I would like to share an interesting scenario we are dealing with currently in Mysore (Karnataka state, India) district. We have a vast number of Dengue cases thronging to our city hospitals from the peripheries and townships which are within a 80 km radius.
Sadly, many of the cases are pediatric.
I have been observing the trend of the dengue epidemic in my district based on in-patient specifics over the last 5 years, and a few interesting findings have been noticed.
1) The number of patients rises every alternate year
2) The number of sick cases and mortality rate also follows a similar pattern (more every alternate year)
3) This year, the clinical features encountered have been area specific - one of the neighbouring districts has had a relatively severe scene this year and I found almost all the cases to have a similar clinical presentation (in this case- extensive and involving at least 70% of the body and on the extensor surfaces (relatively lesser on the flexor aspects) in some cases almost beet-red in color. These rashes were present for 2-3 days and resolved spontaneously. This year, we encountered patients with remarkably low paltelet counts (8000- 13000 cells/cmm) but relatively stable children- in most cases requiring only 3ml/kg/hr of fluid support throughout the illness course.Platelet uptrend was observed by day 6-7 of fever.
Within my city limits however, the patients illness ran a much milder course with most children recovering fully and platelet uptrend observed by day 5 itself.
Yet another saddening scenario was from a small township almost 60Km away, where the mortality was much higher in pediatric patients. Many children, even though referred early to tertiary care centers, succumbed to the illness by day 5-6, and many had ARDS, DSS.
This year has been different from the previous years because of this clear-cut differentiation in the illness trend observed from different pockets of patient population.
Kindly share your experiences, and observed trends.
Hello to all!
I'm from Mato Grosso, Brazil.
In my state there are 40.830 registered cases of dengue form January 1st to August 22th. Considering that our population ranges around 3 million inhabitants, dengue is a major public health concern.
We at karachi pakistan have not seen these changes, may be we have no river around but sea but we do get cases of dengue fever
In Nicaragua we have seen a similar epidemiological pattern of increased number of cases in one year and reduced in the next. This picture seems to be related with serotypes emergence and re-emergence, I wonder which serotypes have been circulating in Karnataka state. The clinical profile of the cases described is interesting, I wonder if other viral infection are concomitant.
Very high seropositivity this year. Situation seems to be grim.
Thanks god no dengue case has been reported in gujrat district this year and in the past. Only few cases has been reported which were migrated from other districts of Pakistan.
There is a recently published paper discribing the situation of Dengue fever in Iran.
The presence of dengue infection was examined in Iranian patients who were referred to the Arboviruses and Viral Haemorrhagic Fevers Laboratory of the Pasteur Institute of Iran and tested negative for Crimean-Congo Haemorrhagic Fever (CCHF) between 2000 and 2012. Serumsamples from these patients were tested for the presence of specific IgG and IgM and viral nucleic acid in blood. Of the 300 sera tested, 15 (5%)were seropositive, and 3 (1%) were both serologically and PCR positive.
Of the 15 seropositive cases, 8 (53.3%) had travelled to endemic areas including Malaysia (5,62.5%), India (2, 25%) and Thailand (1, 12.5%). In contrast, 7 (46.7%) of the cases had not reported travelling abroad.Of these, six cases were fromthe Sistan and Baluchistan provincein southeast Iran and neighbouring Pakistan.
More information is available in the paper: http://www.google.com.tr/url?sa=t&rct=j&q=Preliminary+study+of+dengue+virus+infection+in+Iran+researchgate&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F233761177_Preliminary_study_of_dengue_virus_infection_in_Iran&ei=FCTAUbz_PIfiO6bmgaAP&usg=AFQjCNGrQ1-5Kof9pKEur_F4hYhNyaTXtA
In Iquitos, Peru, we have dengue virus infection since 1999, when DENV-1 was reported by the first time. From 1999 to 2010, all DENV serotypes were present, however, DENV-3 vwas predominant during 2003-2007 and was the cause of several outbreaks and (aprox, less than 5) fatal cases in this city during this period. In 2008, DENV 4 was reported by the first time and caused a huge non severe dengue outbreak. In november of 2010, DENV-2 american/asian strain, caused the most severe outbreak in Iquitos, and was the guilty of 15 deaths in less than 3 months. This new genotype has replaced DENV-4 (most none sever was seen with this serotype) and now is easy to see severe dengue cases in any time who needs intensive care unit. So, with DENV3 infection we had severe cases who usually were adults and appeared in the middle of an evident outbreak and only a few of them required intensive care unit , but with this new strain, we can see severe cases (who probable may need ICU) despite we have an small increase of dengue cases and most of them may be children. So, despite, children were less exposed to several serotypes along the years (primary infection), they suffered severe disease. This also was observed with DENV3 and DENV4 (http://jid.oxfordjournals.org/content/early/2013/06/16/infdis.jit273.short?rss=1). So, it is interesting to share these experience.
sincerely
stalin
Dear
Indrajit Suresh
In Colombia, we have had dengue incidence peaks variables, the highest peak was in 2010 with about 147000 cases. Currently we have an article in press, in which we seek the relationship between the phenomenon of El Niño and dengue cases in the Colombian Caribbean.
In your specific case I think it is necessary to study the annual epidemiology of dengue cases and on the other hand, the signs and symptoms of dengue, because these may vary depending on different factors such as, in addition to the serotype, malnutrition, poverty, access to health systems, etc..
Interesting, poverty and access to health care associated with clinical profile, could you please provide a reference. I have seen some report suggestig that obesity might be associated with more severe symptoms. Serum lipid profile: a predictor of clinical outcome in dengue infection, Trop Med Int Health. 2009 May;14(5):576-85
As a matter of fact I did go through some variables which might have had an impact on the acquisition of infection. Some of them were
1) 72% of the seropositive cases had a sibling or relative (Children) who were seropositive as well. but it is important to note here that in most (90%) of the cases, ONLY children were infected, while adults were relatively healthy.
2) Symptomatology did not vary much in seropositive cases from the same family.
3) Recovery times were also similar for the above.
4) Most of the milder cases were from the middle class or upper middle class families residing in the city limits.
5) Most of the mortality occurred in patients from the rural setting, who were coincidentally referred late to the city hospitals (Almost day 5 of fever)
6) Only 4 cases required platelet transfusions in view of severe thrombocytopenia, and ALL of them were from the same rural township.
7) Highest fever spikes were observed on day 1-3 and settled thereafter.
8) In cases with severe leukopenia, we gave i/v ceftriaxone, and the recovery was observed to be a couple of days quicker.
Dengue is seasonal event in Sudan. Outbreaks depends on the rain fall and mosquito density in the country. If you need specific question I will be happy to answer it.
Many thanks
After one year Dengue outbreaks came back in Central India.
We are coping with an outbreak at present in mandla district of Central India.
Hi Indrajit. This year we are yet to see as many cases as last year. But this year we were getting more atypical cases. We got one neonate with typical beet coloured rash over the foot like your description, we had two children who presented like acute abdomen to the surgery department and later transferred. We had a dengue complicating nephrotic syndrome. We would probably get more cases following NE monsoon which will hit our place during october-november.
I would like to share some uncommon events I experienced in the week gone by-
We had two patients who had a similar kind of history, but experiences poles apart.
Both these patients were women in their late early 30s, who were pregnant nearing term and were Dengue IgM positive.
1) One patient was detected to have oligohydramnios in early 3rd trimester, and had a febrile illness with thrombocytopenia during the 36th week. She was admitted, on day 4 of fever, and surprisingly, the USG showed very severe oligohydramnios (Almost no liquor at all). She had a platelet count of 90,000 cells/cmm on admission, and was posted for emergency LSCS under General Anaesthesia. The delivery was conducted well, and a slightly more than expected blood loss was encountered, which necessitated blood transfusion. The baby had respiratory depression immediately after birth, and was resuscitated well. The mother too came out of the procedure without any adversities, and was stable post extubation, Baby was kept in the NICU for 2 days, but was well, and discharged after a couple of days. No thrombocytopenia was observed.
2) The other patient, had a profile similar to the first patient, but differed in that oligohydramnios was present but to a milder degree. She reported non perception of fetal movements on 36W+3days, and was admitted. She had a history of febrile illness and malaise with onset 4 days prior to hospitalization. Platelet counts were 42000 cells/cmm and Dengue IgM was positive. Sadly, she developed ARDS, DIC and profound shock, and required multiple transfusions and inotropic support. She had to be ventilated, and the outcome of the pregnancy was tragic in that the baby did not survive. The mother is now recovering, and has been extubated, but still in the ICU.
Is it common to encounter oligohydramnios in dengue positive pregnant women?. Kindly share your management strategies and scenarios you have encountered.
hii indrajith...
first let me appreciate you for putting such a important topic up-front so that each have an idea of whats really going around.:)
Our area (Trivandrum, Kerala) is currently experiencing the worst dengue scenario in the state with more case severity as well as more mortality than reported earlier. This has been aided by the onset of monsoon as well. I am not a physician to explain the clinical features of the disease but have heard of reports of more severe pediatric cases of dengue has compared to the earlier periods. the whole state in now under the dengue attack. Our laboratory studies on dengue virus characterization have put in some important changes in the genetic level of all the 3 serotypes-1, 2 and 3- which has been found to be circulating in Kerala. This could also be one of the contributing factor for this current scenario.
I am assistant prof in Cairo but I worked in Jeddah Kingdom Of Saudi Arabia For almost 15 years ,i was confronted with big no of cases between 1500-2000 total cases per year,serotypes 1,2,3 . same clinical presentation of thrombocytopenia which was sometimes sever also leucopenia and skin rash which blanch on pressure and elevated liver enzymes .regarding serology it was negative in yhe first 3-5 days during which diagnosis can be done by rt-PCR .trearment as you know is supportive with hospitalization in cases with warning signs
WHO has a number of web pages on dengue:
1 information at http://www.who.int/topics/dengue/en/ - worth exploring the links / sub-pages as they cover a wide range of issues, including clinical presentation and diagnosis, prevention, mosquitoes...
2 Global Strategy for dengue prevention and control at http://www.who.int/denguecontrol/9789241504034/en/
Information on surveillance of dengue with rates over time by country and other variables is available in an interactive atlas at http://apps.who.int/globalatlas/
best wishes
Alex
A truly amazing and wonderful experience happened last week. A 3 year old girl was admitted with Dengue (Seropositive) and in shock & GI Bleed on day 4 of fever. She was admitted to the ICU and IV fluids were given (Normal Saline) with uptitrations made at regular intervals as Blood pressure failed to improve. She became puffy, had Bilateral pleural effusions, moderate ascites, was oliguric and tachycardic as well.
I spent the most challenging straight 48 hours of my career till now facing the dreaded Dengue virus via the little girl, who bravely combated the scourge. I was literally at her bedside for 48 hours observing, calculating, adjusting and planning the management line.
Platelet counts had dropped to 5000 cells/cmm and she was slowly bleeding internally. we faced an acute shortage of platelet concentrate in our district, but managed to hunt and procure one unit each of Plasma and packed cells.
Once the fluid requirement had gone upto 15ml/kg/hr- I felt there was no point in waiting further and had the FFP transfused- this resulted in marginal improvement - urine output improved and tachycardia reduced marginally.
After 7 hours of the FFP transfusion, the fluid requirement again went back up, and this time I was left with no other option but to order a transfusion of Colloid (Gelofusine) - of which only a single 1 litre bottle was left in our wing. I ran the transfusion at 10ml/kg/hr continuously monitoring the child, and reduced the rate to 7ml/kg after a 3 hour period, and then to 5ml/kg after a further 4 hours- after which the urine output showed a dramatic improvement. Thereafter the gelofusine was stopped and 3ml/kg /hr of Normal saline was used. By then the child's facial puffiness had reduced somewhat, and tachycardia had also settled. Oxygen dependency and mild respiratory distress (which was present initially) had also reduced significantly.
The following day, the platelet counts showed marginal improvement to 12000 cells/cmm, and the child also appeared more active. Her blood profile however showed a significant drop in Hemoglobin and Hematocrit, and hence it was decided to transfuse a 5ml/kg aliquot of Packed red blood cells (As I did not want an overload developing)
Luckily the transfusion was successful, and without any adversities. The child continued to have a very good urine output (almost 3ml/kg/hr) and so IV Fluids were completely stopped. To my surprise the little warrior sat up in bed and asked for ice-cream- which I readily agreed to give her.
It was most heartening to see such a dramatic turn around of events in a 48 hour span, and the sight of a child eating well at her relieved and grateful mother's side really made the effort worth it!.
The little girl improved over the next 36 hours, and was shifted out to the wards. Subsequent blood counts showed a very satisfactory rise in platelet counts, and stable values of hematocrit and Hemoglobin levels. Urine output, blood puressures had also normalized. Pleural effusion had reduced marginally at time of discharge, but on follow-up she was absolutely chirpy and gave me the broadest smile.
That was one epic battle in Child Vs Dengue- and Child won!
Great effort indrajit.i really appreciate that..:)
have read it our local newspapers about the mismanagement of dengue cases and unwanted fluid transfusion that have lead to more complications. I therefore think you really did a great job in bring back her smile.
Another factor that has been going around is the use of our locally available "papaya" leaf-extract for increasing the platelet count. Experts in our area are now on a debate over this matter. Any such case in your area?.
Yes that trend is going around here, wherein parents do make their children consume papaya- I frankly advise them to try whatever they can if the child accepts it. Handling the sentiments of the parents is a tricky issue, and if papaya indeed works- I am all the more appreciative of it. Maybe there are some factors which work- and I always like to encourage patients who cling on to some rays of hope- and in that case- papaya will work either way!
At present the influx of patients is on the decline- with the onset of the rainy season.
How is it in your area?
We are in the middle of one of the worse epidemics of dengue. Cause seems to be re-emergence of DenV-2 after predominance of DenV-3. Many cases are very severe.
We are now seeing a decline in case load here.The cases that do come have a more protracted course of illness, and with complications such as pleural effusions.
We are also observing a spurt in 'Dengue-like-illness' cases.
We experience dengue epidemics every single year here. But fortunately, the morbidity and mortality of dengue keep decreasing, since the people are more aware about the danger of the disease and the patients are brought to hospitals or primary care in early onset.
In my experience, I found cases of dengue fever more than dengue hemorrhagic fever.
I have just returned from a brief trip to Sri Lanka (Colombo and the area around Kandy). Both are experiencing a high number of dengue cases. What surprised me was tht I tried to buy DEET insect repellant to protect myself and although I visited several pharmacies and supermarkets I could not buy them anywhere. Surely encouraging the use of effective repellants would be a reasonable public health initiative? It was possible to buy the plug in insect-control misters but the only repellants available were organic, e.g. citronella, which proved ineffective. Can anyone explain why the repellants were not available?
During the week gone by, another spurt in the number of seropositive dengue cases has been observed after a relative lull in our district. referrals are coming in droves from peripheral townships.
The cases which I encountered have been mostly with effusions (4) or ARDS (2). But the pattern of thrombocytopenia showed a relatively shorter course.
Sadly, we had one case of ADEM in a 6 year old child.
A second wave of dengue has begun. In this past week we have had a sharp spike in the number of NS-1 positive cases being referred from the neighboring township of Mandya- where there were no rains this time. This time around the number of children presenting with effusions and ascites is more. A few also presented with shock.
The second wave of Dengue is now slowing down. A few cases were reported. Referrals to our center keep happening- albeit not as much as a month ago. The pediatric cases now are referred to us by day 5-6 of illness, and with shock (4/4 cases) and 3rd space collections. Platelet counts were not very low (Avg. 25000 cells/cmm on admission) Platelet uptrend was observed by day 7 of illness, and surprisingly- it coincided with an apparent worsening of respiratory symptoms (in spite of appropriate fluid titrations) - which again lasted for just one day (Day 7 of illness).
I have observed the pleural effusions reducing in quantity by day 7, but the children developed pneumonia and consequent respiratory distress (Tachypnea, chest retractions- lasting for a 24-36 hour period), which responded to administered antibiotics (Ceftriaxone), Oxygen and Nebulizations (Salbutamol).
By day 8, good diuresis started in all children, and symptoms ameliorated. Children were all discharged by day 9-10 of illness in good health, satisfactory platelet counts and no distress.
In Hubli, for last 3 months I have seen more than 300 cases of dengue, severity varied mortality was more in government sectors probably late referral, reasons we are investigating .
Dear Indrajit, dear collegues,
here you are the situation in Italy:
2010: 51 cases (36 in the North-est regions of veneto and Emilia)
2011: 47 cases (27)
2012: 74 cases.
(Also west-nile disease makes a incredible spread from 2008 to 2012)
Although here in Italy the Number of patients with confirmed positivity to dengue are much smaller than Portugal (669 confirmed cases in Madeira, 2012) or France and Croatia, we noticed an increased incidence, probably because of the tourism and immigration (which is, most of time control-less).
But I suppose that also the INCREDIBLE spread in Italy of Culex pipiens and Aedes albopictus is one of the major cause. (aedes aegypti is not so much common, yet)
I studied with accuracy the last case of dengue, imported by a business man that has been in Africa in july. The dengue fever was accerted 3rd August.
The ASL (Local Sanitary Company) proceeded with the quarantine of the man, and a huge disinfestation of the "compromised site" (the man's house), for a radius of 100 metres. Families, friends and collegues of course has been controlled.
No one of the cases in last years degenerated in death and nobody was treated with particular terapies, only idratation and antipyretic drugs.
All 4 sierotypes were found, DEN1,2,3,4.
I hope this information will be usefull to you
best regards
SSZ
Dear Samin and fellow researchers
I think it is very interesting what Samin has told us about the mode of transmission in Italy. Albopictus emerging as a leading source is indeed noteworthy. Large scale Immigration would certainly explain the spurt in cases.
All four serotypes causing a not-so severe picture in his setting is also interesting. Could it be that there are other serotypes in action in the asian setting?. Also does a person's genetic makeup have any influence on how each individual responds to the Dengue virus serotypes?. Do share your thoughts.
Hello to all!
I'm from Mato Grosso, Brazil.
In my state there are 40.830 registered cases of dengue form January 1st to August 22th. Considering that our population ranges around 3 million inhabitants, dengue is a major public health concern.
It is a major public health problem, mainly on summers, because of the rain.
Dear indrajit, I do not think that there are genetics differences, also because Indian and mediterranean have the same prehistorical origin.
Consider that here almost 80% of infected are asintomatic; so, maybe, differences in patogenesis and complications and therapy are due to the socio-economical-sanitary environment of patients, and of course we should think that sometimes in Asia there are concurrent infections that maybe don't appear in european countries
A rare success was achieved 2 days ago in the battle against dengue. An 8 year old girl with massive Gastrointestinal bleeding - who went on to require ventilator support - survived and is recovering well in the wards now.
It is now almost a routine observation here that the diuretic phase (Loss of accumulated fluid) starts only on the 8th day and no earlier - in the cases that are coming to our hospital now.
The massive influx of cases has reduced, but the few referrals that we have, have presented with massive effusions and bleeds. Luckily there has been no mortality.
Infact my grandson showed similar rashes which erupted at the ned of a 3-day fever . The recovery was complete without any complications. The hemogram normal including platelet counts. Igg ,igm antigen-specific tests for dengue were negative for dengue.
The scourge of dengue is finally on the decline.
Last 3 hospitalizations were for NS-1 positive cases who had thrombocytopenia (day 5 -7 levels of upto 18000-20000 cells/cmm) but no third spacing. Pharyngitis was the common finding in all 3, and all 3 were in the 7-10 year age group.
High fever spikes were present till day 5 then became afebrile.
All responded to conservative management, and did not even require aggressive fluid therapy.
Hope everyone has a safe year ahead.
one single paediatric case was referred to us in the last 10 days. It would be interesting to know if the coming year is going to show the 'alternating' pattern that is being observed - that is- increasingly severe infection rates every alternate year. How is it in your countries dear colleagues?
At our area (SOUTH INDIA/ANDHRAPRADESH/KAIMNAGAR), the DENGUE cases seems to rise starting from may to September with many cases reported in aug-sept but still it is now controllable, thanks to timely rains and initiation of control measures by local municipalities with lessons learned from 2009 epidemic which has cost hundreds of lives
In my country increases number of Dengue disease, im port from Asia, in this time many cases are from Maledives
Dear colleague, maybe information n ECDC web pages could be useful for you. http://ecdc.europa.eu/en/healthtopics/dengue_fever/pages/index.aspx
The Dengue scare seems to have finally subsided- the month of october saw very few patients with Dengue being admitted to our pediatric wards.
Dataset on the cases is coming up soon- with the observed trend of the illness- I'm just preparing my writeup.
The trend of Severity and the numbers of people affected (cases) may vary with:
1. Dengue serotypes (DEN-1, DEN-2, DEN-3 or DEN-4). Serotypes DEN-2 & DEN-3 may be more lethal. Most of Asian countries being affected by all dengue serotypes but the predominant serotype may change with time of the year.
2. The weather / temperature
3. The vector. Aedes aegypti and Aedes albopictus are the 2 culprits. Aegypti more in urban and albopictus more in suburban/rural. However with rapid developments, more suburban and rural areas have been cleared for housings etc, A. albopictus is becoming more involved in transmitting the disease.
4. Our management of dengue fever/dengue haemorrhagic fever including:
- Public health. Need for more community participation with clearing the vector/mosquitoes breeding areas, fogging etc.
- Primary health clinic should notify within 24 hrs any case of dengue in that particular area so that the control measures can be done quickly to kill the vectors before spreading the disease
- Early referral to the nearest hospital of severe dengue cases
- Management in ward/hospital: need careful and closed observation of fluid infusions. Many cases reported of over transfuse of fluid causing APO despite of dehydration. CVP line might be helpful
In terms of epidemiology: 2 similar studies/observation done in southern states of Malaysia (2010, 2011) showed: upward trend of cases and mortality, affected all ages especially young adults including school children. Ratio of DHF to DF around 1 : 7-8 cases.
Clinical presentations: 1. Fever. Fever will be subsided (or lowered) in day 4-5. 2. Myalgia/arthralgia 3. Retro-orbital pain. 4. Headache 5. Gastrointestinal symptoms (epigastric pain), nausea +- vomiting. 6. Rash 7. Bleeding tendencies
For FBC. Most: decreased platelets < 100,000 (most day 4-5) +- raised haematocrits (if dehydration and movement of fluids from intecellular to extracellular space/3rd space)
Surprisingly, the cases of Dengue are showing a rise again - Pediatric referrals have started from the township of Mandya and a few cases also within the city of Mysore.
one thing is for sure, the timing of rains has a lot to do with mosquito breeding and the incidences of dengue viral infections. At my place in Karimnagar, though this season till now looks clear of a potential epidemic, but that's due to rains that have been continuous in nature followed by hot periods. This might have not allowed extensive breeding of mosquitoes. Another important aspect here is what i observed was that the municipalities/Government/Public has become a bit proactive in take preventive measures.
The dengue outbreak this year were the serious one we ever had. Number of affected and death cases were more serious than the previous year.Type 4 predominated the cause, it was around 90% of all cases instead of type 1 and 2 by the previous outbreak.
Clinical symptoms were also serious deswhile our medical staffs who first met the case at the health center(village level) were not able to manage correctly due to limited of skills, equipment and some medicine which caused the high mortality rate.
Importantly whereever people are committed to destroy the breading site earlier were lest affected than other region.
Dengue is endemic in most part of India including Delhi where I work. This year there are more number of cases of Dengue infection (an outbreak). The virus type isolated is Den 2. This time dengue infection is being treated in all the hospitals of our city (Delhi and New Delhi). Cases of dengue infection started coming to our hospital since August and the numbers are declining now. Number of patients being reported by government agencies is grossly under reporting as it includes patients with IgM positivity.
Other illnesses mimicking Dengue at this time of year in our practice are Enetric fever, chikungunya infection, malaria and occasionally, leptospirosis and scrub typhus.
Possibly with improved awareness and knowledge about illness, mortality is decreasing over past two decades. However measure to remove mosquito breeding sites may go a long way to control dengue and other mosquito born illnesses.
The most important research question for a clinician is to predict dengue infection that is going to develop severe illness (Severe Dengue fever). It is possibly related to host response to infection. I am hopeful that we will get some answer for this question in near future.
WHO defined warning signs of severe dengue can be useful in anticipating which people would require intensive monitoring and support and which people can be managed at home. As rightly pointed by Dr. Sushil sir, measures to control breeding sites are the need of the hour in tackling outbreaks. Environmental engineering, landfills and insecticide spraying in water stagnated areas especially during the monsoon period is required. Unfortunately, the civic administration is not pro-active and only reactionary in most towns and cities.
The late upsurge in Degue cases in Delhi, seen in last week of October and First week of November has been more severe. Number of patients developing plasma leaks and severe thrombocytopenia was higher in comparison to earlier cases of this season. More infants have presented with seizures. It may be due to reinfection or due to weak antibody levels in infants born to immune mothers which act as reinfection.
Dear colleagues I am a bit surprised to read this statement because the news of Dengue fever has just been reported in Dire Dawa, Ethiopia. I am not sure there have confirmed results received by the regional health bureaue but informal sources say two of the four samples sent were confirmed dengue cases. Though Ethiopia falls under the at risk countries according to the CDC and WHO classification there have been no report of Dengue fever till last month. Health professionals in the city describe clinical presentations of dengue as some thing similar to probable dengue fever mostly because majority of patients had epistaxis at presentation currently the outbreak looks to have subsided for there are no more reports of the presumptive dengue cases. But my question remains whether the outbreak in Dire Dawa-Ethiopia was really caused by dengue, why it occurred now and not before(b/c the whether changes experienced was not sustained enough as far as I am concerned) and finally why it stopped suddenly. I want to thank the author of the statement for giving me an eye opener and I will start looking for clues for my own questions as well as others'.
Additionally to my notice I have seen dengue infection more concomitantly with Vit. B 12 deficiency. I wonder if there is any correlation between the two.
in my opinion endemicity of the disease and alarming mortality need to be addressed as still in India there is lacking in medical facilities. moreover, lack of awareness regarding prevention and cure of disease is a major cause of increasing cases year wise. in rural areas malnutrition and anemia in children are the major predisposing factors of high morbidity and mortality and poor prognosis.
my friend from other countries, dengue in Mexico is endemic for almost 85 % of our territory in the last 10 years the presence of these disease is in increase year by year in my state of Tamaulipas we have about 6000 case and of these disease , we hospitalize 25 %, and 4 patient who die, the success of our treat for the patient is because we make a triage independent of emergency room and see all the warning signs of dengue a so the patient with pregnancy so we put all the rules for management of fluid like the clinical guides of WHO, the severe dengue cases were minimum in our hospitals thanks to these strategy,for the following question of vitamin b12 there is no scientific evidence that support this idea I think is more important intrinsic factor of malnutrition like we see here in Mexico with patient of chronic disease or obesity in extreme and pregnancy . the most important treatment is hydration so we can stop the damage in endothelium the keyword of the pathophysiology for dengue.
In Assam once again denge appeared like a demon and affected more than 3500 people in assam this year, of which about 3200 were from guwahati area only. Many casualitities once again. St. aegypti extending its limits of beeding and proliferation into the rurals of assam. Albopicta well established in every nook and corner of even hilly assam including to the mountaneous arunanchal also. Require adequate preparation for next year. I am afraid that now dengue will take over from malaria in NEIndia.
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