Dengue fever

[Guest]

If a person suspectshe has dengue fever, exactly what are the tell-tell signs and what medicines should one take? Or should a person go to the hospital instead of self medication?

[iuytrede]

no exact tell-tale signs

 

don't use self-medication, go to a hospital

[..]

It presents like the flu, with the fever and achey joints, but no sinus problems. It just keeps getting worse until it and breaks and you start getting better. There is no specific medication. The medicos just treat the symptoms and monitor the fever. As I said in an earlier post, it was the sickest I have ever been and have never been conscious but physically unable to move (cut it hurt so much and I was so stiff) as I was when I had this!

 

Getting technical, the CDC says:

 

Dengue fever is an acute viral illness characterized by:

 

* Fever, often with sudden onset;

* Severe headache, often described as retro-ocular;

* Myalgia (muscle pain) and arthralgia (joint pain) that can be very severe;

* Nausea and vomiting;

* A rash that may present at different stages of the illness, and whose appearance can be variable?it may be maculopapular, petechial, or erythematous.

* As many as one-third of patients may develop hemorrhagic manifestations. These hemorrhagic manifestations are usually mild, such as skin hemorrhages?petechiae, purpura, and ecchymoses. Others include gingival or nasal bleeding; gastrointestinal bleeding, such as hematemesis, melena, and hematochezia, the severity of which may vary from very mild to very severe; hematuria, which is usually microscopic; and increased menstrual flow. In some cases, however, the hemorrhage may be frank and severe enough to cause shock from blood loss.

 

Patients may also report other symptoms, such as itching and aberrations in the sense of taste, particularly a metallic taste. In addition, there have been reports of severe depression after the acute phase of the illness.

 

Clinical Case Definition for Dengue Hemorrhagic Fever

 

There are four criteria?all of which must be fulfilled to meet the case definition?that were first set up by a World Health Organization working group for reporting a case of DHF. The criteria, as currently stated by the World Health Organization, are:

 

* Fever, or recent history of acute fever;

* Hemorrhagic manifestations;

* Low platelet count (100,000/mm3 or less);

* Objective evidence of plasma leakage caused by increased vascular permeability, as reflected by one or more of the following:

- Elevated hematocrit (defined as 20% or more over baseline, or a similar drop after volume replacement treatment);

- Low protein; or

- Pleural or other effusions.

 

Plasma leakage is the critical difference between dengue hemorrhagic fever and dengue fever and means that the patient requires fluids, sometimes large amounts of intravenous fluids.

 

The Tourniquet Test

 

This is a quicky field test that Docs use to give them a clue if the paitent may have Dengue without lab work. The tourniquet test assesses capillary fragility. You inflate the blood pressure cuff to a point midway between the systolic and diastolic blood pressures for five minutes. After deflating the cuff, wait for the skin to return to its normal color, and then count the number of petechiae (reddish/purplish spots on the skin) visible in a one-inch-square area on the ventral surface of the forearm. Twenty or more petechiae in the one-inch square patch constitutes a positive test.

 

The treatment of dengue fever consists of the following:

 

* Fluids. Patients should be encouraged to take small, frequent sips of fluids. If the patient cannot be rehydrated by mouth, fluids should be administered intravenously. At times large amounts of intravenous fluids are needed;

* Rest;

* Antipyretics (fever reducuing medication) ? aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen should be avoided so that platelet function will not be impaired;

* Monitoring of blood pressure, urine output, hematocrit, platelet count, and level of consciousness;

* Patients often develop dengue hemorrhagic fever after their fever disappears. So providers should continue monitoring vital signs and hydration status for 24 to 48 hours after defervescence, looking out for any sign of DHF. If there is any doubt, intravenous fluids should be provided and guided by serial checks of hematocrit, blood pressure, and urine output. The volume of fluid needed is similar to the treatment of diarrhea with mild-to-moderate isotonic dehydration (5%-8% deficit);

* Invasive procedures should be avoided whenever possible. There are no data in the published literature regarding the use of steroids, intravenous immune globulin, or platelet transfusions to shorten the duration or decrease the severity of thrombocytopenia. The effectiveness of these methods has not been proven (or disproved). Patients in shock require support in an intensive care unit, with minute-to-minute monitoring.

 

A common misconception is that Dengue kills only by hemorrhage. Though these patients may have severe hemorrhage, the more common scenario is that the patient goes into irreversible shock because of excessive vascular permeability, and this shock is what causes fatalities.

 

More info can be found here.

 

Cheers,

SD