Health World News and Features

Just like other tropical countries all over the world, the Philippines often experiences a rise in the incidence of dengue during the rainy season. Dengue fever is a disease caused by a virus that is transmitted by mosquitoes known as Aedes aegypti. Because of the damp weather, dengue is often mistaken for a simple case of influenza and is often treated as such. However, dengue can be fatal if not properly treated.

Dengue is an acute fever caused by a virus, and can occur in two forms, namely: Dengue Fever and Dengue Haemorrhagic Fever. Dengue fever is marked by sudden onset of high fever, severe headache (mostly in the forehead), pain behind the eyes (which worsens with eye movement), muscle aches and joint pains, nausea or vomiting.

Dengue Haemorrhagic fever (DHF) is a more severe form, in which bleeding and sometimes shock occurs – leading to death. It is most serious in children, Symptoms of bleeding usually occur after 3-5 days of fever.

Symptoms of DHF are similar to dengue fever with the inclusion of any one of the following: severe ad continuous pain in abdomen; bleeding from the nose, mouth and gums or skin bruising; frequent vomiting with or without blood; black stools, like coal tar; excessive thirst (dry mouth); pale, cold skin; and restlessness, or sleepiness.

Typically dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching I the legs and joints occurs during the first hours of illness. The body temperature rises quickly as high as 104°F (40°C). The high fever can continue for five to six days (103-105°F or 39-40°C).

Fever and other signs of dengue usually last for 2 to 4 days, followed by rapid drop in temperature (defervescene) with profuse sweating, which heralds a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows.

There is a relative low heart rate (bradcardia) and low blood pressure (hypotension). The eyes become reddened. A characteristic rash appears simultaneously with the fever, spreading from the extremities to cover the entire body except the face. The palms and soles may become bright red and swollen.

The glands (lymph nodes) in the neck and groin are also often swollen. The patient often experiences much discomfort and feels very weak even several weeks after the illness (asthenia).

There is currently no specific medicine to treat dengue. For typical taking care of the symptoms (symptomatic). Proper and early treatment can relieve the symptoms and prevent complications, even death. Complete bed rest is important.

Acetaminophen/paracetamol, NSAIDs except aspirin, coxibs such etoricoxib, and codeine may be given to relieve the severe headache and the joint and muscle pain (myalgia). However, traditional NSAIDs (like iburprofen, mefenamic acid, naproxen, diclofenac, and the like) have been associated with gastrointestinal irritation and problems such as perforations, ulcers, and bleeding, particularly with prolonged use.

Aspirin should be NOT be given to patients with dengue fever, since it is known to increase the bleeding tendency and can also cause stomach pain and irritation. If dengue is suspected, it is best to take the patient to a doctor or to the hospital immediately. Fluids (water or juice) should be given to the patient often, even while bringing him/her to the hospital.

Dengue ca spread rapidly and can result in the loss of many lives, particularly during an epidemic. Most susceptible to the disease are children and persons with low immunity levels. However, with early diagnosis and proper treatment, complications and death can be avoided.

Prevention is the key in stopping the occurrence and spread of this deadly disease. Homes, schools, and office buildings should be kept clean. It is important to take control measures to eliminate the mosquitoes and their breeding places. Efforts should be intensified before the transmission season (during and after rainy season) and at the time of the epidemic.

Since the dengue mosquito is known to bite during the daytime, it is important to protect oneself fro mosquito bites by wearing clothing that covers the arms and legs (including the feet); using mosquito repellants, insecticide and electric vapor mats even during the day; and using mosquito nets for babies and the elderly during daytime naps.

To prevent the multiplication of dengue mosquitoes, it is advisable to drain all stagnant water from tanks, barrels, drums and buckets, etc.; remove water in coolers when not in use; remove from the house all objects, e.g. plant sauces, etc. which have water collected in them; drain water for refrigerator drip pans every other day; water storage containers should be kept covered at all times; and discard solid waste and objects where water collects, e.g. bottles, tin cans, old car tyres, etc. for schools and office buildings, it would be advisable to have the premises treated and sprayed with insecticide before, during, and after the rainy season.

For comments and insights, please write to Pain Management Information Agency (PMIA) at fax 894-1980 or e-mail at paincare@pmiagroup.com. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.

August 12, 2005 Philippine Star