Dengue fever

How well do you know about dengue fever?

Have you ever experienced it before?

Well, dengue fever is an infection transmitted by female Aedes mosquitoes (you can see the mosquitoes have black and white striped legs!!!) Dengue fever is an endemic in tropical and subtropical areas of the world (for instance Asian and Latin American).

This infection is caused by a single positive-stranded RNA virus of the Flaviviridae family, which consists of four distinct, closely related serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). After being bitten by the infected mosquito, the virus will replicate in the lymph nodes and spread to the blood and other tissues through the lymphatic system, causing inflammatory responses and internal bleeding.

The symptoms of dengue fever usually only appear after exposure for about 4-7 days (average incubation period is 3-14 days). Hence, dengue fever can be asymptomatic in the beginning of the infection. It can only be diagnosed few days after the infection of the virus. The condition can become mild or serious depending on how quickly the infected person get treatment.

How will you identify if you are having dengue?

What should you do?

There are some symptoms which can help you to identify dengue. Let me share with you my personal experience of dengue fever to help you understand more about it. Just about a month ago, I had an unforgettable experience with the dengue fever. Dengue fever can be detected easily because you can identify the symptoms as soon as possible if you know them well. 

Day 1

The first symptom appeared was severe headache that I have never experienced before. Besides that, I can feel muscle and joint pain that radiated to my limbs, which were the upper arms and legs. However, I just assure myself that everything is alright and I tried to rest and massage my head and limbs before sleeping. 

Day 2

Unfortunately the second day, the pain did not improve. Additionally, I was having fever so I took Panadol (paracetamol) so that I could sleep soundly that night.

Day 3

The symptoms were not improving at all instead, it was accompanied with additional symptoms, which were coughing, poor appetite and fatigue. I lay on my bed for almost 12 hours. I recalled not even being able to hold and wash a plate after having lunch. I felt worried as I jogged at a park near my house few days ago and it may be an exposure to the mosquitoes.

At night, my daddy brought me to a clinic. Doctor prescribed a sedative cough syrup and two painkillers (paracetamol and mefenamic acid) for high fever of 39.5^OC and muscle pain. However, it was a nightmare since then. On that night, I could not sleep as I had diarrhoea twice in the middle of night, accompanied with nausea.

Day 4

Early the next morning, I vomited after having my nutritious drink that I used to drink every morning. I tried to rest in bed meanwhile I was compliance to take the medication. I could eat some food despite feeling nausea. It was alright during the day, however I experienced 5 times diarrhoea and I vomited green substance during midnight.

Day 5

I went back to the clinic again the next morning and I found out that I still have a fever of 38.4^OC. My blood was drawn and sent to the laboratory for test immediately. A rapid 20 minutes test kit for dengue was conducted but the result shown was negative. Doctor asked me to go back home to wait for the laboratory result. Meanwhile, additional medication of antibiotic (amoxicillin) and antiemetic (metoclopramide) were prescribed for me. After 2 hours, I was called and informed that the laboratory result was out and my platelet was 82 x 10⁹/L, which was lower than the normal lower limit of 150 x 10⁹/L. The doctor referred me to the hospital because I was suspected to have dengue fever due to PERSISTENT high fever and low platelet count.

I was admitted to the hospital in the evening. A full history of my symptoms were collected and I was given normal saline drip. Doctors came and asked me about my current conditions thrice a day so that warning signs of dengue fever can be monitored closely. My blood was taken four times daily for monitoring purpose. I was having period, hence sign of bleeding was monitored very closely by the doctors.

Day 6

Generally still weak. During the evening, they stopped my normal saline drip when my haematocrit level returned back to the normal range.  My platelet count increased gradually. However, I still have on-off fever and diarrhoea, so paracetamol (Panadol) and oral rehydration salt were given to me. However, my fever was still persistent. Thrombophlebitis was observed on my hand for drip and when the drip was taken off, my fever subsided.

Day 7

I was discharged when the vital signs and laboratory result were improving after monitoring for the first golden 48 hours. Patients are not allowed to discharge if there is any WARNING SIGNS of dengue fever such as severe abdominal pain, persistent vomiting, fluid accumulation in the body, respiratory distress, decrease in platelet count, increase in haematocrit level, and nose or gum bleeding, as well as severe damages of organs (liver, central nervous system, heart, kidneys and others). These severe condition is known as dengue shock syndrome (DSS).

Since I was improving, doctors told me to rest at home and I was told to follow up at clinic after a week. After discharge, I still felt tired so I just sleep long hours and rest well at home. My tiredness slowly improved but my weight shockingly decreased by about 2kgs to less than 40kg that I have never seen for years. However, I was blessed that I have fast recovery when my appetite started to improve with my mummy’s great care and home-cooked food. Our mothers are the great people in the world. So do appreciate and Happy Mother’s Day to all readers!!! J

So, after reading my story, do you have some rough idea about the symptoms, diagnosis and treatment of dengue fever? Take note of the informations being highlighted in red, purple and green respectively.

Other information that you should know:

There are many over-the-counter products which are available in the pharmacy for dengue fever to speed up the healing. An example of the products is the papaya leaf extract, which can help to increase white cell and platelets, as well as normalises the clotting profile of dengue patients. There are different dosage forms of the products, for examples capsules and liquid extracts. You can buy it in the pharmacy store. Make sure to consult the pharmacist to get a safe, trustable and approved brands of products.

Besides that, if you are infected with different serotypes of dengue virus (either “Asian” genotypes DEN-2 and DEN-3) again, you will suffer more compared to the first exposures to the infected mosquitoes as higher viral burdens and stronger inflammatory effect will be produced which can lead to higher tendency to bleed!!!

Since the recurrent infection will be more severe, isn’t there is any prevention of dengue fever, for instance vaccine?

At the moment, there is no vaccine available. There is currently a dengue vaccine (CYD-TDV) under phase 3 efficacy trials which hopefully done in July 2016. The vaccine consists of a recombinant live, attenuated, tetravalent dengue vaccine that was efficacious against virologically confirmed dengue (VCD) and severe VCD which potentially lower the hospitalisation of the patients in endemic area of dengue infection.

While waiting for the approval of the dengue vaccine, you can always buy a mosquito repellent available in pharmacy store if you are going for jogging or jungle trekking at places prone to have Aedes mosquito. You can also wear long sleeves and pants to prevent mosquito bites during the day and evening. Always keep your home area clean and avoid stagnant water in the flower pots to avoid breeding places for the mosquito.

As a summary, 

The most prominent symptoms of dengue fever are sudden onset of high fever for about 5-7 days, severe headache, and vomiting. Other symptoms that are not mentioned are: rashes and retro-orbital pain (pain around the sockets of the eyes). Please seek for medical advice from doctor if you experience the similar condition I had experienced.

Doctors will evaluate these symptoms and if you are being suspected for dengue fever, the doctors will take your blood immediately to confirm dengue fever. 

If your platelet is lower than the normal lower limit reading of 150 x 10⁹/L, you will be suspected to have dengue fever. You will be referred to the hospital to get treatment immediately which includes normal saline and symptomatic treatment (for instance fever, vomiting, and others) if you still experience any of them during hospital stay.

You will be discharged when the platelet count are increasing in trend and there is no warning signs of dengue fever being detected. You can always prevent mosquito bites by using mosquito repellent and protective clothing.

Still having doubt about dengue fever? Kindly comment here to let us know about it.

Author:

Lok Ker Yee

B Pharm (Hons) (IMU)

Editors:

Chang Jen Nee

B Pharm (Hons) (IMU)

Tan Sue Fern

B Pharm (Hons) (IMU)