Dengue fever Prevention

• Proper use of a repellant preferably one containing DEET
• Fumigation and dengue sprays at weekly intervals at least
• Protecting your body by wearing socks and long sleeves shirts
• Using mosquitoes repellant nets at night

• • NS1, IGM and IGG serology for Dengue virus can be done
  • The antibodies may take time to become positive and you may initially be negative
  • The NS1 antigen is a test that can aid in a quicker diagnosis as it appears earlier than the antibodies

If you test positive for dengue fever

• • Don’t panic
  • Take adequate fluids to remain hydrated
  • Avoid over hydration as it can lead to fluid overload especially with IV fluid boluses
  • Keep a continuous/ cautious fluid intake rather than bolus fluids e.g one liter stat especially with IV fluids
  • For fever take acetaminophen or paracetamol
  • Avoid NSAIDs such as ibuprofen or naproxen

Patients that are re infected with Dengue are at a higher risk 

Patients that have a second or third bout of dengue fever have a higher chance of going down the slippery slope of dengue hemorrhagic fever and dengue shock syndrome as they are already sensitized by one strain , already. Prevention through isolation is necessary for infected individuals is important in this scenario.

Look for warning signs

• Persistent vomiting
• anorexia
• puffiness around eyes
• abdominal distention
• shortness of breath
• epistaxis
• hematuria/ blood in urine
• hemoptysis/ blood in sputum
• hematemesis/ blood in vomitus
• low blood pressure
• persistent dizziness, vertigo
• jaundice, bruising, petechiae on skin

Patients with such presentation or combination of signs need admission. An IV line needs to be passed to administer fluids to keep the patient well hydrated. Two IV lines may be passed if suspicion of deterioration is high as in a collapsed patient suffering from hypovolemic shock it would be very hard to gain IV access and a central line may be necessary.

When to give platelets

• If the patient is actively bleeding then platelets should be transfused regardless of the counts
• In absence of bleeding arrange and transfuse platelets if the platelet count drops below 15000
• Daily blood counts are proposed 3  times a day.  However, it should at least/ practically be done once day if the patient is otherwise well with no warning signs
• The recovery of the platelets lags behind the recovery of the TLC (Total leucocyte count)
• Once the TLC starts to rise expect platelet recovery within 48 hours

MONITORING

• Blood pressure
• Pulse pressure
• Heart rate
• Fever chart
• Input and output fluid record
• baseline investigations including U and Es , FBC , Clotting profile and liver function tests for every patient