Dengue cases on rise: What’s the Denv-2 strain all about? Why hydration is the key to managing the infection

Since dengue can be controlled with adequate hydration, early diagnosis is necessary. Take the antigen, antibody, CBC and LFT tests. Rush to the hospital if your platelet levels have fallen to 50,000 with bleeding and low blood pressure for prompt management of parameters, says Dr Suranjit Chatterjee, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospital, Delhi

The dengue virus, which is spread by the mosquito, has a two to 14-day incubation period (Source: Getty Images/Thinkstock)

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By now, we are being told that the Denv-2 strain of the dengue is in circulation and although it is a more severe strain, a little bit of vigilance is expected to prevent complications and see us through the season. Its symptoms are similar to all other variants of dengue with patients more prone to shock and haemorrhage if not diagnosed and addressed in time. Although the numbers of those affected are not that much yet, this year I am seeing cases of platelets dropping significantly.

SIGNS AND SYMPTOMS

So let’s understand the signs and symptoms. Usually patients have a sudden onset of high grade fever which persists, nausea, pain in the eye socket, extreme fatigue, body ache, abdominal pain and rashes. At this stage platelets may not have fallen that much and there could be a dip in white blood cells. As the fever goes on undiagnosed, it could be accompanied by liver pain, vomitting, mucosal bleeding, reduced urination and low blood pressure. Laboratory tests show an increase in red blood cells and a rapid decrease in platelets. In severe haemorrhagic fever, the patient has severe plasma leakage leading to a haemorrhagic shock, fluid retention in the pleural and abdominal cavities and severe breathing difficulty. This could lead to severe bleeding and organ failure.

WHAT TESTS SHOULD YOU GO FOR?

The dengue virus, which is spread by the mosquito, has a two to 14-day incubation period but usually manifests signs and symptoms between four and seven days. Usually, the patient feels better after the fever subsides in four to five days. And if during that period, the patient has not kept himself well-hydrated, complications could arise after Day 4. Dehydration is the enemy and if you want to avoid hospitalisation, drink between three to five litres of water a day. Let me add a caveat that those with heart, liver and kidney ailments, who may not be allowed so much water, have to be guided by their medical practitioner on use of water.

Since dengue can be controlled with adequate hydration, early diagnosis is necessary. And if you get high grade fever at this time of the year, take the dengue NS1 antigen test, which detects the non-structural protein NS1 of the dengue virus that is secreted into the blood during infection. It can be done within the first 48 hours and give you a quick diagnosis in the initial days. Then take the IgM antibody test on the fourth or fifth day. That’s because as the immune system fights the infection, IgM antibodies against the virus are detectable only on the fourth day after onset of symptoms and are detectable for approximately 12 weeks. Simultaneously, you should get a complete blood count (CBC) done, which may have to be repeated on alternate days or even everyday to check for platelet levels. Also do a liver function test (LFT) as markers are deranged during dengue. One of the most important markers is the PCV (packed cell volume), which is a measure of blood viscosity. Once the blood viscosity rises, platelets dip. This indicates an increase in red blood cells or dehydration. While people talk about platelet dips, haemo concentration is critical in understanding the severity of infection. This is often indicative of plasma in the blood leaking that can cause fluid accumulation in the abdomen and lungs. This is the result of severe dehydration and at this stage you need intravenous fluids to increase the blood volume and prevent the body from going into shock.

TREATMENT PROTOCOL

There is no specific treatment for dengue. All you have got to do is keep the fever down with paracetamol every six to eight hours. Your body ache may be troubling you but taking painkillers or non-steroidal anti-inflammatory drugs (NSAIDS) can bring down platelets further and cause breathing difficulties. Stay away from antibiotics as they do not work on the virus. Rush to the hospital if your platelet levels have fallen to 50,000/cu mm with bleeding and low blood pressure. You need medical management of parameters under the doctor’s supervision. A platelet transfusion happens only when platelets fall really low to less than 20,000/cu mm with bleeding. Those who have a count between 20,000 and 40,000/cu mm are at moderate risk and require transfusion only if they have some haemorrhagic tendencies and other complications caused by underlying conditions.