In the current pandemic situation, one more dreaded disease Dengue is raising serious concerns, as we continue to combat COVID-19. The prevalence of dengue has grown dramatically in recent decades. The disease is endemic in more than 100 countries all over the world. A rapid rise in urban population is bringing ever greater number of people into contact with the vector especially in areas that are favorable for mosquito breeding like household water storage is common & where solid waste disposable services are inadequate. The incidence of dengue is seen in all age groups. The classical presentation is usually seen in older children, adolescents & adults, but the severity is more seen in infantile age that is children who are less than 1 year old and adolescents where they have more serious and complicated dengue.
Dengue is a mosquito borne Viral infection which causes mild to very severe disease. It is transmitted mainly by Aedes Aegypti mosquito which also causes other infections like Chikungunya, Yellow Fever. Dengue is caused by 4 related viruses as Dengue Virus 1, 2, 3 & 4 for this reason, a person can be infected with Dengue Virus as many as 4 times.
Dengue causes spectrum of disease from mild infection to severe illness. Dengue fever consists of 3 phases. Febrile Phase usually varies from 1 to 3 days and presents with high grade fever, retro orbital pain, generalized weakness, muscle & joint pains. The virus multiplies in blood during The Critical Phase, that lasts for 4 to 6 days and presents with hypotension, shock, bleeding manifestation such as gum bleeding, vomiting of blood and passage of black, tarry stools. There may be organ impairment and even platelet count may decline during this phase. Recovery Phase which follows, is 7 to 10 days of onset of fever and will see a rising trend of platelets.
Life threading Dengue often requires hospital care. However, mild symptoms of Dengue can be confused with other viral illness that causes fever, headache, rash, body pains. Generally, symptoms of Dengue last for 2 to 7 days and most of the kids will recover after about 1 week.
Occasionally Dengue develops into a potentially lethal complication called Severe Dengue. Severe Dengue develops in 1 in 20 people who got Dengue infection. It can present as shock, bleeding in internal organ or even death. Infants and pregnant woman are at risk of severe dengue. Warning signs of severe dengue are abdominal pain or tenderness, three or more vomiting in 24 hours, blood vomiting, bleeding from nose and gums or in urine and stool, child being restless, irritable etc.
Unusual presentation of patients with severe organ involvement such as liver, kidneys, brain or heart associated with dengue infection is termed as Expanded Dengue. These unusual manifestations may be due to co-infections, co-morbidities or complications of prolonged shock. The consequences of Expanded Dengue on these organs can lead to multiple complications. Expanded Dengue in Central Nervous System can lead to encephalitis, seizure or intracranial bleed. Gastrointestinal involvement can result in inflammation of liver, gall bladder, bile duct or pancreas. Renal involvement may cause acute renal failure, damage of kidney’s small blood vessels or kidney tubule cells. It can lead to complications of the heart like irregular or abnormal heart beat, impact heart’s blood pumping ability, heart muscle inflammation or even extra fluid accumulation around the heart. Respiratory involvement presents as pulmonary edema, Acute Respiratory Distress Syndrome and accumulation of fluids in the lung etc. Sometimes Expanded Dengue can also lead to complications in the eye and rarely visual impairment may also be seen.
Dengue is severe in children and adolescents and its essential to follow some preventive measures to safeguard them. Indoors should be made safe and clean to prevent mosquito breeding. Need to keep the corners and under surfaces of furniture clean. Should avoid standing water inside house and spray mosquito repellents in the garden area. Strong immunity must be built in kids by ensuring immune boosters like curd, fruits, garlic, turmeric and dry fruits in regular diet. Need to ensure that children wear full sleeved clothes and are protected from mosquito bites, especially when they go out to play. Usage of repellents enables protection from mosquito bites.
For an ailment like Dengue, which can turn fatal, prevention will always be better than cure and its essential to know when to visit the doctor. Symptoms like fever, rashes over body, headache, vomiting or body pains are all signs of being cautious and a visit to the doctor can always be beneficial.
Dr. Kanchan S Channawar
Consultant Pediatrician and Pediatric Intensivist,
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