Dengue Fever

 

Vergleich: Siehe: Krankheiten + Viren

 

Family Flaviviridae; genus Flavivirus. Other members of the same genus include yellow fever virus, West Nile virus, St. Louis encephalitis virus, Japanese encephalitis virus, tickborne encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus. Most are transmitted by arthropods (mosquitoes or ticks), and are therefore

also referred to as arboviruses (arthropodborne viruses).

 

[Zeit Online]

Dengue

Wo kommt es vor?

Dengue, auch Siebentagefieber genannt, ist eine Infektionskrankheit, verursacht durch ein Virus. Übertragen wird es durch Mücken.

Erkrankte leiden an schweren Fieberschüben und unspezifischen Symptomen, ähnlich einer Grippe. In schweren Fällen kann es zu inneren Blutungen und Organversagen kommen.

Bisher gibt es kein wirksames Medikament gegen Dengue. Wird mit fiebersenkenden Mitteln und Lösungen gegen den Flüssigkeitsverlust behandelt. Forscher arbeiten

an der Entwicklung eines Impfstoffes. 

Was ist Dengue?

Übertragen wird das Virus durch die Gelbfiebermücke, die hauptsächlich in tropischen Gebieten vorkommt, sowie die Asiatische Tigermücke, die auch in urbanen Gegenden überlebt. Die Mücke nimmt das Virus auf, wenn sie das Blut eines Infizierten saugt. Das Insekt selbst erkrankt nicht, gibt aber die Viren an den nächsten Menschen weiter,

den es sticht.

Der Übertragungsweg

Dengue kommt im gesamten tropischen Gürtel der Erde vor (Asien, Mittel und Südamerika). Auch im südlichen Teil der USA, in Südeuropa und in Australien

kommt es mittlerweile zu Infektionen.

Jährlich erkranken nach Schätzungen der Weltgesundheitsorganisation WHO 50 bis 100 Millionen Menschen daran. Die Autoren der neuen Studie sprechen sogar von

400 Millionen Erkrankten pro Jahr.

Notes on Dengue from the WHO website:

“Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the 4 dengue viruses. It occurs in tropical and subtropical areas of the world.

Symptoms appear 3  14 days after the infective bite. Dengue fever is a febrile illness that affects all.

Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash.

No specific antiviral medicines for dengue available. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal antiinflammatory

drugs (Ibuprofen) is not recommended.

Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and

careful clinical management by experienced physicians and nurses increase survival of patients.

                                              

Eupat-per.

homeopathic medicine Eupatorium for treating Dengue feverit’s the best suited homeopathic medicine for dengue fever, where platelet count get low and + intense pain in joints.

Known as “Boneset”, from the prompt manner in which it relieves pain in limbs and muscles that accompanies some forms of febrile disease, like dengue, malaria and influenza.

Head:

– Throbbing pain.

– Pressure as if a cap pressed over the whole skull.

– Vertigo; sensation of falling to left.

– Top and back of head with pain and soreness of eyeballs.

– Periodical headache (every 3rd and 7th day.

– Occipital pain after lying down, with sense of weight.

Fever:

– Perspiration relieves all symptoms except headache.

– Chill between 7  9 h., preceded by thirst with great soreness and aching of bones.

– Nausea, vomiting of bile, throbbing headache.

– Knows chill is coming on because he cannot drink enough.

Rhus-t.:

wonderful action in dengue fever with chill and red vesicular eruptions, and also acts very well in joints pain in fever

– Influenza, with aching in all bones. [Eupper.]

Fever:

– Adynamic; restless, trembling.

– Dry cough and restlessness.

  Urticaria fever during

– Chilly, as if cold water were poured over him, followed by heat.

– Muscular pains relived by stretching

Arsa.

acts very nicely in all types of fever with restlessness mentally and physically. This homeopathy medicine is often used as a preventive drug for Dengue fever.

Mind:

Great anguish and restlessness. Changes place continually. Fears, of death, of being left alone.

Great fear, with cold sweat.

Thinks it useless to take medicine.

Suicidal.

Hallucinations of smell and sight.

Despair of recovery which drives him from place to place.

Miserly, malicious, selfish, lacks courage.

General sensibility increased [Hep.].

Sensitive to disorder and confusion.

Fever:

High temperature.

Periodicity marked with adynamia.

Septic fevers.

Intermittent. Paroxysms incomplete, with marked exhaustion. Hayfever.

Cold sweats.

Typhoid, not too early; often after Rhust.

Complete exhaustion.

Delirium; < after midnight.

Great restlessness.

Great heat about 3 h.

Chin.:

suitable homeopathic remedy in all fever with debility in body due to loss of vital fluids.

Debility from exhausting discharges, from loss of vital fluids, calls for this remedy.

Periodicity most marked.

Extremities:

Pains in limbs and joints, as if sprained; <, slight touch; > hard pressure

“As of a string around limb”

Joints swollen; very sensitive, with dread for open air.

Great debility, trembling, with numb sensation.

Averse to exercise; sensitive to touch.

Weariness of joints; <: morning/sitting;

Skin:

Extreme sensitiveness to touch, but hard pressure relieves. Coldness; much sweat.

One hand ice cold, the other warm.

Oedema over whole body

Dermatitis; erysipelas.

Swelling of glands; scrofulous ulcers and caries.

Fever:

Intermittent, paroxysms anticipate; return every week.

All stages well marked.

Chill generally in forenoon,  thirst before chill, and little and often.

Debilitating nightsweats.

Free perspiration caused by every little exertion, especially on single parts.

Hay fever, watery coryza, pain in temples.

Gels.:

well known homeopathy remedy in fever cases with chill in spine and also known as 3D medicine for DULLNESS DIZZINESS DROWSINESS.

Fever:

Wants to be held.

Pulse slow, full, soft, compressible.

Chilliness up and down back.

Heat and sweat stages, long and exhausting.

Much muscular soreness, great prostration, and violent headache.

Fever, with stupor, dizziness, faintness; thirstless, prostrated.

Chill, without thirst, along spine; wavelike, extending upward from sacrum to occiput.

Acon.:

Acute acting homeopathic remedy in sudden fevers.

state of fear, anxiety; anguish of mind and body.

Physical and mental restlessness, fright, is the most characteristic manifestation of Aconite. Acute, sudden, and violent invasion, with fever, call for it.

Does not want to be touched.

Sudden and great sinking of strength.

Complaints and tension caused by exposure to dry, cold weather, draught of cold air, checked perspiration, also complaints from very hot weather (gastrointestinal disturbances, etc.)

 First remedy in inflammations, inflammatory fevers.

Serous membranes and muscular tissues affected markedly.

Burning in internal parts; tingling, coldness and numbness.

Influenza.

Skin:

Red, hot, swollen, dry, burning in skin

Rash like measles.

Gooseflesh.

Formication and numbness.

Chilliness and formication down back.

Fever:

Cold stage most marked.

Cold sweat and icy coldness of face.

Coldness # heat

Evening chilliness soon after going to bed.

Cold waves pass through him. Thirst and restlessness always present.

Chilly if uncovered or touched.

Dry heat, red face.

Most valuable fever remedy with mental anguish, restlessness, etc.

Sweat drenching, on parts lain on; relieving all symptoms.

Crot-h.:

it’s a suitable homeopathic medicine in dengue fever case having hemorrhagic tendency. It is often suggested for Dengue hemorrhagic fever, where the platelet count

goes very low.

Diseases caused by a previous low state of the system; low septic typhoid or malarial fever; chronic alcoholism; exhausted vital force; genuine collapse.

Hemorrhagic or broken down constitutions.

Hemorrhagic diathesis; blood flows from eyes, ears, nose, and every orifice of the body; bloody sweat.

Yellow color of conjunctiva; clears up vision after keratitis, or keratoiritis.

Tongue fiery red, smooth and polished (Pyr.); intensely swollen.

Blood decomposition, hemorrhages (dark fluid that forms no clots), tendency to carbuncles, malignant scarlatina, yellow fever, the plague, cholera, give opportunity to

use this remedy.

Fever:

Malignant fevers of a hemorrhagic or tcharacter.

Low bilious remittents.

Yellow fever.

Bloody sweat.

Cold sweats.

Skin:

Swelling and discoloration, skin tense and shows every tint of color, with excruciating pain.

Yellow color of the whole body.

Great sensitiveness of skin of right half of body.

Hemorrhage from every part of body.

Bloody sweat.

Chilblains, felons.

Pustular eruptions.

Insect stings.

Bad effects of vaccination.

Lymphangitis and septicemia.

Boils, carbuncles, and eruptions are surrounded by purplish, mottled skin and edema.

Sore sensation relieved by pressure.

Bry.:

Useful where there is lot of muscle and joint pain, < with every little motion.

The pains are stitching, tearing, < at night, greatly < motion, > rest.

The parts which are the seat of subjective pain become subsequently sensitive to external pressure, and then swollen and red.

Fever:

Pulse full, hard, tense, and quick.

Chill with external coldness, dry cough, stitches.

Internal heat.

Sour sweat after slight exertion.

Easy, profuse perspiration.

Rheumatic and typhoid marked by gastrohepatic complications

Patient <: morning/warmth/any motion/eating/hot weather/exertion/touch;

Cannot sit up; gets faint and sick.

>: lying on painful side/pressure/rest/cold things;

Arn.:

Favorable homeopathic medicine for dengue fevers with sore, lame and bruised feeling in all body.

Fever Prodrome

Drawing pains “As if in the periost”

Thirst: For large quantities of cold water, which refreshes him.

Chill With thirst, pain in muscles of back and extremities, as if bruised; great soreness of whole body.

Less thirst, but increased soreness in muscles; must lie down, yet bed feels too hard; he cannot find a soft place and keeps constantly changing position in search of one.

Sweat Generally absent in recent attacks.

In old cases, sour, and offensive

Bruised feeling and soreness continue through every stage, and persist during apyrexia.

Bell.:

Best homeopathic medicine for high fever, fever is of sudden and violent nature.

Fever:

Pulse: Ordinarily quick, often full, hard and tense, but sometimes also it is full.

Throbbing carotid and temporal arteries.

Violent beating of the arteries.

Chill: In evening, especially on extremities, most on arms, with heat.

Evening shaking chill.

Coldness of limbs, with a hot head.

Shivering, running down back.

Heat: Constant dry burning, with sweat on head and neck only Internal, with anxiety and restlessness of forehead, with cold cheeks.

Internal or external, or both at same time.

Of head, with red face and delirium.

Generally predominating Sweat, Exclusively on the covered parts With, or immediately after the heat, most on face empyreumatic odour, and stains the linen.

Sulph.:

Fever:

Pulse Full, hard and accelerated, sometimes intermittent

Chill : And chilliness, principally internal and without thirst, mostly evenings, but also at other times of day.

External, with concomitant internal heat and redness of face.

Severe, at night in bed.

In forenoon; in afternoon heat with cold feet.

With thirst, after previous heat.

Spreading from toes.  Running up back.

Heat:

Afternoons and evenings, with dry skin and great thirst.

Great, at night, without thirst, often preceding chill with thirst.

Sweat, Nights and mornings, Copious sour smelling , the whole night.

In evening, most on hands.

Copious, from least movement.

Anxious, debilitating, of an empyreumatic, sour, seldom offensive, sometimes also cold.

Nightsweat, only on nape and occiput.

Phosph.:

Another homeopathy remedy with hemorrhagic diathesis. Is useful for both simple Dengue fever as well as Dengue hemorrhagic fever.

Fever:

Chilly every evening.

Cold knees at night.

Adynamic with lack of thirst, but unnatural hunger.

Hectic, with small, quick pulse; viscid nightsweats.

Profuse perspiration.

Tub.:

Fever:

Postcritical temperature of a remittent type.

Here repeat dose every two hours. (MacFarlan).

Profuse sweat.

General chilliness.

<: motion/music/before a storm/standing/dampness/from draught/early morning/after sleep;

>: open air;

Calc.

Fever:

Chill at 14 h. begins internally in stomach region. Fever with sweat.

Pulse full and frequent.

Chilliness and heat.

Partial sweats.

Night sweats (head, neck and chest).

Hectic fever.

Heat at night during menses, with restless sleep.

Sweat over head in children, so that pillow becomes wet.

Skin:

Unhealthy; readily ulcerating; flaccid.

Small wounds do not heal readily.

Warts on face and hands.

Petechial eruptions.

Lyc.:

Fever:

 

Chill between 15 – 16 h., followed by sweat.

Icy coldness.

Feels as if lying on ice.

One chill is followed by another. [Calc.; Sil.; Hep.]

Sep.:

Extremities:

Lower extremities lame and stiff, tension as if too short.

Heaviness and bruised feeling.

Restlessness in all limbs, twitching and jerking night and day.

Pain in heel.

Coldness of legs and feet.  

Fever:

Frequent flushes of heat; sweat from least motion.

General lack of warmth of body.

Feet cold and wet.

Shivering, with thirst; <, towards evening.

Carb-v.:

For the bad effects of exhausting diseases (Cinch, Psor.); cachectic persons whose vitality has become weakened or exhausted.

Useful when there is collapse like state along with Dengue fever.

Fever:

Chilliness in the evening.

Frequent chilliness (at night), chilliness and coldness.

With the irritation to cough, in the evening, chilliness and drawing in the cheeks.  Shivering, frequently lasting an hour.

Shivering in the evening, with weariness and flushes of heat, before going to sleep (after ten hours).

Febrile chill in the morning, with thirst, chattering, and blue fingernails, lasting till afternoon; then in the evening heat and sweat, without thirst.

Chill with thirst.

Drawing chill, with great thirst.

Feverish coldness in the evening; he does not feel the warmth from the stove.

Coldness of the left arm and left leg.

Very cold hands and feet in the evening.

She could not get the feet warm, in the evening, in bed, before 1 o’clock.

Chilliness and heat towards evening (after twelve days).

Chill at 11 h. for several days; heat in the evening at 18 h.

Heat at night in bed.

Sensation of heat, with great anxiety, in the evening, although she was cold to touch all over.

General burning heat in the evening, with great weariness and fantasies at night.

A little wine heats him very much.

Warmth in the spine rising up to the throat.

Much heat the whole day, though with constantly cold feet.

Much inclined to sweat.

Increased sweat in the morning on waking (after three days).

Profuse sweat of the body, and even of the head, before midnight.

General sweat after a moderate breakfast.

Warm sweat in the morning (after 29 hours).

Sour smelling sweat (after eight days).

Sweat of an offensive odour at night.

He sweat easily on the upper part of the body in a warm room, and then again became just as easily chilled.

Sweat on the forehead while eating.

Frequent profuse sweat on the face (in a boy two years old).

Heat on the balls of the hands.

Sweat of the feet when walking.

Sil.:

Fever:

Chilliness; very sensitive to cold air.

Creeping, shivering over the whole body.

Cold extremities, even in a warm room.

Sweat at night; < towards morning.

Suffering parts feel cold.

<: new moon/in morning/from washing/during menses/uncovering/lying down/damp/lying on l. side/cold;

>: warmth/wrapping up head/summer/in wet or humid weather;

Merc.:

Fever:

Generally gastric or bilious, with profuse nightly perspiration; debility, slow and lingering.

Heat # shuddering

Yellow perspiration.

Profuse perspiration without relief. Creeping chilliness, < in the evening and into night.

Alternate flashes of heat in single parts.

<: at night/wet, damp weather/lying on right side/perspiring/warm room/warm bed;

Lach.:

Like all snake poisons, Lachesis decomposes the blood, rendering it more fluid; hence a hemorrhagic tendency is marked.

Fever:

Chilly in back; feet icy cold; hot flushes and hot perspiration.

Paroxysm returns after acids.

Intermittent fever every spring.

<: after sleep; (Kali bich.) Lach. sleeps into aggravation; ailments that come on during sleep. [Calc.]

<: left side/in the spring/warm bath/pressure/constriction/hot drinks/closing eyes;

<: appearance of discharges/warm applications;

Pyrog.:

For septicemia; puerperal or surgical from ptomaine or sewer gas infection; during course of diphtheria, typhoid or typhus; when the best selected remedy fails to >> or permanently improve.

The bed feels hard (Arn.); parts lain on feel sore and bruised (Bapt.); rapid decubitus (Carb-ac.).

Tongue: large, flabby; clean, smooth as if varnished; fiery red; dry, cracked, articulation difficult (Crot-h., Ter.).

Taste: sweetish; terribly foetid; puslike; as from an abscess.

Vomiting: persistent; brownish, coffeeground; offensive, stercoraceous; with impacted or obstructed bowels (Op., Plb-met.).

Fever:

Coldness and chilliness.

Septic fevers.

Latent pyogenic condition in Dengue fever.

Chill begins in back.

Temperature rises rapidly.

Great heat with profuse hot sweat, but sweating does not cause a fall in temperature.

Anthrac.:

In carbuncle, malignant ulcer and complaints with ulceration, sloughing and intolerable burning.

When Arsenicum or the best selected remedy fails to relieve the burning pain of carbuncle or malignant ulceration.

Haemorrhages: blood oozes from mouth, nose, anus or sexual organs; black, thick, tarlike, rapidly decomposing (Crot-h.).

Septic fever, rapid loss of strength, sinking pulse, delirium and fainting (Pyr.)

Apis.:

Fever:

Chilliness (periodic at 15 h.

Heat predominates, without thirst (usually), with drowsiness.

Heat of head with throbbing, ameliorated by pressure.

Sweat not marked, skin usually dry.

Ferr-p.:

Fever:

Chill daily at 13 h.

All catarrhal and inflammatory fevers; first stage.

<: r./at night and 16 - 18 h./touch/jar/motion;

>: cold applications;

Skin:

Hyperaemia; from mechanical injuries, fresh wounds, not yet suppurating.

Capillary congestion, with burning of the skin, more exercise and warmth.

Abscesses, boils, carbuncles and felons; at the commencement of these affections this remedy reduces heat, bloodaccumulation, pain and throbbing.

Chickenpox, erysipelas and erysipelatous inflammations of the skin, for the fever and pain.

Suppurative processes on the skin with febrile symptoms.

Measles, scarlet fever and smallpox.

Pimples, acne, for the pain and heat and congestion.

Ulcers with febrile accompaniments.

Bapt:

The symptoms of this homeopathy drug are of an asthenic type, simulating low fevers, septic conditions of the blood, malarial poisoning and extreme prostration.

Dengue fever with marked prostration and muscle pains.

Indescribable sick feeling.

Great muscular soreness and putrid phenomena always are present.

All the secretions are offensive breath, stool, urine, sweat, etc.

Epidemic influenza.

Chronic intestinal toxaemias of children with fetid stools and eructations.

Fever:

Chill, with rheumatic pains and soreness all over body.

Heat all over, with occasional chills.

Chill about 11 h.

Adynamic fevers.

Typhus fever.

Shipboard fever.

<: Humid heat/fog/indoors;

Ph-ac.:

Extremities:

Weak.

Tearing pains in joints, bones, and periost.

Cramps in upper arms and wrists.

Great debility.

Pains at night, “As if bones were scraped”

Stumbles easily and makes missteps.

Itching, between fingers or in folds of joints.

Skin:

Pimples, acne, bloodboils.

Ulcers, with very offensive pus.

Burning red rash.

Formication in various parts.

Falling out of the hair. [Nat-m. Sel-met.] Tendency to abscess after fevers.

Fever:

Chilliness.

Profuse sweat during night and morning.

Low types of fever, with dull comprehension and stupor.

>: from keeping warm;

<: exertion/from being talked to/loss of vital fluids/sexual excesses;

Everything impeding circulation causes aggravation of symptoms.

Mur-ac.:

Extreme prostration.

Cold extremities.

Heat without thirst.

Typhoid types, stupid.

Haemorrhages.

Restlessness.

Involuntary discharges.

Bedsores.

Pulse rapid and feeble.

Excessive prostration.

<: in damp weather/before midnight;

>: lying on left side;

 Homeopathy Prophylaxis for Dengue Fever

 

The most commonly suggested homeopathy medicines for prevention or prophylaxis of Dengue fever are Eupatorium perfoliatum and Arsenic album, but the remedy can change every year.

 

[Navin Pawaskar]

Drs. Navin Pawaskar and J. Srikanth present a homoeopathic approach to dengue fever. Repertory analysis must be combined with material medica in determining the acute and constitutional remedy.

INTRODUCTION

Dengue is an acute mosquito transmitted viral disease characterized by fever, headache, muscle and joint pains, rash, nausea and vomiting. Dengue fever usually selflimited, biphasic febrile illness, its presentation may range from asymptomatic to Dengue Hemorrhagic Fever (DHF) and fatal shock (Dengue Shock SyndromeDSS). The illness is more severe and begins more suddenly in adults, infection is asymptomatic in 80% of infants and children. In 2013 dengue was estimated to be responsible for approximately 3.2 million severe cases and 9000 deaths worldwide. In India the case fatality rate is about 35%.

 

Causative organism

It is an arbovirus from Genus –Flavivirus. It is the most common among all arbovirus infections. There are four 4 serotypes (DENV1, 2, 3 & 4) of infections identified. Infection with one serotype does not include solid immunity to the other. Hence, individual may suffer from dengue fever more than once.

 

Epidemiology

Large number of cases regularly occurs in urban, suburban and rural areas, with increasing proportion of Dengue Hemorrhagic Fever and Dengue Shock Syndrome.

In India during 2013, about 74168 cases were reported with 168 deaths. Case fatality rate was 0.22%. The highest numbers of cases were reported from Punjab

followed by Tamilnadu, Gujarat, Kerala and Andhra Pradesh.

 

Transmission

Dengue is transmitted via Aedes aegypti mosquitoes. It is transmitted by female mosquitos’, bites during day time only.

 

Incubation period 2 7 days

 

CLINICAL PRESENTATION:

Classical Dengue

    Dengue Hemorrhagic fever

    Dengue Shock Syndrom

CLASSICAL DENGUE

    Sudden onset of chills and high fever with intense headache

    Retroorbital pain with photophobia

    Muscle and joints pain which prevent all movements

    Intense myalgia; BREAK BONE FEVER

    Constitutional symptoms like extreme weakness, anorexia, constipation, altered taste sensation, colicky abdominal pain, sore throat and general depression.

    Typical morbilliform rash spreading centripetally to face; trunk & limbs, spares palms & soles with first 2448hrs. Lasting for 15 days, resolves with desquamation.

DENGUE HEMORRHAGIC FEVER (DHF)

    Especially children and young females

    Precirculating antidengue antibody is predominant risk factor. It may be acquired from previous infection with different serotype or in the form of transplacental transfer.

    Leakage in plasma takes place in DHF & extravasations occur in the endothelial gaps due to increased capillary permeability.

    Onset3rd - 7th day of illness

 

Criteria for diagnosis of DHF

    Fever or H/O fever lasting 27 days

    Hemorrhagic tendencies indicated by any of the following: Positive tourniquet test, Petechie, ecchymosis or purpura, bleeding from mucosa, gastrointestinal tract,

injection sites or other locations

    Enlargement of liver

    Thrombocytopenia : platelet count < 1,00,000/mm3

    Hemoconcentration: hematocrit increased by > 20%

 

Plasma leakage evidenced

Rise in haematocrit > 20%

    Fall in haematocrit > 20% after IV fluids

    Positive tourniquet test i.e. appearance of more than 20 petechiae per 2.5 cm2 on inflating sphygmomanometer cuff for 5 minutes.

DENGUE SHOCK SYNDROME

All the criteria of DHF plus, Shock manifested by rapid and weak pulse with narrowing of the pulse pressure  20 mmHg or less) or hypotension, tachycardia,

with the presence of cold, clammy skin & restlessness.

 

Grades of Dengue…

Grade I fever + nonspecific constitutional symptoms. The only hemorrhagic manifestation is a positive tourniquet test.

Grade II manifestations in grade I plus patient with spontaneous bleeding (skin hemorrhage).

Grade III circulatory failure by rapid and weak pulse, narrowing of pulse pressure or hypotension with the presence of cold clammy skin and restlessness.

Grade IV profound shock with undetectable blood pressure and pulse.

 

Warning signs for shock…

    Intense, sustained abdominal pain

    Persistent vomiting

    Restless or lethargy

    Sudden change from fever to hypothermia with sweating and prostration.

INVESTIGATIONS.

Probable diagnosis

Serological tests

    NS1 Ag Rapid tests

    ELISA for IgM (for recent infection) Appear within 5 days, persists for months 3.ELISA IgG (for Chronic infection)

 

Confirmed diagnosis

    Culture is positive within first 5 days (sensitivity < 50%); can also obtain culture from liver at autopsy.

    Detection of virus in tissue, serum, or CSF by IHC, IFA or ELISA

    Increased specific IgG or IgM

    WBC decreased (2,0005,000/uL) with toxic granulation of leukocytes and neutropenia; may have marked atypical lymphocytes.

    In DHF, decreased platelets (<1,00,000/uL) with impaired aggregation, prolonged prothrombin time in severe cases of DHF. DIC may occur.

    Increased transaminase (5,001,000 U/L) and bilirubin indicating decreased hepatic & renal functions.

    RTPCR: Detection of genomic sequence of virus by RTPCR (sensitivity > 90% early, <10% in 7 days). Reverse transcriptase polymerase chain reaction

(RTPCR) sensitive and specific for detection of viral RNA. But this test is still a research tool.

COMPLICATIONS

    Bleeding

    ARDS (= Acute respiratory distress syndrome)

    Renal failure

    Hepatic failure

    Encephalopathy

 

Homoeopathic Approach in Dengue:

CASE 1

DD.:

Nux-v. Puls. and Sep. come close on Repertorization.

Nux-v. marked chilliness along with body ache, cannot bear to uncover. Patient is thirsty during chills and thirstless during fever. Low back pain is hall mark

along with aching limbs during fever. Nuxv. loud, painful retching and water brash along with nausea. Gastric bilious symptoms are present during apyrexia.

Puls. slow insidious onset with subdued mild symptomatology. Thirstlessness is a hallmark of Pulsatilla along with loathing for food which is < on eating.

Taste is bad (morning with white coated tongue).

Sep. irregular fever with changing paroxysm (caused by allopathic or homoeopathic intervention). Extremely chilly. Nausea not > eating is hallmark concomitant during fevers. Thirst during chill and though thirsty during heat, less thirst compared to chilliness stage.

 

CASE 2

LOCATION             SENSATION             MODALITY             CONCOMITANT

DD.:

Chin.:                        Prodromal : nervous excitement, anxiety, headache, nausea, irritability

                        Chill followed by thirst, wants to wrap himself warmly, chill begins in the breast.

                        Heat without thirst, fiery red face with congestion of head, other parts chilly

                        Sweat with thirst, drenching profuse, debilitating

                        Apyrexia: debility, restlessness, anemia, edema

                        Headache and weakness as concomitants.

 

            Fever patterns clear and well defined

Nux-v.            Fever with prominent gastrobilious symptoms

                        Chill: preceded or accompanied by blueness of fingernails

                        Chill with yawning & aching in limbs and back

                        Chill not > covering or external heat

                        Thirst less during fever

                        Low backache during heat

                        < Pressure

 

            Weakness is not a prominent concomitant.

Nat-m.:             Useful in inveterate and badly treated cases of fever

                        Chill: 10 11 am, begins in small of back or feet

                        Chill with thirst and generalized aches and pains

                        Heat: high fever with throbbing headache, increased thirst,

                        Fever blisters around lips

                        Sweat: debilitating , relieves headache

                        Marked periodicity

 

Sep.:                        Irregular Fevers

                        Marked Chilliness

                        < Jarring

                        > Pressure

                        Profound Prostration

                        Nausea at smell and sight of food

                        Nausea not better by eating

                        Thirst less during fever

 

DISCUSSION:

Repertory is a tool of great help but, has its limitation. Quantitative aggregation presented by repertory software needs qualitative analysis. In this case Sepia does not come

up in first five remedies, yet on qualitative studies in Materia Medica stands up prominently. Meticulous differentiation of remedies based on Materia Medica brings down errors in prescribing.

 

OBSERVATIONS MADE OF PATIENT’S BEHAVIOUR

    Patient was a quiet lady who spoke little and appeared to be mild

    Patient was always accompanied by someone for the follow up.

    She was afraid when spoken to about admission and the diagnosis

    She timidly followed everything told to her by the team of physicians and her husband.

 

PROBABLE CLINICAL DIAGNOSIS Dengue fever

REASONS:

    Sudden onset of fever with severe intense headache and myalgia.

    The appearance of rash at the deeffervescence of fever with its characteristic pattern of initial macular to later purpuric type are characteristic of dengue fever.

    A low leucocyte count.

    Falling platelets with appearance of bleeding is also more suggestive of a dengue infection.

 

ON EXAMINATION

Rash same, Purpuric spots on the lower extremities and very few over the abdomen.

Case taking of the chronic totality done to know the deep acting CONSTITUTIONAL REMEDY as well as the probable ACUTE REMEDY in relationship with the constitutional remedy.

 

Acute Totality:

1.       Dullness fever during

2.       Weeping pain due to

3.       Thirstlessness

4.       Nausea < eating

5.       Head pain > binding the head

6.       Bitter taste

7.       Nausea < drinking

8.       Head pain < noise

9.       Menses profuse

10.   Menses dark red

 

CHRONIC TOTALITY

1.               Sensitive to reprimands

2.       Weeping tendency

3.       Mildness

4.       Timidity

5.       Aversion milk

6.       Aversion sour

7.       Aversion sweet

8.       Hunger agg

9.       Thermals HOT

10.   Menses dark

11.   Menses offensive

12.   Menses staining

13.   Head pain do to exposure to sun

 

FOLLOW UPS:

DATE             GENERALS             PLATELET COUNT             ACTION

18/9/09            App and thirst improved, No fever, body ache Rash reduced, Headache mild, PV bleeding reduced            58,000            Placebo

19/9/09            App and thirst further improved, energy levels better Rash improved, purpuric spots SQ, erythema reducing, bleeding reduced            62,000            Placebo

20/9/09            Better Purpuric spots also fading, no erythema, bleeding stopped            1,68,000            Placebo

22/9/09            Improved Only mild headache Rash only 12 purpurae seen            1,68,000            Placebo

29/9/09            No symptoms            2,35,000            Placebo

 

DISCUSSION:

Case presented during de effervescence of the episode. Onset duration and progress clearly showed a slow mild, and insidious pace of illness. Thou patient did not have high grade fever lady was weeping due to headaches and also had other concomitants like drowsiness. Complete history was sought to obtain constitutional data. Constitutional data helps plan the treatment based on remedy relationships.

In this case constitutional remedy Pulsatilla itself covered the fever totality. Susceptibility assessment did not show any gross deviations from state of health as illness was in declining phase. Hence single stimulation was adequate for the case to sail through.

Key decision making points were stage of disease, pace and progress of symptoms, state of susceptibility and confirmation of acute and chronic totality coverage by Pulsatilla.

 

CASE 4

PRELIMINARY INFORMATION

Name: R.C.N.  Age:  25 yrs, Sex:  Male, Religion: Hindu Education: student          D.O.A: 8092004

Patient presented with high grade fever sever chilliness and body pains since 2 days. He had travelled to an endemic area a few days ago, also had ice cream on the journey. Since the fever he had low appetite, bitter taste, thirstless and headache. Body ache was extremely severe associated with restlessness. Whole body was sore, patient was unable to lie down in one position for more than a minute.

 

Totality of symptoms: 1.Ailment from ice cream.

    Restlessness due to intense soreness and aching of body parts lied upon

    Feel too weak to move in bed.

    Fever with rapid prostration.

    Thirst decreased during fever.

    Highgrade fever with toxic state.

    Painless inflammation of tonsils.

 

DD.:

Bapt. Ars. Arn. Gels.

Allopatic diagnosis was inconclusive for first 3 days, though had suspicion of Dengue and Malaria, but because prescribing characteristics were present in the case homoeopathic treatment could be started even before conclusive diagnosis was arrived at. This is one advantage of using homoeopathy in early stage of diseases, even

before classical pathological symptoms develops, because homoeopathic treatment is patient specific and not disease specific. However this doesn’t undermine importance

of diagnosis for the homoeopathic physician. Diagnosis helped to do follow up investigations, to anticipate complications, to understand natural course of disease visa vis course of disease in this specific case after homoeopathic treatment.

 

CONCLUSIONS:

    Homoeopathic treatment helps in cutting short the clinical course of disease, reduction of distress of patient, prevention of complications & cutting short the convalescence in Dengue.

    Meticulous homoeopathic case taking during Dengue fever focusing on; onset, duration and progress of each symptom, fever pattern & concomitants during different stages is essential.

    Carefully elicited symptoms and systematic recording in LSMC format as suggested by Boenninghausen helps in analysis, of common symptoms from individualizing characteristics.

    Assessment of individuals susceptibility based on pace of disease, stage of illness, presence of homeopathic characteristics help in deciding the potency and repetition schedule. In Dengue, rarely is multiple dose repetition essential unless clearly indicated by severely deviated state of susceptibility like in DHF or DHS.

    Close follow up of dengue patient is essential. Mere sense of well being, absence or reduction of fever should not be relied upon. Dengue is known for relapses and

kickback fevers. Objective signs like platelet count, purpuric rash and active bleeding should be observed closely.

    After patient is a febrile for 48 hours or during convalescence, the deep acting constitutional remedy should be prescribed to prevent relapse.

 

[Julia Groß]

Dengue ist eine höchst unangenehme Krankheit, die auch Knochenbrecherfieber genannt wird. Zwar können Infektionen auch so mild wie eine schwere Erkältung verlaufen. Doch meist zwingen sie Patienten mit extremen Kopf und Gliederschmerzen, hohem Fieber und Schwäche tagelang ins Bett. Tückisch sind Komplikationen, die auftreten können, wenn das Fieber gesunken ist und die Erkrankten sich schon auf dem Weg der Besserung wähnen. Dann kommt es zu inneren Blutungen, der Blutkreislauf kann zusammenbrechen und die Patienten geraten in einen Schockzustand. Schätzungen zufolge verläuft Dengue bei etwa einem Prozent der Erkrankten tödlich, Kinder sind überproportional häufig betroffen.

[Dr. Anshu Nema]

Dengue Fever and its homeopathy treatment explained in great detail with effective homeopathic remedies like Eupatper. Ars. Croth. etc.

Dengue fever (Bone Breaking Fever) is a vector borne fever, caused by a virus known as arbovirus which is spread by the bite of mosquitoes (Aedesaegypti, main vector

of the disease).

This is also known as Break bone fever, because this fever produces very much pain in bones and joints.

Dengue fever is a selflimiting disease. When there is a prevalence of Aedes aegypti and Aedes albopictus together, with circulation of more than one type of dengue virus

in a particular area, it gives birth to either Dengue Haemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS).

[Joe de Livera]

Virus infection and highly contagious/transmitted by the Aedes Egyptii mosquito which can be identified by the zebra like black and white markings on its thorax and abdomen. Onset usually starts when the patient feels unwell and runs a low temperature with acute body pains and splitting headache which usually follow within 24 hours after the onset of the  disease.

Used Eupat-per. C 200 as Wet. dose (every 2 hours for the first day and every 3 hours thereafter till the patient is cured) treated many patients presenting Dengue and the majority have confirmed that they experienced perceptible relief in about an hour after their first dose, when their throbbing headache left them. They also reported that

their excruciating body and joint pains left them within 2  3 hours.

Some have reported that they suffered from a low temperature on the 2nd day. Rest and drinking plenty of fluids is needed till the temperature drops and if it continues,

it is best to enter hospital as it is possible that the Blood Platelet count may have dropped in the case of the Hemorrhagic type of the Dengue Flu when more invasive

methods of treating the disease with a blood transfusion may be called for.

There are 4 virus serotypes –

    DENV1

    DENV2

    DENV3

    DENV4

Virology

Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus Flavivirus. Most are transmitted by arthropods (mosquitoes or ticks), and are therefore

also referred to as arboviruses (arthropodborne viruses).

 

Mechanism

When an infective mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito’s saliva. It enters white blood cells, and multiplies

inside the cells and they move throughout the body. The white blood cells respond by producing a number of signalling proteins, such as cytokines and interferons,

which produces many of the symptoms, such as the fever, the flulike symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into

body cavities due to capillary permeability. As a result, less blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone marrow due to infection of the stromal cells leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever.

 

The secondary infection by dengue serotype2 or multiple infections with different serotypes leads to form either DHF OR DSS.

 

Vector of Demgue Fever

Aedes aegypti and Aedes albopictus are 2 causative vectors of dengue. They both have high susceptibility towards infective virus as carrier of this infection.

Aedes aegypti bytes more than one host to complete 1 blood meal and it’s a discordant species i.e. it bites more than 1 host to complete the gonotropic cycle.

Aedes albopictus is that species which complete its blood meal by biting only 1 person at a time and does not require a second blood meal for completion of the

gonotropic cycle.

 

DISEASE TRANSMISSION.

The Aedes mosquito becomes infective by feeding on the patient from the day before the onset to the 5th day (viremia stage) of illness. After incubation period

of 8th to 10th day, mosquito becomes infective, and becomes capable to transmit the infection.

Once the mosquito becomes infective, it remains so for life. The virus attacks the genital tract of mosquito and start transmitting in the fully developed eggs at

the time of oviposition.

 

BREEDING SEASON OF AEDES AEGYPTI WITH ENVIRONMENTAL FACTORS

The Aedes aegypti mosquito breeds during rainfall and in humidity. Its favourable temperature and weather for the influence of life span is humid wet weather,

it best survives in the temperature between  30° C and relative humidity of 60%  80%.

It breeds in a hollow vessels and containers where rain water is accumulated.

It is of 3 types

    Classical dengue fever

    Dengue haemorrhagic fever (DHF)

    Dengue shock syndrome (DSS)

 

INCUBATION PERIOD: 3  10 DAYS

 

SIGN AND SYMPTOMS OF DENGUE

Dengue patients repeated attacks of chills, facial flushing, with nonspecific febrile syndrome which may accompanied by maculopapular rashes.

Other symptoms:

    Headache

    Nausea and vomiting

    Severe myalgia

    Retro orbital pain

    Skin Rashes

    Constipation

    Colicky pain

    Abdominal tenderness

    Arthralgia of knee and shoulder

    Anorexia

    Weakness

    Sore throat

    Mild haemorrhagic manifestations (epistaxis, haematuria)

Fever is usually between 39.0C40.0C.skin eruptions appear in majority of the cases. The rashes may be reddish, pointed, maculopapular mainly at face, neck and chest.

These rashes last up to 2 hours to several days.

 

Fever ends for about 57days. Infection with 1 serotype gives immunity against that particular serotype and partial protection against others.

DENGUE HEMORRHAGIC FEVER

It’s the infection caused by more than one dengue virus (double dengue serotypes). Initially the dengue hemorrhagic fever is also very similar to classical dengue fever

but shortly after the fever, symptoms of leakage of plasma appears with hemorrhagic symptoms, which also appears such as gum bleeding, epistaxis, haematuria.

 

Dengue hemorrhagic fever turns to dengue shock syndrome if left untreated, including persistent headache with nausea and vomiting, restlessness.

 

There is a persistent decrease in platelet count which causes hemorrhage.

DENGUE SHOCK SYNDROME (DSS)

Shock syndrome is a dangerous complication of dengue infection and is associated with high mortality. Severe dengue occurs as a result of secondary infection with a different virus serotype. Increased vascular permeability, together with myocardial dysfunction and dehydration, contribute to the development of shock, with resultant multi organ failure. The onset of shock in dengue can be dramatic, and its progression relentless. The pathogenesis of shock in dengue is complex. It is known that endothelial dysfunction induced by cytokines and chemical mediators occurs.

Diagnosis is largely clinical and is supported by serology and identification of viral material in blood. No specific methods are available to predict outcome and progression. Careful fluid management and supportive therapy is the mainstay of management. Corticosteroids and intravenous immunoglobulins are of no proven benefit. No specific therapy has been shown to be effective in improving survival.

 

CLINICAL FEATURES OF DENGUE ILLNESS PROGRESSING TO SHOCK

Dengue infection should be considered when patients who live in areas where dengue is prevalent present with a febrile illness together with hemorrhagic manifestations

or features of shock.

Dengue infection begins as a febrile illness; the fever is accompanied by constitutional symptoms and a characteristic flushing of the skin. Intermittent highgrade fever accompanied by chills and rigors is a feature. Vomiting, headache, myalgia, epigastric discomfort, and abdominal pain are common, and patients often feel quite ill.

    The fever lasts 2–7 days and is followed by a fall in temperature; complications of dengue often take place at this point. Patients who remain ill, despite their temperature returning to normal, are             more likely to develop shock. Shock generally occurs on day 3–4 of the illness.

    Thrombocytopenia is a characteristic finding. Platelet counts below 1, 00,000/mm3 together with a rise in the haematocrit define DHF. In the classical shock syndrome, increased vascular permeability results in third space fluid loss, leading to pleural effusions, pericardial effusions, ascites, noncardiogenic pulmonary oedema and, subsequently, hypotension. Right hypochondriac pain occurs similar to that seen in cholecystitis; without calculous, cholecystitis is a characteristic feature of DHF.

    Myocarditis is a wellknown complication

    Although often mild it can result in heart block and can be severe enough to result in progressive acute heart failure with acute cardiac dilatation.

    Lactic acidosis, which occurs as a result of the sluggish circulation, possibly contributes to myocardial depression in severe cases. Acute hepatic derangement can occur though fulminant liver failure is rare.

    Acute renal failure is usually secondary to hypotension in shock syndrome and is associated with increased mortality.

    Death is usually due to severe haemorrhage or intractable shock with multi organ failure.

 

DIAGNOSIS WITH INVESTIGATIONS

The WHO guidelines on dengue have clearly defined criteria for the diagnosis of dengue shock.

    Confirmation of dengue infection is by serology or detection of dengue viral material in blood by RTPCR. Denguespecific IgG and IgM ELISA is widely used.

    The test is relatively inexpensive, and becomes positive for IgM antibodies on or after day 5 of the fever. IgM ELISA has a sensitivity of 83.9–98.4% and a specificity

of 100%.

    The presence of IgG antibodies indicates previous infection; hence, the presence of both IgG and IgM antibodies suggest the possibility of a secondary infection, although this has not been validated in clinical studies.

    RTPCR for dengue viral material can help to diagnose the illness early, before antibodies become positive; the method, although relatively expensive, is very sensitive and allows for serotyping.

    While these tests are used for diagnosis of dengue infection, they do not accurately predict which patients are likely to develop dengue shock. The association between

high antibody titers or high viral load and the clinical manifestations of dengue has not been studied. No other biochemical investigations are available to predict which patients will develop shock, which is largely a clinical diagnosis. Haem concentration and dropping platelet counts herald the onset of shock. Extravasation of fluid due

to vascular leakage can be detected radiologically (chest radiography for pleural effusions, echocardiography for pericardial effusions, and ultrasonography for ascites).

The presence of fluid around the gall bladder, together with thickening of the gallbladder wall, has been shown to be associated with shock.

    None of these features, however, predict the development of severe shock syndrome or mortality. Patients with shock do, however, show a variety of metabolic derangement, including lactic acidosis, elevated transaminases, and rising serum creatinine and blood urea. Pulse oximetry and arterial blood gas analysis showing hypoxia

may indicate the development of pulmonary oedema, which may be cardiogenic or noncardiogenic. Electrocardiography is useful in identifying early myocarditis

(T wave and ST segment changes are seen).

    Echocardiography is the main investigation used to diagnose myocardial dysfunction and should be done early when impending shock is suspected. The place of cardiac troponins in diagnosing myocarditis has not been evaluated.

 

NS1 ELISA

The nonstructural protein 1 (NS1) of the dengue viral genome has been shown to be useful as a tool for the diagnosis of acute dengue infections. Dengue NS1 antigen has been detected in the serum of DENV infected patients as early as 1 day post onset of symptoms (DPO), and up to 18 DPO. The NS1 ELISA based antigen assay is commercially available for DENV and many investigators have evaluated this assay for sensitivity and specificity. The NS1 assay may also be useful for differential diagnostics between flaviviruses because of the specificity of the assay.

 

 

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