This story is from September 13, 2021

‘Dengue is disease of young but elderly too need care’

‘Dengue is disease of young but elderly too need care’
Dr Dipti Chand
Although mosquitoes are tiny little creatures, they can create a huge problem for humans as well as animals, as severe diseases are caused by them like dengue and malaria amongst others, resulting in extensive morbidity and mortality.
Recently an outbreak of dengue is being witnessed in the town. Dengue is a seasonal, viral infection presenting with headaches, muscle & joint pains, tiredness, rash that last for 4-7 days and need to be treated symptomatically with paracetamol and plenty of oral fluids.
Ibuprofen and Aspirin containing drugs are not to be given. There are 4 distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4).
Infection with any of the four serotypes for the first time is believed to elicit lifelong immunity against that serotype, but confers partial or transient immunity against other serotypes. Second infection by other serotypes result in higher viral burden and contribute to increased disease severity. Usually it is a disease of young, but the disease in elderly needs special care. Secondary infections have been associated with large, clinical outbreaks of dengue haemorhagic fever and dengue shock syndrome.
Warning signs of severe dengue are persistent vomiting, severe abdominal pain, bleeding from any site, rapid breathing, restlessness, confusion and irritability. These patients may land in multi organ failure, and hence should immediately seek medical attention. They may need hospitalisation for effective fluid management, and organ support in intensive care units. Platelets need to be watched after 4 days and transfusion is indicated only if the patient starts bleeding.
Dengue is diagnosed by serological tests. The NS1 Antigen being positive in the initial days followed by IgM antibodies 1 week after infection, that are highest at 2 to 4 weeks after the onset of illness. They remain detectable for about 3 months. The presence of IgM antibody is indicative of a recent dengue viral infection. IgG antibody levels take longer to develop than IgM, but IgG remain in the body for years. The presence of IgG is indicative of a past infection. Platelets need to monitored after 4 days of fever along with the liver and kidney functions.

Dengue viruses (DENV) are spread to humans through the bite of an infected female Aedes species (Ae. aegypti or Ae. albopictus) mosquito. The mosquito is 4-7mm in size, dark in colour and has white markings on legs and lyre markings on thorax. The Aedes Aegypti mosquito cannot stay alive during the winter season and thus only lays eggs in the summers or monsoons. They usually lay their eggs near households due to the proximity to potted plants and still water.The dengue mosquito mostly bites its victims during the day. The mosquito is most active during the daytime, approximately two hours after sunrise and several hours before sunset. These mosquitoes usually rest in cool and shaded areas, like closets and under the beds. Though they usually bite during the day, there are chances that they may bite humans during the night as well. They usually target areas such as ankles and elbows.
Mosquitoes become infected from people who are viremic with DENV. This can be someone who has a symptomatic dengue infection, someone who is yet to have a symptomatic infection (they are pre-symptomatic), but also people who show no signs of illness as well (they are asymptomatic). Human-to-mosquito transmission can occur up to 2 days before someone shows symptoms of the illness, or up to 2 days after the fever has resolved.
The author is Associate Professor in Medicine, Government Medical College, Nagpur. She is also Secretary, Association of Physicians of India - Vidarbha Chapter.
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