Discussing the issue, Dr Chawla, said, “As dengue cases continue to surface, panic has gripped people yet again. Dengue outbreak seems to have now become an annual phenomenon.”With dengue cases on a steady rise in the city, coordinated measures need to be undertaken to target mosquito breeding sites, besides the use of repellants and wearing appropriate clothing. Dr Parvinder Chawla, Senior Consultant, Internal Medicine, Fortis Hospital, Mohali, through an advisory, gives an insight into the causes, symptoms, and ways to prevent the disease.
Discussing the issue, Dr Chawla, said, “As dengue cases continue to surface, panic has gripped people yet again. Dengue outbreak seems to have now become an annual phenomenon.”
Explaining the cause of dengue, Dr Chawla, said, “Dengue is caused by four types of dengue viruses that spread by infected mosquitoes. Cases of dengue usually rise in the monsoon season. Patients with dengue fever exhibit symptoms such as chills, fatigue, fever, loss of appetite, nausea, vomiting, body rash, aches, and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain).
Just like Covid, dengue infection too may be sub-clinical – infected but not developing any symptoms. A typical patient with dengue goes through three phases: febrile, critical, and recovery. In the febrile phase, fever and body pain are the hallmark symptoms and fever-reducing medicines (paracetamol) and plenty of fluids are all that are required. Most patients seem to go straight into the recovery phase from the febrile phase without developing an overt critical phase. Some patients however develop symptoms that are medically called ‘warning signs’ which indicate the need for hospitalisation and close monitoring.
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The warning signs include vomiting, pain in the abdomen, severe headache, persisting pain anywhere else in the body, bleeding from any site, and inability to continue with good liquid intake. The presence of any of these warning signs means that the patient is definitely in the critical phase and needs to be monitored closely for at least 48-72 hours in a hospital setting, said Dr Chawla.
Talking about monitoring the blood platelet count in patients with dengue, Dr Chawla said that monitoring hemoglobin and hematocrit is more important than even monitoring platelet count in dengue. We should be checking these two values on the second/ third day of fever and monitor them closely, especially in a patient who continues to have symptoms.
An increase in haemoglobin and hematocrit signifies poor oral intake (and hence the need for hospitalisation), while falling haemoglobin and hematocrit along with clinical deterioration suggests internal bleeding and hence, requires hospitalisation too. A slight decrease in these two parameters along with improvement in symptoms is indicative of the patient entering the recovery phase of the disease.
Falling platelet count alone (unless it is drastically low) usually doesn’t imply the need for admission to a hospital. Even if the platelet count is low, platelets need to be transfused only if the count is below 10,000/cmm or there is evidence of active bleeding from any site. For most other patients in the critical phase of the disease, judicious guarded intravenous fluids suffice to tide over the crisis, she added.