Dengue Haemorrhagic Fever and Shock Syndrome on the rise

Rawalpindi

The incidence of Dengue Shock Syndrome and Dengue Hemorrhagic Fever has been recording a great increase this year among patients of dengue fever being tested positive and it is alarming that nearly 30 per cent of all patients tested positive for dengue fever here at the three teaching hospitals in town suffered either from DHF or DSS.

Data collected by ‘The News’ reveals that till November 1 this year, the allied hospitals in town received a total of 2,601 confirmed patients of dengue fever of which as many as 782 suffered DHF, while 51 contracted DSS. The on-going severe outbreak of dengue fever has claimed at least seven lives at the allied hospitals this year.

The cases of DHF are differentiated from dengue fever on the basis of history of bleeding from gum or skin while the mortality rate of DSS is much higher as compared to dengue fever. The health experts believe that rare complications of dengue fever, DHF and DSS are more fatal forms of the infection. The DHF occurs usually by day 3-5 of the fever.

Studies reveal that bleeding during DHF can occur from the gums, nose, intestine, or under the skin as bruises or spots of blood especially under a tourniquet. The liver is often enlarged. Patients can have rapid onset of marked drowsiness, lethargy or restlessness or the presence of shock as manifested by a rapid and weak pulse, low blood pressure and cold clammy skin. Such patients should be immediately referred to a good hospital for further management.

DHF shock can be a mortal illness and requires rapid and careful in-hospital management with assiduous correction and replacement of fluid, electrolytes, plasma and sometimes, fresh blood/platelets transfusions. Mortality from DHF ranges from 5-30% (in untreated native populations) and the highest risk is to infants under one year.

According to a recent survey done by medicine and emergency department of PIMS, one in every three patients reaching hospitals with fever is suffering from dengue fever and of all patients of dengue fever, nearly 30 per cent patients goes into dengue shock or hemorrhagic fever.

In allied hospitals including Holy Family Hospital, Benazir Bhutto Hospital and District Headquarters Hospital, special measures are being taken to treat dengue fever and a large number of doctors have been deputed to run the dengue screening counters, dengue clinics and especially equipped dengue wards and intensive care units.

Intensive Care Consultant at HFH Dr. Muhammad Haroon expressed this to ‘The News’ saying that dengue shock can be prevented by increasing fluid intake from first day of diagnosis. The main reason for deterioration of dengue patient is dehydration, he said.

He added that every patient should increase fluid intake up to three to four litres per day. The next most important thing is monitoring of blood counts. White cells and platelets are decreased in over 87 per cent of dengue positive patients but it should be emphasized that the management of dengue is changed over the last four years by infectious disease society of USA, India & association of critical care medicine, said Dr. Haroon.

He said that all dengue fever patients should get blood counts checked every day for one week and on alternate day for next week and on every third day for the next week, the third week.

Dr. Haroon said early increase in intake of fluids can prevent dengue shock. Studies say that once white blood counts are less than 3000, patient should be admitted in isolation and prophylactic antibiotics should be given to such patients to prevent sepsis. Even the medicines to raise white cell counts are suggested for such patients, he said.

He added that the other life threatening complication is bleeding that is usually treated by early red blood transfusions. There is no role of platelets transfusion till platelets are less than 15000/ul or there is disseminated intravascular coagulation, he said.

To a query, he said warning signs of DHF and DSS are low blood pressure, excessive sleep, fever not responding to treatment, jaundice or yellow discoloration of skin, blackout dizziness, raised pulse up to 130 beats per minute, palpitations, decrease urination, abdominal pain, persistent vomiting, swelling of skin and edema, blood in stools or urine, shortness of breath, cold hands and feet and drowsiness. The new guidelines should be implemented in all hospitals and practiced by health providers to avoid incidence of DHF and DSS, he said.

He said the DHF is a severe form of dengue fever and is caused by two or more sequential infections with different dengue serotypes. Young adults and children are more often involved with DHF-DSS. Effective intensive care and monitoring can prevent dengue shock in all dengue patients, he said.

He added that Sodium levels are low in dengue patients and all patients should increase salt and water intake along with monitoring of sodium levels. Blood sugars are usually low and glucose is recommended for such patients. Acidosis or acidic blood can be treated with fluids, he explained.

He said another aspect is complications of treatment. Most common is fluid overload, hypervolemia, in heart patients, kidney patients or small children. These patients need intensive care and can deteriorate very rapidly, said Dr. Haroon.