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Dengue

The rainy season is coming have a specialist doctor Some caution against the deadly pneumonia, or SARS, because the virus can reproduce well after the summer season. Therefore, strict measures to prevent this disease should be continued until it is certain that Thailand is truly free from SARS. Dengue fever, which is more dangerous than other diseases in order to be able to prepare for protection early

Thai name Dengue Fever Dengue Fever
english name Dengue fever, Dengue hemorrhagic fever (DHF)

cause Caused by dengue hemorrhagic fever, which is a virus that has two types, dengue (dengue) and chikungunya. (chigunkunya) about 90 percent of dengue patients. will be caused by dengue It is also divided into four subspecies: types 1, 2, 3, and 4. These dengue germs can cause severe dengue fever. In general, when infected with dengue for the first time (Can be infected from the age of 6 months) with an incubation period of about 3-15 days (mostly 5-7 days). Patients will have high fever like flu for 5-7 days and most will not have symptoms of bleeding. Only a small minority of them may bleed. or have severe symptoms Later, when the patient was infected again (which may be the same type of dengue or a different type that was received for the first time and has a shorter incubation period than the first), the body will react, causing the capillaries to become brittle and low platelets This causes plasma (blood) to seep out of the blood vessels. (Detected high hematocrit fluid in the pleural and abdominal cavity) and bleed easily causing shock

In general, recent infections causing severe symptoms It usually occurs approximately 6 months to 5 years after initial infection, often leaving no later than 5 years. For this reason, severe dengue fever is more common in children under the age of 10 than at other ages, approximately 10% of cases. Dengue patient It is caused by Chikungunya. which often have mild symptoms is not causing shock conditions such as those caused by dengue The disease is carried by Aedes aegypti mosquitoes, meaning that Aedes aegypti bites a person with dengue first. and then go and bite the people nearby (In a radius of not more than 400 meters) will infect others. It is a mosquito that is active (biting people) during the day.

symptom The symptoms of dengue fever are divided into three stages:

Phase 1 High fever phase. The patient develops a high fever that occurs suddenly. Characterized by high fever all the time. (Take antipyretic drugs, it usually does not reduce) red face, red eyes, headache, thirst, the patient is lethargic, often with anorexia and vomiting. Some people may complain of abdominal pain in the area. under the rib cage or right rib or general abdominal pain There may be constipation or diarrhea.
Most people rarely have a stuffy nose, runny nose, or a cough (for example, someone with the flu or measles), but some people may have a sore throat. slightly red neck or a little cough
Around the 3rd day of fever, there may be a red, non-itchy rash on the arms, legs and torso, which lasts for 2-3 days. Some people may have bleeding spots that look like small red spots. (Sometimes there may also be a green blotch) up the face, arms, legs, armpits, in the mouth (palatine, cheekbones, uvula). and had a slight tenderness Most Tourniket* tests are positive from day 2 of fever, and in a circle 1 inch in diameter, more than 20 hemorrhagic spots are usually found. if there are no severe symptoms In most cases, the fever will subside on days 5-7. Some people may have fever for more than 7 days, but if it is severe It will appear in phase 2.

Phase 2 shock and bleeding phase It is most often seen in dengue hemorrhagic fevers caused by Severe dengue III and IV, and rarely in cases caused by chikungunya. Symptoms occur between days 3-7 of the disease, which is considered a critical period. The fever will begin to decrease. But the patient’s symptoms worsened. More frequent abdominal pain and vomiting, increased drowsiness, restlessness, cold body, cold hands and feet, sweating, less urine output. Light but fast pulse (maybe more than 120 beats per minute) and low blood pressure which is a symptom of shock This condition occurs because plasma seeps out of the blood vessels. causing the volume of blood to be greatly reduced If severe, the patient may have symptoms that are unconscious, cold, cyanotic, and unable to feel the pulse. and the pressure dropped to the point of being unable to measure If not treated promptly, it may die within 1-2 days.

In addition, the patient may also have skin bleeds. (with green blotches repeating) nosebleed vomiting fresh blood or coffee color fresh bloody stools or the color of crude oil If bleeding tends to cause rapid, fatal shock, this phase 2 will last approximately 24-72 hours if the patient is able to get through the critical phase. will enter phase 3.

Phase 3 Recovery period in patients with mild shock When the crisis has passed will get better quickly or even patients with severe shock when treated properly and in a timely manner will recover to normal The symptoms that suggest that the patient will start to want to eat and then symptoms. will return to normal This phase may last 7-10 days after the second phase.

The total time from onset to good health is about 7-14 days, in the case of mild symptoms, it may be 3-4 days and disappear on its own. )

disease isolation Dengue fever is characterized by high fever (hot body), which should be distinguished from other fevers:

1. Flu: Intermittent heat, runny nose, cough, slight sore throat. The fever usually resolves on its own within 2-4 days.

2. Influenza with intermittent hot flashes. Severe body aches, loss of appetite, slight sore throat, cough and slight runny nose. The fever usually resolves on its own within 3-5 days.

3. Measles, feeling hot all the time, red face, red eyes, similar to dengue fever. But different in that measles will have mucus, cough, and after 3-4 days of fever, there will be a red rash on the body. This disease usually resolves on its own within 7-10 days.

4. Pneumonia (pneumonia) with high fever, cough, chest pain and shortness of breath. If in doubt, seek immediate medical attention. Often, a sputum examination and X-ray of the lungs are required.

5. Typhoid fever (typhoid) is a persistent high fever, abdominal pain, nausea, vomiting, constipation or diarrhea, no runny nose, fever, often for weeks or more. If in doubt, the doctor will do a blood test to prove it.

6. Leptospirosis (leptospirosis) will have high fever all the time, chills, calf pain, red eyes, jaundice. If in doubt, you should see a doctor asap.

diagnosis The doctor will draw blood. Check the blood concentration (hematocrit), which is found to be higher than normal. (more than 50 percent) platelet count (acting to stop bleeding), which is lower than normal cause easy bleeding The definite diagnosis is that a blood test reveals signs of dengue infection.

self care During the first 2-3 days of fever, symptoms may be unclear, i.e. still able to eat food, drink water, no vomiting, no abdominal pain, no blood bruising. no bleeding Can still get up and walk anywhere. may provide general fever care as follows:

1. Get plenty of rest.

2. Do not take a cold shower. Should use a damp cloth to wipe the body often.

3. Drink plenty of water, 3-4 liters (15-20 glasses) per day by sipping gradually throughout the day. May be plain water, sweet water, soft drinks (should avoid water that is red, black or brown, because if the patient has vomiting blood. (may be mistaken for the color of the water you drink) Orange juice, lemon juice, or boiled rice water, depending on your preference.

If you notice that your lips are full The tongue is blemish, the throat is dry, and the urine is clear and clear. It is considered that the body has enough water. This practice will help prevent dehydration and shock. should drink a lot of water every day until the end of the crisis period (about 7 days)

4. Take paracetamol to reduce fever.

  • Adults take 1-2 tablets per time.
  • Older children eat half-one tablet at a time.
  • Small children use the syrup type, eat 1-2 teaspoons at a time.

If there is still a fever, repeat every 6 hours. If the fever has not reduced, do not take the drug more often. because taking paracetamol Excessive doses can be toxic to the liver, while aspirin (eg different brands of fever pills) should not be consumed. Because it may cause bleeding more easily. This is because aspirin prevents blood from clotting. Taking fever-reducing medications can cause the fever to decrease for a short time. Or it might not work at all. Should use a towel often. will help you feel more comfortable

5. You should closely monitor the symptoms at all times. If the patient has abdominal pain, vomiting, unable to eat, drink less water, drowsy, urine output is light and tea-colored. There are red and green spots on the body. or bleeding or have anxiety You should see a doctor asap.

treatment The doctor will make a diagnosis by asking a detailed history and physical examination. and conducting the Tourniket test Some people, especially the violent groups, were admitted to hospital. Blood tests may be required periodically, while treatment for mild cases may include antipyretics, paracetamol, and self-treatment. above The doctor will make an appointment to check the patient every 1-2 days until he is sure that he has recovered (may take 7-10 days). The doctor will accept him for treatment in the hospital. by giving saline intravenously and periodic blood tests for blood concentration (hematocrit) are performed in cases of bleeding. It is necessary to give blood to replace.

Complications In addition to severe bleeding (If there is a large amount of gastric bleeding or cerebral hemorrhage, there is often a high mortality rate) and then shock. Liver failure may also occur. (with jaundice), which is a fatal condition Often found in patients who are in shock for a long time. In addition, it may be pneumonia. (may or may not be accompanied by pleural effusion), bronchitis, or complication of myocarditis But there is a very small chance of happening. In addition, if too much saline Pulmonary edema can be dangerous. should be closely monitored for symptoms

disease progression Approximately 70-80 percent of people with dengue fever will have mild symptoms. and disappears on its own within about 7-14 days, just give symptomatic treatment and drink plenty of water To prevent dehydration and shock is sufficient. Do not have to be admitted to the hospital Do not need to inject or give IV intravenous saline, about 20-30 percent may have shock or bleeding. which there is a way to treat it by giving saline or blood Only a small percentage of them can be fatal. Especially if it is found in children under 1 year old, it may have a higher mortality rate than other age groups.

defense

1. At present, there is no vaccine against dengue fever. Prevention lies in the destruction of mosquito breeding sites such as

– Close the lid of the water tank and wash the water tank every 10 days.

– Change the water in the vase every 10 days for the alkaline betel vase. Must use water to wash off the eggs or larvae that adhere to the roots.

– Pantry saucers Should add boiling water every 10 days or put table salt in the water in the saucer, size 2 teaspoons per 1 glass of water.

– Should keep cans, shells, old tires or what will be a swamp Which is in the area of ​​the house, school and community destroy or bury all the soil

– Adjust the ground and the field not to be bumpy with waterlogging

– A convenient method is to put 1% abate sand into the water blister and all kinds of water storage containers at a ratio of 10 grams per 100 liters of water (8-year dragon blister, use 2 teaspoons of abate. , cement blister size 12 years old, use 2.5 teaspoons of abate) should be refilled every 2-3 months.

2. Provide health education to people when the rainy season approaches. and campaigning for the destruction of mosquito breeding sites at the same time both in the home, school and community Therefore, it will be effective in controlling mosquitoes.

3. Children sleeping during the day should spread a mosquito net so that mosquitoes do not bite.

prevalence Dengue fever is often found in the rainy season. or in areas with stagnant water There are many mosquitoes. This disease is more common in children aged 5-9 years, followed by 10-15 years. In the first year, it is usually found between the ages of 7-9 months, while in the age group from 15 years and older, it is more likely to be found.

* The tourniquet test is performed using a pressure gauge placed above the patient’s elbow with a pressure value midway between the person’s upper and lower pressure. (upper pressure plus lower pressure divided by two) for 5 minutes without a pressure gauge. Use a rubber slingshot slightly above your elbow. (Still enough to feel the pulse at the wrist) for 5 minutes. If more than 10 bleeding spots (red spots) are found on the forearm in the compression position, in a circle with a diameter of 1 inch (approximately equal to a dollar coin), show If the test is positive, if it is less than 10 points, it is considered negative.

in dengue patients This test is more than 80 percent positive since the onset of fever 2 days onwards. The first 1-2 days may be negative. People with low platelet counts, such as ITP (104), aplastic anemia (103), or people with the flu or other fevers may also have a positive result. Patients with dengue hemorrhagic shock This test may give a negative result.

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