Punjab and in particular Lahore is being crippled by increasing number of Dengue fever patients. We all know it is an illness caused by a virus. This virus is spread by Dengue mosquito. Without going into details of types and kinds of the mosquito, viruses and irrelevant data, I will endeavor to present here some basic facts so that if you or anyone near and dear to you has a fever these days, you should know what to do.
SYMPTOMS OF DENGUE FEVER: How can you diagnose Dengue fever.
Dengue virus infections cause a spectrum of illness ranging from asymptomatic, mild undifferentiated fever to classical dengue fever (DF), and dengue fever with haemorrhagic manifestations, or dengue haemorrhagic fever (DHF) and the dengue shock syndrome (DSS). Keep the following in mind when dealing with Dengue fever.
The symptoms generally are:
1. High continuous fever of 3 days or more
2. Abdominal pain
3. Small hemorrhages under the skin.
4. Rash. The skin rash of Dengue fever is mostly itchy and mostly occurs on the back.
5. Abdominal pain due to enlargement of Liver.
6. Fall in platelet count that precedes or occurs simultaneously with a rise in haematocrit
7. Normal WBC or leucopaenia with increase in Lymphocyte count.
8. Normal ESR (< 20mm per hour) It tends to increase in fevers caused by most of the infections in our region.
Some less common but very significant symptoms are:
• Acute abdominal pains, diarrhoea, severe gastrointestinal haemorrhage
• Severe headache,
• Inflammation of brain (Encephalitic) signs associated with or without intra-cranial hemorrhage
• Irregular pulse and heart rate
• Respiratory distress / difficulty in breathing.
In a normal person the platelet count in a blood sample is 150,000 to 250,000 / cu.mm. Platelets are the small particles which help in coagulation. If the platelet count is BELOW 100,000/ cmm, it should be considered an emergency and patient should be hospitalized. Remember the duration of fever is 5 – 7 days after which there is afebrile (fever less) phase which lasts for 2 to 5 days but is of high importance as most of the complications (including bleeding) occur in this period of time. So absence of fever in diagnosed case of Dengue does not mean that the patient should be allowed to move about.
If there is no bleeding and the platelet count is not going below 100,000 /cmm, majority of treatment consists of correcting the fluid balance, giving antipyretic medication (NEVER USE ASPIRIN as it can further complicate bleeding disorder), rest, good protein diet and antibiotics (if needed) to reduce the chance of secondary infection. As such antibiotics (Tarivid, Ofloxacin, Leflox, Ofloxin, Cephradine, Septran, Vibramycin, etc.) have no role in the treatment of Dengue fever. They are only used for any secondary infection in the body and in its absence should NOT be used.
TREATMENT OF DENGUE FEVER:
Look for these symptoms and decide:
• Restlessness or lethargy
• Cold extremities
• Bleeding in any form
• Oliguria (low urinary output), reluctance to drink fluids
• Rapid and weak pulse
• Haematocrit of 40, or rising haematocrit
• Platelet count of less than 100,000/mm3
• Acute abdominal pain
Most of the times such patients MUST be hospitalized and further treatment is done there.
If the patient REFUSES TO GO TO HOSPITAL, Do these:
1. Encourage the patient to drink fluids
2. Observe for coldness / blueness of extremities
3. Administer Paracetamol(Panodol, Calpol) for fever 10-15mg/kg/dose 4-6 hourly (limit to 5 doses in 24 hours)
4. Cold sponging as necessary, especially if the fever is above 102 F
5. Avoid aspirin and non-steroidal anti-inflammatory drugs (Bruffen, Feldene, Naproxyn, Synflex, Dicloran etc.)
HOW DO WE KNOW THAT THE PATIENT IS NOW OK AND DOES NOT NEED ANY MORE HOSPITAL STAY:
If these six (6) conditions are fulfilled, the patient should be discharged from the hospital:
1. Absence of fever for 24 hours without the use of antipyretics, and a return of appetite
2. Visible improvement in clinical picture
3. Stable haematocrit (laboratory finding on blood test)
4. Three days after recovery from shock
5. Platelet count greater than 50,000/mm3 and rising
6. No respiratory distress
PLEASE FOLLOW the instructions on media/ press about how to prevent Dengue fever and stay away from mosquito. Remember, this mosquito bites early in the morning and in the evenings, so avoid being outside at these times. Also this mosquito breeds in fresh water. So be careful of any such collection (leaking pipes, the drainage of air-conditioner and fridge, old/new tires, store room stuff which is not cleaned / dried daily, flower and other pots, water tanks (over head or at the ground level), kitchen and bathroom fittings where fresh water can pool and if allowed to stand for sometime will be a breeding ground for the Dengue mosquito. USE mosquito repellent when going out. AVOID going out to the public places during the time the infection is rampant. THIS INFECTION IS NOT TRANSMITTED THROUGH ANOTHER HUMAN BEING so there is no need to keep the patient in solitary rooms/ areas but as the mosquito can bite any of us after biting a patient with fever, it is advisable to avoid contact with large number of people.
If you or anyone around you have fever for more than 2 days with vomiting, headache, pain in the eyes and abdominal pain, DO NOT WASTE TIME but go to the nearest doctor/ hospital.
All dengue patients must be carefully observed for
complications for at least 2 days after recovery from fever. This is
because life threatening complications often occur during this phase.
Patients and households should be informed that severe
abdominal pain, passage of black stools, bleeding into the skin or
from the nose or gums, sweating, and cold skin are danger signs.
If any of these signs is noticed, the patient should be taken to the
In case of emergency you can contact me also:
Tel: (+92) 0333 4307227.
PS: If you are outside Pakistan and plan to visit (particularly Lahore), this is NOT one of the best times to come back. If it is important pleases make sure you take all precautions to keep the mosquitoes away from you. That includes using mosquito repellents and avoiding going out doors. Also instead of PARACETAMOL we can use TYLENOL / ACETAMINOPHEN/ WILGESIC/ DIAGESIC. Last but not the least have faith in God. He will protect you.
WHERE CAN I GET TREATMENT FOR DENGUE FEVER AND GET MY TESTS DONE:
These hospitals in Lahore are catering for the needs of patients with Dengue Fever infection. They are mostly offering their services free of charges. Even the laboratory tests are charged at minimal rates. There are a number of private clinics/ hospitals which also take care of such patients but charge large amounts of money as their fees / lab charges.
1. Mayo hospital, Lahore.
2. Sir Ganga Ram Hospital, Queens road.
3. Sheikh Zayed hospital.
4. Ittefaq hospital.
5. Services hospital, Shadman, Jail road.
6. Jinnah hospital, near Canal bank.
7. Mian Munshi hospital. Band road.
Other, expensive labs are Chughtai lab, Shokat Khanum lab, Agha Khan hospital lab, Labex, Zeenat clinic, Karachi Lab, Raceview lab, Mehran lab, and hundreds of others in virtually every area of the city.
The Punjab government has announced that 8 of its social security clinics in the city are being equipped to deal with cases of Dengue Fever. Information about these clinics can be had from the following toll-free number:
(+92)42 0800 73774. (This is not an on-line advisory service. Only for inquiries about social security clinics).
USEFULNESS OF PAPAYA LEAVES IN RAISING PLATELET COUNT:
There is no cure as such for Dengue fever as discussed. There have been reports that Papaya (scientific name Circa Papaya) leave extract works miraculously in raising the platelet count if that goes down. Doctors working in the field of infectious diseases have confirmed this fact.
METHOD OF PREPARATION:
Take two fresh papaya leaves (use only the leafy part, remove the stalks), wash, clean, pound and squeeze out the juice into a blender. That should yield approximately 2 tablespoons of bitter juice to be taken as it is. Do not boil or dilute with water. One serving per day is recommended.