Snowy Owl
Retired in 2010, In Memoriam
Dumaguing: Unusual manifestations of dengue infection
zhttp://www.sunstar.com.ph/static/bag/2006/09/04/oped/dr..vic.dumaguing.to.your.health.html
zhttp://www.sunstar.com.ph/static/bag/2006/09/04/oped/dr..vic.dumaguing.to.your.health.html
Monday, September 04, 2006
THE past few weeks saw an alarming rise in hospital admission of dengue cases, with about 40 percent of the patients children less than 10 years old, plus the disturbing thought that a few of them did not survive the infection.
Dengue virus infection causes a spectrum of illness -- from the classic dengue fever, dengue hemorrhagic fever and the dengue shock syndrome.
Clinically, dengue infection may be confused with influenza, measles, typhoid, leptospirosis (which is also common during the rainy season) or any non-specific viral syndrome.
Dengue viruses belong to the genus Flavovirus, family Flaviviridae. There are four anti-genically related but distinct dengue serotypes. The clinical course of classic dengue include signs and symptoms like drenching sweats, cough, sore throat, epistiaxis (nose bleeding), hyperesthesia (increased sensitivity) of the skin, pain in the groin and testicles, delirium, alteration of taste and diarrhea. Menigismus and encephalitis-like symptoms may be present. Hair loss during and after convalescence has also been reported. Very common finding is enlargement of the liver, although the spleen is normal. Convalescence may be prolonged and is usually accompanied by depression, with a few patients showing suicidal tendencies during this period.
Skin eruptions occur in 50 to 80 percent of cases of dengue fever, which may be elevated and flat irregularly shaped rashes and uriticaria and hives. These rashes appear between day 3 and 6 of the illness and may persist for three to seven days. The sequence of fading of the eruption is the reverse order of its appearance. Eruptions have a scattered distribution and seldom occur on the abdomen or the loin. Rashes on the legs are mainly on the front. Scarlatini-form rash may appear in the palms and sole. Desquamation (sloughing) and pruritus (itchiness) may occur after the acute phase.
Dengue fever is associated with hemorrhaging in 5-30 percent of cases. Variable degrees of bleeding may occur at any site, usually on day 5 to 8 of the illness. Haematuria (bleeding into the urine), bleeding within the cranium or internally may be so severe that can result to significant blood loss, hypotension, shock and death.
Severe liver enlargement occurs in 10 to 30 percent of dengue fever cases. The enlarged liver causes pain and tenderness in the right hypochondrium or in right upper quadrant of the abdomen, with concomitant increase in the level of serum transaminases, jaundice and fulminant hepatitis may follow. The bleeding tendencies are aggravated by the involvement of the liver, being the source or factory of the proteins fibrinogen and prothrombin that promote blood clotting.
Neurological complications following dengue infection have been reported in nearly every country in Asia. The patient may manifest any of the following: headaches, dizziness, irritability, confusion, seizure, muscle weakness and possibly, coma.
Symptoms of upper respiratory tract infection are commonly seen in the prodromal period of dengue infection. Pleural effusion (accumulation of fluids in the cover of the lungs) commonly right-sided, occurs during the period of plasma leakage. The patient has dyspnea (difficulty of breathing) with tachycardia (heart rate faster than 100 beats per minute). As for the heart, a certain study by Cachero et al. reported a 24 percent incidence of myocarditis in confirmed dengue infection but no impairment of myocardial function occurred except for mild transient conduction defects.
As expected, because of the internal bleeding, hematuria is caused by all virus serotypes, thus, a routine urinalysis of the patient reveals the presence of red blood cells and sometimes, cast. Mild form of glometulonephritis has been associated with dengue infection.
The key to the control of dengue is the eradication of the Aedes aegypti mosquito that transmits the virus. This is a difficult task considering the enormous amounts of non-biodegradable old tires and plastic containers surrounding our houses, which serve as breeding grounds for the mosquito. Public information about the transmission of dengue should take tri-media saturation. Even the simple act of periodically replacing water in vases should be emphasized. Live attenuated vaccines are in the making and clinical trails have shown promising results.
Till that vaccine comes, let us not allow dengue to ruin our lives. Cleaning our surroundings will go a long way in its prevention and hopefully its eventual eradication.
THE past few weeks saw an alarming rise in hospital admission of dengue cases, with about 40 percent of the patients children less than 10 years old, plus the disturbing thought that a few of them did not survive the infection.
Dengue virus infection causes a spectrum of illness -- from the classic dengue fever, dengue hemorrhagic fever and the dengue shock syndrome.
Clinically, dengue infection may be confused with influenza, measles, typhoid, leptospirosis (which is also common during the rainy season) or any non-specific viral syndrome.
Dengue viruses belong to the genus Flavovirus, family Flaviviridae. There are four anti-genically related but distinct dengue serotypes. The clinical course of classic dengue include signs and symptoms like drenching sweats, cough, sore throat, epistiaxis (nose bleeding), hyperesthesia (increased sensitivity) of the skin, pain in the groin and testicles, delirium, alteration of taste and diarrhea. Menigismus and encephalitis-like symptoms may be present. Hair loss during and after convalescence has also been reported. Very common finding is enlargement of the liver, although the spleen is normal. Convalescence may be prolonged and is usually accompanied by depression, with a few patients showing suicidal tendencies during this period.
Skin eruptions occur in 50 to 80 percent of cases of dengue fever, which may be elevated and flat irregularly shaped rashes and uriticaria and hives. These rashes appear between day 3 and 6 of the illness and may persist for three to seven days. The sequence of fading of the eruption is the reverse order of its appearance. Eruptions have a scattered distribution and seldom occur on the abdomen or the loin. Rashes on the legs are mainly on the front. Scarlatini-form rash may appear in the palms and sole. Desquamation (sloughing) and pruritus (itchiness) may occur after the acute phase.
Dengue fever is associated with hemorrhaging in 5-30 percent of cases. Variable degrees of bleeding may occur at any site, usually on day 5 to 8 of the illness. Haematuria (bleeding into the urine), bleeding within the cranium or internally may be so severe that can result to significant blood loss, hypotension, shock and death.
Severe liver enlargement occurs in 10 to 30 percent of dengue fever cases. The enlarged liver causes pain and tenderness in the right hypochondrium or in right upper quadrant of the abdomen, with concomitant increase in the level of serum transaminases, jaundice and fulminant hepatitis may follow. The bleeding tendencies are aggravated by the involvement of the liver, being the source or factory of the proteins fibrinogen and prothrombin that promote blood clotting.
Neurological complications following dengue infection have been reported in nearly every country in Asia. The patient may manifest any of the following: headaches, dizziness, irritability, confusion, seizure, muscle weakness and possibly, coma.
Symptoms of upper respiratory tract infection are commonly seen in the prodromal period of dengue infection. Pleural effusion (accumulation of fluids in the cover of the lungs) commonly right-sided, occurs during the period of plasma leakage. The patient has dyspnea (difficulty of breathing) with tachycardia (heart rate faster than 100 beats per minute). As for the heart, a certain study by Cachero et al. reported a 24 percent incidence of myocarditis in confirmed dengue infection but no impairment of myocardial function occurred except for mild transient conduction defects.
As expected, because of the internal bleeding, hematuria is caused by all virus serotypes, thus, a routine urinalysis of the patient reveals the presence of red blood cells and sometimes, cast. Mild form of glometulonephritis has been associated with dengue infection.
The key to the control of dengue is the eradication of the Aedes aegypti mosquito that transmits the virus. This is a difficult task considering the enormous amounts of non-biodegradable old tires and plastic containers surrounding our houses, which serve as breeding grounds for the mosquito. Public information about the transmission of dengue should take tri-media saturation. Even the simple act of periodically replacing water in vases should be emphasized. Live attenuated vaccines are in the making and clinical trails have shown promising results.
Till that vaccine comes, let us not allow dengue to ruin our lives. Cleaning our surroundings will go a long way in its prevention and hopefully its eventual eradication.