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Dengue epidemic showing “peculiarities”, warns Pera Professor
View(s):Many elders affected, leakage of fluid starts early with more ‘leakers’, Platelet count dropping fast, more involvement of the liver in DHF
By Kumudini Hettiarachchi
As the dengue virus ravages the country like an unstoppable wildfire, sparing no one, a health expert was concerned over certain “peculiarities” he is seeing in this epidemic. Naming this the “worst” dengue epidemic in terms of numbers he has experienced in 20 years as a Physician, Prof. Thilak Jayalath, who is part of the Professorial Team looking after a ward with 48 beds for men and 48 beds for women at the Peradeniya Teaching Hospital, points out that in May alone they treated more than 500 dengue patients.
Before highlighting the “peculiarities” of the current epidemic, Prof. Jayalath who is also Professor in Medicine at the Department of Medicine, Peradeniya Medical Faculty, stresses that the wards are “flooded” with patients. Many patients are on the floor, some with saline-drips attached to them because they have gone into the ‘critical’ fluid-leakage stage of Dengue Haemorrhagic Fever (DHF).
“Our ward has a good track record in managing dengue, but we can see that the doctors, nurses and support staff, are stretched to capacity,” he laments, adding that a look at their faces show the strain, though they soldier on. It’s the DENV2 (there are four dengue virus serotypes – DENV1, 2, 3 and 4) which is doing the rounds this time and Prof. Jayalath highlights some of the “unusual and peculiar” aspects of this epidemic:
Usually, we don’t see the elderly affected much by the dengue virus. However, in the current epidemic we have treated even an 85-year-old who had been confirmed as having dengue. So the elderly need to be aware that they too can fall victim to this virus.
An unusual picture also seems to be emerging during DHF – the leakage of fluid starts early, with more and more patients going in to leakage. There are more ‘leakers’ than usual, with some starting fluid leakage as early as Day 2 of the illness and others as late as Day 6.
In some of those hit by DHF, even though the platelet count does not drop drastically, the leakage of fluid begins.
Patients’ platelet count also drops very fast. Usually it should be between 150,000 and 400,000, but the platelets of some even dropped down as low as 1,000.
There also seems to be more involvement of the liver in DHF in this epidemic.
There should be constant monitoring of the condition of patients by keeping track of the Packed Cell Volume (PCV) and liver enzymes as well as whether there is abdominal pain.
Sometimes even though the Dengue NS1 Antigen Test is negative, the patient is down with dengue, with strong clinical evidence that it is dengue. When asked by the Sunday Times, whether it could be due to poor quality antigen test kits being used, he conceded that it may be due to this, but advised colleagues to be careful even if it was negative and check the clinical presentation.
Commending the Peradeniya Teaching Hospital authorities for providing much support to face the dengue epidemic, Prof. Jayalath is perturbed that sometimes patients act irresponsibly.
“We provide them with mosquito nets to prevent the transmission of the dengue virus from an infected person to another patient but they simply don’t use them. They need to help minimise or break the dengue transmission to stop this epidemic from gathering more and more momentum,” he added.