Dengue alert: What to watch out for to avoid severe infection

As the monsoon advances and moisture becomes the ideal condition for mosquitoes to breed, dengue outbreaks are overwhelming cities in Karnataka, Kerala and Maharashtra.

But we can manage this disease if we are vigilant. Dengue fever presents itself with a sudden onset of fever, severe headache, pain behind the eyes, muscle and joint pains, nausea, vomitting, swollen glands and a rash.

These usually appear 4-10 days after the mosquito bite and can last for 2-10 days. Early diagnosis is necessary because it can quickly transform into severe dengue, also known as dengue hemorrhagic fever or dengue shock syndrome, when the number of clot-forming cells (platelets) in your bloodstream drops and your blood vessels are damaged enough to be leaky. This can lead to shock, internal bleeding and organ failure.

WHEN TO TEST FOR DENGUE?
If you have the symptoms listed above, go for the dengue NS1 antigen test, which measures the non-structural protein of the virus, or PCR tests. Then take the IgM antibody test on the fourth or fifth day when you are most likely to pick it up. Get a complete blood count (CBC) done and if diagnosed, repeat it on alternate days to check for platelet levels. One of the most important markers is the PCV (packed cell volume), which is a measure of blood viscosity. This indicates an increase in red blood cells or dehydration.

WHY HYDRATION IS IMPORTANT?
Usually, the patient feels better after the fever subsides in four to five days. And if the patient has not kept themselves well-hydrated to compensate for fluid loss due to fever and vomitting, complications could arise after Day 4. Have between three to five litres of water or oral rehydration solutions, coconut water and clear soups. Severe dengue can lead to plasma leakage and intravenous (IV) fluid therapy may be required in a hospital setting.

HOW TO PREVENT SEVERE DENGUE
Regular blood tests to monitor platelet levels and importantly hematocrit levels can manage complications. Hematocrit level is simply the percentage of red cells in your blood. In dengue, an increased hematocrit is a clue for plasma leakage, whereas a decreased hematocrit is a clue for bleeding. If platelet levels drop significantly, medical intervention may be necessary.

The hematocrit level should be monitored every 24 hours to facilitate early recognition of dengue hemorrhagic fever and every 3-4 hours in severe cases of dengue hemorrhagic fever.

Pain relievers and fever reducers like paracetamol can help manage the symptoms. Avoid non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, as they can increase the risk of bleeding, which is a serious complication of dengue.

IS THERE A VACCINE?
In some regions, a dengue vaccine (Dengvaxia) is available and recommended for individuals who have been infected previously. In India, trials are ongoing but finding one vaccine to tackle four prevalent virus strains is a challenge.