Civil servant explains how he knew he had dengue

SINGAPORE - When the civil servant felt an itch on his left index finger in April, he thought: "Oh oh, it was probably the Aedes mosquito." He got dengue that week.

Yesterday,when he heard that a second person had died from the disease this year and that the number of dengue cases had crossed the 9,000 mark, he was stunned.

Jason (not his real name) , 31,lives on landed property in Hougang.

One Tuesday morning in April, he woke up and saw the mosquito bite and had a bad feeling about it.

On Friday that week, he felt feverish but went to work as he had an important meeting.

On Saturday, a fever of more than 39 deg C floored him and he didn't have the strength to leave his bed to see a doctor.

Said Jason: "In my heart, I knew I had dengue. I took (medicine) but the fever kept coming back."

He saw the doctor on Sunday, and although he recovered from the fever, rashes broke out on his body on Wednesday and his nose bled now and then.

Blood test

He went to a polyclinic and a blood test confirmed it was dengue.

He recovered days later.

On hearing about the second death this year, Jason said the only people who fully understand how deadly the disease is, are the ones who have suffered from it.

He said: "Many people do not know the seriousness of this illness. Only people who have got it will realise how bad it is.

"Most people have had the fever before. If they get a fever again, they might be complacent, as they might not think it could be dengue."

Next        Symptoms to watch out for

  Symptoms to watch out for  

Symptoms of dengue fever

- Develops within four to seven days after being bitten by an Aedes mosquito.

- High fever up to 40.6 deg C

- Severe headache with retro-orbital (behind the eye) pain

- Nausea and vomiting

- Severe joint and muscle pain

- Body rash which appears on day three or four

Dengue Hemorrhagic Fever  is more severe and can result in death. It's symptoms include severe bleeding from the nose, gums, or under the skin, causing purplish bruises.

Dengue Shock Syndrome  is the most severe form of dengue fever and usually occurs in children having a reinfection. It is sometimes fatal and is characterised by:

- Massive bleeding

-Shock (very low blood pressure)

Diagnosis

Two blood tests done two to three weeks apart help determine if the blood samples contain antibodies to the virus.

Treatment

There is no specific treatment for dengue fever and most people recover within two weeks. To help with recovery, general measures include:

- Getting plenty of bed rest.

- Drinking lots of fluids.

- Taking medicine to reduce fever. Avoid aspirin, but paracetamol is considered safe.

Next        What should you do if you suspect you have dengue

  What should you do if you suspect you have dengue  

What should you do if you suspect you have dengue

We speak to Dr Leong Hoe Nam, an infectious disease physician from Rophi Clinic at Mount Elizabeth Novena Specialist Centre, on what to do if you suspect you have dengue fever.

Prior to going into private practice, Dr Leong was a consultant with the Department of Infectious Disease at the Singapore General Hospital.

What should I do if I suspect I have dengue fever?

If there is a concern for dengue fever (an illness transmitted by the Aedes mosquito), you should do the Dengue NS1 antigen test (which involves the drawing of blood). The market rate for the test is about $30.

Where can I get tested other than at hospitals?

The test has been provided to various polyclinics and certain general practitioners at subsidised rates by the National Environment Agency.

What is the turnaround time for the diagnostic test?

The turnaround time can be one to two working days, depending on the time the sample was collected.

What should I do if I have dengue fever?

Drink three litres of fluid on top of your normal fluid intake. Water is cheap and good. Only fluids have been shown to make a difference in saving lives. A good way to find out if you are drinking enough water is to drink until your urine is clear.

Next        TTSH explains why patients are not tested for dengue immediately

  TTSH explains why patients are not tested for dengue immediately  

TTSH explains why patients are not tested for dengue immediately

Why aren't dengue patients tested the moment they are admitted?

The dengue virus is usually present between day two and day five of infection.

Dengue antibodies do not rise to detectable levels until day five to day seven of the infection. While the test is available for patients who insist on early testing at the Emergency Department (ED), having it done too early does not give conclusive results.

Testing negative on the first day of the fever does not conclusively exclude the possibility of dengue, but may instead provide "false reassurance" to doctors and patients.

Will all dengue patients be hospitalised?

Not all patients with dengue need to be hospitalised. Patients who present themselves in stable health at the ED may be kept for a few hours of observation and given fluids and medication to relieve their symptoms.

If they do not improve or do not remain stable during the observation, they may be admitted for closer monitoring and treatment.

Otherwise, they will be given fever and other necessary medication, a request to follow-up in one to two days' time for review. They will also be advised to return to us if their symptoms worsen.

What happened to the two patients who died from dengue?

We would like to assure the public that our guidelines, protocols and processes are evidence-based and we follow established standards. We will continue to work on our processes.

As for the second casualty of dengue, the 60-year-old man died in the Intensive Care Unit on Sunday from multi-organ failure and complications associated with abnormal heart rhythm.

He was first admitted on June 5 after a day of fever, general malaise - feeling of discomfort, illness, or lack of well-being - and infection of the leg.

Dengue was confirmed during his second hospitalisation on Friday and we continued with the treatment.

His condition deteriorated and by the second day of hospitalisation, he had passed away.

Dengue had complicated his infection and his underlying conditions, including diabetes mellitus and hypertension may have contributed to his inability to recover.

Next        Blood test first for suspected dengue patients

tnp@sph.com.sg

   
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