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Sunday, October 21, 2012

Dengue can be Very Dangerous and Take Life; Rely on Non-structural Antigen, NS 1 Test

Posted by Dr Prahallad Panda on 9:21 PM Comments

Dengue, a viral fever transmitted by tiger mosquito, Ades. Ades prefers stagnant water to breed. Normally, stagnant water is found near residential areas, in flower vases, abandoned broken utensils and water of air cooler etc.. It also transmits Yellow fever.

Main symptoms of dengue fever. To discuss imag...
Main symptoms of dengue fever. To discuss image, instead see Talk:Human body diagrams (Photo credit: Wikipedia)

Dengue, “The Brake Bone Fever”, as the name signifies can be suspected very well, clinically. But, the classical manifestation of body ache, headache, sore throat, pin head bloody rashes may not be always there. It can be easily confused with other viral diseases like the common cold, viruses infecting intestine like ECHO virus and even with Typhoid.
This is very much confusing, if laboratory tests like depressed white blood cell count and platelet count are not taken seriously; even though the antibody tests for IgG and IgM are negative between day one and day five.
These tests to be positive may take 5 days. Now, tests for “Non-structural Antigen, NS 1” showing promise for early diagnosis, as early as 2nd or 3rd day.
A repeat complete blood count; and antibody test for IgG and IgM on 5th day of fever will definitely clinch the diagnosis. But, that may be too late for severe dengue to be treated carefully.
Around 4th or 5th day complications begin to appear, if the dengue is taking up the severe form, “hemorrhagic dengue”.

English: A typical rash as seen in dengue fever.
English: A typical rash as seen in dengue fever. (Photo credit: Wikipedia)

Dengue Shock Syndrome” may appear by this time with sudden black out, fainting attack, hypovolumic shock; leading to death.
Another fatal complication is bleeding, either internal or external leading to shock and kidney failure.
It is always good to suspect it clinically in the earlier stages, when IgG/IgM can be negative, continue treatment, if the patient is improving with paracetamol and multivitamin; and repeat tests again around 5th day.
Sometimes, it mimics the features of intestinal infection, like that of ECHO virus infection or typhoid in early days, when the tests for IgG/IgM are negative.
So, never be assured, if the tests for IgG/IgM are negative in early days in the face of depressed WBC and platelet count, and clinically suspicious; till conclusively proved negative on 5th day. Always, wherever possible a test for “Non-structural Antigen, NS 1” is to be done to keep a watch on the further course of disease.
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