Dengue 101: What I should know?

Having recently recovered from dengue fever myself, I have decided to share a number of dengue-related FAQs. I hope these would encourage all to seek early medical attention so that proper and timely interventions can be carried out.

 

 What are the common signs and symptoms of dengue?

Sudden-onset, continuous high fever and two or more of the following: severe headache, severe pain in the bones and joints as well as behind the eyes, , rash, bruising, bleeding (bleeding gums, nose bleed, unknown bruises) and vomiting (with or without blood). I personally also experienced bitterness in the mouth.

 

 What should I do if I have the signs and symptoms mentioned above?

Do not delay seeking medical consultation with your GP or at the hospital emergency department if the symptoms have persisted for two days or more. This is especially important in children, elderly, pregnant women and people with other concurrent medical conditions such as diabetes, kidney failure, asthma and heart conditions. Dengue NS-1 antigen rapid test or rapid combo test can be carried out as early as the first day of symptom occurrence to confirm suspected dengue infection and are commonly offered in clinics. I personally sought medical attention and underwent the NS-1 antigen and a full blood test 24 hours after noticing that my fever wouldn’t subside on the maximum doses of fever medication.

 

What happens next if the dengue test is positive –

1. Will I need antibiotics?

Contrary to popular belief, dengue is not bacterial but a viral infection transmitted by Aedes mosquitoes. Thus, one will not receive antibiotics for treatment of dengue. Unfortunately, there is currently no antiviral agent available for treatment of dengue. Dengue is usually self-limiting and treatment is mainly in the form of supportive care such as pain-killers, fever lowering medications, bed rest and fluid replacement.

2. What should I expect?

The initial high fever (febrile phase) associated with dengue may subside after 2 – 7 days of first symptom appearance however, this does not mean that one has fully recovered from dengue. In fact this signifies a normal progression into the ‘critical phase’ which lasts for 24 – 48 hrs, when patients are most susceptible to complications including shock, bleeding or organ impairment. It is important to never default a scheduled daily dengue monitoring or discharge against the doctor’s advice even if the fever has subsided. Having said that, most patients without complications will experience a rather mild and uneventful critical phase before progressing to the final ‘recovery phase’. During the recovery phase, patients will generally feel better (regain appetite and energy, reduced gastrointestinal discomfort), but some patients may experience a generalised itchy rash known as ‘convalescent rash’. I personally experienced convalescent rash over my body, arms and legs alongside swelling of my fingers and wrists which subsided gradually over the next few days. Always seek medical advice if you have any concerns regarding your condition.

3. Will I be hospitalised?

Some dengue patients who are stable and able to maintain adequate hydration can be managed on an outpatient basis with daily blood test monitoring. These patients will be provided with a dengue monitoring record as well as a homecare advice leaflet. These patients however, will need to seek immediate medical attention if they experience any warning signs (such as abdominal pain; persistent diarrhoea or vomiting; bleeding of nose or gums; blood in vomit, black tarry stools, drowsiness or confusion or irritability or pale, cold clammy skin, difficulty breathing).

Patients who are unable to maintain hydration, critically unwell or have other significant diseases will require admission.

 

Any advice for patients under home-care management?

  • Maintain adequate fluid intake (at least 8 glasses or 2 L), this can be in the form of plain water, barley water, oral rehydration salts (ORS), milk, fruit juices and isotonic drinks. Patients with diabetes however, should be cautious on the sugar content in processed fruit juice and isotonic drinks.
  • Ensure sufficient bed rest.
  • Apply mosquito repellent to avoid getting bitten and subsequent viral transmission through mosquitoes  to another person.
  • Clear any mosquito breeding sites in your home vicinity.
  • DO NOT take over-the-counter non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin or ibuprofen for fever and body aches.
  • Always check with your healthcare providers before consuming any traditional remedies or engaging in massages, acupuncture, ‘gua sha’ or cupping sessions.

 

Remember, timely and appropriate medical interventions can help save lives!

 

References:

  1. Pang J et al. (2017) Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patient : A matched case-control study. Scientific Reports 7, article 9872. https://www.nature.com/articles/srep39872
  2. Kassim FM et al. (2011) Use of dengue NS1 antigen for early diagnosis of dengue virus infection. Southeast Asian J Trop Med Public Health. 42(3):562-9. https://www.ncbi.nlm.nih.gov/pubmed/21706934
  3. Clinical Practice Guidelines: Management of dengue fever in adults. Third Ed. 2015. Ministry of Health, Malaysia. http://www.moh.gov.my/penerbitan/CPG/CPG%20Dengue%20Infection%20PDF%20Final.pdf

 

 

Hui Ling Lau
Hui Ling Lau

PhD, MPharm, RPh

A Doctor of Philosophy (PhD) in Pharmacy currently lecturing in Taylor's University.

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