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Upsurge in dengue numbers
View(s):Don’t give NSAIDs for fever, urge experts
By Kumudini Hettiarachchi
A massive upsurge in dengue patients has been seen in the past 72 hours in hospitals, aggravating the situation of already very high numbers, experts warned yesterday.
The reason for this upsurge no one knows, but patients are flocking into hospitals, making the already overburdened system to groan and creak, which could lead to serious repercussions, an expert lamented, while many more were wringing their hands in despair.
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The need right now is to declare a health emergency with regard to dengue, pull out all stops and face this crisis head-on, the source reiterated, pointing out that as the waters receded in the disaster-hit districts, the threat of dengue would worsen. Dengue patient numbers have reached 55,000 in just five months, with more than 170 deaths.
Alerting people on some basic precautions that need to be taken, the expert said that even though it may be extremely difficult, major efforts have to be made not to get bitten by the dengue mosquitoes.
“The dengue mosquitoes – Aedes aegypti and Aedes albopictus – are mostly active from about 6-8 a.m. and about 4-6 p.m. during the day,” he said, urging people to wear long-sleeved clothing which also covers the whole body and use a mosquito-repellent.
If, however, you get fever, get the dengue NS1 Rapid Antigen Test done within 12-24 hours of the onset of fever. When checking the full-blood count (FBC), look out for a sudden-drop in your platelet count even if your platelet count is over the ideal limit and seek treatment at a hospital, was his advice. “When FBCs are done, even when consequent platelet counts are above the normal range, if there has been a big drop from one to the other, such patients are likely to do badly than those whose platelet counts are dropping at a slower pace.”
Sending out a strong alert against the use of common pain-relieving medications for people including children with fever, this expert stressed that not only would these medications worsen the complications of Dengue Haemorrhagic Fever (DHF), but would also result in the death of the patient. “Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, mefenamic acid and diclofenac sodium can cause death in dengue patients,” he cautioned, a view echoed by many others.
Tearing apart the “myth” among doctors, both Specialists and General Practitioners (GPs), that prescribing NSAIDs on Day 1 or 2 of fever will not have an impact on dengue, he said it “definitely does”. The management of such patients becomes really complicated. NSAIDs — which are administered orally as tablets or syrup or inserted as suppositories — are a definite “No, no”, the Sunday Times learns, and fevers should be managed with paracetamol and sponging.
For, if the fever is dengue, NSAIDs would have two impacts – systemic and local, according to these experts. The systemic effect would be impaired platelet aggregation (clumping together to cause clotting); an impact on the coagulatory system; and liver damage. The local effect would be tiny gastric erosions and if the NSAID has been in suppository form in the rectum, mucosal damage in this region.
Going into meticulous detail, the expert said that in DHF, when fluid leakage starts and the blood pressure drops, the situation gets worse. The patient’s body attempts a compensatory distribution of blood to the peripheries and vital organs, constricting blood supply at gut level. This results in the gastrointestinal (GI) tract getting affected before the peripheral supply is compromised and the mild gastric erosion caused by the NSAIDs becoming bigger. This causes bleeding in the GI tract, stopping of which is not easy.
“Dengue patients die due to prolonged shock, fluid overload or massive bleeding. The cause of death in a large number is massive bleeding,” he added. There are four strains of dengue — DENV-1, DENV-2, DENV-3 and DENV-4 and any of these strains can cause both Dengue Fever (DF) and DHF. Infection with one strain provides immunity only to that strain, while if a person gets another strain, the antibodies created in the body by the first infection will make the second more severe. Currently, Sri Lanka is in the grip of DENV-2, with the danger of the platelet-count dropping quicker than the other strains and fluid leakage also beginning earlier, if it is DHF.