There has been an increasing trend in dengue cases across the country with the disease map now spreading pan-India, way up to Jammu and Kashmir. In fact, there is no State or Union Territory left with zero cases. According to data from the National Vector Borne Diseases Control Programme (NVBDCP) till August end, there have been more than 30,627 cases and 12 deaths. Karnataka (5,392) Maharashtra (2,927)and Kerala (2,007) have the maximum cases. The new additions in the dengue map are Jammu and Kashmir (96) and Nagaland (two). In 2021, there were 1.93 lakh dengue cases and 346 deaths across the country while 2020 had seen a dip, probably because the focus was on treating COVID 19. What’s worrisome this year is the emergence of unusual symptoms in focal areas, resulting in a quick descent to dengue haemorrhagic fever.
WHAT ARE UNUSUAL SYMPTOMS THIS YEAR?
This year, there have been some patients with complications. In Delhi, where cases have surged over the last two weeks, people are coming to hospitals with internal bleeding, shock (sudden drop in blood pressure) and liver complications. Dr Rommel Tickoo, Director of Internal Medicine, Max Healthcare, said, “Although the numbers are not as high as what Delhi saw in 2015 and 2016, we are seeing more people with complicated dengue. Those with liver involvement show symptoms of jaundice, but these cases are self-limiting.”
Some patients in Maharashtra have reported severe complications. According to Dr Sanjay Pujari, infectious diseases expert, we should be worried if the rate of complications is higher than previous years. Dr Rajesh Gadia, consulting physician at KEM hospital, who has been involved in the management of dengue viral fever for over two decades, says that largely cases have a mild presentation. However complications can occur due to the prevalent serotype and in some cases, which are mainly from Baramati and Phaltan, patients have come in with shock and fluid in their lungs. “Clinical manifestations vary from undifferentiated fever to florid haemorrhage and shock. The clinical presentations depend on age, immune status of the host and the virus strain,” Dr Gadia noted.
Among some of the rare complications are Hemophagocytic Lymphohistiocytosis (HLH), which is an inflammatory state that can be triggered by infections or other immune disorders, usually among those with an underlying genetic predisposition. It is not only seen in dengue but other infections as well, Dr Pujari said. “Capillary fluid leak from the blood goes into the interstitial compartment and can lead to fluid accumulation in the lung or abdomen – once the fluid goes into extra blood space, there is a drop in blood pressure and hence shock occurs,” explained Dr Pujari. Which means all the body’s blood cells get affected, causing liver and heart injury, a drop in platelet count, abnormal clotting system, massive drop in blood pressure. This leads to a refractory shock in the patient.
A specific rare case of dengue-induced Acute Respiratory Distress Syndrome (ARDS) was spotted in Arush Wandhekar, a four-year-old boy from Maharashtra’s Ahmednagar. His breathing became difficult and his oxygen levels dipped.
SEEK HEALTHCARE EARLY
“By and large, there is no reason for panic. However, it is extremely important to seek healthcare early,” says Dr Parikshit Prayag, infectious diseases expert at Deenanath Mangeshkar Hospital. When the hidden dengue virus gets diagnosed at the very end, it inevitably ends up causing other health problems.
The onset involves an acute febrile illness between two and seven days, with symptoms like headache, retro-orbital pain, myalgia, arthralgia, rash and haemorrhagic manifestations. These need to be monitored carefully. The phase of febrile illness is one where fever can last for a week after which most people recover. There will be post-viral convalescence and the patient has weakness and fatigue.
Given that COVID-19 and dengue are circulating in the city simultaneously, Dr Tickoo warned against people popping any pain-killers without consulting a doctor. “With COVID-19, many people do take painkillers without consulting a doctor, but that can be dangerous if they have dengue. Combiflam and painkillers such as Diclofenac can increase the risk of internal bleeding and affect the liver. Paracetamol is the only medicine they should take for the fever,” said Dr Tickoo.
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HLH is a life threatening condition and its diagnosis can be challenging because the initial symptoms may mimic other problems such as persistent fevers, rash, enlarged liver, low platelet count and altered mental functions.
There are four virus serotypes that are designated as DENV-1, DENV-2, DENV-3 and DENV-4. Infection from any one serotype confers lifelong immunity to the virus serotype.
WHY YOU NEED TO WATCH RAINFALL PATTERNS
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With researchers and studies finding a link between dengue and rainfall patterns, experts like Dr Gadia have cautioned that monsoon and post-monsoon months are crucial for the vulnerable lot. The Aedes Aegypti mosquito has an average adult survival of 15 days. During the rainy season, when survival is longer, the risk of virus transmission is greater. The dengue mosquito is a day time feeder and can fly up to a limited distance of 400 metres. Aedes Aegypti breeds almost entirely in domestic, man-made water receptacles found in and around households, construction sites and factories. Natural larval habitats are tree holes, leaf axils and coconut shells. Unused tyres, flower pots and desert coolers are among the most common domestic breeding sites.