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Diagnosed with Dengue: Don’t panic

Dengue, a mosquito-borne viral acute febrile disease places nearly two thirds of global population at risk to infection. Based on the level of endemicity, India has been placed in Category B countries with cyclic epidemics, along with Bangladesh and Maldives. The Category A countries with yearly epidemics are Indonesia, Thailand, Sri Lanka and Timor-Leste.

Dengue is transmitted by the Aedes Aegypti mosquito. This species of mosquito breeds in stagnant water and an interesting fact is that this mosquito usually bites during daylight hours.

The dengue virus belongs to a group known as Flavivirus and can be typically divided into four viral serotypes, DEN-1, DEN-2, DEN-3, and DEN-4. A person infected with a single type of dengue virus serotype out of the four, develops resistant to that particular virus. However, they become much more susceptible to infection by other three serotypes. Therefore, a second infection with a dengue virus may be much more severe than the first one.
Here are some important common queries about the Dengue fever

1. What are the symptoms of the disease?
High fever and at least two of the following:
    1. Severe headache
    2. Severe eye pain (behind eyes)
    3. Joint pain

    4. Muscle and/or bone pain
    5. Rash
    6. Mild bleeding manifestation (e.g., nose or gum bleed, or easy bruising)

Fever starts to decline 3-7 days after beginning of symptoms. Most problems start after fever subsides, and one should be watchful of the danger signs.

2. What are the warning signs of Dengue?
Seek Emergency medical advice in case of any of the following
    1. Severe abdominal pain or persistent vomiting Red spots or patches on the skin

    2. Bleeding from nose or gums
    3. Vomiting blood
    4. Black, tarry stools
    5. Drowsiness/increased sleepiness or irritability

    6. Pale, cold, or clammy skin

    7. Difficulty breathing
 
3. What are the severe forms of Dengue?
Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. In the next 24-48 hours, the blood vessels become abnormally leaky, and a lot of fluid may escape into the tissues and cavities of the body.
This may lead to failure of the circulatory system and abnormally low blood pressure, followed by death. In addition, the patient with DHF has a low platelet count (cells necessary to form blood clots) and bleeding manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding.

4. What you should do in case of high grade fever?
    1. Do not take medicines without seeking a doctors’ consultation.
    2. Only take Paracetamol for fever.
    3. Take plenty of oral fluids. Keep your body well hydrated.
    4. In case of any of danger symptoms mentioned above, consult a doctor immediately.



5. How is Dengue diagnosed?
Dengue should be suspected in all cases with high grade fever, in endemic areas. Diagnosis is made based on clinical findings and laboratory tests. Dengue virus has an incubation period of three to seven days before symptoms appear. Dengue fever diagnosis confirmation is based either on viral antigen detection (such as for NS1) or specific antibodies (serology, that is antibodies IgM or IgG).

These blood tests are available at select government specified laboratories. An important aspect of these tests is that, they may be falsely negative, and require careful correlation with the onset of symptoms of the disease. At different times, from the incubation period (time from infection to first symptoms) to recovery, different tests may be valuable in diagnosing dengue. For example, the detection of NS1 antigen is useful for diagnosing the disease in it’s early stage.

6. What to do if you have Dengue fever?

Don’t panic if you have been diagnosed with Dengue fever. Dengue is a self limiting disease, that is it resolves itself with supportive measures. For the large majority of people infected with dengue fever viruses, the prognosis is excellent, although they are likely to feel very ill during the first one or two weeks of the acute illness and weak for about one month. Overall, the fatality rate is about 1% of all dengue fever infections. Deaths are mainly because of severe dehydration, low blood pressure, bleeding and delay in treatment.

7. Do you need hospitalization if you have been diagnosed with Dengue?

No, most of the patients can be managed with home based care. Patients need to be aware of the danger signs, as mentioned above. If any danger signs appear, medical professional help should be sought immediately. The doctor may advise you home based care depending upon severity of your symptoms, risks for possible complications, and any co-existing diseases. The doctor may advise you to get your blood counts regularly done for a week after the fever subsides.

8. What is the treatment of Dengue?

No specific drugs are available for dengue. It is a self limiting disease. With adequate hydration, paracetamol for fever and rest, most patients would improve over a period one or two weeks.

9. Should you believe in local myths for treatment?
   
There is no scientific reason behind any of these myths. Whenever there is any disease outbreak, rumours spread like wildfire, like goats milk, papaya seeds and coconut water in dengue. As per an article published in ‘Journal of Pharmaceutical and Biomedical Sciences’, goat milk being a rich source of Selenium can cure dengue. Then, there are other source of selenium as well. It is abundantly found in fish, meat, chicken, spinach, broccoli, cabbage and sunflower seeds.

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