Demystifying Dengue

Dengue is a viral disease transmitted by bite of a mosquito – in the day time (Malaria is transmitted by night time bite of another mosquito).
Dengue presents with high fever and severe body ache; especially pain behind the eye balls, nausea & vomiting and may be a rash. These symptoms are similar to any other viral / bacterial infection.

Diagnosis of Dengue is by a blood test and obtaining one of the below as positive: o NS1 antigen
IgM antibody
PCR Dengue (if NS1 and IgM are negative and there is strong clinical suspicion with thrombocytopenia (low platelets), PCR is resorted to.
IgG antibody indicates old infection.

Dengue is a self-limiting condition.
Mainstay of treatment is hydration and proper nutrition
Most cases recover with domiciliary management
A small percentage cases may progress to
Dengue Haemorrhagic Fever (DHF-episodes of bleeding from nose, intestinal tract or in urine)
Dengue Shock Syndrome (DSS-critical fall in blood pressure with patient requiring medicines to elevate blood pressure to normal)
Both of the above may need prolonged ICU management and could be fatal

Management of Dengue does not need antibiotics (unless there is evidence of secondary infection).
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are also better to be avoided in Dengue
Platelet transfusion may be indicated at platelet count below 20,000/cmm or with evidence of mucosal bleeding
Near 90%-95% patients do not need hospitalization

Clinical fluid accumulation (pleural effusion/ ascites).
Mucosal bleed.
Extreme lethargy or restlessness.
Liver enlargement > 2 cm.
Laboratory finding of increasing Haematocrit concurrent with rapid decrease in platelet count.

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