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Dengue season
Here comes the rain, and with it comes mosquitoes. These bloodsuckers aren’t just inconvenient pests. They can carry the deadly dengue virus. Know what to do these cold rainy months so you won’t burn up with dengue fever.
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CCORDING TO THE WORLD HEALTH ORGANIZATION, 50 MILLION PEOPLE ARE INFECTED WORLDWIDE WITH DENGUE EVERY YEAR. DENGUE FEVER IS CAUSED BY FOUR TYPES OF DENGUE VIRUSES FOUND IN THE TROPICS, THE PHILIPPINES INCLUDED. The virus is transmitted from one person to the other by the tropical mosquito called the Aedes mosquito (Aedes aegypti and rarely, Aedes albopictus). Aedes aegypti is an urban dweller. In the past, dengue was seasonal because the rainy season brought about more stagnant water, which is the breeding ground of the mosquito. But this is no longer true. Metro Manila gets cases of dengue fever all year round, probably because of deteriorating sanitation and rapid urbanization. This mosquito feeds on blood during daytime. If the mosquito feeds on virus-laden blood from a person with dengue virus, the mosquito can then transfer the virus to another person on its next meal. More importantly, the virus can stay up to two weeks in the blood without causing any fever. By the time fever shows up in the first victim, the virus would have already been transmitted to several people.
A Slice of Orange is a newsletter designed to help clarify basic health information and offer juicy tips on uplifting your health.
Editorial team Alvin Delfin Christine Llenes Voltz Olea, MD
V o l u m e
Breakbone fever In some countries, dengue fever is called “breakbone fever” because of its symptoms: a sudden fever with severe muscle and joint pains, as if your bones are being broken. It can also cause severe headache and a skin rash. The dengue rashes are bright red, pinpoint rashes that appear first on the legs, thighs and chest. Less common symptoms are stomach pain, nausea, vomiting or diarrhea.
The fever usually lasts about six to seven days. In some cases, the blood platelets decrease and the blood thickens as the fever begins to break. This can lead to dengue hemorrhagic fever (DHF), a dangerous complication of dengue fever where the patient experiences bleeding in different parts of the body, including the gums, stomach, and intestines.
Rarely, DHF leads to dengue shock syndrome, where the bleeding and thickening of the blood leads to low blood pressure and poor blood flow to vital organs, leading to shock and multiple organ failure.
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Based on these descriptions alone, we cannot overemphasize how deadly a simple mosquito bite can become.
Call the doctor very quick Any person who has a high fever and muscle or joint pains should see a doctor as soon as possible. The presence of even mild signs of bleeding should also prompt you to see the doctor. These signs include: • Nose bleeding • Gum bleeding (especially in the ab- sence of vigorous brushing of teeth) • Bruises (especially in the absence of trauma) • Fresh or old (dark) blood in the stool, sputum, saliva or vomit • Vaginal bleeding • Heavier than usual menstruation • Wounds or cuts that take longer than usual (or 5 minutes) for bleed- ing to stop. Fever with drowsiness, excessive sleepiness, photophobia (fear of lights), restlessness, weakness, seizures, stiffness of the limbs, slowness in movement, clumsiness, or stiff neck may also mean that the brain may already be affected. In the hospital, a test called a complete blood count can check if blood platelet levels are falling, or if the blood is getting thicker. Special blood tests that can directly detect the virus can also be performed. A tourniquet test will also be performed.
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The tourniquet test This test checks how fragile your tiny blood vessels (capillaries) are, and can help tell a patient’s tendency to bleed. A positive tourniquet test may also be a sign of low platelet count. It is a requirement by the WHO before a diagnosis of DHF is made. However, other diseases may also cause a positive tourniquet test. Also, early DHF may be negative at first. Hence, a negative test does not mean you can let your guard down.
How is it performed: 1. Your blood pressure is taken using a regular blood pressure (BP) apparatus. 2. After a few minutes, the cuff is re- inflated to a pressure between the sys- tolic (upper number of the BP) and dia- stolic (lower number) pressures and maintained for five minutes (this can be painful). 3. The test is positive if there are more than 20 red dots per square inch of skin around where the cuff was inflated. While you can do a tourniquet test at home, the results can become incorrect if the test is not done correctly. It is best to have a tourniquet test performed by a health professional.
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Once dengue fever or DHF is confirmed, your vital signs (heart rate, blood pressure, breathing, and temperature) will be monitored meticulously. This will detect the first signs of shock, which will then be treated promptly. Signs of bleeding and platelet counts will also be regularly monitored. If platelet counts drop to critical levels, or there is massive bleeding, blood transfusion will be performed.
Dodging the dengue bug The Aedes mosquito is critical to the life cycle and transmission of the dengue virus. Hence, mosquito control has been the cornerstone of dengue prevention since the 1960s. There are two main methods:
Not everyone who has dengue fever will be hospitalized. Stable patients will be sent home, but will be requested to undergo regular platelet testing (from every few hours to daily).
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All patients, whether at home or in the hospital, need to increase their intake of fluids. This will prevent dehydration and blood thickening, which could lead to shock. Dengue patients should never take medicines such as aspirin or ibuprofen (or other pain killers), as this may increase the risk of bleeding. The only anti-fever/ pain medicine they can take is paracetamol (acetaminophen).
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Larval (wriggler) control Eliminate possible breeding grounds Periodically drain stagnant water in plastic cups, used tires, bottles, flowerpots, etc. Cover water drums and water pails at all times. Replace water in flower vases once a week. Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides. Clean gutters of leaves and debris so that rainwater will not collect in them.
Adult mosquito control Careful use of insecticides, insect repellents, and mosquito nets.
A dengue vaccine?
There is no vaccine yet available to prevent dengue. Although progress is underway, developing a vaccine against the disease has proven challenging. One of the biggest challenges to vaccine development is the fact that there are four distinct types of dengue viruses. The vaccine must immunize against all four types to be effective. To make matters worse, the body seems to react to each type in a different way. With other infections, previous exposure to a virus makes subsequent infections milder, or may even prevent subsequent infections, because the immune system is already more prepared for a second onslaught. But in the case of dengue, subsequent infections tend to be worse than the previous one, until the person is exposed to all four types. Only then will the body become immune.
A slice of trivia Dengue fever can turn deadly once blood platelet counts start going down and the blood begins to thicken. What blood test can detect these initial but alarming signs of DHF? Freshen up on your researching skills, e-mail us the answer at orange@activelink-consult.com and win a prize!
Answer to last issue’s question:
From those with the correct answer, 10 people will be randomly chosen to win a gift pack from ActiveLink. We’ll
What are the two active ingredients of Strepsils that kill bacteria and viruses that cause sore throat?
include the answer in the next issue of A Slice of Orange.
Strepsils contains amylmetacresol and dichlorobenzyl alcohol, two ingredients with antiviral and antibacterial properties. A study showed that oral lozenges containing these two ingredients prevent viruses, including the
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influenza virus, from infecting other people.
The Orange wants to he ar from you! Dying to ask us your health related questio ns? Itching to share your pe rsonal health tips? Want to sugg est topics for future issues? Feel free to contac t us. You can e-m ail our team at orange@activ elink-consult.c om.