This is
the third post in a 4 part series, about Dengue, which originally appeared at blogtorchey.blogspot.com in Spanish on June 2011.
We have
already seen how the Aedes
reproduces and transports the dengue virus. In this installment we focus on its
effects on us. I will start by differentiating the two general variants of the
disease: the classic dengue and the hemorrhagic dengue. Even though considered
two different entities, they clinically show a linear evolution: we all start
with the symptoms of the classic dengue and, in some cases evolving to
hemorrhagic dengue. I will not go into deep medical details, but it is
important to mention that the presence of the virus in the blood produces an
initial inflammatory response which produces in the body symptoms of classic
dengue. In light of certain factors, the body may trigger a second inflammatory
response by producing an accelerated use of platelets and dehydration which
typify the symptoms of a hemorrhagic dengue.
The
classic dengue has a variety of symptoms, hence often mistaken. An important
example came about in 2009 with the presence of influenza, when a patient’s
symptoms could be considered suspect of dengue and flue, assuming an important
epidemiological challenge. At present dengue’s cardinal symptoms, those that
determine a suspicious case are fever, headache, myalgia and arthralgia (bone
and muscle pain); there is practically no case where these symptoms are not
presents. Sometimes an allergic rash is present and may be preceded by a
manifestation similar to a cold or simply sore throat and cough. With lower
frequency we will find diarrhea, nausea or abdominal pain. Classic dengue
symptoms last 3 to 4 days and, though we will not talk therapeutics in detail,
the most important part of the treatment focuses on being well hydrated (4 to 5
liters of water or saline solution every day) and controlling the fever; use of
antibiotics is usually a preventive measure (viruses are not attacked with
antibiotics) and there are no antiviral medications or other drugs at present
that may revert or reduce the duration of the symptoms.
Hemorrhagic
dengue often manifests on the fourth or fifth day after the fever began. It’s a
paradoxical and critical period as it comes about at the right moment the
patient starts to feel better and the fever drops (which cause the symptoms to
be underestimated). The essential symptoms are those that, after the classic
dengue manifestation, they present abnormal bleeding: bleeding of the gums,
nose bleeding, extended menstrual period, faces with blood or too dark. As
well, presence of red punctiform spots on the skin usually on shins and
forearms is a bottom-line manifestation of hemorrhagic dengue. At this point
medical and lab evaluation are of utmost importance, as most cases require
intravenous hydration, supervision of platelet levels, supervision and control
of hemorrhages; very few are those cases that can be treated as out-patients
(outside the hospital.)
Finally,
I want to address some questions on the matter. First: this is a serious
disease and has a large complication potential. I find that many patients feel
that “nothing is being done” to them while at the hospital and want to be
discharged. The reality is that although they do not require expensive or
specialized medication, the sole administration of intravenous saline solution
prevents many complications and, in case of hemorrhage, it can be controlled
and patient’s complications be avoided. The second one is recovery. When
patients are released, they want to return to their regular daily routines; it
must be understood that hemorrhagic dengue (even the classic one) is a disease
which, like pneumonias or kidney infections, significantly deplete the body
reserves. Third and last, it is important to always seek medical advice when
the main symptoms are present, in addition to the evaluation and proper
treatment, the respective authorities must be notified of the case.
I hope
this information is helpful. Wait for the next installment: D. Diagnosis and
Epidemiology. Cheers.
