Dengue Fever In Pakistan

HOW DENGUE SPREADS FROM ONE PERSON TO THE OTHER?

2011-10-09T13:10:00.002-07:00

HOW DENGUE SPREADS FROM ONE PERSON TO THE OTHER?

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

Dengue spreads from one person to the other by a special Dengue Mosquito. This mosquito grows up and multiplies primarily in FRESH WATER (the artificial house hold containers) and it can grow on stagnant/dirty water too. Fresh water is the water present for weeks in POT/PLATES in your kitchen, or WATER in a vase placed on the table for decoration purpose, or water standing in the lawns outside houses.
Dengue mosquito lays eggs in water , in which adult mosquitoes grow up. When they bite a patient suffering from dengue , the mosquitoes acquire infection . And further when they bite a healthy individual, the healthy person gets dengue. And so the cycle continues. More mosquitoes grow in standing-fresh-water and bite dengue patients first, and then they bite healthy person and cause dengue in them.
Dengue Mosquito is usually found indoors i-e in houses near the floor/under beds , chairs and sofas . Its found through insect studies that it usually bites near the time of sunrise and sunset , and hence at these times maximum preventive measures against the bites of mosquitoes should be taken.
Prevent Yourself from bites OF Mosquito , You will not have dengue ! That’s a foremost measure to be adopted.Prevent Mosquitoes from growing in water , and Kill them by SPRAYS , this is the 2^nd most important thing to be done by YOU. REMEMBER, Dengue Spreads Only and Only by MOSQUITO BITES. You DO NOT get dengue when you drink contaminated water.

PREVENTING DENGUE FEVER :

2011-10-09T13:10:00.001-07:00

PREVENTING DENGUE FEVER :

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

Prevent yourself from the Bite of mosquito and you will not get dengue.

Prevent mosquito from biting a dengue patient, and dengue will not spread from him to other healthy persons.

Kill dengue mosquito by sprays or by flushing all the standing-water around you, and the disease of dengue will be killed forever.

1. Wear full sleeve shirts.
2. Apply mosquito repellents on face/neck/hands/feet/ankles. And encourage its use in school going children.
3. Keep dengue patients in mosquito nets
4. Find places around you where water is standing. Start Search from your house. From kitchen to your lawn flush water where ever you find it standing.
5. Get your lawns sprayed against mosquito. If there’s too much mosquito in your house , get your house sprayed too.
6. Get Electric MOSQUITO Killers for your office and house and install them to the door entrances.
7. Throw away the junk items placed in your home ,in ware houses , etc.
8. Water pooled in tyres at Petrol Pumps should be moved and dried under sun to kill all growing mosquitos.
9. Clean the pots n plates of your pets regularly.
10. Avoid going to swimming pools . Rather encourage that pools be emptied.
11. If you sleep outdoor , Sleep in a mosquito net.
12. Do mosquito killing spray in bathroom daily.Small Pressurized Canisters are available for home use.

DENGUE PATIENT :

2011-10-09T13:10:00.000-07:00

DENGUE PATIENT :

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

**Most of the patients who acquire dengue complain that they have MILD or HIGH FEVER , and severe PAIN IN BODY , PAIN IN LEGS and in back bone. There is headache. Many patients complain of severe pain behind EYES. The platelet Cells are also decreased but do not worry too much about it. Rather act according to the advise of your doctor.
**Some patients with dengue have High FEVER and Vomiting along with it.
** Some patients of dengue also have Blood coming from nose/or mouth/or in faeces/in cough/or in saliva,etc.
** some times a patient presents just with sore throat , or just a flu
** So ALL DENGUE PATIENTS are NOT ALIKE. Some have just a fever . And many severe cases have Blood coming along with fever and with other complications.

The majority of the patients are those who just have fever and body pains ,and vomiting complains along with this.

TREATMENT OF DENGUE :

2011-10-09T13:09:00.002-07:00

TREATMENT OF DENGUE :

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

DO NOT TAKE DISPRIN in dengue .
Tell all your relatives/friends, that if they get fever or headache in these days , they should avoid DISPRIN or BRUFEN- DO NOT TAKE DISPRIN- DO NOT TAKE BRUFEN- DO NOT TAKE any medicine on which ASPIRIN is written .
PLEASE NOTE THAT the treatment written here is just for general information purpose and is incomplete. This is NOT the real treatment that you/or other patients need because Treatment Strategy and DRUG DOSES VARY greatly from patient to patient. Patient may also need to be admitted to the hospital. Please consult your doctor for proper treatment.

Patient is KEPT in a NET . So that no mosquitoes bite him and thus disease wont progress to other persons. (While the relatives around the patient are advised to apply MOSPEL (or mosquito repellents to their naked body parts).
Panadol is given to the patient to relieve FEVER and BODY PAIN.
Anti-Emetics are given. (This is medicine that stops vomiting)
Medicine to Support Stomach function is given (like “omeprazole”)
Lot of water is mostly advised to patient . ORS is preferred.
>> In other cases , your doctor may advise GIVING PLATELETS TO THE PATIENT
>> Or the doctor may advise GIVING WHOLE BLOOD to the patient.

IN HOW MUCH TIME DENGUE CURES ?

2011-10-09T13:09:00.001-07:00

IN HOW MUCH TIME DENGUE CURES ?
(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

The time in which dengue cures is different in different people. It depends on the health status of the patient that how quick he gets cured as well as on severity of the disease he got.
Normally , it takes around 7 to 10 days to get cured from dengue , but weakness may continue after this time.
Dengue Patients who just had had fever and body aches (with or without vomiting) cure in about ten days, and may be sent home without getting admitted in hospital.

While the Dengue patients who have blood coming from their nose or mouth etc may need more careful monitoring in hospital.

REMEMBER, when the fever of a dengue patient gets cured do get the patient checked up properly by a doctor ! This is necessary because this is the time when the dengue disease can get complicated in some specific patients.

PLATELET TRANSFUSION :

2011-10-09T13:09:00.000-07:00

PLATELET TRANSFUSION :

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

As discusses earlier, in a patient of Dengue Platelet Cells begin to Decrease.If these decrease below 20,000 (or 30,000) your doctor may advise you to find a BLOOD DONOR . The Blood of the donor is MATCHED with the blood of the patient and and through a special machine in Laboratory the platelet cells are separated from blood. These platelets are then transfused into the blood of the patient.
This is being practiced successfully in most of the hospitals and there is hardly anything to worry about it.
(Though We, the Doctors in Mayo Hospital DO NOT ADVISE platelet transfusion. That is the procedure mentioned above , that you separate the platelet cells from BLOOD and give to the patient. We advise GIVING WHOLE BLOOD TO THE PATIENT and that too in extreme conditions where there is severe bleeding from patient’s nose/mouse/in faeces/in cough etc. BUT as stated previously, NOT all the patients of dengue are treated alike. Follow the advice of your doctor who is monitoring the patient.)

LABORATORY TESTS & UNDERSTANDING THEM :

2011-10-09T13:08:00.000-07:00

LABORATORY TESTS & UNDERSTANDING THEM :

(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

Two types of tests are being done to evaluate a patient of dengue . These are :
1. CBC Test
2. Serological IgM and IgG Test

CBC Test means Complete Blood Count. By this test blood cells are counted. It is through this test that the patient comes to know that his Platelet Cells are decreasing and then he begins to get tense(though its nothing to worry about , and that its normal in this disease. Your doctor will also tell you the same).

Serological IgM and IgG Tests :
In simple words, If in a report it says that IgM is Positive then it means that there is high chance that you have Dengue.
If IgM is negative then it means that there is very high chance that you do not have dengue.

If IgG is positive and more than 0.9 then it means that you may have dengue previously too(before the current attack of dengue you got)

“Dengue Fever Epidemic” by Dr. M Tauseef Omer

2011-10-09T13:07:00.001-07:00

Dengue Fever Epidemic

(If you are NOT a doctor, read this simplified article to know all about dengue fever)

By Dr. M Tauseef Omer

King Edward Medical University, Lahore.

Contact: tauseef_ravian153@hotmail.com

Click on the Links below to Read :

WHAT IS DENGUE FEVER ?

HOW DENGUE SPREADS FROM ONE PERSON TO THE OTHER?

PREVENTING DENGUE FEVER :

DENGUE PATIENT :

TREATMENT OF DENGUE :

IN HOW MUCH TIME DENGUE CURES ?

PLATELET TRANSFUSION :

LABORATORY TESTS & UNDERSTANDING THEM :

WHAT IS DENGUE FEVER ?

2011-10-09T13:07:00.000-07:00

WHAT IS DENGUE FEVER ?
(This text is intended to be read by those persons who are not doctors and want to understand dengue , if you are a doctor please read this article : A GLIMPSE ON DENGUE FEVER(click here)

Dengue fever or Dengue is a disease that is caused by a virus and it spreads from one person to the other by special type of mosquitoes. The most evident feature of this disease is “fever” with severe “body aches”. No age group is safe from dengue fever and every one including children, youngsters, old men and women all can acquire dengue.
In Pakistan, currently Punjab is under the epidemic of this disease. This article targets the common people ,who are not doctors, about various aspects related to this new evil in our country, Dengue Fever.Very few cases of dengue fever were reported in Pakistan in previous 3 or 4 years. Sri Lankans are fighting with this disease from past 2 to 3 decades. They haven’t been fully successful yet. The disease is also prevalent in India.

Dengue Awareness–Urdu

2011-10-08T15:38:00.001-07:00

click on the image above to Enlarge it.

“A GLIMPSE ON DENGUE FEVER” by Dr. Arslan Baig

2011-10-08T10:56:00.001-07:00

A GLIMPSE ON DENGUE FEVER

WRITTEN BY: DR. MUHAMMAD ARSLAN BAIG

King Edward Medical University, Lahore, Pakistan

Contact: pak_asfa@hotmail.com

Click on the Links below to go through the article:

PURPOSE OF WRITING THE ARTICLE On DENGUE FEVER:

DENGUE VIRUS & Its SPREAD BY MOSQUITOES:

CLASSIFICATION OF DENGUE FEVER

IMMUNITY AGAINST DENGUE VIRUS:

MISCONCEPTIONS About Dengue Hemorrhagic Fever:

Presentation OF DENGUE FEVER :

DETAILED DISCUSSION ON CLASSIFICATION OF Dengue Fever

ROLE OF ANTIBODIES IN DIAGNOSING DENGUE FEVER:

MANAGEMENT OF DENGUE FEVER:

PREVENTION FROM DENGUE :

CONDITION Of Dengue Fever IN PAKISTAN: (October 2011)

CONDITION Of Dengue Fever IN PAKISTAN: (October 2011)

2011-10-08T10:52:00.001-07:00

CONDITION Of Dengue Fever IN PAKISTAN: (October 2011)

Right now the mortality rate of patients with dengue fever is very low. Its because most of the patients are getting the primary infections and so are getting dengue classical fever with symptoms during first five days, platelets decreasing usually for 3 days and resolution afterwards without any complications. Such cases get fine even without any management. But in the coming years people would start getting dengue hemorrhagic fever more due to secondary infections and possibilities of going into dengue shock syndrome would be more and hence the cases may decrease but the mortality would be very high. So its high time for every individual of the society as well as the government to take proper measures to unite and eradicate dengue fever from our country. So even when in winters this mosquito would die and dengue would vanish we should not be taking rest at homes as they say THE BATTLE IS GONE BUT THE WAR IS STILL ON. Proper measures to avoid its recurrence must be taken.

PREVENTION FROM DENGUE :

2011-10-08T10:48:00.001-07:00

PREVENTION FROM DENGUE :

As far as prevention is concerned either we will have to stop aedes aeqypti or albopticus mosquitoes to stop breeding by destroying their breeding places or we will have to stop the contact of mosquito with the human beings. We can do this by

·.. Cleaning the parks and not allowing clean water to gather in them

·.. Emptying the pools and all places where water may gather

· ..Even a money plant inside home can be a breeding place so avoid such things

· ..Using mosquito repellants or mosquito killing sprays inside home to avoid contact of mosquito with humans

·.. Massive fumigation programs by government to kill mosquitoes.

·.. Isolation of dengue patients and avoidance of their contacts with mosquitoes to avoid spread

· ..Public awareness by print media and television.

MANAGEMENT OF DENGUE FEVER:

2011-10-08T10:45:00.001-07:00

MANAGEMENT OF DENGUE FEVER:

The most important thing to do about management is counseling the patient about dengue fever. We have to tell them that its not dangerous and if treated accordingly the mortality is very low. We should make patient and his attendants tension free.

Now we will discuss management plans for different types of dengue fever

****AYMPTOMATIC DENGUE FEVER: we don’t have to do anything in this case as the patient already has immuntity against it.

****UNDIFFERENTIATED FEVER: in this case too no treatment is offered and patient gets fine on its own usually.

****CLASSICAL DENGUE FEVER:

· PANADOL (ACETAMINOPHEN) 2 tablets after every 6 hours. We ask the patient not to take any other NSAID for 2 reasons.

First of all NSAIDS are known to have anti platelet action and so as in dengue fever the platelets decrease so we avoid any drug with anti platelet actions. Secondly NSAIDS are known to cause gastric ulcers or to aggravate them. So we avoid them so that if they create such problem in a patient with decreased platelet count we may have to deal with internal GI bleed which can be dangerous.

· IV FLUIDS. As the patient has nausea and vomiting so dehydration would be a common finding. We give IV fluids as ringer lactate or dextrose to the patient

· ANTI EMETICS. To decrease the symptoms of nausea and vomiting anti emetics like metoclopramide are suggested

· NO PLATELETS. No platelet infusion is required in dengue patients. Its indicated in only 0.1 percent of the cases with proper indication. Its seen that it may cause anaphylactic shock in the patient and should be avoided at all costs. Instead patient may be given whole blood if any signs of bleeding or very low platelet count may be seen.

****DENGUE HAEMORRHAGIC FEVER WITHOUT SHOCK:

The reason for emphasizing that the patient must present on 4^th day of disease to doctor so as to differentiate dengue hemorrhagic fever from classic fever is the fact that the management plan of both are opposite. So if we continue to treat a case of hemorrhagic fever in same way as that of classic fever we would end up getting a disaster. Lets see how to manage a case of dengue hemorrhagic fever

· COUNSELLING. Tell the patient that crucial phase starts from 4^th day and as a clinician we must identify it as well.

· SIGNS OF LEAK. Signs of capillary leakage must be looked for. Patient with persistent vomiting, RHC pain must be identified and managed accordingly

· ACETAMINOPHEN (PANADOL) 2 tablets 6 hourly for fever reduction if fever is still present. No NSAIDs for same reason as written above in management of dengue classical fever

· RESTRICTION OF FLUIDS. We must tell patient to take less fluids because fluid is leaking into extra vascular compartment so we will overload extra vascular compartment and later when the capillary leak would end after 48 hours same fluid would come back to intravascular compartment overloading it and ending into congestive heart failure etc. So we suggest giving diuretics to decrease overload problem after the passage of crucial phase.(But in case of dengue classical fever more fluids must be given as patient has dehydration with no capillary leakage)

· IV DEXTRAN 40. We do not give ringer lactate or dextrose to these patients as we do not want to over load their extravascular compartment due to capillary leakage. So we give patient IV dextran 40 (10ml/kg body weight in half hour). Dextran 40 makes extravascular fluid to come into intravascular compartment and hence protects our patient to go into intravascular overload after 48 hours of crucial phase.

· NO PLATELETS. Again for same reasons as described in management of dengue classical fever platelet transfusion is contraindicated. They are only given in patients with absolute indication but such patients are 1 in 1000. Whole blood transfusion for platelets and clotting factors is a better option.

****DENGUE SHOCK SYNDROME:

It’s a very serious condition which is managed as a case of shock under strict supervision of neurosurgeons and physicians and mortality rate is high. Still timely and correct management can make most of the cases recover. The management plan of dengue shock syndrome is above the level of discussion we are having here.

ROLE OF ANTIBODIES IN DIAGNOSING DENGUE FEVER:

2011-10-08T10:39:00.001-07:00

ROLE OF ANTIBODIES IN DIAGNOSING DENGUE FEVER:

Patients can develop dengue hemorrhagic fever in primary infection and even patients getting secondary infection can have simple dengue classical fever. But the incidence of development of dengue hemorrhagic fever in patients with secondary infection is remarkably more. Lets discuss the role of different antibodies helping us to diagnose dengue fever.

IgM antibody shows current infection and is usually positive from 5^th day till 10^th day.

IgG antibody shows previous infection and is positive usually after 10^th day of infection

Viral antigen can be detected during first three days of infection as well.

So lets discuss different scenarios:

** In a patient who has got dengue first time , during first three days we will find viral antigen positive. From day 5 to day 10 IgM would be positive , while after 10 days IgG would be positive for rest of his life.

** In patient who has got dengue second time (secondary infection) during first three days viral antigen and IgG( of previous infection) would be positive. From 5^th to 10^th days IgM and IgG would both be positive. From 10^th day onwards only IgG would be positive and would remain positive throughout his life

DETAILED DISCUSSION ON CLASSIFICATION OF Dengue Fever

2011-10-08T10:28:00.001-07:00

DETAILED DISCUSSION ON CLASSIFICATION OF Dengue Fever

ASYMPTOMATIC DENGUE PATIENT:

These are the patients who previously had dengue infection. They developed life long immunity against the serotype they got infected with and 6 months immunity against other serotypes. So if the previous serotype infection would occur anytime in life or any serotype infection would occur within 6 months of dengue infection then the patient would remain asymptomatic. He would develop no symptoms and is good to go.

SYMPTOMATIC DENGUE PATIENT:

It’s the patient who develops symptoms of dengue fever. He has not got immunity against the serotype he is being infected with. Now we will discuss that what can be different types of patients in this category
1. UNDIFFERENTIATED FEVER:
These are the neonates who are born to mothers who ever had dengue infection. The mothers developed anti bodies against the serotype they were infected with and those anti bodies travelled through the placenta and got transferred to the baby. Though the baby never got dengue fever but he has got the anti bodies but they are less in number so he has partial immunity. So if baby gets bitten by aedes egypti he would develop undifferentiated fever just like other viral infections in which the symptoms are undifferentiated and not clear. Fever would not be high grade and baby would get fine on its own in couple of days with mild disease.
2. DENGUE CLASSICAL FEVER
Dengue classic fever can be of three types
i) DENGUE CLASSIC FEVER WITHOUT THROMBOCYTOPENIA
Now in these patients after the common duration we will see that there would be no change in CBC. Fever would subside in around 5 days and patient would get fine and might not even know that he had dengue fever. These cases rarely present to doctors and sometimes get fine even by self medication
ii) DENGUE CLASSIC FEVER WITH THROMBOCYTOPENIA WITHOUT UNUSUAL HEMORRHAGES
In these patients after common duration the only change in CBC would be fall in platelet count. Normal platelet count being 150,000 to 450,000 per microlitre of blood. The platelets would start to fall from 4^th day and would keep on falling till 6^th or 7^th day. Fever subsides same way on day 5^th to 7^th. After 7^th day platelets start to rise again on their own. All rest things on the lab tests would be in normal range. In these patients we would not see any presentation of any bleeding from nose or GIT or in cough or any internal bleeding. That’s the reason why this category is named as being “without unsusual bleeding”.
iii) DENGUE CLASSIC FEVER WITH THROMBOCYTOPENIA WITH UNUSUAL HEMORRHAGES
In these patients after common duration again the only change in CBC would be fall in platelet count. Normal platelet count being 150,000 to 450,000 per microlitre of blood. The platelets would start to fall from 4^th day and would keep on falling till 6^th or 7^th day. Fever subsides same way on day 5^th to 7^th. After 7^th day platelets start to rise again on their own. All rest things on the lab tests would be in normal range. In these patients we would surely see any presentation of any bleeding from nose or git or in cough or any internal bleeding. That’s the reason why this category is named as being “with unsusual bleeding”.
3.DENGUE HEMORRHAGIC FEVER:
(Further Classification Of Dengue Hemorrhagic Fever is Explained in the end of this page)
Now is the time to discuss what dengue hemorrhagic fever actually is. Basically the differentiating point between hemorrhagic and other forms of dengue fever is CAPILLARY LEAK. In Dengue hemorrhagic fever the capillaries of patient become leaky and that’s why from 4^th day onwards the intravascular fluid of patient starts oozing out into the extra vascular compartment. But the patient does not get edema which is also a fact. Now due to the transfer of intravascular fluid into the extra vscular compartment we see some typical changes in the lab tests of the patient.
First of all surely the platelets of the patient decrease and the decrease may be more and quicker than what we see in dengue classical fever with thrombocytopenia. The fever may show biphasic pattern as well which is seen in some cases but its not always seen. From 4^th day onwards the hematocrit of the patient starts to increase. Due to capillary leakage and oozing of fluid into extravscular compartment RBCs gets concentrated in the intra vascular compartment and so we see a rise in hematocrit. The diagnostic value is more than 20 percent rise in the reference value of HCT of the same patient. That’s where the CBC of the patient we did in first three days of disease gets beneficial. Further more plasma albumin accompanies the fluid and goes into extra vascular compartment showing a decrease in plasma albumin (less than 3.5d/dl). Moreover the serum cholesterol of the patient may decrease (less than 100) but it may not be a good index as its very variable unless and until we have a recent cholesterol report of the patient in near past. All these derangements would start on 4^th day and would remain for 48 hours after which the capillary leak would stop and all values would start to come back to normal. This period of 48 hours is very dangerous period as we have to manage patient accordingly during this time.
Clinically after three days the features of dengue hemorrhagic fever may be:
Restlessness
Mucosal bleed
Positive hess test or tourniquet test
Platelets less than 100000
HCT increase by 20 percent
Albumin less than 3.5
Cholesterol less than 100
Pain RHC
Ultrasound showing ascites
Xray chest showing pleural effusion

As discussed in General Classification Of Dengue ;
Patient of dengue hemorrhagic fever can present to us in 2 forms :
i) DENGUE HEMORRHAGIC FEVER WITHOUT SHOCK
In dengue haemorrhagic fever without shock we would have all the features described above but the patient would not be in shock and so the pulse pressure of the patient would be normal. Pulse pressure is the difference between systolic and diastolic blood pressure. Keep in mind that 140/130 has low pulse pressure but 90/50 has normal pulse pressure.
ii) DENGUE SHOCK SYNDROME
In dengue shock syndrome we would have all the features of dengue hemorrhagic fever as well as the patient would be in shock and the pulse pressure of the patient would be narrow. Patient may be drowsy, unconscious, having fits etc like presentation.
Its worth stressing again here that a mismanaged case of dengue classic fever does not get converted into dengue hemorrhagic fever and that both diseases start separately from the very beginning though both have same presentation during first 3 days (common period) and can be differentiated usually only after 4^th day.

Presentation OF DENGUE FEVER :

2011-10-08T10:09:00.001-07:00

Presentation OF DENGUE FEVER :

Dengue fever has a duration of around 10 days(in most of the cases) . For ease of understanding we will divide these 10 days into three spans:

1 to 3 days… Common duration

4 to 6 days… Dangerous duration needs appropriate diagnosis

7 to 10 days… Resolution phase

COMMON DURATION (1^ST DAY TO 3^RD DAY):

By common duration we mean the first 3 days of dengue fever infection. I termed it as the common duration as it’s the time period during which you are not sure what you are dealing with and all the types of dengue fever may it be classic or hemorrhagic have same symptoms during this period and you can never diagnose the type of dengue. If we see a typical case scenario in which patient gets bitten from aedes egypti mosquito which had already bitten a dengue patient 2 days before. After 2 days of mosquito bite the patient may develop symptoms like

** High grade fever around 104 C

** Nausea

** Vomiting

** Head aches

** Muscle and back aches

** Retro orbital pains

** Sever weakness

The symptoms and presentations of patients vary a lot. You may get a patient who may present just with severe weakness without any fever or vomiting or aches and you will further see that he has dengue fever. So the symptoms vary and so the involvement of labs is very important to diagnose the dengue fever. All what we discussed is happening to the patient in first three days and all the patients of dengue either classic or hemorrhagic would present with same symptoms during first 3 days and you cannot tell the difference. Even the lab tests cannot tell us the difference and diagnosis but still its advisable for the patient to get his serial CBC done during these 3 days so that we may get reference values for comparison with deranged ones coming later in the disease.

DANGEROUS DURATION WITH APPROPRIATE DIAGNOSIS (4^TH TO 6^TH DAY)

Usually the fever of the patient goes during this duration. So its very important to advise the patient that as long as you have fever you are in the safe duration but as soon as your fever would subside must report to a doctor as that’s the time when we have to decide whether patient has dengue hemorrhagic fever or dengue classical fever. During this duration we can make accurate diagnosis of the type of dengue fever. For that purpose we will make use of some signs and some lab test which are as follows

Sings indicating that patient might be going in dengue hemorrhagic fever

1. Persistent vomiting

2. Right hypochondrium pain due to associated hepatitis

3. Decreased pulse pressure

If you see these three sings in any patient on his 4^th day onwards of disease suspect dengue hemorrhagic fever in him and get lab tests done and manage accordingly

Tests during dangerous duration for diagnosis

§ CBC

§ Serum albumin

§ Serum cholesterol

§ Regular BP checkup

§ Live function tests

Now how will we diagnose the patient by help of these tests? Lets see. Its really easy. I would suggest that you go back to start of article and see the classification again. Now I would discuss all the classification in a way that you would know the way to diagnose the patient

MISCONCEPTIONS About Dengue Hemorrhagic Fever:

2011-10-08T09:53:00.001-07:00

MISCONCEPTIONS About Dengue Hemorrhagic Fever:

1. “People think that a mismanaged case of dengue fever gets converted into dengue hemorrhagic fever. That’s totally wrong. Dengue fever classic and dengue hemorrhagic fever both are different diseases. Though they both present in the same way in the start but the hemorrhagic fever is hemorrhagic from the very first day while the dengue fever classic or whatever starts from very first day. These types are not inter convertible. “

2. “A second misconception is that dengue haemorrhagic fever is different from dengue fever classic on the basis of bleeding (hemorrhage). Its wrong too. A case of dengue fever classic can have bleeding while a person can have dengue hemorrhagic fever without having any bleeding. We will further discuss that how we would know that person has classic or hemorrhagic fever. So it is very important that we clear these misconceptions from our minds.”

IMMUNITY AGAINST DENGUE VIRUS:

2011-10-08T09:51:00.001-07:00

IMMUNITY AGAINST DENGUE VIRUS:

As we know that there are four serotypes of dengue virus its very interesting to know that when a mosquito gives you dengue fever infection of any one serotype you get a life long immunity against that serotype. For example if an aedes egypti with dengue virus 1 bites you and you get dengue fever and then you get fine after 10 days, then life long if any aedes would bite you with dengue virus 1 you wouldn’t get dengue fever because you already would have enough anti bodies to avoid any infection. But when you get dengue infection with one serotype you get immunity from other serotypes for just 6 months. For example in same above case after 10 days when person would get fine, for next six months he cant have dengue fever because he has acquired immunity against all serotypes viruses but after 6 months he can have dengue fever from serotype 2,3 and 4 but not from 1 for which he has got life time immunity now.

One more thing to discuss here is that dengue virus is the only virus which has got ANTIBODY MEDIATED REPLICATION. It means that if you have antibodies against any of the serotypes of the dengue virus in your blood and you get infection with some other serotype then the viral multiplication in the blood would be very fast as the antibodies already present in the blood would help it. That is the reason that the secondary infection of dengue is more dangerous as compared to primary (first time) and is more involved in dengue hemorrhagic fever with shock.

CLASSIFICATION OF DENGUE FEVER

2011-10-08T09:47:00.001-07:00

CLASSIFICATION OF DENGUE FEVER

** ASYMPTOMATIC

**SYMPTOMATIC

Symptomatic dengue fever can be

1. Undifferentiated fever

2. Classical dengue fever

3. Dengue haemorrhagic fever

Classical dengue fever can further be:

i) Classical dengue fever without thrombocytopenia

ii) Classical dengue fever with thrombocytopenia either with unusual bleeds or without unusual bleeds.

Dengue hemorrhagic fever can further be:

i) Dengue hemorrhagic fever without shock

ii) Dengue shock syndrome (DSS)

DENGUE VIRUS & Its SPREAD BY MOSQUITOES:

2011-10-08T09:44:00.001-07:00

DENGUE VIRUS & Its SPREAD BY MOSQUITOES:

Dengue fever is a viral infection caused by dengue virus which has four serotypes said to be serotype 1, 2, 3 and 4. In Pakistan the most common serotypes involved are 2 and 3.

The vector of dengue fever is aedes aegypti mosquito but in Pakistan it has been seen that in 50 percent of the cases aedes albopticus mosquito is also involved. Only the female mosquitoes of these before mentioned types are responsible for spread of dengue virus as they lay eggs and need proteins for that purpose and they get that protein from the blood of human beings. Male mosquitoes don’t bite and so are not involved in the spread.

These mosquitoes have a life cycle of total of 2 weeks out of which first week is for the maturation of mosquito and the second week is for reproductive cycle in which these female mosquitoes lay eggs. Every mosquito can lay around 600 eggs in its life , 300 being at a time. These eggs can stay at any place for about 9 months till the weather becomes favorable upon which eggs hatch. Breeding places of these mosquitoes are mostly damp places and clean water outdoor. Parks, pools, lakes, green places which are watered every day being at the top of the list. But the mosquito itself likes to live indoor and usually is seen under the sofa or beds etc and so it mostly bits on ankles and feet. A research has shown that its sting has some local anesthetic effect due to which when the mosquito bites person usually does not feel any pain. The mosquito has white stripes on its body and is very fast and quick. So its like a commando equipped with best ammo ever and with all the abilities of hiding and being very quick. So it’s a bit difficult to smash it if you try to. When the mosquito bites a person with dengue virus in its blood the virus gets transferred to the mosquito. It multiplies in the mosquito and it takes around 2 days to reach tissues of the mosquito and ultimately its salivary glands so that the mosquito might be able to transfer it further to others. So it means that if any aedes aegypti bites a dengue patient and bites you immediately you may not get dengue fever. Furthermore when these mosquitoes with viruses bite human, symptoms develop after around 2 days. So if you develop symptoms of dengue then it does not mean that a mosquito just bit you. Keep it clear that these are due to some mosquito which bit you about 2 days ago. And as its painless sting so you can never be sure when that happened.

PURPOSE OF WRITING THE ARTICLE On DENGUE FEVER:

2011-10-08T09:37:00.001-07:00

A GLIMPSE ON DENGUE FEVER

WRITTEN BY: DR. MUHAMMAD ARSLAN BAIG

PURPOSE OF WRITING THE ARTICLE On DENGUE FEVER:

Due to a gross epidemic of dengue fever in Pakistan I found it helpful to write an article on it so that I may be able to spread some public awareness and may help common people as well as clinicians to know about it and treat it accordingly. People have a misconception that dengue fever wasn’t existent before and has come in the recent years but if u see at the history you will come to know that countries like Thailand and Sri lanka have been fighting against it for more than 2 decades and its still existing there.