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BY JESSICA SEGOVIA-YAP, MD
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Saturdsy, August 19, 2017
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IT’S THE rainy season once again. And with the rains come different illnesses like flu, diarrhea, leptospirosis and the one that we are all scared of – dengue fever.
Although dengue fever has become an all-year illness, cases tend to rise during the rainy season. This is thought to be due to the accumulation of stagnant water brought about by the rain that becomes breeding places of mosquitoes, the vector of the disease.
The Department of Health has continually issued warnings and reminders on how to prevent as well as detect the illness early so that proper and adequate medical management can be instituted.
Among the signs and symptoms to be watched out for is fever of two to five days duration accompanied by any two of the following: headache, myalgia or body malaise, joint pains, loss of appetite, nausea and/or vomiting, diarrhea, and flushed skin or rashes for early dengue.
Parents are strongly advised to seek consultation or have initial laboratory work up done such as CBC, platelet and dengue screening tests like NS1 Antigen and Dengue IgM.
But the triad of fever of more than two days, with abdominal pain and persistent vomiting are warning signs suggestive of dengue fever. More so if there is mucosal bleeding usually in the nose and gums as well as if you are living or have just travelled to a dengue endemic area. If these are present prompt medical intervention with hospitalization is strongly advised.
Not all cases of dengue fever though have to be admitted. Those diagnosed with dengue fever with NO warning signs only need to be monitored for their platelet and hematocrit counts. They are encouraged to increase their fluid intake in the form of water or oral rehydration solutions. Fever medicines are given but we shy away from giving non steroidal anti inflammatory drugs as these may lead to NSAID- induced gastritis leading to vomiting and possible bleeding in the intestinal tract in case the platelet count drops and the other bleeding parameters become deranged.
Probiotics can be given to boost the count of good bacteria in the body but these are still under investigation and has not been officially included in the management guidelines yet. Herbal medicines such as tawa-tawa were previously tried but have not yet been proven to be beneficial and might even have detrimental side effects especially in the kidneys.
Those patients that present with warning signs need to be admitted. Management is focused on prevention of and control of bleeding, maintaining the blood pressure in case the patient goes into shock and monitoring of and managing dengue related complications such as carditis (swelling of the heart), pleural effusion or water in the lungs and hepatomegaly or enlargement of the liver. These already fall under severe dengue.
As we always say, prevention is better than cure. Let us start with keeping our surroundings clean. We should get rid of sources of stagnant water such as in pails or containers, vases, man-made aquariums or ponds or clogged open drainage, the possible breeding places of mosquitoes.
Wear clothes that cover exposed areas such as arms and legs especially when you go out. Use mosquito repellants (although I am not a fan of repellant lotions or sprays as these may cause skin irritation or allergies and may have harmful long-term effects). I use repellant patches instead since it does not have skin contact. You just stick it on your clothes.
Use citronella candles inside the house. If you need to spray with mosquito killers, make sure that the space is well ventilated and refrain from staying in the room for an hour or so.
And yes, we already have a vaccine for dengue. It can be given to patients nine to 45 years old. This was a cause of concern among mothers actually, considering that a significant number of patients with dengue come from the younger age group. But according to the manufacturer, their data is still insufficient for the vaccine to be approved for those younger than nine years old that we have to wait for a couple of years more. Nonetheless, it is still good news that a vaccine is already available. Visit your doctors and check on this.
I have heard from our local City Health Office that so far our cases are lower now compared to last year. I believe the anti-dengue campaign is really working and we have become conscious and aware about it.
Because, really, why wait for dengue to be present when you can prevent it?
Jessica P. Segovia-Yap, M.D., FPAFP is a Diplomate and Fellow of the Philippine Academy of Family Physicians. She is a practicing Family Medicine Specialist and holds clinic at the Medical Arts Building of Iloilo Mission Hospital. For comments, questions and suggestions, you may email at drjec.is.in@ gmail.com./PN
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