10 Myths on Dengue Fever #MsiaEndsDengue- Dr Nur Hidayati

Myth 1 – Dengue fever is harmless

Are you sure? If it is truly harmless, kindly explain how  61 people in Malaysia alone have died from it since January until 3^rd  November 2013. At the same time, 29,754 cases were reported. There was an increase of 11,486 cases, or 63 per cent rise of cases compared to 18,268 dengue cases which were reported in the same period last year in our country alone!

People have this notion that dengue is harmless as many people gets it and most gets well without any treatment. Some people can get very mild cases of dengue where they do not exhibit any symptoms at all, while others may not be as lucky. Most will get fever.  Others develop facial flushing, redness of the skin, generalized body/muscle/joint ache and headache. Many may also  develop loss of appetite, nausea (feeling of vomiting), vomiting, abdominal pain and sometimes diarrhea. Some will display bleeding symptoms like gum bleeding, prolonged menstruation, bleeding from the gut or commonly, bleeding to the skin and oral mucosa which appear like multiple small red dots on your skin and your mouth.

However, it is rare to develop severe bleeding, difficulty to breath, liver failure, confusion and drop in blood pressure. This is what we called severe dengue and without timely medical intervention, some may die from it.

Myth 2 – Try taking guava juice, papaya leaves, 100 plus, crab soup etc. to increase your platelet count

When you are diagnosed with dengue, it is very important to stay hydrated and this means you need to take plenty of fluids. Because of this, I do advise patients to drink more plain water, unsweetened fruit juices or nutritious soups. I do not advise them to take soft drinks (isotonic or not) as most of these drinks are very sweet. Taking them in large amount might cause diuretic effect, which makes you to urinate more frequently, and subsequently causing you to be dehydrated and feeling weaker instead.

Regarding the use of papaya leaves, there was this small study conducted in our country, where it showed that papaya leaves increased platelet count in patients with dengue who were consuming it within 48 hours. But most people are not aware that in dengue illness – once you have reached the recovery phase of dengue infection – your platelet count will rise regardless, whether or not you are taking these natural remedy like papaya leaves. Your recovery rate does not correlate with the increase rate your platelet count.

Again, the most important thing to do to make sure a dengue patient recovers is to keep he/she well hydrated. That means… drink lots and lots of fluid.

Read more about this here at: http://alt.medicine.com.my/2013/07/does-taking-papaya-leaves-cure-dengue/

 

Myth 3 – If you have low platelet count – it must be dengue

If you have fever and a low platelet count, you might have dengue. But, it can also NOT be dengue. There are a lot of diseases presented with fever and low platelet count such as viral illnesses like chikugunya, yellow fever, HIV, hepatitis B/C, protozoan parasite infection like malaria, rickettsial infection like scrub typhus or bacterial infections like leptospirosis. Some non-infectious diseases like idiopathic thrombocytopenic purpura, lupus or even cancer like leukemia can present in similar way.

 So, if you have low platelet – it can be dengue but it may not be dengue either. The best way to know whether you have dengue  is to go see a doctor who can assess you properly. Do not self-treat!

  

Myth 4 – I stay in high rise building so I am protected from mosquito bites. I would not get dengue.

Do you know that mosquitoes have been found in upper floors of apartment building? They can even travel inside elevators! So – nope – even if you stay on some condominium penthouse – if there is stagnant water anywhere – mosquitoes still can breed and spread dengue in your home.

Myth 5 – Dengue is a tropical disease. You do not get it in cold countries.

Before 1970, only 9 countries experienced severe dengue epidemics. But now, there are more than 100 countries in Africa, America, Eastern Mediterranean, South-east Asia and the Western Pacific suffered from dengue infection. The American, South-east Asia and the Western Pacific regions are seriously affected by dengue.

Because of international air travel – not only is the number of dengue cases are increasing, the disease now spreads to new areas. World Health Organisation (WHO) had reported dengue as one of the new emerging global pandemic in the past 10 years. The threat of a possible outbreak of dengue fever now exists even in Europe and local transmission of dengue was reported for the first time in France and Croatia in 2010.

That means – even if you are staying in cold temperate climate countries – you still can get dengue.

Myth 6 – Using insecticide spray is effective to eliminate Aedes mosquito.

Outdoor spraying or fogging with insecticides is a common step used to kill adult mosquitoes. However, it is not the most effective method. Why? This is because it will only kill adult mosquitoes outside the house. It does not kill the mosquito eggs, larvae or pupae living in stagnant water inside our houses. Therefore, even if outdoor spraying is effective in killing adult mosquitoes, mosquito eggs in stagnant water inside our houses will hatch and become adults in about a week.

Besides that, mosquitoes have become really smart. They can fly some distance away the moment our health departments’ workers start fogging our homes. After that, the mosquitoes will return to terrorize our homes again.

So how do we eliminate the pesky mosquitoes then? Well, we can start within our own homes with weekly 10 minutes sessions of doing the 5 steps Mozzie Wipeout, which are:

1. Change water in vases and bowls on alternate days;
2. Remove water from flower pot plates on alternate days;
3. Turn over all water storage containers;
4. Cover bamboo pole holders when not in use; and
5. Clear blockages, put BTI insecticide or Abate larvacide in roof gutters monthly

Another way to protect ourselves from dengue is by protecting yourself from mosquito bites: 

1. Wear long sleeves and long pants;
2. Use insect repellents when outdoors( always follow label instructions);
3. Keep mosquitoes out of your home.  Repair screens in windows and doors.  Avoid propping open doors;
4. If you have air conditioning, use it; and
5. Kill mosquitoes in your home with insecticide.

Myth 7 – If your platelet count is low – the doctor should transfuse you with platelets

Platelet transfusion is not used in dengue treatment. Main treatment for dengue is by giving intravenous fluid infusion. A doctor will only prescribe blood transfusion if a dengue patient develops severe bleeding or decreasing hematocrit (that signifies occult internal bleeding).

 

Myth 8 – If you have dengue before – you are forever immune to dengue.

Yes and no. Why do I say it like this?  Well, dengue virus is not only one type but consists of four distinct types – DEN-1, 2, 3 and 4. Each episode of infection will give you a life-long protective immunity to the same serotype but gives you temporary and incomplete protection against subsequent infection by the other three serotypes.

Because of this fact – research in dengue vaccines has been promising. Do you know that Malaysia is one of the countries that are part of the ongoing clinical trials for safe and effective dengue vaccine? In fact – the vaccine is jointly produced by a Malaysian research company – yup Malaysia Boleh!

Myth 9 – My platelet count is very low – it means that I must have severe dengue.

Severe dengue means that a dengue patient has developed complications like bleeding.

How do you know if you are at risk from severe dengue? You need to watch out for the following warning signs:

1. Severe abdominal pain or tenderness;
2. Persistent vomiting;
3. Difficulty in breathing or abdominal distension (that signifies you having fluid accumulation in your lungs or in your abdomen);
4. Mucosal bleeding like gum bleeding; or
5. Lethargy or restlessness.

If you have any of these warning signs – you need to be seen by a doctor who would later examine you and check your blood.

Things that a doctor looks for are:

1. Liver enlargement (≥2cm);
2. Pleural effusion (or fluids in the lung);
3. Ascites (free fluids in the abdomen);
4. Increase in hematocrit concurrent with rapid decrease in platelet count;
5. Rising liver enzymes; and
6. Prolonged bleeding time.

If you have any of these signs – you need to hurry to the nearest hospital for further treatment.

If you do not have any of these signs, felt very well but have very low platelet, you probably have mild form of dengue fever. The doctor may decide not to admit you and let you rest at home with daily monitoring of your blood counts.

What should you do at home?

1. Adequate bed rest;
2. Adequate fluid intake (more than 5 glasses of plain water for an average person);
3. Take paracetamol (not more than 4 gram per day);
4. Tepid sponging (wipe patient’s body with wet cloth or sponge which was soaked with lukewarm water)
5. If possible, use mosquito repellent or rest under a mosquito net even during day time to prevent mosquito bites;
6. Look for mosquito breeding places in and around your home and eliminate them.

WHAT SHOULD BE AVOIDED?

• Do not take non-steroidal anti-inflammatory (NSAIDS) medication such as  aspirin/mefenamic acid (ponstan) or steroids. If you are already taking these medications please consult your doctor.

Myth 10 – We need antibiotics to treat dengue.

As dengue is a viral illness, we do not use antibiotics to treat dengue. Currently, there are no specific antivirals that work against dengue.

More info:

Danger of dengue: https://www.mmgazette.com/the-danger-of-dengue-dr-khoo-yoong-khean/

Dr. Nur Hidayati is in training to be an internal medicine specialist with special interest in infectious disease and nephrology. She is a permanent columnist for the Malaysian Medical Gazette. Learn more about her on The Team page.

 

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

 

References:

• Malaysia Clinical Practice Guidelines on Management of Dengue Infection in Adults (Revised 2nd Edition) 2010
• WHO Worldwide Dengue situation update
• http://www.wpro.who.int/emerging_diseases/DengueSituationUpdates/en/

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