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Dengue Fever: Why Do You Need to Stick to Paracetamol? Painkillers increase the risk of internal bleeding and affect the liver

There has been a trend of increasing dengue cases across the country, as the disease map is now spreading across India, the way Jammu and Kashmir. In fact, no state or union territory is left with zero cases. According to the National Vector Borne Disease Control Program (NVBDCP) data till August end, there have been over 30,627 cases and 12 deaths. Karnataka (5,392) has the highest number of cases in Maharashtra (2,927) and Kerala (2,007). Newly added to the dengue map are Jammu and Kashmir (96) and Nagaland (two). In 2021, there were 1.93 lakh dengue cases and 346 deaths across the country, while 2020 saw a decline, probably because the focus was on treating COVID 19. What is worrying this year is the emergence of unusual symptoms in the focal areas, resulting in the descendants of accelerated dengue hemorrhagic fever.

What are the unusual symptoms this year?

This year, some patients have faced complications. In DelhiIn India, where cases have increased in the past two weeks, people are coming to hospitals with internal bleeding, shock (sudden drop in blood pressure) and liver complications. Dr Rommel Tikoo, Director, Internal Medicine, Max Healthcare, said, “Although the numbers are not as high as were seen in Delhi in 2015 and 2016, we are seeing more people suffering from uncomplicated dengue. People with liver involvement show signs of jaundice, but these cases are self-limiting.”

Some patients in Maharashtra have reported serious complications. According to infectious disease specialist Dr Sanjay Pujari, we should be concerned if the rate of complications is higher as compared to previous years. Dr Rajesh Gadia, Consulting Physician at KEM Hospital who has been involved in the management of dengue viral fever for more than two decades, says that the presentation of cases is mild at large. Although the prevalent serotypes can lead to complications and in some cases, mainly from Baramati and Phaltan, patients have tremors and fluid in the lungs. “Clinical manifestations vary from undifferentiated fever to florid hemorrhage and shock. Clinical presentations depend on age, immune status of the host and strain of the virus,” said Dr. Gadia.

Some rare complications are hemophagocytic lymphohistiocytosis (HLH), an inflammatory condition that can be triggered by infection or other immune disorders, usually in people with an underlying genetic predisposition. Pujari said that this is seen not only in dengue but also in other infections. Priest explained, “Leakage of capillary fluid from the blood moves into the interstitial compartment and fluid can accumulate in the lungs or abdomen – once the fluid moves into the extra blood space, there is a drop in blood pressure and therefore shock. ” Which means all the blood cells in the body are affected, causing liver and heart injury, a drop in platelet count, abnormal clotting system, a drastic drop in blood pressure. This causes refractory shock to the patient.

A uniquely rare case of Dengue-induced Acute Respiratory Distress Syndrome (ARDS) was observed in four-year-old boy Arush Vandekar from Ahmednagar, Maharashtra. His breathing became difficult and his oxygen level dropped.

seek quick health

“Overall, there is no reason to panic. However, it is extremely important to seek health care early,” says Dr Parikshit Prayag, infectious disease specialist at Deenanath Mangeshkar Hospital. When the latent dengue virus is finally diagnosed, it inevitably leads to other health problems.

The onset includes an acute febrile illness between two and seven days, with symptoms such as headache, retro-orbital pain, myalgia, arthralgia, rash and hemorrhagic manifestations. These need to be carefully monitored. The febrile illness is the stage where the fever can last for a week after which most people recover. There will be recovery after viral and the patient has weakness and fatigue.

let’s say COVID-19 And with dengue spreading in the city simultaneously, Dr. Tikku warns people not to give any painkillers without doctor’s advice. “With COVID-19, many people take painkillers without consulting a doctor, but it can be dangerous if they have dengue. Combiflam and pain relievers like diclofenac can increase the risk of internal bleeding and can affect the liver. Paracetamol is the only medicine they should take for fever,” said Dr Tikku.

HLH is life-threatening and its diagnosis can be challenging because early symptoms can mimic other problems such as persistent fever, rash, enlarged liver, low platelet count and altered mental functions.

There are four virus serotypes designated as DENV-1, DENV-2, DENV-3 and DENV-4. Infection with a single serotype confers lifelong immunity to the virus serotype.

Why do you need to look for rainfall patterns?

With researchers and studies finding a link between dengue and rainfall patterns, experts like Dr Gadiya caution that the monsoon and post-monsoon months are critical for vulnerable people. The Aedes aegypti mosquito lives for an average of 15 days. During the rainy season, when survival is longer, the risk of virus transmission is higher. Dengue mosquito is a day feeder and can fly for a limited distance of 400 metres. Aedes aegypti is found almost exclusively in domestic, man-made water receptacles and around homes, construction sites and factories. Natural larval habitats are tree holes, leaf axils and coconut shells. Unused tires, flower pots and desert coolers are among the most common home breeding sites.

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