Dengue — A Mosquito Bite Can Be Deadly

Burning fever that comes on suddenly, a pounding headache with intense stabbing pain behind the eyeballs, aching joints and muscles, nausea, fatigue, mysteriously itchy rash all over body, lacerations from scratching and a dipping platelet count… 

Dengue fever  – a mosquito born tropical viral disease is often difficult to detect at the outset. The unusually severe pain in muscles, joints and bones at times can make people assume distorted body positions or exaggerated walking movements in an effort to reduce their pain, giving it other names like “break-bone fever” or “dandy fever”. Dengue is also called dangei or dengi.

It’s an infectious disease that was originally prevalent/endemic in tropical and subtropical regions in the rainy season and post rains. But the global incidence of dengue has grown dramatically in recent decades as cases have been imported via tourists returning from these areas making it endemic in over 100 countries.

WHO estimates that 50 million new cases occur worldwide every year. About half of the world’s population are now at risk.

Dengue virus requires both – Humans and Mosquitoes to complete its life cycle

Dengue-virus-lifecycle

Dengue or H1N1 virus has 4 closely related types – DENV-1, DENV-2, DENV-3 or DENV-4. The viruses are transmitted from Aedes aegypti and Aedes albopictus mosquitoes to humans in a viral life cycle that requires both humans and these mosquitoes.

Once a mosquito is infected, it remains infected for its life span. A human can infect mosquitoes when it has high number of viruses in the blood i.e right before the symptoms develop.


There is no human-to-human dengue fever transmission.


The mosquito Aedes aegypti can be easily distinguished –

aedes-aegypti

a) They are large in size.
b) They have black and white stripes on their bodies and thus are also called tiger mosquito.
c) They usually bite during the day time and not at night.
d) They breed in artificial accumulation of fresh water such as in broken bottles, tins, flowerpots, tree holes, coolers, uncovered water tanks and at construction sites.

Incubation period is generally 3-13 days, that is, one develops fever 3-10 days after the bite. Travelers returning from endemic areas are unlikely to have dengue if fever appears more than 14 days after arriving home.

rash-dengue

Symptoms of a classical dengue include sudden onset of high fever with chills, headache especially behind eyes, severe pain in muscles and joints and a typical skin rash similar to measles. Other symptoms can be vomiting, acute pain abdomen, constipation, weakness, puffy face, red eyes, bleeding gums or nose, red palms and soles etc.

In a few cases, the disease many develop into life threatening Dengue Hemorrhagic Fever (DHF) – a specific syndrome that tends to affect children under 10 years of age. During this phase, there may be significant fluid accumulation in chest and abdomen due to increased capillary permeability and leakage and decreased blood supply to vital organs. This leads to organ dysfunction and severe bleeding especially from gastrointestinal tract and lowered platelet counts.

In less than 5% cases, blood pressure falls very low leading to Dengue Hemorrhagic shock (circulatory collapse). One is at an increased risk if infected previously.

Recovery phase involves resorption of leaked fluid into the bloodstream (2-3 days). One may experience severe itching and slow heart rate. During this stage, a fluid overload may affect brain causing reduced level of consciousness or seizures.

How is it diagnosed?

Diagnosis is generally serological and shows –

  1. Presence of Dengue IgM antibodies in acute infection (usually appears on the 4th day of fever).
  2. Presence of Dengue IgG antibodies in chronic infection.
  3. Platelet counts are reduced.
  4. Lowered level of WBC’s.

For diagnosis Dengue Triad is also important i.e. presence of fever, rash and headache/other pains.

What are the Dos and Don’ts

  • It is important to maintain hydration so drink plenty of fluids and take plenty of water.
  • Avoid the use of medicines like aspirin, brufen, combiflam (non steroidal anti inflammatory drugs) available over the counter to control fever as they increase the risk of hemorrhage. Use the safer options like paracetamol and crocin especially in children as they can be at a risk of developing febrile convulsion due to high fever. Homoeopathic antipyretics come with an added advantage of causing no haemorrhage.
  • Get your platelet counts done periodically if you have fever especially if you notice any bleeding from nose, gums, under skin or black stools. You may need a blood, plasma or platelet transfusion.
  • Infected humans are the main carriers and multipliers of the virus. They serve as a source for uninfected mosquitoes. The virus circulates in the blood of infected humans for 2-7 days at approximately the same time that they have fever. Aedes mosquito may acquire the virus when they feed on an individual during this period and thus spread the infection. So mosquito nets and repellents should be used to prevent further mosquito bites.
  • Patient should always be under medical supervision.

Prevention – What all you need to know

Dengue fever and Dengue Haemorrhagic fever are the most common mosquito borne viral disease in the world. Infection with one type usually gives lifelong immunity to that type but only short term immunity to other serotypes.  Subsequent infection with different types increases the risk of severe complications. But it’s a totally preventable disease.

  • Aedes-mosquito-thriving-in-fresh-waterOnly the female mosquito feeds on blood. This is because they need the protein found in blood to produce eggs. Male mosquitoes feed only on plant nectar.
  • The female Aedes searches for suitable places to lay their eggs (artificially accumulated fresh water).
  • Aedes are day-biters, most active during dusk and dawn.

What you can do to help 

  • guidelines-on-the-prevention-of-dengue-feverStay in air-conditioned or well-screened housings.
  • Reschedule outdoor activities and avoid being there at dusk and dawn when more mosquitoes are out.
  • Remove all  sources of stagnant water. Deny the Aedes mosquito of any chance to breed.
  • Wear shoes, socks, long sleeved shirts when you go into a mosquito infested area.
  • Use mosquito repellents, coils and nets.

Treatment

Since it is caused by a virus, in allopathy no specific medicines or antibiotics are given. Treatment is entirely symptomatic to relieve discomfort.
Oral and intravenous rehydration is required for mild-moderate cases.
Blood transfusion, fresh frozen plasma or sometimes platelet transfusion may be required in more severe cases where platelet counts have dropped down or the patient has gone into shock.

Dengue and Homoeopathy

Homeopathy offers about 20-25 potent medicines to cure Dengue depending upon the stage and symptoms. To control the acute stage of this viral fever where conventional medicines have nothing much to offer, Homoeopathy is known to take quick and effective care without any side effects. It can cut short the duration of illness (like in all viral fevers), making the patient afebrile in a span of 3-4 days! On top of that there is no danger of medicine induced haemorrhage. In fact there are a number of medicines that can control the hemorrhage and raise the platelet counts too; which is the prime concern in the management of this disease. There have been times in my clinical practice where a periodical platelet count estimation and constant supervision helped the patient respond well even without hospitalization and/or a blood/plasma transfusion.

While medicines like Arsenic, Belladonna, Bryonia, Eupatorium perf, Gelsemium, Ipecac, Rhus Tox to name a few, can cut short the febrile stage, Crotalus Horridus, Ferrum met, Hamamelis, Secale Cor are few of the many that help control bleeding and raise the platelet counts thus working wonders if given on Homeopathic principles.

 

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