By Tedler D. Depaynos, MD
The patient just went for a visit to their hometown which is a municipality in Ifugao when he noticed that many of their neighbors including some of his relatives were having high fever allegedly due to Dengue. After a few days stay, he also started feeling febrile so that he had to cut off his visit, came home and went directly to a hospital for admission. After several lab tests, true enough he was also infected with a Dengue Virus.
With the onset of the rainy season the increased incidence of Dengue Fever is again very significant. Hence, I am constrained to once again write on this Infectious Disease and most of it came from our interview with Dra. Rhoda Orallo-Fajardo, an Infectious Disease specialist some time ago in a Radio Program.
Dengue Fever used to be spread by a daytime mosquito called Aedis Egypti that thrives on fresh water. With continuous rains their breeding places become abundant and this may explain their multiplication during rainy seasons. They were observed to bite mostly at 10 AM and 4 PM. At present, however, other types of mosquitoes that bite at night were also observed to spread the disease. Hence, Dengue Fever can now be spread day and night.
To help control Dengue, the mosquito breeding places should be eradicated and this would only be effective if it is a community effort.
The mosquito gets the virus by biting an infected individual. When it lays eggs or larvae, the mosquitoes produced would also carry the virus. Jokingly, they will not die because they are Dengue infected. The virus and the mosquitoes have symbiotic relationship.
Dengue is made up of 4 strains so that even if you develop immunity from one Dengue attack, you could still be infected by the other strains. One could then have Dengue attacks 4 times in their lifetime. Dra. Fajardo could recall during her interview that she had two cases or 2 patients who were infected with Dengue twice.
There are no reported cases yet that a pregnant mother at the first and second trimester could infect her fetus. It may be possible on the third trimester, but the mother develops anti bodies against the virus which is also transmitted to the fetus so that even if it would be infected, the antibodies will overcome the virus.
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. These may last for 3-5 days. 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.
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 the 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, in the intestinal walls manifesting bloody stools or melena, in the lungs or even in the brain which may resemble a stroke. The virus may also cause extravasations of fluid from the blood vessels causing edema or even fluid in the lungs or pleural effusion. It may directly affect also the heart muscles causing heart failure.
The serious complications we encountered several years ago were bleeding in the brain and bleeding in the lungs.
The origin of the word Dengue is unknown.**
