Wednesday, October 29, 2014

The season of dengue: some biting facts

The key lies in early detection of the syndrome, say paediatricians

Watch out, Chennai. Intermittent showers have brought with them the breeding season of the day-biting mosquito, Aedes aegypti, that spreads, with every bite, the virus that causes dengue.
“While 90 per cent of the dengue cases pass off as fever, there is 10 per cent that might progress to dengue hemorrhagic fever, or dengue shock syndrome, both of which can be fatal for a child, if not detected early,” says senior paediatrician, and former director of the Institute of Child Health, Rex Sargunam.
The key, therefore, lies in early detection, paediatricians argue.
The first symptom of dengue is a bi-phasic fever. In the first phase, there is consistent high temperature (104-105 degrees) for two or three days. After the fever abates, seemingly the child is recovering, but has headaches, vomiting and abdominal pain. “This is what parents have to watch out for,” cautions Janani Sankar, senior consultant, Kanchi Kamakoti CHILDS Trust Hospital.
Most parents think the child is tired, and exhausted because he or she is recovering from the fever, and this delays getting the child crucial help. This season has been pretty bad, she says. Though there was delayed onset this year, the children who have come to this referral centre these past weeks, have been really ill.
Dr. Janani says, “Last week, we lost three children, two others are very sick in the ICU. Even when they come in to hospital, their lower limbs are very cold, and there is no recordable blood pressure or pulse in that region.” This is the shock stage. Consciousness, however, is preserved till the end, further misleading parents about the seriousness of the case.
While parents are mostly careful with younger children, the fatalities occur mostly in children aged between 8 and 12 years. “Sometimes, we are not even able to get an intravenous line to push fluids in, as the veins have collapsed.
Then we have to go through the bone and pump them directly into the marrow,” she adds.
At Apollo Children's Hospital, another referral centre where children come from various other hospitals in the State, doctors see the spectrum of kids that are sicker, says Indira Jayakumar, consultant, paediatric ICU and Emergency.
“When shock sets in, the liver is hit, the child accumulates fluid, and ventilation is a problem. The kidneys also pack up, requiring dialysis. At the DHF stage, the child bleeds from everywhere,” she explains.
The only solution, paediatricians feel, to prevent children from going into the severe dengue stage is to spread awareness of the symptoms to every parent, general physicians and family physicians. Medical intervention, in terms of fluids and blood products, can begin only after the shock stage sets in, but if children come early, they can be saved easily. “It is a pity we are losing children to a mosquito bite. It is entirely unavoidable,” Dr. Janani says.
Dr. Rex says general practitioners who see kids for fever must be suspicious about dengue given that the season is here. Calling for a platelet test apart from testing for dengue antibodies should be recommended, he adds.
According to Chennai Corporation authorities, a number of children from other districts and States are being referred to Chennai, because of its high quality medicare facilities.
As far as the city goes, all schools are being fogged regularly, and health centres are being advised to test for dengue in case of suspicion.


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