We
have seen a recent rise in the cases of Dengue Fever and along with that Dengue
Haemorrhagic fever (DHF), or Bad Dengue. But most of the times we tell people
about DHF or “Bad Dengue”, but they have no idea what it really is, what is
happening and what is being done.
Some
people (quacks, charlatan, frauds) claiming to have the “cure” for dengue fever
and DHF are using these poor understanding and misconceptions, to prove a point
and make money. So the best way to not getting wool in your eyes is to know
what actually happens in DHF or Bad dengue.
DHF or Bad Dengue
Dengue
Haemorrhagic Fever (DHF) or bad dengue is one of the paths a person who has
been bitten by the mosquito carrying the dengue virus can take. And this
percentage is only about 5-8% of those who are symptomatic. Usually the
symptoms are milder than those with just dengue fever (DF). They will have a
fever (>100 F), aches and pains, with maybe abdominal pain. These symptoms
will last for about 4-5 days the least or 7-8 days maximum. Then there will be
a sudden crash in the fever.
But
you are not out of the woods yet. This fever free period needs to be closely
monitored because; classically this is the period when DHF manifests itself.
What happens in Bad dengue?
What
differs from Dengue fever from DHF is, something that we call plasma leaking.
So
just imagine your blood to be a soup with a certain level of thickness. Usually
it is just thick enough to be runny so that it can go all over the place
through the smallest of blood capillaries. It is thick because of “the water
component”, the plasma, and “the vegetable component”, the red blood cells, the
white cells, and the platelets. (BTW, I am using a soup metaphor!)
So
when you get the dengue virus into your body, the body makes small proteins
called antibodies. These are like “the special forces” of our body. But
sometimes, our body can do stupid things and the antibodies can be defectively
activated that causes it to fight against our own body. This leads to create
weaknesses in the floor of the blood vessels.
The
“water part” of the blood can thus “leak” through the floor, out of the vessels
into anyplace that can retain water. This includes the thin lining outside the
lungs, and the abdominal cavity. So as the “water part” starts to leak, the
“vegetable part” (the blood cells and platelets) become relatively more. This
increases the thickness of blood.
This
increase in thickness is bad because, that means the blood cannot be effective
enough to transport oxygen and energy to vital organs like the liver, kidneys,
the heart and the brain.
These
deficits in oxygen and energy can lead to problems in the organs mentioned
above.
How long does it last?
Well
it usually lasts never for more than 48 hours. Usually it is less than this.
But the doctors calculate for 48 hours of leakage phase, to be on the safe
side.
Does having high liver enzymes
(SGOT/SGPT) mean that I have liver failure in dengue?
Well,
not always. There have been patients with high liver enzymes, who did not
develop DHF or leaking. Some who have a high viral load in the blood can get
elevated liver enzymes even in the absence of leaking or shock. This is
transient, and it will come down automatically without the need of much
intervention.
If it is a very dangerous, why am I being
told to take fluids “as ordered”, to measure urine, and being pricked to do
blood tests regularly and not given any medication? Isn’t there any medicine?
The
level of “water” component in the blood is reflected through the urine output
effectively.
The
fluids being given are calculated according to the weight and divided with the
saline that is being given via the IV cannula. As I said earlier, there is a
fluid component that is “leaking” out of the blood vessels; you have to replace
that correctly in order to maintain good functioning of the organs.
The
full blood count (Which gives indices of white cells, platelets, and the
thickness of the blood-PCV) is a relatively direct measurement of the thickness
of the blood. Also a dropping platelet count means that the virus actions
and/or virus-body reactions are still going on. A rising platelet count will
show that the body is recuperating. It will happen naturally, not needing any
external influences. (There have been several children and adults with a platelet
count of zero (0) who recovered without incident.)
There
is no “scientifically proven” cure for dengue. But there are people who claim
that they have found cures. They are welcome to do their research and show that
it works better than the current management strategies, and are not due to mere
chance.
Is dengue a lethal illness?
We
as a country are better in treating dengue than we did, 5 years back. Yes,
there are still dengue deaths and they are heart breaking. But we can do
better.
“Dengue is a disease
with a predictable course which need not be lethal, if proper treatment is
taken from the start.”
Dr. Dinusha Saminda Sirisena (MBBS),
Medical Officer,
Centre for Clinical Management of Dengue &
Dengue Haemorrhagic Fever
District General Hospital, Negombo,
Sri Lanka.
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