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V o l u m e 3 I s s u e 7 J u l y 2 0 0 9 s ..


Dengue season
Here comes the rain, and with it comes mosquitoes. These bloodsuckers aren’t just inconvenient
pests. They can carry the deadly dengue virus. Know what to do these cold rainy months so you
won’t burn up with dengue fever.


The virus is transmitted from one person to the

other by the tropical mosquito called the Aedes
mosquito (Aedes aegypti and rarely, Aedes

Aedes aegypti is an urban dweller. In the past,

dengue was seasonal because the rainy season
brought about more stagnant water, which is the
breeding ground of the mosquito. But this is no
longer true. Metro Manila gets cases of den-
gue fever all year round, probably because of
deteriorating sanitation and rapid urbanization.

This mosquito feeds on blood during daytime.

If the mosquito feeds on virus-laden blood from
a person with dengue virus, the mosquito can
then transfer the virus to another person on its
next meal.

More importantly, the virus can stay up to two

weeks in the blood without causing any fever.
By the time fever shows up in the first victim, the A Slice of Orange is a newsletter
virus would have already been transmitted to designed to help clarify basic health
information and offer juicy tips on
several people. uplifting your health.

Editorial team
Alvin Delfin
Christine Llenes
Voltz Olea, MD
V o l u m e 3 I s s u e 7 J u l y 2 0 0 9

Breakbone fever Based on these descriptions alone, we

cannot overemphasize how deadly a
The tourniquet test
In some countries, dengue fever is called
“breakbone fever” because of its symp- simple mosquito bite can become. This test checks how fragile your tiny
toms: a sudden fever with severe muscle blood vessels (capillaries) are, and can
and joint pains, as if your bones are Call the doctor very quick help tell a patient’s tendency to bleed. A
being broken. It can also cause severe Any person who has a high fever and positive tourniquet test may also be a sign
headache and a skin rash. The dengue muscle or joint pains should see a doctor of low platelet count. It is a requirement by
rashes are bright red, pinpoint rashes that as soon as possible. The presence of even the WHO before a diagnosis of DHF is
appear first on the legs, thighs and chest. mild signs of bleeding should also prompt made. However, other diseases may also
you to see the doctor. These signs include: cause a positive tourniquet test. Also, early
Less common symptoms are stomach pain,
• Nose bleeding DHF may be negative at first. Hence, a
nausea, vomiting or diarrhea.
negative test does not mean you can let
• Gum bleeding (especially in the ab-
your guard down.
sence of vigorous brushing of teeth)
• Bruises (especially in the absence
of trauma)
• Fresh or old (dark) blood in the
stool, sputum, saliva or vomit
• Vaginal bleeding
• Heavier than usual menstruation
• Wounds or cuts that take longer
than usual (or 5 minutes) for bleed- How is it performed:
ing to stop. 1. Your blood pressure is taken using a
regular blood pressure (BP) apparatus.
The fever usually lasts about six to seven
2. After a few minutes, the cuff is re-
days. In some cases, the blood plate- Fever with drowsiness, excessive sleepi-
inflated to a pressure between the sys-
lets decrease and the blood thickens as ness, photophobia (fear of lights), restless-
tolic (upper number of the BP) and dia-
the fever begins to break. This can lead ness, weakness, seizures, stiffness of the
stolic (lower number) pressures and
to dengue hemorrhagic fever (DHF), a limbs, slowness in movement, clumsiness, maintained for five minutes (this can
dangerous complication of dengue fever or stiff neck may also mean that the brain be painful).
where the patient experiences bleeding may already be affected. 3. The test is positive if there are more
in different parts of the body, including the than 20 red dots per square inch of
gums, stomach, and intestines. In the hospital, a test called a complete skin around where the cuff was inflated.
blood count can check if blood platelet
Rarely, DHF leads to dengue shock syn- levels are falling, or if the blood is getting While you can do a tourniquet test at
thicker. Special blood tests that can directly home, the results can become incorrect
drome, where the bleeding and thickening
detect the virus can also be performed. if the test is not done correctly. It is best
of the blood leads to low blood pressure
to have a tourniquet test performed by a
and poor blood flow to vital organs, lead-
health professional.
ing to shock and multiple organ failure. A tourniquet test will also be performed.
V o l u m e 3 I s s u e 7 J u l y 2 0 0 9

Once dengue fever or DHF is confirmed, Dodging the dengue bug

your vital signs (heart rate, blood pres- The Aedes mosquito is critical to A dengue vaccine?
sure, breathing, and temperature) will be the life cycle and transmission of the
monitored meticulously. This will detect dengue virus. Hence, mosquito control There is no vaccine yet available to
the first signs of shock, which will then has been the cornerstone of dengue prevent dengue. Although progress is
underway, developing a vaccine against
be treated promptly. Signs of bleeding prevention since the 1960s. There
the disease has proven challenging.
and platelet counts will also be regularly are two main methods:
monitored. If platelet counts drop to criti- One of the biggest challenges to vaccine
cal levels, or there is massive bleeding, Larval (wriggler) control development is the fact that there are
blood transfusion will be performed. Eliminate possible breeding grounds four distinct types of dengue viruses. The
vaccine must immunize against all four
types to be effective.
Not everyone who has dengue fever • Periodically drain stagnant water
will be hospitalized. Stable patients will in plastic cups, used tires, bottles, To make matters worse, the body seems
be sent home, but will be requested to flowerpots, etc. to react to each type in a different way.
undergo regular platelet testing (from • Cover water drums and water pails With other infections, previous exposure
to a virus makes subsequent infections
every few hours to daily). at all times.
milder, or may even prevent subsequent
• Replace water in flower vases once infections, because the immune system
All patients, whether at home or in the a week. is already more prepared for a second
hospital, need to increase their intake of • Clean all water containers once a onslaught.
fluids. This will prevent dehydration and week. Scrub the sides well to remove
But in the case of dengue, subsequent
blood thickening, which could lead to eggs of mosquitoes sticking to the
infections tend to be worse than the
shock. sides. previous one, until the
• Clean gutters of leaves and debris so person is exposed
Dengue patients should never take medi- that rainwater will not collect in them. to all four types.
cines such as aspirin or ibuprofen (or Only then will
the body
other pain killers), as this may increase Adult mosquito control
the risk of bleeding. The only anti-fever/ Careful use of insecticides, insect immune.
pain medicine they can take is paraceta- repellents, and mosquito nets.
mol (acetaminophen).

A slice of trivia

Dengue fever can turn deadly once blood platelet counts start going down and the blood
begins to thicken. What blood test can detect these initial but alarming signs of DHF?
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