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Source: http://thestar.com.my/health/story.a...122&sec=health
Sunday April 12, 2009
Managing dengue (A Malaysian Example)
The commonplace and inconsistent symptoms of dengue fever have long hampered its early detection, leading to complications in patients and outbreaks in communities nationwide.
EVEN though she lived in a flat where dengue infections are common, the only symptom of dengue fever Vanitha Devi Senagiah knew about before she was admitted to a hospital last October was that ?it gives you red spots on your body?.
?It was during the Deepavali period when I started purging and getting diarrhoea. Soon after, I was down with a very high fever.? But the possibility of a dengue infection did not cross her mind, or her doctors?, as the characteristic red spots were not present.
?I went to four different clinics and the doctors there told me that it was probably a normal fever,? she recalls. Finally, after a blood test on her visit to the fifth clinic, the attending doctor suspected a dengue infection due to low platelet levels.
The skin rash described as 'islands of white in a sea of red' is a typical sign of dengue infection, although it may persist in the recovery phase.
?The doctor recommended me to be admitted, but the first hospital I went to also did not find anything. I was eventually discharged,? says the 24-year-old.
By the time she checked in to the second hospital, where she was confirmed to have dengue fever, she was very weak and had difficulty breathing. Her doctors chastised her for coming for treatment late.
?It was only after I was given treatment that the rashes appeared. It took me a month to recover from the infection,? she says.
While Vanitha?s doctor-hopping may have played a part in the delay of her diagnosis, she and her doctors are hardly to be blamed.
The commonplace and inconsistent symptoms of dengue fever have long hampered its early detection, leading to complications in patients and outbreaks in communities nationwide.
With this in mind, the first clinical practise guidelines (CPG) on dengue infection in adults was published by the Ministry of Health and Academy of Medicine Malaysia in 2003.
?The (2003) CPG was a consensus guideline based on expert opinions and literature searches at that time. It provided a general approach to the management of dengue infection,? says senior consultant and infectious disease physician Dr Mahiran Mustafa, the chairperson of the latest dengue CPG development group.
With the results of new studies and clinical trials made available, a new CPG was released in January this year, with more details on the clinical manifestation of the disease and recommendations on how to manage it effectively.
Varying symptoms
In response to the increase in dengue cases earlier this year, health director-general Tan Sri Dr Ismail Merican explained the situation at a press conference: ?Now, dengue cases come with different presentations, like epileptic (seizures), jaundice, hepatitis and organ failure, so people don?t realise it is dengue. These atypical presentations are not like the standard cases of fever, bleeding or low-platelet counts.
?Because of this, some of the diagnoses were made very late. That?s why we have informed all our doctors to be aware. If someone has fever and comes from a dengue-infested area, always do extra testing for dengue,? he added.
The infection can be asymptomatic for some, but for others, symptoms can range from mild flu-like illness to severe disease, with or without bleeding, plasma leakage (the loss of fluids from blood vessels into the body) and organ impairment.
?In a specific group of patients with other co-morbid diseases such as diabetes mellitus, heart failure, renal failure, liver failure and blood disorders, the risk of complications due to pulmonary oedema (collection of fluid in the lungs) and bleeding episodes may be more significant,? says Dr Mahiran.
Sunday April 12, 2009
Managing dengue (A Malaysian Example)
The commonplace and inconsistent symptoms of dengue fever have long hampered its early detection, leading to complications in patients and outbreaks in communities nationwide.
EVEN though she lived in a flat where dengue infections are common, the only symptom of dengue fever Vanitha Devi Senagiah knew about before she was admitted to a hospital last October was that ?it gives you red spots on your body?.
?It was during the Deepavali period when I started purging and getting diarrhoea. Soon after, I was down with a very high fever.? But the possibility of a dengue infection did not cross her mind, or her doctors?, as the characteristic red spots were not present.
?I went to four different clinics and the doctors there told me that it was probably a normal fever,? she recalls. Finally, after a blood test on her visit to the fifth clinic, the attending doctor suspected a dengue infection due to low platelet levels.
The skin rash described as 'islands of white in a sea of red' is a typical sign of dengue infection, although it may persist in the recovery phase.?The doctor recommended me to be admitted, but the first hospital I went to also did not find anything. I was eventually discharged,? says the 24-year-old.
By the time she checked in to the second hospital, where she was confirmed to have dengue fever, she was very weak and had difficulty breathing. Her doctors chastised her for coming for treatment late.
?It was only after I was given treatment that the rashes appeared. It took me a month to recover from the infection,? she says.
While Vanitha?s doctor-hopping may have played a part in the delay of her diagnosis, she and her doctors are hardly to be blamed.
The commonplace and inconsistent symptoms of dengue fever have long hampered its early detection, leading to complications in patients and outbreaks in communities nationwide.
With this in mind, the first clinical practise guidelines (CPG) on dengue infection in adults was published by the Ministry of Health and Academy of Medicine Malaysia in 2003.
?The (2003) CPG was a consensus guideline based on expert opinions and literature searches at that time. It provided a general approach to the management of dengue infection,? says senior consultant and infectious disease physician Dr Mahiran Mustafa, the chairperson of the latest dengue CPG development group.
With the results of new studies and clinical trials made available, a new CPG was released in January this year, with more details on the clinical manifestation of the disease and recommendations on how to manage it effectively.
Varying symptoms
In response to the increase in dengue cases earlier this year, health director-general Tan Sri Dr Ismail Merican explained the situation at a press conference: ?Now, dengue cases come with different presentations, like epileptic (seizures), jaundice, hepatitis and organ failure, so people don?t realise it is dengue. These atypical presentations are not like the standard cases of fever, bleeding or low-platelet counts.
?Because of this, some of the diagnoses were made very late. That?s why we have informed all our doctors to be aware. If someone has fever and comes from a dengue-infested area, always do extra testing for dengue,? he added.
The infection can be asymptomatic for some, but for others, symptoms can range from mild flu-like illness to severe disease, with or without bleeding, plasma leakage (the loss of fluids from blood vessels into the body) and organ impairment.
?In a specific group of patients with other co-morbid diseases such as diabetes mellitus, heart failure, renal failure, liver failure and blood disorders, the risk of complications due to pulmonary oedema (collection of fluid in the lungs) and bleeding episodes may be more significant,? says Dr Mahiran.