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‘Unusual’ new trend spotted in some dengue patients
View(s):- Expert warns of fluid leakage starting when platelet count is relatively high, early into the illness in some children
By Kumudini Hettiarachchi
An ‘early’ warning with regard to a different trend in the rapid deterioration of dengue patients to severe and dangerous disease comes from an expert this week.
“The critical fluid leakage stage in Dengue Haemorrhagic Fever (DHF) is hitting patients even when the platelet counts are relatively high early into the illness,” reiterated Consultant Paediatrician, Dr. LakKumar Fernando, the former Head of the Centre for Clinical Management of Dengue Fever and Dengue Haemorrhagic Fever in Negombo.
He strongly urged people to seek treatment early and doctors to be watchful of this new trend which could, otherwise, lead to a higher dengue death rate.
Dr. Fernando underscored that he is currently overseeing the treatment of two children who had begun heavy fluid leakage even when their platelet count was above the danger mark of 100,000. They were descending into shock, with a rapid heart-rate and pulse drop and there was a lot of fluid in the pleural (chest) cavity.
Platelets are small, colourless cell fragments in the blood and a normal count is between 150,000 and 450,000 platelets per microlitre of blood. Usually, fluid leakage is suspected in dengue patients when their platelet count drops below 100,000.
Referring to this “new” rather “unusual” trend, Dr. Fernando said the first is a four-year-old girl from Ethukala, Negombo, admitted to hospital on Thursday (December 5) at noon. Her platelet count that night was 147,000 and an ultrasound scan had been normal, revealing no signs of leakage. She had been affected by a high fever for three days since Monday, but with paracetamol the temperature had come down.
By Friday (December 6), even though the platelet count was 135,000, her heart-rate had begun racing, sending her “almost” into shock. Leakage had also begun.
The second is a six-year-old boy from Kuda Paduwa, Negombo, who had begun fluid leakage on the 6th Day of dengue. His platelet count on the 4th Day of illness had been 302,000 and even when the leakage started on the 6th Day it had been 172,000. By that time, there was also no fever. On Friday which was the 7th Day, though there was heavy leakage, the platelet count was 105,000. He may also have had a little bleeding internally earlier, Dr. Fernando said.
Assuring that the children’s condition is stable, he said that “we need to be alert” and respond speedily when the need arises.
Earlier too, in November, he had seen a similar patient – a five-year-old boy’s platelet count had been 212,000, when there was leakage on Day 3. It had been 152,000 when he was having “massive” bi-lateral pleural leakage. When the leakage stopped, the count had been 94,000.
Dealing with ‘Why’ there seems to be a new trend, he said it may be due to the dengue serotypes changing but that needs to be further investigated and researched.
There are four dengue virus strains or serotypes – DENV1, DENV2, DENV3 and DENV4. While the dengue epidemic in 2017 had been almost exclusively due to DENV2, the 2019 epidemic had been due to both DENV3 and DENV2. Currently (2024), Dr. Fernando believes that the predominant serotype is DENV3, with DENV2 also doing the rounds. He explains that every time a person gets a dengue infection, that person gets lifelong immunity to that strain or serotype, gaining limited ‘cross-immunity’ to the other strains for about six months to one year. “If Patient A is affected by DENV1, he/she would not usually get DENV1 again, having lifelong immunity. He/she would also not get the other three serotypes (DENV2, DENV3 and DENV4) for a while – but that would be short-lived, only for a period of about six months to one year. Sometimes, though, this shorter immunity against the other strains may last for about two years.”
But, warns Dr. Fernando, the moment that short immunity wears off, if Patient A gets those strains – DENV2, DENV 3 or DENV 4 – the virulence of that attack increases in leaps and bounds. This second attack of dengue is very likely to manifest as DHF in Patient A.
“However, there are a few reports of patients having fluid leakage even when they get dengue for the first time. This is mainly noted with DENV1 and DENV3. The five-year-old boy who was ill in November began leaking when his platelet count was above 200,000. An antibody test found that he was likely to have got the dengue infection for the first time,” added Dr. Fernando.
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