Monday, December 6, 2010

Dengue in India - wake up

Well...well...well.......I was little busy with my ICU rotation this month....and in the middle of it...I had to rush to India as my grandmother was taken ill to the hospital with Dengue. I should say...that people in US & Europe should be praising their government for giving them an extraordinary health system with excellent doctors and nurses. Anyway...... I wanted to write a lilttle about Dengue (this is almost non existent in Europe...and present along the mid south and south west of US)

Dengue, caused by the bite of Aedes mosquito (for some reason the worse bites are during the day) comes in three forms - 1. Dengue fever (most common type - mild symptoms lasting a week or so without any complications)  2. Dengue Hemorrhagic fever - complicated by thrombocytopenia and bleeding from mucosa.
3. Dengue shock syndrome - characterised by circulatory shock (mortality is 6 - 30% ).

A quick pathophysiology - The main pathophysiology is capillary leak and thrombocytopenia...both occuring after the fever has abated..and lasting for 2-3 days.So the critical period is those 2-3 days after fever and rigors settle down. Because of the capillary leak....there will be an increase in hematocrit(a >20% increase from baseline is significant). If supportive measures are not taken...this will proceed to circulatory shock needing careful fluid replacement.....as excessive replacement will worsen capillary leak and enhance third spacing(pleural, ascitic & pericardial)
The management is entirely supportive. Most can be managed as outpatients provided they check their platelet & hematocrit after their fever stops. Patients with thrombocytopenia need to be monitored in hospital for need for transfusions and prevention of complications including coagulopathy,bleeding into internal organs and circulatory shock. One other complication which has been reported to be present in around 40% of dengue patients is hyponatremia. The reason for this has been postulated to be hypovolemia with some SIADH. replacement with 0.9% NS would help correct it.

There have been many cases of Dengue so far...and still no action has been taken to get rid of the Aedes. Common India.......act quick.

16 comments:

  1. what action can government take to get rid of ALL Aedes in the country

    ReplyDelete
  2. There are a few things they can do ...apart from improving the awarness abt Dengue & its prevention among the public...
    1.Larviciding - these are wetlands & breeding sites. constant monitoring and controlling them.
    2.Source reduction - Reducing or removing larval habitat by recycling, waste disposal on a permanent basis(not dumping them somewhere ..where AEDES can have a party!)
    3.Wetland restoration
    4. Adulticiding - This includes space spraying..
    5. Constant Surveillance
    6. Developing a Vaccine ...if possible. Have a look at this article(http://medind.nic.in/maa/t08/i2/maat08i2p161.pdf) about vaccine development. While the major need for the vaccine is in countries like India, thailand etc.....the labs working on the vaccines are all in US!!.
    Having said these...I have had people from my state infectious disease dept visit my house twice ..to gather data. A lot of clever planning and resources are needed(luckily INDIA has both...its just a matter of application!)

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