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SINGAPORE - The second victim of this year's dengue epidemic was cremated on Monday at Mandai Crematorium, a day after he died in Tan Tock Seng Hospital (TTSH).
On Tuesday, The Straits Times visited the flat in Ang Mo Kio Avenue 3 where the victim - a 60-year-old Singaporean Chinese man - reportedly stayed.
Several people inside were seen cleaning the flat, which had a strong smell of disinfectant.
When approached, two of the occupants - dressed in black - denied that the victim lived there, and directed reporters to the flat next door.
But neighbours confirmed this was indeed the victim's flat, which he shared with his ailing 86-year-old mother. Neighbours added that the victim also had two older sisters.
His 66-year-old older sister told Lianhe Zaobao that her brother had been in some discomfort even before he first went to TTSH last Wednesday.
But he chose not to seek treatment initially because he did not want to leave his mother alone at home.
The family said they had been surprised that the victim had contracted dengue fever because he did not live in an identified dengue cluster.
The sister told the Chinese daily: "When my brother went for a medical check-up a few months ago, he was found to be suffering from diabetes, high blood pressure, high cholesterol and mild asthma, so when we saw the rashes on his feet... we thought they were symptoms of these conditions at first."
When the victim went to TTSH last Wednesday, he was initially diagnosed with skin inflammation of the left leg and given antibiotics.
However, he returned to the hospital last Friday when his leg got so weak that he could hardly stand on it, while still having a fever.
The man was sent to a general ward the next day and diagnosed with dengue.
His condition worsened, and he was placed in the intensive care unit, before dying of dengue shock syndrome on Sunday morning.
More than 9,500 people in Singapore have been infected by dengue fever in the current epidemic so far.
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Families of dengue death victims 'satisfied' with TTSH's treatment
Families of dengue death victims 'satisfied' with TTSH's treatment
Families of dengue death victims 'satisfied' with TTSH's treatment
Tan Tock Seng Hospital said that the families of the two dengue victims who had been treated there "are satisfied that the hospital has done its best" in managing the patients.
The latest victim, a 60-year-old man, had been admitted for blood poisoning caused by an unknown leg infection.
It said that dengue plus other underlying conditions such as diabetes and hypertension had complicated this infection, and "may have contributed to his inability to recover".
It added: "He was started on aggressive treatment for severe infections."
While in hospital, he tested positive for dengue.
Despite the treatment he received, his condition "kept deteriorating", and he died the day after he was warded.
The first man to die, Mr Ang Yong Han, was 20 years old and had no other known health problems.
He was to have entered national service on the day he died.
Both victims were warded after their second visit to the hospital's emergency department.
The hospital said: "We would like to assure the public that our guidelines, protocols and processes are evidence-based, and we follow established standards."
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Diagnosing dengue "challenging"
Diagnosing dengue "challenging"
TTSH gave details of how it treats suspected dengue patients and said that although there is no treatment for the disease, most dengue sufferers will recover.
In a statement, the hospital said that diagnosing dengue fever is challenging because the symptoms, such as fever, headache and muscle ache, are similar to those of many other infections and diseases.
The doctors in its emergency department see many patients for a wide range of conditions and must consider all possible causes so as not to miss anything serious.
The hospital explained that dengue antibodies can be detected only a week after a fever has developed, so doing a blood test in the early days would not give conclusive results. A false negative result in the early stage might "provide false reassurance to doctors and patients".
The hospital was responding to Straits Times queries following the deaths of two dengue patients with fever who had gone to the hospital complaining that they were not feeling well, and were sent home without being tested for the disease.
The Ministry of Health said the two men - Mr Ang Yong Han, 20, from Hougang Avenue 1, and a 60-year-old from Ang Mo Kio Avenue 3 - later died of dengue shock syndrome. Mr Ang died about two weeks ago, while the second man's identity remains unknown.
The hospital said the dengue test is done only for patients who show symptoms of dengue or have two or more days of fever. But the test is available for patients who insist on early testing.
The hospital added that its system will alert doctors to a patient who returns to the emergency department soon after his first visit and complains of continuing or worsening symptoms.
Besides a blood test, other tests like X-rays may be done. Given that there is no treatment for dengue, patients are kept hydrated as their bodies fight the disease.
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Not all patients need to be hospitalised
Not all patients with dengue need to be hospitalised. Those in a stable condition may be kept in hospital for observation and given fluids and medication. If they do not improve or their condition does not remain stable, they may be admitted.
Those in a stable condition will be sent home with medication, and be told to go for a follow-up with a doctor and to return to hospital if their condition worsens.
TTSH said: "It is generally better for most people to recuperate at home, away from other ill people, follow doctors' instructions and monitor their own health."
It added that dengue is "usually self limiting" and most patients recover within one to two weeks.
But for a minority of people, severe dengue can cause life-threatening complications such as dengue haemorrhagic fever or dengue shock syndrome.
It added: "For a few of us, the disease would regrettably prove stronger even with aggressive medical interventions such as intravenous fluids, blood transfusions and organ support."
How Dengue Fever is Spread
The dengue virus is spread by the Aedes mosquito, which is most active during the day.
It breeds in clean, stagnant water. Common places are jars, flower vases, watering cans, pails, plant bowls, basins and roof gutters. Symptoms of dengue fever include sudden onset of high fever, severe headache, pain behind the eyes, muscle and joint aches, rashes, skin bleeding, or bleeding from the gums and nose.
Dengue haemorrhagic fever, a more serious strain, can cause death through bleeding and shock.
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