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V o l u m e 3 I s s u e 7 J u l y 2 0 0 9 s ..
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R E F R E S H I N G Y O U R H E A L T H

Dengue season
Here comes the rain, and with it comes mosquitoes. These bloodsuckers aren’t just inconvenient
pests. They can carry the deadly dengue virus. Know what to do these cold rainy months so you
won’t burn up with dengue fever.

A
CCORDING TO THE WORLD HEALTH
ORGANIZATION, 50 MILLION
PEOPLE ARE INFECTED WORLDWIDE
WITH DENGUE EVERY YEAR. DENGUE
FEVER IS CAUSED BY FOUR TYPES OF
DENGUE VIRUSES FOUND IN THE TROPICS,
THE PHILIPPINES INCLUDED.

The virus is transmitted from one person to the

other by the tropical mosquito called the Aedes
mosquito (Aedes aegypti and rarely, Aedes
albopictus).

Aedes aegypti is an urban dweller. In the past,

dengue was seasonal because the rainy season
brought about more stagnant water, which is the
breeding ground of the mosquito. But this is no
longer true. Metro Manila gets cases of den-
gue fever all year round, probably because of
deteriorating sanitation and rapid urbanization.

This mosquito feeds on blood during daytime.

If the mosquito feeds on virus-laden blood from
a person with dengue virus, the mosquito can
then transfer the virus to another person on its
next meal.

More importantly, the virus can stay up to two

weeks in the blood without causing any fever.
By the time fever shows up in the first victim, the A Slice of Orange is a newsletter
virus would have already been transmitted to designed to help clarify basic health
information and offer juicy tips on
several people. uplifting your health.

Editorial team
Alvin Delfin
Christine Llenes
Voltz Olea, MD

Breakbone fever
In some countries, dengue fever is called
“breakbone fever” because of its symp-
toms: a sudden fever with severe muscle
and joint pains, as if your bones are
being broken. It can also cause severe
headache and a skin rash. The dengue
rashes are bright red, pinpoint rashes that
appear first on the legs, thighs and chest.
Less common symptoms are stomach pain,
nausea, vomiting or diarrhea.
The fever usually lasts about six to seven
days. In some cases, the blood plate-
lets decrease and the blood thickens as
the fever begins to break. This can lead
to dengue hemorrhagic fever (DHF), a
dangerous complication of dengue fever
where the patient experiences bleeding
in different parts of the body, including the
gums, stomach, and intestines.
Rarely, DHF leads to dengue shock syn-
drome, where the bleeding and thickening
of the blood leads to low blood pressure
and poor blood flow to vital organs, lead-
ing to shock and multiple organ failure.
V o l u m e 3 I s s u e
Based on these descriptions alone, we
cannot overemphasize how deadly a
simple mosquito bite can become.
Call the doctor very quick
Any person who has a high fever and
muscle or joint pains should see a doctor
as soon as possible. The presence of even
mild signs of bleeding should also prompt
you to see the doctor. These signs include:
• Nose bleeding
• Gum bleeding (especially in the ab-
sence of vigorous brushing of teeth)
• Bruises (especially in the absence
of trauma)
• Fresh or old (dark) blood in the
stool, sputum, saliva or vomit
• Vaginal bleeding
• Heavier than usual menstruation
• Wounds or cuts that take longer
than usual (or 5 minutes) for bleed- How is it performed:
ing to stop.
Fever with drowsiness, excessive sleepi-
ness, photophobia (fear of lights), restless-
ness, weakness, seizures, stiffness of the
limbs, slowness in movement, clumsiness,
or stiff neck may also mean that the brain
may already be affected.
In the hospital, a test called a complete
blood count can check if blood platelet
levels are falling, or if the blood is getting
thicker. Special blood tests that can directly
detect the virus can also be performed.
A tourniquet test will also be performed.
7 J u l y 2 0 0 9
The tourniquet test
This test checks how fragile your tiny
blood vessels (capillaries) are, and can
help tell a patient’s tendency to bleed. A
positive tourniquet test may also be a sign
of low platelet count. It is a requirement by
the WHO before a diagnosis of DHF is
made. However, other diseases may also
cause a positive tourniquet test. Also, early
DHF may be negative at first. Hence, a
negative test does not mean you can let
your guard down.
1. Your blood pressure is taken using a
regular blood pressure (BP) apparatus.
2. After a few minutes, the cuff is re-
inflated to a pressure between the sys-
tolic (upper number of the BP) and dia-
stolic (lower number) pressures and
maintained for five minutes (this can
be painful).
3. The test is positive if there are more
than 20 red dots per square inch of
skin around where the cuff was inflated.
While you can do a tourniquet test at
home, the results can become incorrect
if the test is not done correctly. It is best
to have a tourniquet test performed by a
health professional.
 V o l u m e 3 I s s u e 7 J u l y 2 0 0 9

Once dengue fever or DHF is confirmed, Dodging the dengue bug

your vital signs (heart rate, blood pres-
sure, breathing, and temperature) will be
monitored meticulously. This will detect
the first signs of shock, which will then
be treated promptly. Signs of bleeding
and platelet counts will also be regularly
monitored. If platelet counts drop to criti-
cal levels, or there is massive bleeding,
blood transfusion will be performed.
Not everyone who has dengue fever
will be hospitalized. Stable patients will
be sent home, but will be requested to
undergo regular platelet testing (from
every few hours to daily).
All patients, whether at home or in the
hospital, need to increase their intake of
fluids. This will prevent dehydration and
blood thickening, which could lead to
shock.
Dengue patients should never take medi-
cines such as aspirin or ibuprofen (or
other pain killers), as this may increase
the risk of bleeding. The only anti-fever/
pain medicine they can take is paraceta-
mol (acetaminophen).
The Aedes mosquito is critical to A dengue vaccine?
the life cycle and transmission of the
dengue virus. Hence, mosquito control There is no vaccine yet available to
has been the cornerstone of dengue prevent dengue. Although progress is
underway, developing a vaccine against
prevention since the 1960s. There
the disease has proven challenging.
are two main methods:
One of the biggest challenges to vaccine
Larval (wriggler) control development is the fact that there are
Eliminate possible breeding grounds four distinct types of dengue viruses. The
vaccine must immunize against all four
types to be effective.
• Periodically drain stagnant water
in plastic cups, used tires, bottles, To make matters worse, the body seems
flowerpots, etc. to react to each type in a different way.
• Cover water drums and water pails With other infections, previous exposure
to a virus makes subsequent infections
at all times.
milder, or may even prevent subsequent
• Replace water in flower vases once infections, because the immune system
a week. is already more prepared for a second
• Clean all water containers once a onslaught.
week. Scrub the sides well to remove
But in the case of dengue, subsequent
eggs of mosquitoes sticking to the
infections tend to be worse than the
sides. previous one, until the
• Clean gutters of leaves and debris so person is exposed
that rainwater will not collect in them. to all four types.
Only then will
the body
Adult mosquito control
become
Careful use of insecticides, insect immune.
repellents, and mosquito nets.

A slice of trivia

Dengue fever can turn deadly once blood platelet counts start going down and the blood
begins to thicken. What blood test can detect these initial but alarming signs of DHF?
Freshen up on your researching include the answer in the next Strepsils contains amylmeta- influenza virus, from infecting
skills, e-mail us the answer at issue of A Slice of Orange. cresol and dichlorobenzyl other people.
orange@activelink-consult.com alcohol, two ingredients with
and win a prize! Answer to last issue’s question:
antiviral and antibacterial
properties. A study showed that
From those with the correct What are the two active
answer, 10 people will be ingredients of Strepsils that oral lozenges containing these
randomly chosen to win a gift kill bacteria and viruses that two ingredients prevent viruses,
pack from ActiveLink. We’ll cause sore throat? including the

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The information in this newsletter is not intended as a substitute for professional medical care. Consult a doctor for
all matters relating to your health, particularly for symptoms that may require diagnosis or medical attention. Dying to ask
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