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Monsoon and dengue at the doorstep
"Bed netting is of little use in preventing dengue since dengue mosquitoes are most active during the daytime," says Dr KK Aggarwal, Honorary Secretary General IMA.

Staying indoors in well-screened or air-conditioned buildings during the day can reduce the risk of exposure. When outside, one should wear clothing that reduces the amount of exposed skin and should use an effective mosquito repellent, such as N, N–diethyl–metatoluamide (DEET).

Dramatic plasma leakage can develop suddenly, and therefore, substantial attention has been given to early identification of patients at higher risk of shock and other complications. The following clinical features are of help in this regard.

  • Duration of illness: The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after the fever is over.

  • Alarm signs: Severe abdominal pain, persistent vomiting, abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation, are noted in a minority of patients.

  • Hematocrit: An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.

  • Platelet count: Severe thrombocytopenia (<100,000/mm3) is one of the clinical criteria for dengue hemorrhagic fever and usually precedes overt plasma leakage.

  • Serum aspartate transaminase (SGOT): Mild elevations in serum transaminases are common in both dengue fever and dengue hemorrhagic fever. However, levels are significantly higher in patients with dengue hemorrhagic fever and elevated SGOT levels are noted earlier in illness.

Patients with suspected dengue with none of the above indicators can be safely managed on an outpatient basis as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.

A patient should be hospitalized under the following conditions:

  • Blood pressure <90/60 mmHg

  • Hematocrit >50%

  • Platelet count <50,000/mm3

  • Evidence of bleeding other than petechiae

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