Future Complications of Dengue

Future Complications of Dengue

A review article by

Dr. Somedatta Ghosh (Pal)

Like in previous years, in the middle of the rainy season, the dengue outbreak is occurring in West Bengal, Tamilnadu, Karnataka, Bihar, and many other parts of India.

In September, Bangalore witnessed around 5000 reported dengue cases.

Dengue in Asia and the Pacific Islands

Dengue is an ongoing risk factor to public health in the Asia and Pacific islands, hosting more than 70% of the world’s population.

Dengue is found to be highly endemic in five countries: India, Indonesia, Myanmar, Sri Lanka, and Thailand. In spite of all the preventive efforts, every year a sharp spike in the number of dengue cases is observed mostly in the months of July, August, September, and October.

How Dengue Spreads?

Dengue is the fastest-spreading mosquito-borne disease. It spreads through the bites of female Aedes species mosquitoes. A mosquito becomes infected after biting a person who has dengue in his/her blood. Almost after one week, the mosquito starts to spread the disease by biting healthy people.

It can spread to an unborn child in the womb from a pregnant mother. Otherwise, dengue does not spread directly from one human to another.

Symptoms

80% of dengue cases are asymptomatic or have mild symptoms. The fever can last for 2-7 days with the following symptoms:

  • Joint and muscle pain
  • Rash
  • Intense headache

Only 5% of the patients suffer from a severe form of dengue, called hemorrhagic dengue. Its symptoms are:

  • High fever
  • loss of appetite
  • persistent vomiting
  • difficulty breathing
  • abdominal pain

Medical Care in Dengue

Since there is no specific dengue treatment, the symptoms go away after a few days. Saline and oxygen therapy are provided for patients who are seriously ill. In case of severity, people must avail the proper medical care to avoid future complications.

Probable Future Complications

A high level of viral load in dengue can damage many internal organs, like the liver, heart, lungs, brain, etc.

 

Liver problem

The liver is the easiest target organ of dengue. The infection and associated oxidative stress and immune-mediated injury can damage the blood flow to the liver. Lack of supply of oxygenated blood through blood flow causes death of liver cells.

In most cases, patients remain asymptomatic after liver damage and the liver becomes fatty.  But sometimes the effects vary in severity and cause acute liver failure (ALF). Dengue is a leading cause of ALF and the symptoms are:

  • Fatigue
  • Nausea
  • Diarrhea
  • Vomiting blood
  • Jaundice
  • Swelling of abdomen, legs, and hands

 

Heart Problem

Severe dengue infection affects both the structure and function of the heart. The resulting cardiac complications may be mild to severe.

Mild problem

The probable mild complication is arrhythmias, when the heart beats too quickly, too slowly, or with an irregular rhythm. Usually, the problem resolves after a certain time period without any treatment.

Severe problem

  • Heart Attack: A high fever can damage the arteries and the heart starts to get less oxygen. It results in a heart attack.
  • Cardiogenic shock: The heart cannot pump enough blood to the various organs of the body. It is a life-threatening condition.
  • Low blood pressure: People may feel tired, lightheaded, dizzy, etc.

Pneumonia

Very rarely dengue fever infection causes pneumonia. When the fever subsides, fluid may accumulate inside the lungs. If simultaneously the platelet count also starts dipping rapidly, it may lead to serious illness or even death.

 

Scrotal Edema

Due to fluid accumulation, male patients sometimes suffer from scrotal swelling and itching after the fever. Mostly it goes away after a few days.

 

Inflammation in Ovaries

High fever in dengue can cause inflammation in the ovaries of female patients. As a result, after recovery from dengue, the patient may suffer from intense pelvic pain, heavy menstrual bleeding, difficulty in urinating, and vaginal discharge for a few months.

 

Brain Damage

Dengue fever can cause inflammation to the brain tissues and then they start to swell. It can lead to headaches, stiff neck, sensitivity to light, mental confusion, and seizures.

 

References

  1. https://www.cnbctv18.com/healthcare/dengue-outbreak-india-karnataka-bengaluru-bihar-patna-platelets-17786721.htm
  2. https://www.who.int/southeastasia/health-topics/dengue-and-severe-dengue
  3. Fernando S, Wijewickrama A, Gomes L, Punchihewa CT, Madusanka SD, Dissanayake H, Jeewandara C, Peiris H, Ogg GS, Malavige GN. Patterns and causes of liver involvement in acute dengue infection. BMC Infect Dis. 2016 Jul 8;16:319.
  4. Araiza-Garaygordobil D, García-Martínez CE, Burgos LM, Saldarriaga C, Liblik K, Mendoza I, Martinez-Selles M, Scatularo CE, Farina JM, Baranchuk A; Neglected Tropical Diseases and other Infectious Diseases affecting the Heart (the NET‐Heart) project. Dengue and the heart. Cardiovasc J Afr. 2021 Sep-Oct 23;32(5):276-283.
  5. Marchiori E, Hochhegger B, Zanetti G. Pulmonary manifestations of dengue. J Bras Pneumol. 2020 Mar 2;46(1):e20190246.
  6. Shamim M, Naqvi SZ. Dengue fever associated with acute scrotal oedema: two case reports. J Pak Med Assoc. 2011 Jun;61(6):601-3.
  7. Wiwanitkit S, Wiwanitkit V. Excessive menstruation bleeding as a presentation of dengue hemorrhagic fever. Arch Gynecol Obstet. 2013 Jun;287(6):1271.
  8. Trivedi S, Chakravarty A. Neurological Complications of Dengue Fever. Curr Neurol Neurosci Rep. 2022 Aug;22(8):515-529.

 

 

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