SINGAPORE - When she started getting mild headaches and fever at night about 11/2 months ago, Mrs Sharan Kaur Sahdev just took a painkiller and a cup of tea and went to bed.
The Briton, 29, who has been living here for four years, thought she was just "a little under the weather".
She had no idea that she had been infected with dengue haemorrhagic fever, the more severe form of dengue fever, a viral infection transmitted by the Aedes mosquito.
Her blood platelet count soon dropped to dangerously low levels and she was at risk of bleeding complications and even death.
Singapore is experiencing a surge in dengue cases, with the number of infections this year hitting 8,001 as of Wednesday. This is about 50 per cent higher than the 4,632 cases seen in the whole of last year.
The bulk of the cases are in the east, where Mrs Sahdev lives.
After 11/2 weeks of suffering such symptoms, she noticed another symptom which gave her pause - a blood clot at the back of her mouth.
That same day at about 8pm, she suddenly noticed tiny rashes on her legs and feet.
She said: "The blood clot in my mouth felt very hot, almost like an ulcer. It didn't feel right. That was when I called my family doctor. She said I had to go and see her."
The general practitioner (GP) said Mrs Sahdev could have dengue, but she could not tell for sure until a blood test was done.
The GP asked her to return the next morning and drew her blood. By that time, the blood clots had spread in Mrs Sahdev's mouth.
"She said I should take medical leave and that she would call me as soon as she knew anything," said Mrs Sahdev, a personal assistant.
She was beginning to feel a little more unwell. She went home, got into bed and fell asleep.
The GP's clinic closes for the afternoon at 1.30pm and opens again in the evening at 6.30pm.
But at around 4pm, the GP called, sounding extremely concerned.
"She said she had received my blood test results and my platelet count had dropped and I had to go to an accident and emergency department immediately," said Mrs Sahdev.
Fifteen minutes later, the GP rang again, this time saying she was going to pick Mrs Sahdev up.
"She drove from her house to my place, picked me up and drove me to the hospital.
"She said if I had gone to the hospital even just half an hour later, there was no knowing what would have happened," said Mrs Sahdev.
Dangerously low platelet count
Mrs Sahdev's platelet count had dropped to 5,000 per microlitre of blood and she had just started her menstruation, which put her at risk of having bleeding complications.
Platelets are necessary for clotting, thus preventing haemorrhage - the hallmark of severe dengue.
A normal person has 145,000 to 450,000 platelets per microlitre of blood.
Patients are admitted to hospital if their platelet level falls below 60,000 per microlitre of blood.
There is no vaccine to prevent dengue fever.
Treatment is "symptomatic and supportive", said Dr Mukund Doshi, a specialist in internal medicine at Parkway East Hospital.
This means the patient is given treatment for symptoms, such as pain and fever, and intravenous fluids to keep him well hydrated so he does not go into shock.
If there are bleeding complications, the patient will be given platelet transfusions.
Danger of bleeding in the brain
Danger of bleeding in the brain
Mrs Sahdev was quickly admitted into Parkway East Hospital and a blood test found her platelet count had dropped even further.
Within 15 minutes, she was in the intensive care unit.
Dr Doshi said: "Sharan's condition was serious as her platelet count was less than 5,000 per microlitre of blood.
"She had evidence of bleeding - haematoma (blood clot) in the tongue, cheek, bruises on legs and bleeding under the skin."
He said that a person is at a higher risk of developing the more severe form of dengue fever if he has been infected previously.
There are four types of the dengue virus. When a person is infected with one type, he develops lifelong immunity to that specific type, said Dr Doshi.
However, if he subsequently becomes infected by another type of dengue virus, he would not have full immunity against it.
Mrs Sahdev does not recall being bitten by a mosquito before this or having had dengue before, but her first brush with the disease was already a serious one.
At the time, the doctors were concerned that she might start to bleed in the brain.
She was given multiple blood transfusions and doctors also stopped her menstruation with medication.
She said: "I had five bags of blood, followed by four bags. I was in the intensive care unit for four days.
"It was very embarrassing. They wouldn't let me go to the toilet at all in case I fell. And I wasn't allowed to brush my teeth, in case my gums bled."
Worst case of dengue
After four days, she was out of danger when her platelet level began, slowly, to rise again.
She went home a few days later, on April 29, when her platelet count was up to 88,000.
"I was told to eat lots of fruit, have lots of liquid and rest," she said.
Another blood test five days after she was discharged showed that her platelet count had reached 155,000.
She said: "I am on my way to recovery. I have bruising all over my legs and toes and even on my arms.
"I feel very worn out, like I've just fought a battle. When I walk to the corner mamak shop (provision shop) and back to the apartment, I feel like I have just run a marathon."
Her advice to others is to see a doctor if one has a fever, especially now during the dengue outbreak.
She intends to become a blood donor when she has fully recovered.
"If it weren't for those donors, I wouldn't be here today," she said.
Her husband, Mr Sandeep Kumar Sahdev, 34, an IT consultant in the banking sector, recalled how scared he was when she went into intensive care.
"I had gone home to get her stuff when the hospital called and said she was on the verge of haemorrhaging. The doctor said it was the worst case of dengue fever he had seen," he said.
"I love my wife very much and I could have lost her then. But her attitude was very positive.
"The nurses could not believe how positive she was even with blood clots all over her mouth and rashes all over her body. Her body was bleeding out."
It hit Mrs Sahdev how serious her situation was only after she was discharged.
"My husband and I had a bit of a cry when I came home, when we thought about what if things had gone the other way. Thankfully, it didn't," she said.
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