DENGUE VIRUS/ MANAGEMENT

Dengue viral fever is not a difficult disease to manage , it needs proper understanding to treat dengue. We see cases in double figures every day in hospital and hardly people die.
For common people it is important to recognize the symptoms of Dengue. It starts with.

Features:-
High grade fever, on day three to four of mosquito bite, develop fever, so on the frist day of symptoms, fever will be high grade, associated with
Headache
Intra ocular pain
Loss of apetire( no feeling to eat)
Generalized body pains
Joint pains
Fever takes three to four days to settle, once fever has settled, then one feels weak and fatigued.
Dengue fever on day 4 and on wards one can notice small, pin head size dots at arms and forearms, and ankles, called petechiael haemorrhage, if platelets are low patients may have gum bleeding and blood in stools. (Must be admitted if gum bleeding is found)
Hess test: to check for petechiael bleeding: Apply torniquet at arm, lower third, just above arm bend at elbow (cubital fossa) tightly for about 5 to 7 minutes and if you notice dot like spots, red in color, called petechiae, means patient has tendency of low blood platelets.
Generally Hess test is rough test, and not encouraged to do.

Investigations:-
This is the time that person must do a blood test [Full Blood Count, (FBC).
Blood Detailed Report, (Blodd DR)],if full blood count done earlier may not show indirect signs of dengue.
Important to note is platelet count, if it is less then 200, 000, it is indicative of viral fever. If the range is less then 150, 000, it is more likely dengue, if it is less then 100, 000, it is almost certain with other symptoms and lab investigations to be dengue, if it is less then 50, 000, it is very much dengue.
Total white cell count (TWC), if this is also low like less then 4 or 3 then it means that either dengue or viral fever is implicated.
Haematocrit count (Hct/ PCV), if it is high, this indicates loss of body water, and increased blood viscosity. Which further confirms dengue viral fever.
Haemoglobin (Hb) this is also an indication of viscosity caused by decrased body fluids.
Dengue Serology, to test, IgG, and IgM to confirm dengue virus.

Management:-
One should monitor dengue patients at home.
Patients must take compelte bed rest, no masks are required, and dengue virus is not spread with contact or even touching the secretions.
Patients on day three to four must be investigated with blood test, to see platelets, Hct/ PCV, Hb and TWC.
If platelet count is between 150, 000 to 50,000, patient is advised to do platelet cound and Hct/ PCV every day, and he can stay at home. to self monitor. if platelet count is less then 50, 000, patients are admitted to medical ward and treated symptomatically and given, intravascular fluids like N/Saline and D/ Salin alternate, 1.5 to 2 liters in 24 hrs. Patients are encouraged to take ample fluids/ ORS orally.
If gum bleeding or blood in stools are present then patient certainly needs platelet concentrates, 3 to 4 units at one time daily till platelets start going back to normal.
Patients are advised to take full rest, not walk or work.
Only Paracetamol is required for fever, or if vomiting is there then metoclopromide (Maxolon) is given orally or by intra venous route.
NO antibiotics required.
One can use diclofenac sodium, by anal route, as suppositories, for sever aches/ pain and fever more then 39 C. It is very effective to give diclofenac suppositories, as patients often develop acute gastritis if given NSAIDs orally.

Once platelets start going back to normal, checking of daily blood is not required. Patients who had dengue before can only suffer from hemorrhagic fever.
So do not worry. Just concentrate on drinking water, good rest and if required take Two Tablets of Panadol (Paracetamol 1000mg), every six hours. Please mail me if you need any assistance. mubbashir9@gmail.com