Keep alert to symptoms of dengue fever in kids

By Donya Betancourt

SANUR, Bali (JP): When the rainy season comes, dengue fever is never far away.

An Aedes aegypti or Aedes albopictus mosquito finds its prey and bites, causing only mild irritation at first. However, fever and an unusually heavy tiredness that develops after five to seven days are the first signs that something is wrong.

Dengue fever is a viral infection common throughout the tropical regions of the world. The virus has four serotypes, but being infected with one serotype does not protect you from the other, which means your child can be infected by dengue more than once in their life.

Getting a second infection, especially with type 2, can lead to serious illness from either dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Symptoms take three forms:

1. Mild -- fever and rash like other viral conditions, but clears up within seven days.

2. Typical dengue fever -- starts with a sudden, rapidly climbing fever, a severe headache behind the eyes that throbs and pounds with pressure, nausea and vomiting, loss of appetite, rash and deep muscle and joint pains. The disease is nicknamed "breakbone fever" because of these last two symptoms. The rash usually appears three to four days after the start of the symptoms and begins on the body before spreading to the face, arms and legs.

Your child may have small bleeding spots, called petechiae, because of low platelet (the blood component to maintain blood vessels and prevent bleeding is always low in dengue fever). The fever can last for three to seven days depending on the individual followed by a long period of tiredness and fatigue.

3. Severe forms of dengue, mostly occurring in a recurrence of the infection, have the following three stages:

* High fever period -- The infected person will experience the acute onset of a high fever, ranging from 39 degrees to 41 degrees Celsius, for two to five days. In a young infant this can lead to convulsions.

A strange pink rash appears soon after and spreads across the chest, belly, and back. The patient appears red, especially in the face and eyes, there are severe headaches, abdominal pain in the right side, or epigastrium, loss of appetite, vomiting and muscle pain.

Around day two or three, children may be apathetic and have some bleeding spots on the arms and legs. Bleeding from the nose, gums or intestinal tract is dengue hemorrhagic fever, which is more severe than just petechiae.

* Critical period -- There is leakage of plasma from vessels because blood vessels and blood pressure drops as a result of the blood failing to meet the metabolic demands of the cells in the body -- which is the definition of shock. It mostly happens between 24 hours before and 24 hours after the fever has passed.

Symptoms are restlessness, cold clammy hands and feet, a rapid and weak pulse rate, severe vomiting, severe abdominal pain with liver enlargement and low blood pressure. This period lasts for 24 to 48 hours and hopefully the patient will survive.

* Recovery period: Plasma returns to blood vessels, everything seems to get better, appetite returns, there is no more pain or vomiting and the liver returns to its normal size. There is a recovery rash, which will be red with a small white halo along the body.

Treatment and prevention

There is no vaccine and there is no cure, so if one contracts dengue, the treatment is "supportive" which means rest, plenty of fluids, the use of acetaminophen, i.e. Tylenol, for fever (never ever use aspirin).

Hospitalization is required if the hemorrhagic fever or shock forms develop. Doctor will monitor the patient every day after the third day, and that may include checking blood to see the amount of platelets because they are normally low before the fever begins to subside. The doctor may keep the patient in hospital if physical and clinical examinations indicate the possibility of shock or bleeding from dengue.

This leaves us with prevention, stopping the mosquito bite once we know its cycle. It transmits dengue via bite only, but a mosquito feeding on a person who is in the first to fifth day of the disease symptoms can vector the disease to another person.

The dengue virus does not affect the mosquito in any way, but an incubation period of eight days to 11 days is required before the mosquito is deemed infective. The insect may be immediately infective after feeding on a host due to the virus present in its mouth area. Transmission from mechanical means is a short-lived phenomenon however. Once infected, the mosquito remains that way the rest of its life (from 15 days to 65 days).

The Aedes mosquito likes to bite in the morning (9 a.m. to 11 a.m.) and afternoon (2 p.m. to 4 p.m.), often indoors or in the shade. The Aedes species is a day biter, so during daylight hours, in areas where mosquitoes are present, take appropriate measures to protect yourself. These include wearing repellents, such as DEET (20 percent to 30 percent safe and effective) and spraying clothing with permethrin (spraying mosquito nets and tents is important, too). Mosquito coils also work. Wear long sleeves, long pants or skirts.

Aedes mosquitoes like to breed in standing water, which may be found in empty tires, flower pots, artificial ponds, etc., especially after rain. These are quite common in tropical urban areas, even around hotels. Empty all stagnant water or use larvicide (Abate) and malathion fogging to eradicate mosquitoes. Ultra-low-volume malathion spraying by aircraft can also be effective. Keeping fish in water pots can be valuable, too.

These methods work well in the short-term, but mosquito populations inevitably increase after a period of two to three weeks. Prevention is always the best measure and, as I always say, please take care of your child and yourself.

-- The writer is a pediatrician based in Sanur, Bali. Questions? Contact her at drdonya@hotmail.com or features@thejakartpost.com.