Dengue Fever

Introduction

Dengue (DENG-gey) fever is a mosquito-borne disease that occurs in tropical and subtropical areas of the world. Over half of WHO member states representing a total of 2000 million are affected by dengue. The dengue infection may be asymptomatic or symptomatic. The symptomatic varieties are classical dengue fever, dengue haemorrhagic fever with shock or dengue haemorrhagic fever without shock.

References: www.mayoclinic.org

Causes

Dengue fever is an infectious tropical disease caused by the dengue virus. Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae and exists in four serotypes, namely DEN 1, DEN2, DEN 3 and DEN 4. Infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. Dengue is not transmitted directly from person-to-person. Aedes mosquitoes are the carrier of dengue viruses. This mosquito can be easily distinguished as it is larger in size and have black and white stripes on its body, so it is sometimes called tiger mosquitoes . They usually bite during the day time. They breed in artificial accumulation of fresh water, such as broken bottles and tins, flower pots, coconut shell, tree holes etc. Dengue fever is caused by any one of four dengue viruses spread by Aedes mosquitoes that thrive in and near human lodgings. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito. When the infected mosquito then bites another person, the virus enters that person's bloodstream. Possible factors for increase in the incidence of Dengue fever are unplanned urban overpopulation leading to inadequate housing and public health systems (water, sewerage and waste management, poor vector control, e.g., stagnant pools of water for mosquito breeding, climate change and viral evolution (increased virus transmission has been linked to El Nino conditions) and increased international travel to endemic areas.

References: www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/msds50e-eng.php www.denguevirusnet.com/history-of-dengue.html www.mayoclinic.org

Symptoms

Usually the symptoms begin four to 10 days after bitten by an infected mosquito. Mild dengue fever causes high fever, rash, and muscle and joint pain. A severe form of dengue fever, also called dengue hemorrhagic fever, can cause severe bleeding, a sudden drop in blood pressure (shock) and death.

The classical symptoms of dengue are sudden onset of fever with chills, intense headache (retro-orbital), severe muscle and backbone pain, vomiting, tastelessness, weakness, dry tongue, constipation, reddish eye, oedoma on face and a characteristic skin rash. The fever is raised upto 102 to 105 degree, lasts for 5-7 days after which the recovery is usually complete.

Due to severe muscle and joint pain associated with this infection, the fever due to this diseases    is commonly known as “Breakbone” fever.

Dengue haemorrhagic fever is the severe form of Dengue fever with any one of the following:

  •  Severe and continuous pain 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
  • Restlessness or sleepiness

Dengue shock syndrome is defined as dengue haemorrhagic fever with weak, rapid pulse, narrow pulse pressure (less than 20 mm of Hg), cold clammy skin and restlessness.

The clinical manifestations are acute onset of continuous fever lasting for 2-7 days, liver enlargement and tenderness, nausea and vomiting, abdominal pain, severe body pain     especially in backbone and joints and bleeding under skin, from nose, gum,  blood in vomitus  and or in stool.

References: 
www.webmd.com
www.medicinenet.com
www.emedicinehealth.com
www.denguevirusnet.com
www.homeopathy.com.pk

Guidelines for Homeopathic practitioners for clinical management of Dengue fever, Central Council for Research in Homeopathy, New Delhi,  2014

 

Diagonosis

Diagnosing dengue fever can be difficult, because its signs and symptoms can be easily confused with those of other diseases such as malaria, leptospirosis and typhoid fever.

The diagnosis of dengue is usually based on clinical manifestation. The classic picture is high fever with no localising source of infection, a petechial rash with low platelets and relative leucopenia (low white blood cell count).

If one has persistent fever for more that 2 days then one should go for a complete blood count (CBC). If the platelet count and WBC count are below than their usual range, one should go for Dengue Antigen test.

Even when the definitive diagnosis has not been made yet, the following three essential laboratory tests may help in the evaluation of the real clinical condition  of the patient and its early supportive management.

Total White Blood Cell  Count: In case of dengue, this test will reveal leukopenia. The presence of leukocytosis and neutrophilia excludes the possibility of dengue and bacterial infections (leptospirosis, meningoencephalitis, septicaemia, pyelonephritis etc.) must be considered.

Thrombocytopenia (less than 100.000 per mm3): Total platelets count must be obtained in every patient with symptoms suggestive of dengue for three or more days of presentation. Leptospirosis, measles, rubella, meningococcemia and septicaemia may also course with thrombocytopenia.

Hematocrit (micro-hematocrit): According to the definition of DHF, it’s necessary the presence of hemoconcentration (hematocrit elevated by more than 20%); when it’s not possible to know the previous value of hematocrit, we must regard results more than 45% as significantly elevated  .

References:
www.mayoclinic.org
www.delhihomeo.com
www.denguevirusnet.com

Complications

The fever lasts for 5-7 days after which the recovery is usually complete. The chance of fatality is very low. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

If severe, dengue fever can damage the lungs, liver or heart. Blood pressure can drop to dangerous levels, causing shock and, in some cases, death.

References
www.medicinenet.com
www.emedicinehealth.com

Management

The homoeopathic intervention  on dengue fever are preventive for unaffected/high risk population (relatives, neighbours of diagnosed patient) as well as curative for persons already suffering with dengue fever like symptoms.

Dr. William Boericke's "Pocket Manual of Homeopathic Materia Medica and Repertory" whose preface was written by Dr. William Boericke himself in San Francisco in June 1927 mentions of Dengue Fever. On page 924 of this pocket manual, Dr. William Boericke has listed twelve (12) medicines for Dengue Fever, which clearly indicates that this type of fever was known to homeopathic doctors even in 1927. The medicines he has listed are Aconitum Napellus, Arsenicum Album, Belladonna, Bryonia Alba, Cantharis, Cinchona Officinalis, Eupatorium Perfoliatum, Gelsemium, Ipecacuanha, Nux Vomica, Rhus Toxicodendron and Rhus Venenata.  Medicines are selected based on the symptoms as per the Homeopathic concepts.

These remedies have a potential to reduce the intensity of fever, headache, body ache, weakness, loss of appetite, nausea and other associated symptoms and, also reduce the probability of developing shock, haemorrhage and other complications. These remedies are safe and can be given to any age group and even to the pregnant women without any side effects, but it is always advised  to take medicine in consultation with qualified physician.

Those who are able to drink adequate fluids and are passing urine can be managed at home with daily follow up and oral rehydration therapy. Those who have other health problems or who cannot manage regular follow up should be cared in hospital. Those with severe dengue fever should be provided care in an area where there is access to an intensive care unit.

As per the principles of homeopathy, a genus epidemicus (a drug capable of prevention of a disease) can be identified for the sporadic and epidemic situations. The medicine, which is most frequently indicated and has potential of providing the quick and favourable response to the patient, shall be the genus epidemicus for that epidemic.

Drugs commonly found indicated as Genus epidemicus in the past is Eupatorium perfoliatum.

Dose:  200 potency taken twice daily for three days as prophylactic.

Preventive measures are very important in epidemics. Impart knowledge about the common symptoms; the virus and the vector are also important for effective control and management of epidemics. Measures to reduce vector breeding and safeguards for preventing mosquito bites are the best practices in preventing Dengue.

Personal prophylactic measures:

  • Use mosquito repellent creams, liquids, coils, mats, etc.
  • Wear full sleeve shirts and full pants with socks
  • Use bed nets for sleeping infants and young children to prevent mosquito bite

Environmental management & source reduction methods:

  • Identify & eliminate mosquito breeding sources
  • Prevent collection of water on roof tops, porticos and sunshades
  • Properly cover stored water
  • Frequently change water in water pots, flower vases, water coolers, etc.
  • Waste must be disposed properly and should not be allowed to collect

Biological & Chemical measures to  control the  mosquitoes breeding

  • Use larvivorous fishes in ornamental tanks, fountains, etc.
  • Use biocides or chemical larvicides for control of mosquitoes breeding
  • Aerosol space spray
  • Health awareness programmes

To prevent the infection of dengue virus, social awareness and control of mosquitoes is very important. The environment should be clean, water tanks and containers should be covered and mosquito nets should be used. If there is any fever, immediately consult a qualified doctor, if required get hospitalized either in a clinic or hospital for proper observation and treatment.

References: 
www.medicinenet.com
www.emedicinehealth.com
www.delhihomeo.com

Guidelines for Homeopathic practitioners for clinical management of Dengue fever, Central Council for Research in Homeopathy, New Delhi,  2014

The Central Council for Research in Homeopathy has published the Guidelines for Homeopathic practitioners for clinical management of Dengue Fever, which may be seen at www.ccrhdengueinfo.org/guidelines.pdf

 

  • PUBLISHED DATE : Sep 24, 2015
  • PUBLISHED BY : NHP CC DC
  • CREATED / VALIDATED BY : NHP Admin
  • LAST UPDATED ON : Feb 13, 2016

Discussion

Write your comments

This question is for preventing automated spam submissions