The Importance of Early Diagnosis of Dengue Fever

In a season like now, it is not uncommon to see cases of dengue fever. Patients often come with complaints of fever for 1-2 days and doctors always suspect dengue fever. Actually, what is dengue fever? Dengue fever is a disease condition experienced by patients due to a viral infection, there are several terms you need to know, namely dengue fever (DF/dengue fever) and dengue hemorrhagic fever (DHF), both of which are infectious diseases caused by dengue virus infection with symptoms diverse.

The difference between dengue fever and dengue hemorrhagic fever is the patient's clinical condition, where patients with dengue fever are still more stable and the results of blood tests are still quite good. In dengue fever there is plasma seepage and hemoconcentration as well as accumulation of fluid in the patient's body cavity so that the patient will feel uncomfortable and have a fever. It is known that the virus that causes dengue fever is the genus Flavivirus, family Flaviviridae. This virus can replicate in mosquitoes of the genus Aedes and Toxorhynchites which are often found in tropical countries.

Indonesia is an endemic area with distribution in almost all parts of Indonesia at various ages. Transmission in Indonesia is caused by the mosquito vector of the Aedes genus (A. Aegypti and A. Albopictus) which we often encounter around us, both at home and in schools and gardens around us. Apart from being able to cause dengue fever, this mosquito can also cause other viruses such as yellow fever, chikungunya and Zika fever. The characteristic of this mosquito is that its body is black and covered with scales with white lines. These mosquitoes are active in the morning and afternoon and the spread of dengue fever is carried out by female mosquitoes because only female mosquitoes suck blood. This mosquito can fly up to 400 meters so that the spread of the dengue virus can occur long distances from where the mosquito nests.

Patients with DHF can be asymptomatic (asymptomatic) and can be symptomatic. The dominant symptom is fever. The fever phase will last approximately 2-7 days, followed by a critical phase of 2-3 days. In this condition, patients sometimes have no fever but are at risk of shock if not treated properly. Other complaints that often arise are:

  • Nausea and vomiting
  • Joint and muscle pain
  • Headache or back of the head
  • And if it is heavy there are signs of bleeding such as red spots on the skin, nosebleeds or bleeding gums.

The doctor will carry out a physical examination to see the patient's signs and clinical signs, after which the doctor will carry out supporting examinations such as laboratory (complete blood count, dengue fever examination (NS1/IgG IgM dengue), kidney and liver function examination, etc.) and radiological examination if there are medical indications and required.

Patients with positive results will be evaluated regarding the severity of the dengue fever, the doctor will determine whether they need to be hospitalized or outpatient. In outpatients, periodic evaluations need to be carried out to assess the patient's condition and usually a laboratory examination will be carried out again the following day. Patients who are hospitalized will have their condition evaluated, often requiring a special room such as a high care unit / intensive care unit to carry out strict therapy for severe dengue fever conditions.

Management of patients with dengue fever is supportive. And evaluated regularly every day. Patients need to pay attention to oral fluid intake to avoid dehydration and hemoconcentration during dengue infection. The doctor will provide intravenous fluid therapy, fever medicine, nausea/vomiting medicine, and other medicines according to the doctor's clinical findings. It is not uncommon for patients with dengue fever to require blood transfusions in severe conditions. From research it turns out that the benefits of guava juice for dengue fever do not affect platelets, but from clinical experience, drinking guava juice can be beneficial for patients to stay well hydrated so doctors sometimes don't forbid it. Meanwhile, for other foods, there is no definite research that can increase platelets. Patients are advised to stay healthy by eating healthy and nutritious food. Once the patient is stable and free from fever with good examination results, the doctor will usually allow him to be admitted for outpatient treatment. The patient will be asked to control and check his condition again.

Currently there is a dengue vaccine for children and adults. The aim of giving this vaccination is to reduce complications/severity if infected with dengue fever. Currently there are two types of vaccines that can be used from children aged 6 years to adults aged 45 years. This vaccine is divided into 3 doses which are given every 6 months. You can ask your doctor about vaccination for dengue fever if you want to know more. Meanwhile, another prevention of dengue infection is a clean and healthy lifestyle.

3M's program to always keep the environment free from standing water (draining bathtubs, closing water reservoirs, burying used goods) and also adding several other points such as planting plants that can ward off mosquitoes, checking places used as water reservoirs, using medicine anti-mosquitoes, raising fish that eat mosquito larvae, carrying out mutual cooperation to clean the environment and always coordinating with the environment if there are patients with dengue fever so that they can be identified and carried out evaluations to prevent transmission such as periodic fogging and carrying out community service.

Don't hesitate and get yourself checked if you have complaints and want to know more about dengue fever. Healthy greetings!

Article written by dr. Patriotika Ismail, Sp.PD (Specialist in Internal Medicine at EMC Cikarang Hospital).