Dengue fever is caused by 1 of 4 antigenically distinct single-stranded RNA virus - dengue flaviviruses (DEN-1 to DEN-4). Dengue is transmitted by the bite of an infected Aedes aegypti mosquito. The Aedes aegypti mosquito transmits the virus while ingesting a blood meal. An aegypti is a small, highly domesticated, black-and-white tropical insect which typically lays its eggs in artificial containers that contain water. That’s why dengue is frequently an urban-acquired disease. This virus and its vector have a worldwide distribution in the tropical regions of the world. The clinical presentation of dengue infection involves a wide spectrum of findings, from asymptomatic or mild self-limiting infection of dengue fever to potentially fatal hemorrhage and shock (dengue hemorrhagic fever [DHF], dengue shock syndrome [DSS]).
An estimated 2.5-3 billion people worldwide are at risk for dengue infection. Yearly, approximately 50-100 million people are infected with dengue, and 250,000 individuals develop dengue hemorrhagic fever.
An estimated 2.5-3 billion people worldwide are at risk for dengue infection. Yearly, approximately 50-100 million people are infected with dengue, and 250,000 individuals develop dengue hemorrhagic fever.
Transmission:
After virus incubation for 8 to 10 days, an infected mosquito is capable of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring via the eggs.
Infected humans are the main carriers and multipliers of the virus. They act as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for 2 to 7 days, at approximately the same time that they have a fever. Aedes mosquitoes may acquire the virus when they feed on an individual during this period.
Dengue affects people of all ages. In Southeast Asia, dengue hemorrhagic fever usually affects children younger than 15 years. However, in the Americas, dengue hemorrhagic fever shows no age predilection.
After virus incubation for 8 to 10 days, an infected mosquito is capable of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring via the eggs.
Infected humans are the main carriers and multipliers of the virus. They act as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for 2 to 7 days, at approximately the same time that they have a fever. Aedes mosquitoes may acquire the virus when they feed on an individual during this period.
Dengue affects people of all ages. In Southeast Asia, dengue hemorrhagic fever usually affects children younger than 15 years. However, in the Americas, dengue hemorrhagic fever shows no age predilection.
Symptoms of Dengue Fever:
1. Once inoculated into a human, dengue has an incubation period of 3-14 days (average 4-7 d), during which the virus replication takes place in target dendritic cells.
2. Dengue may be asymptomatic in 50%-90% cases and only result in a nonspecific febrile illness.
3. In others there is an acute febrile illness with fever typically begins on the 3rd day and lasts 5-7 days, abating with the cessation of viremia. Fever may be as high as 41°C. Fever is often preceded by chills, erythematous mottling of the skin, and facial flushing. Occasionally, and more commonly in children, the fever abates for a day and then returns, a pattern that has been called saddleback fever.
4. Patients are at risk for development of dengue hemorrhagic fever or dengue shock syndrome at approximately the time of defervescence.
5. In travelers, the chance of dengue is rare if the symptoms begin more than 2 weeks after they depart from an endemic area and if the fever is lasting more than 10 days.
6. Headache is usually generalized.
7. Severe Retroorbital (behind eye ball) pain is common.
8. Patients may have nausea and vomiting.
9. Rash: There may be a maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands of skin sparing which typically begins on day 3 and persists 2-3 days.
10. There may be severe myalgias (muscular pain), particularly of the lower back, arms, and legs, and arthralgias (joint pain), especially of the knees and shoulders.
11. Hemorrhage: There may be bleeding from the nose or gums, melena (blood in stool), hematuria (blood in urine), menorrhagia (profuse menstrual bleeding), or hematemesis (blood in vomiting).
12. Abdominal pain: There may be abdominal pain especially upper abdominal.
13. Other symptoms which may be present are:
a. Weakness
b. Restlessness,
c. Change in mental status,
d. Altered taste sensation
e. Anorexia (loss of appetite)
f. Hypothermia (temperature below 36.6 degree C),
g. Fatigue and malaise.
h. Conjunctival injection, sore throat, and cough.
1. Once inoculated into a human, dengue has an incubation period of 3-14 days (average 4-7 d), during which the virus replication takes place in target dendritic cells.
2. Dengue may be asymptomatic in 50%-90% cases and only result in a nonspecific febrile illness.
3. In others there is an acute febrile illness with fever typically begins on the 3rd day and lasts 5-7 days, abating with the cessation of viremia. Fever may be as high as 41°C. Fever is often preceded by chills, erythematous mottling of the skin, and facial flushing. Occasionally, and more commonly in children, the fever abates for a day and then returns, a pattern that has been called saddleback fever.
4. Patients are at risk for development of dengue hemorrhagic fever or dengue shock syndrome at approximately the time of defervescence.
5. In travelers, the chance of dengue is rare if the symptoms begin more than 2 weeks after they depart from an endemic area and if the fever is lasting more than 10 days.
6. Headache is usually generalized.
7. Severe Retroorbital (behind eye ball) pain is common.
8. Patients may have nausea and vomiting.
9. Rash: There may be a maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands of skin sparing which typically begins on day 3 and persists 2-3 days.
10. There may be severe myalgias (muscular pain), particularly of the lower back, arms, and legs, and arthralgias (joint pain), especially of the knees and shoulders.
11. Hemorrhage: There may be bleeding from the nose or gums, melena (blood in stool), hematuria (blood in urine), menorrhagia (profuse menstrual bleeding), or hematemesis (blood in vomiting).
12. Abdominal pain: There may be abdominal pain especially upper abdominal.
13. Other symptoms which may be present are:
a. Weakness
b. Restlessness,
c. Change in mental status,
d. Altered taste sensation
e. Anorexia (loss of appetite)
f. Hypothermia (temperature below 36.6 degree C),
g. Fatigue and malaise.
h. Conjunctival injection, sore throat, and cough.
Dengue hemorrhagic fever (DHF): Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. DHF can be life-threatening and can progress to the most severe form of the illness, Dengue shock syndrome. The World Health Organization (WHO) has 4 minimal criteria for diagnosis of dengue hemorrhagic fever:
1. Fever
2. Hemorrhagic manifestations
3. Circulatory failure, such as signs of vascular permeability
4. Hepatomegaly
1. Fever
2. Hemorrhagic manifestations
3. Circulatory failure, such as signs of vascular permeability
4. Hepatomegaly
Dengue shock syndrome (DSS): Untreated, dengue hemorrhagic fever mostly likely progresses to dengue shock syndrome. Common symptoms include abdominal pain, vomiting, and restlessness. Patients also may have symptoms related to circulatory failure. Findings include the following:
i) Hypotension
ii) Bradycardia (paradoxical) or tachycardia associated with hypovolemic shock
iii) Hepatomegaly
iv) Hypothermia
v) Narrow pulse pressure (<20>
i) Hypotension
ii) Bradycardia (paradoxical) or tachycardia associated with hypovolemic shock
iii) Hepatomegaly
iv) Hypothermia
v) Narrow pulse pressure (<20>
Physical Findings of Dengue Fever:
1. Rash: Up to 50% of patients may develop a characteristic maculopapular or macular rash.
2. Conjunctival injection develops in approximately 30% of patients with dengue hemorrhagic fever. Optic neuropathy has also been reported.
3. Pharyngeal injection develops in almost 97% of patients with dengue hemorrhagic fever.
4. There may be generalized lymphadenopathy.
5. Hepatomegaly is present more often in dengue shock syndrome than in milder cases.
6. Hemorrhagic manifestations in the form of Petechiae and bleeding at venipuncture sites are most common. Tourniquet test are often positive. It is performed by inflating a blood pressure cuff on the upper arm to midway between diastolic and systolic blood pressures for 5 minutes. The results are considered positive if more than 20 petechiae per square inch.
1. Rash: Up to 50% of patients may develop a characteristic maculopapular or macular rash.
2. Conjunctival injection develops in approximately 30% of patients with dengue hemorrhagic fever. Optic neuropathy has also been reported.
3. Pharyngeal injection develops in almost 97% of patients with dengue hemorrhagic fever.
4. There may be generalized lymphadenopathy.
5. Hepatomegaly is present more often in dengue shock syndrome than in milder cases.
6. Hemorrhagic manifestations in the form of Petechiae and bleeding at venipuncture sites are most common. Tourniquet test are often positive. It is performed by inflating a blood pressure cuff on the upper arm to midway between diastolic and systolic blood pressures for 5 minutes. The results are considered positive if more than 20 petechiae per square inch.
Laboratory Studies of Dengue Fever:
A. Complete blood cell count (CBC):
i) Leukopenia especially lymphopenia,
ii) A hematocrit level rise of greater than 20% is a sign of hemoconcentration and precedes shock. The hematocrit level should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever and every 3-4 hours in severe cases of dengue hemorrhagic fever or dengue shock syndrome.
iii) Thrombocytopenia has been demonstrated in up to 50% of dengue fever cases. The platelet count should be monitored at least every 24 hours for early recognition of dengue hemorrhagic fever.
B. Electrolytes:
i) Hyponatremia is the most common electrolyte.
ii) Elevated BUN levels and Metabolic acidosis is seen in shock.
C. Liver Function Test (LFT):
i) Transaminase levels may be mildly.
ii) Low albumin levels are a sign of hemoconcentration.
D. Coagulation Profile: (in severe hemorrhagic manifestations)
i) Prothrombin time (PT) is prolonged.
ii) Activated partial thromboplastin time is prolonged.
iii) Low fibrinogen and elevated fibrin degradation product levels are signs of disseminated intravascular coagulation.
E. Sero-diagnosis & PCR:
i)Serodiagnosis is made by antigen based test (rapid or Elisa) which becomes positive on first day of fever or IgM capture enzyme-linked immunosorbent assay (five days) of feverMAC-ELISA.
iii) For a rapid reliable diagnosis, clinically available PCR studies should be done.
F. Cultures of blood, urine, CSF, and other body fluids should be performed as necessary to exclude or confirm other potential causes of the patient's condition.
Imaging Studies:
G. Chest radiography: Right-sided pleural effusion is typical. Bilateral pleural effusions are common in dengue shock syndrome.
H. Ultrasonographic findings include fluid in the chest and abdominal cavities, pericardial effusion, and a thickened gallbladder wall. Thickening of the gallbladder wall may presage clinically significant vascular permeability.
A. Complete blood cell count (CBC):
i) Leukopenia especially lymphopenia,
ii) A hematocrit level rise of greater than 20% is a sign of hemoconcentration and precedes shock. The hematocrit level should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever and every 3-4 hours in severe cases of dengue hemorrhagic fever or dengue shock syndrome.
iii) Thrombocytopenia has been demonstrated in up to 50% of dengue fever cases. The platelet count should be monitored at least every 24 hours for early recognition of dengue hemorrhagic fever.
B. Electrolytes:
i) Hyponatremia is the most common electrolyte.
ii) Elevated BUN levels and Metabolic acidosis is seen in shock.
C. Liver Function Test (LFT):
i) Transaminase levels may be mildly.
ii) Low albumin levels are a sign of hemoconcentration.
D. Coagulation Profile: (in severe hemorrhagic manifestations)
i) Prothrombin time (PT) is prolonged.
ii) Activated partial thromboplastin time is prolonged.
iii) Low fibrinogen and elevated fibrin degradation product levels are signs of disseminated intravascular coagulation.
E. Sero-diagnosis & PCR:
i)Serodiagnosis is made by antigen based test (rapid or Elisa) which becomes positive on first day of fever or IgM capture enzyme-linked immunosorbent assay (five days) of feverMAC-ELISA.
iii) For a rapid reliable diagnosis, clinically available PCR studies should be done.
F. Cultures of blood, urine, CSF, and other body fluids should be performed as necessary to exclude or confirm other potential causes of the patient's condition.
Imaging Studies:
G. Chest radiography: Right-sided pleural effusion is typical. Bilateral pleural effusions are common in dengue shock syndrome.
H. Ultrasonographic findings include fluid in the chest and abdominal cavities, pericardial effusion, and a thickened gallbladder wall. Thickening of the gallbladder wall may presage clinically significant vascular permeability.
Treatment of Dengue Fever:
1. Dengue fever is usually a self-limited illness. No specific antiviral medication currently is available.
2. Bed rest is recommended.
3. Acetaminophen (Paracetamol) is recommended for treatment of pain and fever. Dose is 500- 1000 mg three to four times daily; not to exceed 4 g/d.
4. Aspirin, other salicylates, and NSAIDs should be avoided.
5. Patients with known or suspected dengue fever should have their platelet count and hematocrit measured daily from the 3rd of illness until 1-2 days after defervescence.
6. Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage.
a. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated.
b. If this fails to correct the deficit, the hematocrit value should be determined; a rising value suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used.
c. If the patient does not improve after this, blood loss should be considered. Patients with coagulopathy may require fresh frozen plasma.
7. After patients with dehydration are stabilized, they usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.
8. Platelet and fresh frozen plasma transfusions may be required to control severe bleeding.
9. Patients who are resuscitated from shock rapidly recover. Patient with dengue hemorrhagic fever or dengue shock syndrome may be discharged when he/she is:
a. afebrile for 24 hours without antipyretics
b. having good appetite,
c. having adequate urine output
d. having stable hematocrit level
e. more than 48 hours lapsed since he recovered from shock
f. not having any respiratory distress
g. having Platelet count greater than 50,000 cells/μL
Complications of Dengue Fever:
a. Neurologic manifestations such as seizures and encephalitis/encephalopathy have been reported in rare cases of dengue infection. Other neurological complications associated with dengue infection include neuropathies, Guillain-Barré syndrome, and transverse myelitis.
b. Liver failure has been associated with dengue hemorrhagic fever/dengue shock syndrome epidemics.
c. Overhydration is a well-recognized complication of dengue fever and dengue hemorrhagic fever/dengue shock syndrome.
Mortality/Morbidity:
Dengue fever is typically a self-limiting disease with a mortality rate of less than 1%. When treated, dengue hemorrhagic fever has a mortality rate of 5%. Untreated, dengue hemorrhagic fever has a mortality rate as high as 50%.
Deterrence/Prevention:
1. There is no vaccine to protect against dengue. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity, but each individual can eventually be infected by all 4 serotypes. Several serotypes can be in circulation during an epidemic.
2. The only way to prevent dengue virus acquisition is to avoid being bitten by a vector mosquito. This can be accomplished in several ways, as follows:
a. If possible, avoid travel to areas where dengue is endemic
b. Use N, N-diethyl-3-methylbenzamide (DEET) mosquito repellant.
c. Use permethrin-containing mosquito repellent to your clothing, shoes, and camping gear and bed netting. Keep in mind that chemical repellants can be toxic, and use only the amount needed for the time you'll be outdoors.
d. Wear protective clothing, preferably impregnated with permethrin insecticide.
e. Avoid unnecessary outdoor activity when mosquitoes are most prevalent, such as at dawn, dusk and early evening.
f. Remain in well-screened or air-conditioned places.
g. The use of mosquito netting is of limited benefit, as Aedes are day-biting mosquitoes.
h. Eliminate the mosquito vector using indoor sprays.
i. Eliminate the breeding ground of the mosquitoes by not allowing them access to small accumulations of stagnant water around human habitats.
1. Dengue fever is usually a self-limited illness. No specific antiviral medication currently is available.
2. Bed rest is recommended.
3. Acetaminophen (Paracetamol) is recommended for treatment of pain and fever. Dose is 500- 1000 mg three to four times daily; not to exceed 4 g/d.
4. Aspirin, other salicylates, and NSAIDs should be avoided.
5. Patients with known or suspected dengue fever should have their platelet count and hematocrit measured daily from the 3rd of illness until 1-2 days after defervescence.
6. Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage.
a. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated.
b. If this fails to correct the deficit, the hematocrit value should be determined; a rising value suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used.
c. If the patient does not improve after this, blood loss should be considered. Patients with coagulopathy may require fresh frozen plasma.
7. After patients with dehydration are stabilized, they usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.
8. Platelet and fresh frozen plasma transfusions may be required to control severe bleeding.
9. Patients who are resuscitated from shock rapidly recover. Patient with dengue hemorrhagic fever or dengue shock syndrome may be discharged when he/she is:
a. afebrile for 24 hours without antipyretics
b. having good appetite,
c. having adequate urine output
d. having stable hematocrit level
e. more than 48 hours lapsed since he recovered from shock
f. not having any respiratory distress
g. having Platelet count greater than 50,000 cells/μL
Complications of Dengue Fever:
a. Neurologic manifestations such as seizures and encephalitis/encephalopathy have been reported in rare cases of dengue infection. Other neurological complications associated with dengue infection include neuropathies, Guillain-Barré syndrome, and transverse myelitis.
b. Liver failure has been associated with dengue hemorrhagic fever/dengue shock syndrome epidemics.
c. Overhydration is a well-recognized complication of dengue fever and dengue hemorrhagic fever/dengue shock syndrome.
Mortality/Morbidity:
Dengue fever is typically a self-limiting disease with a mortality rate of less than 1%. When treated, dengue hemorrhagic fever has a mortality rate of 5%. Untreated, dengue hemorrhagic fever has a mortality rate as high as 50%.
Deterrence/Prevention:
1. There is no vaccine to protect against dengue. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity, but each individual can eventually be infected by all 4 serotypes. Several serotypes can be in circulation during an epidemic.
2. The only way to prevent dengue virus acquisition is to avoid being bitten by a vector mosquito. This can be accomplished in several ways, as follows:
a. If possible, avoid travel to areas where dengue is endemic
b. Use N, N-diethyl-3-methylbenzamide (DEET) mosquito repellant.
c. Use permethrin-containing mosquito repellent to your clothing, shoes, and camping gear and bed netting. Keep in mind that chemical repellants can be toxic, and use only the amount needed for the time you'll be outdoors.
d. Wear protective clothing, preferably impregnated with permethrin insecticide.
e. Avoid unnecessary outdoor activity when mosquitoes are most prevalent, such as at dawn, dusk and early evening.
f. Remain in well-screened or air-conditioned places.
g. The use of mosquito netting is of limited benefit, as Aedes are day-biting mosquitoes.
h. Eliminate the mosquito vector using indoor sprays.
i. Eliminate the breeding ground of the mosquitoes by not allowing them access to small accumulations of stagnant water around human habitats.
Home Remedy for Dengue Fever:
a. Adequate consumption of water as well as diluted fruit juice.
b. Consumption of boiled juice made by mixing one foot Long Branch of Giloi (Tinospora, Amta) and 7-8 leaves of Tulsi helps in strengthening the immune system and also helps in increasing platelet counts.
c. Consumption of diluted orange juice helps in indigestion and it strengthen immunity.
d. Consumption of fresh extract of papaya leaves helps to cure the disease. Cleaned, pound and squeeze two fresh papaya leaves with filter cloth to extract juice. Do not boil or cook or rinse with hot water, it will loose its strength. Take two table spoonful of this juice as a single daily dose. This is an excellent home remedy for the cure of dengue fever.
e. Frequent consumption of herbal tea made of basil, ginger, and cardamom helps to provide a fresh feeling for the patient.
f. Fried foods are to be avoided in this situation.
g. Application of neem tonic on body, made with tender neem leaves acts as repellant for mosquitoes.
h. Two cups syrup made of kakamachi herbs everyday fights the situation.
i. Dhatura (belladonna) is a potential medicine in strict recommended dose which can reduce the complications.
a. Adequate consumption of water as well as diluted fruit juice.
b. Consumption of boiled juice made by mixing one foot Long Branch of Giloi (Tinospora, Amta) and 7-8 leaves of Tulsi helps in strengthening the immune system and also helps in increasing platelet counts.
c. Consumption of diluted orange juice helps in indigestion and it strengthen immunity.
d. Consumption of fresh extract of papaya leaves helps to cure the disease. Cleaned, pound and squeeze two fresh papaya leaves with filter cloth to extract juice. Do not boil or cook or rinse with hot water, it will loose its strength. Take two table spoonful of this juice as a single daily dose. This is an excellent home remedy for the cure of dengue fever.
e. Frequent consumption of herbal tea made of basil, ginger, and cardamom helps to provide a fresh feeling for the patient.
f. Fried foods are to be avoided in this situation.
g. Application of neem tonic on body, made with tender neem leaves acts as repellant for mosquitoes.
h. Two cups syrup made of kakamachi herbs everyday fights the situation.
i. Dhatura (belladonna) is a potential medicine in strict recommended dose which can reduce the complications.
Myths and facts:
Myth: Dengue mosquitoes breed in dirty water.
Fact: Aedes aegypti mosquito breeds in clean, stagnant water like flower vases, dish drains, water containers of household.
Myth: Dengue occurs only during the rainy season.
Fact: Though more prevalent in rainy season, dengue occurs all year round. This eggs Aedes aegypti can stay dormant for up to 9 months.
Myth: Dengue can only be contracted once.
Fact: Person infected by one particular strain is still at risk of being infected by another strain of dengue virus.
Warning: The reader of this article should exercise all precautions before following any of the method mentioned in this article and the site. To avoid any problems, it is advised that you consult a doctor. The responsibility lies solely with the reader and not with the site or the writer.
Myth: Dengue mosquitoes breed in dirty water.
Fact: Aedes aegypti mosquito breeds in clean, stagnant water like flower vases, dish drains, water containers of household.
Myth: Dengue occurs only during the rainy season.
Fact: Though more prevalent in rainy season, dengue occurs all year round. This eggs Aedes aegypti can stay dormant for up to 9 months.
Myth: Dengue can only be contracted once.
Fact: Person infected by one particular strain is still at risk of being infected by another strain of dengue virus.
Warning: The reader of this article should exercise all precautions before following any of the method mentioned in this article and the site. To avoid any problems, it is advised that you consult a doctor. The responsibility lies solely with the reader and not with the site or the writer.
Hi, I had dengue fever 2 weeks back and was admitted in hospital for 6 days with IV fluids given.My platelets were down to 74,000.
ReplyDeleteAfter Iv was removed and I started walking around, I had etreme fatigue and dizziness. Days after discharge I still had dizziness n fatigue, so much so, that I could not stand/walk around for more than 5-10 min. Now it's been more than 1 week since I got discharged and I still have fatigue and dizziness. When will it go away n how can I minimise this?
Thanks so much
Deesha
Hi Deesha
ReplyDeleteWeakness in form of fatique and dizziness is common after dengue. You just continue to take rest for few more days or try do light activity. I will recommend you to take as much fluid as possible to keep good hydration, including orange juice. And strictly avoid exposure to mosquito to prevent reinfection since second attack from other strain can be serious. you can also follow some homeremedies to improve you immune system.
t.c.
Dr akshay
Hi I was diagnosed with Dengue (3) in 2002 and was chronicly ill for some time (DHF).
ReplyDeleteAfter my initial recovery, I developed long term chronic pain which has been loosely diagnosed as a post viral infection. I have yet found a Doctor who knows anything about my condition. This Chronic pain has been with me (joints, lower back and neuralgic pain) for 8 years. It is so severe I take Oramorph. Do you know of any president for this?
Hello. My mother had been hospitalized for about 5days bcoz of fever. (at first she refuse to hosp, but after 1 week of fever then she go to hosp). Yesterday she has been discharge frm hosp, but since @home she experienced very severe headache, chill, cold @finger, weakness, and nervousness. Is it that the symptoms for shock/anything relate to blood clot since she had IV fluid therapy while in hosp. or is it just normal symptoms that will experience from dengue pt? currently she s taking paracetamol. she really worried bout her severe headache (almost all the time, but after take PCM the symptm w reduce little bit, but the headache still there). What can i do to help her?
ReplyDeleteHi Damiantoal!
ReplyDeleteAs you mentioned that you was diagnosed DHF, did you test positive for dengue antigen or IgM antibodies? Joints pain of such a severity for such long duration is very uncommon in any post viral infection though severe joint pain is common in dengue and Chikungunya. The pain of dengue persists only for few months while in case of Chikungunya the pain may be upto two years. I would like to know which are the joints involved and does there any morning stiffness and whether you have gone through any investigations (blood or Radiological).
t.c.
Dr. Akshay Bahadur
Hi Stone!
ReplyDeleteAfter going through the history, I would like to know whether she is still having fever (greater than 100 or low grade) and what were the results of blood investigations? What was the diagnosis made and treatment given by the physician? Did she undergo any specific test for dengue like NS1Ag or IgM antibodies test? Have you notice similar cases in your neighborhood areas. These symptoms are generalized manifestation of many diseases including any viral fever, malaria etc. These symptoms in a person with normal blood pressure do not indicate any shock.
t.c.
Dr. Akshay Bahadur
I'm not really sure about the NS1Ag or IgM test. But her temp now was normal. The blood pressure when discharge from hosp (2days ago) was 90/60, better than previous day which was 85/55. While @hosp her platelet was reduced (if I'm not mistaken 110) and her BP also low (80/40). But today she quite okay, her headache reduced a lot than yesterday. Until now there still no cases in my neighbourhood area.
ReplyDeletePS;Maybe her BP about 90/60 used to be normal (I think so, bcoz she having hypotension all the time).
Thanks for the info Dr.
Hi Dr Akshay,
ReplyDeleteI did test positive for Dengue. Whilst joint pain persits on and off the principle pain is neuralgic, from the base of the spine outwards, with stinging palms and soles of feet. Whilst admitted there were several botched attempts to take a lumber puncture. I don't know if this has anything to do with it. I also have symptoms similar to iritis. Dry stinging, painful eyes.
Regards
Damian
Hi Damian!
ReplyDeleteFirst of all, dengue is not supposed to be associated with such type of pain. Though repeated attempts of lumbar puncture may be sometimes be associated neuralgic pain, the same can not be associated with your pain in palms. You should consult a neurologist and get investigated for MRI back, RA factor, Serum uric acid and ANA.
t.c.
Thanks Dr Akshay,
ReplyDeleteI appreciate that the current symptoms are a result of a post-viral infection following Dengue. I have never received a satisfactory diagnosis, or satisfactory pathology.
When I was admitted to hospital, despite my protests, as the symptoms presented similar to meningitis, I was treated with a broad spectrum of anti-biotics, which I feel would have compromised my immune system. It was not until a visiting specialist took an interest was I tested for Dengue.
Thank you for your advice, do you have any thoughts what these tests might reveal?
Best Wishes
Damian
Hi Damian!
ReplyDeleteI was out of station for a while, therefore I could not reply you before. Your symptoms are more suggestive of Auto-immune disorder (dry eyes, joint pain). The RA factor, Serum Uric acid, ANA and S. B12 should be investigated to find out the cause of your symptoms.
t.c.
Dear Dr Akshay,
ReplyDeleteI am 26 years old. I hospitalized bcz of dengue fever 2 weeks back. My platelet count went down till 18000. And when I check 3 days back the count was 3.6 lacks. I back to work and still I am feeling heavy tiredness and very small temperatue variations sometimes. But heavy tiredness is the main problem. Yesterday I felt like I am about to fell down so I went to hospital and checked the platelet count agian. It was 2.5 lacks now. 3 days back it was 3.5 lacks.
Today also I am feeling tiredness but better than yesterday but small temperature variation also. Could you please explain me the reason?
Thank you so much
Dear akshay sir,
ReplyDeleteI had my blood test on 6 Nov 2017, it stated dengue igm positive and Ns1 negative igg negative, My platelets decreased gradually from 2.63 lac to 1.59 lakh till now,I consulted the doc he advised me medicines and multi vitamin, non of the doctors hospitalised me as I don't have fever at all,My body temperature is 96 to 97 degree ferenheit,it's been over a month I feel immense dizziness, it's like some one holding my brain too tight all the time, please guide me regarding this. Can someone who is dengue igm positive don't have fever at all and why I am still very very tired not to do a single thing and my brain is feeling so heavy please guide me sir regarding this
Dear dr Akshay,
ReplyDeleteI was diagnosed dengue on last Oct(2017), I still ve tiredness, dizziness and heavy head. Is this normal ?