By Tedler D. Depaynos, MD
For a lolo who has been enjoying doing “apostolic” work for his two granddaughters, losing one of them who was just four years old due to Dengue was very painful. One cannot imagine the deep sorrow he suffered together with the parents of his “apos”. They are from a municipality adjacent to the city and his children have to go to work daily in the city so that his granddaughters are with him most of the time.
Dengue causes non-specific signs and symptoms and maybe similar to those caused by other viruses like fever, body malaise, joint pains and anorexia. However the fever in Dengue is usually high and joint pains are usually more severe. They may last for 3-5 days or more. When the high fever disappears, rashes appear. They may also be itchy but unlike in allergy they are not edematous. They may look like pinpoint pettechiae and flat and actually they are micro extravasations of blood.
During this time “home medications” are given and because probably it coincides with the disappearance of the signs and symptoms, they attribute this to the effect of their home concoctions. Some give “juice of boiled guava or papaya leaves 1 teaspoon 3x/day” until the fever disappears. What is dangerous is it would delay the hospital consultation of the patient and would be brought only when the complications occur. I guess this happened to the patient. Bringing her to the hospital was delayed.
The home medications were learned from their neighbors who applied them to their relatives with Dengue. Hence their neighborhood is with the Dengue virus.
Dengue Fever is used to be spread only by a daytime mosquito called Aedis Egypti that thrives on fresh water. With continuous rains, their breeding places become abundant hence this would explain their multiplication during the rainy season. They were observed to bite at 10 AM and at 4 PM. At present, however, other mosquitoes that bite at night were observed to be also spreading the disease. Hence Dengue Fever could now be spread day and night.
To help control Dengue then should be a community effort. The breeding places should be eradicated. In another town, because it is a farming community they used the insecticides they used in their farm to spray the suspected breeding places in their neighborhood. I was not aware if the insecticides used had a negative side effects but the Barangay Captain was proud that the incidents of Dengue in their community became negligible compared to the previous years.
The mosquito gets the virus by biting an infected individual. When it lays eggs or larvae, the mosquito produced would also carry the virus. Jokingly they should also die because they are also infected with the virus. They do not because the mosquitoes and the virus have symbiotic relationship.
Dengue is made up of four strains so that even if you develop immunity from one Dengue attack you could be infected by the other strains. One can then have four Dengue attacks in their lifetime.
There are no reported cases yet that a pregnant mother could infect her fetus in the 1st or 2nd trimesters. It may be possible in the 3rd trimester, but the mother also develops antibodies against the virus which is also transmitted to the fetus so that even if it would be infected the antibodies are expected to overcome the virus. It is best however to consult your OB-GYN MD because one cannot imagine an unborn child having internal bleeding.
Appearance of Chikungunya virus is suspected but I am not aware if it could already be confirmed in our locality by our local laboratories. Classically, it may have similar manifestations like Dengue but the rashes are mostly observed to appear together with the fever and the joint pains may last longer. Other viral diseases may also produce rashes but the fever may be milder and joint pains more tolerable.
Laboratory tests for Dengue are needed to confirm its presence. A simple Complete Blood Count (CBC) would tell us if the infection is bacterial or if it is viral. The Hemoglobin (Hb) in the CBC is a test for anemia but it may also tell us if the patient is dehydrated and likewise the Platelets maybe seen normal or depressed. The Platelets are responsible for blood clotting mechanism and if it is severely depleted which may be caused by the Dengue Virus, the patient may bleed and may cause the Hb to decrease. Specific tests for early or late Dengue cases are also available.
There is no specific anti viral drugs yet given for Dengue virus. In general just like any viral infection, they are self limiting. Patients are merely hydrated but monitored closely for possible complications. Patients with “warning signs” or with possible complications are those that are advised confinement after a series of laboratory tests. Patients with no “warning signs” are treated as out-patients but still are advised follow-ups for possible sudden appearance of “warning signs”. These “warning signs” are defined by DOH and implemented by attending MDs.
Complications of Dengue are mainly due to bleeding which is due mainly to Platelet depletion. A patient could bleed anywhere like underneath the skin which may cause not only rashes but sometimes hematomas. Bleeding in the nose or thru the gums may initially appear. This is what happened to the patient before she was brought to the hospital. Before the platelets could be corrected by transfusion, the patient had “internal bleeding”. Some patients may manifest bleeding in the lungs and even in the brain which may resemble a stroke. It may directly affect also the heart muscles causing heart failure.
It is best therefore to seek early consultations when Dengue is suspected!**