Dr K. K. Aggarwal
Padma Shri and Dr B C Roy National Awardee
President, Heart Care Foundation of India
Bed netting is of little use since the dengue mosquitoes are most active during the daytime.
Remaining in well-screened or air-conditioned buildings during the day can reduce the risk of exposure. When outside during the day, one should wear clothing that reduces the amount of exposed skin and should use an effective mosquito repellent, such as N, N-diethyl-metatoluamide (DEET).
Because dramatic plasma leakage can develop suddenly, substantial attention has been placed upon the early identification of patients at higher risk for shock and other complications. The following clinical features are of help in this regard.
Duration of illness: The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after fever is over.
Hematocrit: An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.
Platelet count: Severe trrombocytopenia ( < 100,000/ mm3) is one of the clinical criteria for the dengue hemorrhagic fever and usually precedes over plasma leakage.
Serum aspartate transaminase (SGOT): Mild elevations in serum transaminases are common in both dengue fever and dengue hemorrhagic fever. However, levels are significantly higher in patients with dengue hemorrhagic fever, and elevated SGOT levels are noted earlier in illness.
Patients with suspected dengue who do not have any of the above indicators can be safely managed as outpatients as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.
A patient should be hospitalized when:
Blood pressure< 90/60 mmHg
Hematocrit> 50 %
Plarelet count < 50,000/ mmHg
Evidence of bleeding other than petechiae