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An overview of the dengue menace



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by Shivanthi Ranasinghe


Though dengue is everyone’s fear these days, we are still quite ignorant of the subject. As a result, we have lost control of the problem. Worse, when afflicted with it, we do not know what exactly needs to be done. 


Dengue is widely believed to have originated from Africa. The word ‘Dengue’ in Swahili, an African dialect, means ‘bone breaking pain’, explains Dr. Sarath Ranasinghe, MD at Kandy Private Hospital. As a physician with 50 years of experience, he sees many patients with dengue. Over the years, the pain levels patients suffer have lessened, but the shock syndrome that some dengue patients experience is a fairly recent development, he notes.


"Dengue is a virus," Dr. Ranasinghe explains "which has four strains. Illness from one strain however does not give immunity against the other strains.


"Out of 1,000 dengue patients, for 900 it will be an ordinary cold-like infection that will settle within a week with rest and Panadol. Most patients do not get the overt symptoms. Recently a survey revealed that 54 percent of those surveyed had antibodies against dengue though they have never had the visible clinical symptoms. That means they didn’t even know they had got dengue."


Dengue History


Dengue illness usually lasts for about a week for by that time the body has developed antibodies to fight against the dengue virus, says Dr. Ranasinghe. 


"Most patients’ platelet count drops within the first few days, but within five-six days, usually with rest, it again rises. Sometimes, when the platelet count drops, it causes bleeding from gums especially when brushing teeth, nose and with urine. Patients may also experience a heavier than usual menstruation. Some may experience hemorrhagic rashes with either tiny bleeding spots known as petechia or larger spots called purpura. Sometimes, patients can bleed from bowels, stomach, bladder and lungs."


However, the falling platelet count is not the serious issue, warns Dr. Ranasinghe. The situation becomes grave if the patient suffers from Dengue shock syndrome or multiple organ failure. 


Dengue Shock Syndrome 


"Dengue shock syndrome can occur when plasma leaks out. Plasma is the fluid part of the blood. This can ooze out of the capillaries to surrounding tissues, and this fluid leak is the most dangerous, as it can cause two complications:


"One, depletion of fluids from blood can cause low volume and hemoglobin to concentrate. In turn blood pressure may drop. When there is not enough blood pressure to pump blood into vital organs such as the brain or kidneys, it can cause shock syndrome. Patients may lose consciousness if there is not enough blood to the brain, or suffer renal failure if the kidneys do not get sufficient blood. 


"Two, plasma in surrounding tissues can cause fluid buildup in lungs, abdominal cavity and the liver can get enlarged. Especially if lungs fill with fluids, it can obstruct functioning of the lungs causing breathing difficulties.


"However, this plasma leak lasts for about two days. During this time adequate fluids must be given, usually intravenously to maintain blood pressure."


One has to be careful giving extra fluids because after about two days the leaking stops and gets re-absorbed into blood vessels, cautions Dr. Ranasinghe.


"If not careful, the extra fluid given can overload the circulatory system and result in heart failure. Most casualties occur due to this shock syndrome."


Therefore, he emphasizes, this fluid management must be done by experienced nursing care. Some carers, especially parents, try to give fluids to patients hourly. This is not necessary. It is only if plasma leaking occurs that fluid intake has to be strictly managed. As many factors need to be taken into consideration, this is not something a layperson can do.  


Multiple Organ Failure 


Sometimes the body can get overwhelmed by the virus, which attack all vital organs like the brain, kidneys and liver and cause death. Dengue Myocarditis is when heart muscles get inflamed and result in heart failure. 


The liver of most patients at acute stage can get inflamed. This can cause higher secretion of enzymes that can result in liver failure. 


Dengue Debilitating Syndrome 


Even after the patient recovers from the acute illness, for few more weeks they can feel tired, lifeless, debilitated and not fit enough to work. This, explains Dr. Ranasinghe, is known as the Dengue debilitating syndrome and the patient should take it easy. 


General Symptoms 


Sudden onset of high fever with chills and rigors accompanied with sever headaches, muscle and joint pain, vomiting and/or pain behind the eyes are the general symptoms to watch out for, lists Dr. Ranasinghe.


"In the first few days, with the spiking temperature, the white blood cells and platelets drop. Usually, the platelet count is over 150,000 and this can drop drastically to even 20,000 or at times to as low as 3,000. However, after four-five days the body develops antibodies against the virus and begins to fight back. Then the fever starts settling and the aches and pains lessen."


Treatment 


"Fever is the natural treatment," states Dr. Ranasinghe. "So, allow heat to dissipate and provide support by tepid sponging with adequate fluid and calories for patient to fight the infection. The calorie intake should be in natural food that is easy to digest. 


"Avoid foods that stress the liver such as red meats, alcohol and saturated fats. My general observation is that those who anyway avoid these in their normal diet, especially red meats, fare better.


"Not belittling the virus as this is a very serious illness, only the acute cases should be admitted to the hospital like when the patient is vomiting, feels drowsy, has respiratory difficulties and/or abdominal pains. Otherwise, the best care is a clean, relaxed environment cared for by someone with maternal instincts. Two-three patients in one bed, hearing others groaning with pain, perhaps vomiting is not the best environment for recovery. 


"However, the patient, especially children, must be closely monitored with daily blood reports studied by a doctor. This is not an illness where the patient can be asked to come back in few days as it can take sudden nasty turns. 


"Avoid aspirins as it can cause thinning of blood. Also avoid non-steroidal anti-inflammatory drugs such as diclofenac sodium (Voltaren) and Brufen because these reduce beneficial fever and can cause bleeding ulcers in the stomach. Also, like aspirins, these may also cause thinning of blood."


Is Papaw Leaf Juice a Cure for Dengue?


In the absence of ‘western’ medicine, many alternatives are being suggested such as the papaw leaf juice. 


Literature on the Internet claims papaw leaf as non-toxic and considered to have a number of curative properties. Apparently a study in Florida has found it can even fight cancer. According to Dr Sanath Hettige, the leaf juice from a fruit bearing tree improves patient’s platelet count, helps blood to clot normally and improves liver function by repairing the damage done to the liver by dengue. Therefore, he argues that papaw leaf juice helps dengue patients to recover.


Molecular biologist Manohari Wickramaratchi who has a doctorate in Biomedical sciences agrees that this juice can improve the platelet count. However, she cautions, just because the platelet count increases does not mean the virus is cured. The virus will still be in the system. Therefore, the stabilizing platelet count could be a false indicator to the actual condition of the patient. 


"Out of 1,000 patients, about 900 produce their own antibodies and recover in about a week," further explains Dr. Ranasinghe. "Also, the platelet count that drops drastically in the first few days also starts to rise. This recovery happens whether papaw leaf juice is given or not. However, many believe that papaw juice helps and sometimes they bring it even to the hospital and feed the patient. When the patient recovers, they believe it is because of the papaw leaf juice. 


"However, to understand whether papaw leaf juice is effective in treating dengue, it must be subjected to a controlled trial. It must be given to about 100-200 patients and a placebo given to another 100-200 patients and then only can the results be analyzed and a conclusion reached."


Is there a Vaccine for Dengue?


Both Dr. Ranasinghe and Dr. Wickramaratchi explain the problem with Dengue is that it has four strains. 


"Immunity against one strain does not give immunity against other strains. The virus is likely to undergo genetic modifications and that has been the challenge creating a vaccine against it," explains Dr. Ranasinghe.


"The Dengue strains present in Sri Lanka and perhaps India may be similar, but that may not be what’s found in Australia," further explains Dr. Wickramaratchi. "Unlike bacteria that can be treated with an antibiotic, finding a medication for a virus is difficult. They invade normal living cells and form their colonies. They can change their forms and even disguise themselves. They can even form colonies inside bacteria."


(To be continued)


 


 
 
 
 
 
 
 
 
 
 
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