It’s officially that bittersweet time of the year. The weather turns absolutely beautiful, but with a price – The Viral Fevers. Dengue Season, as a lot of doctors fondly refer to the months of June to October, is upon us, and here’s the bare minimum one needs to know about the different viral infections that run rampant through the population at this time of the year.
The important thing to remember about these viral illnesses is that they all resemble each other in the initial stages of the infection – a stage of the illness called the prodromal stage – which manifests as symptoms such as a fever, running nose, a rash, headache, chills, joint pain, bodyache, generalized weakness, feeling tired, loss of appetite, nausea, vomiting, loose stools, etc. It is only after this initial prodromal stage that the patient will manifest with signs and symptoms specific to the infection, if it persists.
Most of these viral infections are preventable, but not treatable. Therefore, the treatment for patients with these infections revolves around supportive care – maintaining body functions as close to physiologically normal as possible, while allowing the body to fight the infection, and recover naturally, and preventive measures take on an important role in decreasing the occurrence and spread of these infections.
Transmitted by predominantly day-biting mosquitoes (Aedes species), Dengue Fever is a viral infection that is becoming alarmingly, increasingly prevalent in the Indian community in recent years. It can be extremely dangerous, as reflected by the huge number of deaths it causes globally, every year (estimated to be around 22,000, by the WHO).
Up to a half of all patients with Dengue infections can remain completely asymptomatic.
In the rest, the spectrum of illness can range from a mild, non-specific febrile syndrome to classic dengue fever (DF), to the severe forms of the disease, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Severe forms typically manifest after a two to seven day febrile phase and are often heralded by clinical and laboratory warning signs.
The most common symptoms of Dengue Fever are:
- High-grade fever
- Muscle pain
- Joint pain
- Rashes that usually affect the lower limbs, initially
Severe DF (DHF and DSS) usually develop after 2-7 days after the onset of the fever, and require urgent hospitalization and supportive, and possibly, intensive care. These are characterized by leakage of fluid from inside blood vessels to outside, thus decreasing circulating blood volume, and potentially causing cardiovascular complications, and by the decrease in the number of circulating platelets, the component of blood that is responsible for the formation of a blood clot, should an injury occur.
There are no curative options for the management of Dengue Fever currently, and the mainstay of medical management in these cases revolves around supportive care.
- Bed rest
- Medication to decrease fever and joint/muscle pain
- Judicious administration of fluids
- Periodic monitoring of clinical and laboratory parameters that reflect the severity and progression of the illness
- Transfusion of blood products, if required
The preventive measures against Dengue Fever are focused mainly on controlling the transmission of the virus by mosquitoes by controlling the mosquito population, and by controlling personal exposure to mosquitoes – use of mosquito nets, preventing water accumulation as possible breeding grounds for mosquitoes, use of insect repellent spray/cream, etc. There is no vaccination available yet that would protect against Dengue Fever.
The word ‘chikungunya‘ is believed to have been derived from a description in the Makonde language, meaning “that which bends up”, of the contorted posture of people affected with the severe joint pain associated with this disease.
It is also a mosquito-borne viral infection, caused by the Chikungunya virus, and transmitted by the Aedes species of mosquitoes (identical to the ones that transmit the Dengue Fever-causing viruses), that presents, initially, with an abrupt onset of high-grade fever and severe joint pain.
Other common features include a headache, rash, muscle pain, nausea, vomiting, diarrhea, fatigue, and a running nose. As one can clearly see, there is a considerable overlap amongst the clinical features of Dengue Fever and Chikungunya, that has even caused misdiagnoses, in areas where both are prevalent.
Chikungunya, however, causes severe and debilitating joint pain, that can last for the few days that the fever lasts, or, in some cases, persist for weeks to months after the initial infection.
There is no specific cure for Chikungunya, and treatment is focused on supportive measures, such as bed rest, judicious fluid intake, medication to decrease fever and joint/muscle pain, physiotherapy, and local application of heat to decrease joint pain, etc.
Preventive measures include measures to control the mosquito population, and measures to control personal exposure to mosquitoes. There is no vaccination available against the Chikungunya virus.
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