a period of time. This can have an impact on workers and employers as the number of requests for extended leave can be banned. A thorough workplace assessment of common and currently prevalent infectious diseases can guide infection prevention, control and management strategies.
A dengue vaccine has been developed but is not widely available for general use. Its use remains limited to those at high risk of reinfection. Individuals, organizations, vector control agencies, and health authorities must coordinate to ensure dengue prevention. What is needed on war base is:
• Increased surveillance and public awareness
• Regular misting/spraying of mosquito breeding areas and avoiding water stagnation
• Use of protective/barrier clothing in conjunction with repellents
• Avoid outdoor exposure during the day as much as possible
The only way to actually prevent dengue is to avoid being bitten by mosquitoes that carry the virus. Staying current with credible information and staying alert are the cornerstones of fighting dengue and other viral diseases.
Content By: Dr. Vikram Vora, Medical Director, Indian Subcontinent, International SOS
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