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Breaking out from dengue

"Get the 411 on how to breakout from this deadly disease."
By: Neslie Buena, MDBreaking out from dengue

In a tropical country such as ours, and having had our unwanted share of epidemic outbreaks over the past several years, Dengue has had its considerable time on the media, becoming a diagnosis that’s been readily tossed around by everyone. 

Dengue belongs to a class of viruses called Flavivirus, making it classmate to the Yellow Fever, West Nile and Japanese encephalitis among others.  Currently, there are four serotypes or strains of this virus:

  • DEN-1,
  • DEN-2,
  • DEN-3,
  • DEN-4. 

This means that one person can be inflicted with Dengue four times in one lifetime. Unlike the common cold, the Dengue virus is not directly transmitted between humans. This conniving pathogen has enlisted the help of a group of mosquitoes, namely the Aedes aegypti and Aedes albopictus.   From the time of a virus-ridden mosquito bite, there is a quiet period before symptoms appear.  This is what we call the incubation period, usually spanning an average of 4-10 days.  During this time, the bitten person will go about his or her routine without knowledge of the virus purposely replicating inside his or her body.  Then the first symptom appears.

Fever is the first to say “hello”—high-grade fever that is usually coupled with two or more of these following symptoms:

  • Aches and pains (i.e. muscle and joint pain, eye pain, headache)
  • Nausea (or the sensation of wanting to vomit) or vomiting
  • Rash
  • Low white cell count
  • Positive Tourniquet test
  • Any warning sign. Any warning sign?  That means any one of these:
    • Severe stomach pain or tenderness
    • Continuous vomiting
    • Mucosal bleeding (i.e. nose bleeding or gum bleeding)
    • Decreased energy (a.k.a. lethargy) or restlessness
    • Liver enlargement of >2cm
    • Clinical signs of fluid accumulation
    • Laboratory findings of increased HCT and a fast decline of platelet count

You just have to watch out for the symptoms that you do understand and count on your physician to interpret the rest. If Dengue is suspected, your doctor may order a test or two.  Depending on the entire clinical picture, you’ll be classified into three general categories:

✓  Dengue without warning signs

✓  Dengue with warning signs, or

✓  Severe Dengue

Since there is really no cure when it comes to this condition, we want to catch it before we go from the benign to the complicated; because for a lot of patients, this could literally spell between life and death. So what can we do? 

Monitor symptoms.  High fever, along with the other symptoms of Dengue, can last between 3-7 days.  During this week, you may have self-medicated with paracetamol, tepid sponge bath and plenty of fluids.  But if the fever just won’t go down after 3 or more days, then a clinic visit is most wise. 

Consult.  During the consultation, once your history has been obtained, your doctor may ask for a few lab examinations.  Usually, this could mean a Complete Blood Count (CBC with platelet count), a Tourniquet test, maybe even a urinalysis.

Supportive Measures.  In the event that your doctor decides you can go home, be sure to drink lots of fluids and get plenty of rest.  You may medicate with paracetamol for pain and fever, but be sure to avoid aspirin; because aspirin can aggravate bleeding if present. 

Watch out for when the fever breaks.  Once the fever subsides, there is what we call a critical period of 24-48 hours, wherein we want to look for the warning signs that herald a more severe form of Dengue—Dengue Hemorrhagic Fever (DHF).

When it comes to Dengue Fever, a shield remains to be the best fighting weapon.  The old adage that goes, “An ounce of prevention is better than a pound of cure” still goes a long way for everyone.  So how do we do this?

Get your shots.  Though a cost-effective vaccine, that will cover all four serotypes, is what everyone is waiting for, we might have to wait a little bit more for its full development and approval.  But with 3 companies/institutions leading on this front, the wait won’t seem too long anyhow.

Regular environmental clean-up.  If you want to stop Dengue, you want to nip it in the bud.  This means we eliminate and clear up areas that could breed the mosquitoes that bring the virus to us humans. 

Put on your shield and protective gear.  This can go as simple as wearing long-sleeve shirts and pants during high-risk months.  You can take it up a notch by applying insect repellant lotions or putting on insect-repellant patches. 

Involve the community.  Much like any endeavor of global significance, involving your neighbors will prove your personal efforts more effective.  The mosquitoes from your uninformed neighbor’s house won’t be too discerning as to whom to bite. 

So how ‘bout it?  What’d you say we break out from Dengue… now!

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