“Dengue Fever" : Prevention is better than cure. Pakistan

The dengue fever outbreak in Pakistan has officially become an epidemic, reports the International News Network. Hundreds of people have died of the disease and more than 8000 people have been infected. Dengue fever is an infectious disease transmitted to humans through the bite of a mosquito carrying the virus. Characteristics of the disease include fever, severe headache, muscular and joint pains, and rash. The disease is non-fatal, reports The Nation.

Poor hygiene is the most common cause for the spread of the disease, but heavy rainfall is providing a breeding ground for the mosquitoes, Doctors advised that dengue fever affected patients should ensure the maximum use of boiled water, besides, using honey in normally hot water. The common use of fruit like oranges, guava, apple and Kalwanji and black pepper could also help prevent the dengue fever, especially in growing children.

This information is about Dengue fever for my friends and all the people around who are infected or not  because it is better to stop something bad happening than it is to deal with it after it has happened as we all know very well that prevention is better than cure. If you think that i am doing right please move it forward as it is an ongoing charity (Sadqa-e-Jaria).

Dengue Fever Treatment and Management

Dengue fever is usually a self-limited illness, and only supportive care is required. Acetaminophen may be used to treat patients with symptomatic fever. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided.

Patients with known or suspected dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after defervescence. Patients with a rising hematocrit level or falling platelet count should have intravascular volume deficits replaced. Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for continued hydration.

Patients who develop signs of dengue hemorrhagic fever warrant closer observation. Patients who develop signs of dehydration, such as tachycardia, prolonged capillary refill time, cool or mottled skin, diminished pulse amplitude, altered mental status, decreased urine output, rise in hematocrit levels, narrowed pulse pressure, or hypotension, require admission for intravenous fluid administration.

Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. If this fails to correct the deficit, the hematocrit value should be determined, and, if it is rising, limited clinical information suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One recent study has suggested that starch may be preferable because of hypersensitivity reactions to dextran.If the patient does not improve after this, blood loss should be considered. Patients with internal or gastrointestinal bleeding may require transfusion. Patients with coagulopathy may require fresh frozen plasma.

After patients with dehydration are stabilized, they usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.

Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. A recent case report demonstrated good improvement following intravenous anti-D globulin administration in two patients. The authors proposed that, similarly to nondengue forms of immune thrombocytopenic purpura, intravenous anti-D produces Fcγ receptor blockade to raise platelet counts.

Patients who are resuscitated from shock rapidly recover. Patients with dengue hemorrhagic fever or dengue shock syndrome may be discharged from the hospital when they meet the following criteria:
  • Afebrile for 24 hours without antipyretics
  • Good appetite, clinically improved condition
  • Adequate urine output
  • Stable hematocrit level
  • At least 48 hours since recovery from shock
  • Absence of respiratory distress
  • Platelet count greater than 50,000 cells/μL
For more details "Dengue Fever Treatment and Management"
                          WHO dengue fact sheet.

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