Lammergeier
fever
.
Red spots on the skin.
Intense abdominal pain.
Diarrhea.
Vomiting.
Hemorrhage.
Liver and kidney failure.
Neurological disorders.
The manifestations of severe dengue
are so varied
in the intensive care units and intermediate wards where
Clarín
consulted due to the poor evolution of patients with the virus.
Most of them, at the beginning, when they were admitted by guard, had the same symptoms as the rest who also suffered the bite of the
Aedes aegypti
mosquito.
and recovered at home.
With more than 100,000 cases and 79 deaths, specialists explain why we are all susceptible to the worst side of this disease.
Also,
how many times we can have dengue
throughout life
, the keys to the
asymptomatic majority
and the decisive fourth day of the infection.
Dengue has four serotypes: DEN1, DEN2, DEN3 and DEN4.
In Argentina, DEN2, which is more aggressive and was identified in 25 of the 35 deaths in which it was searched, raced to second place to DEN1, followed by DEN3.
According to the latest Epidemiological Bulletin, no cases of DEN4 have yet been recorded this season.
Severe dengue: what are the risk groups?
"
We are all vulnerable to becoming infected with dengue.
However, there are groups that have a greater chance of developing
severe dengue
: those under 5 years of age, those over 65, pregnant women and all people who have a history of having had dengue,"
infectologist Eduardo López
explains to
Clarín .
If in this vulnerability the expert had to define
who is even more vulnerable
, he lists
three groups
: first, "those who have had dengue", second, "those who have comorbidities" and, third, "those who live in areas of hyperoutbreaks of dengue."
Like Missions and Jumps.
Aedes aegypti is the mosquito that transmits the four serotypes of dengue.
Photo EFE
In addition to the fact that pregnant women are pregnant because they cannot receive the dengue vaccine, because it is a live attenuated virus (against the four serotypes), like those who are less than 4 years old, there are certain comorbidities that can lead to the evolution most unfavorable.
"Morbid obesity, high blood pressure, diabetes and other chronic diseases, such as asthma, and cardiovascular and liver diseases," he reveals.
He also mentions immunosuppressed people, who also cannot be vaccinated.
So far,
28 of the deceased had comorbidities
.
The majority, twelve, suffered from diabetes.
Deaths (more men than women) were recorded in all age groups.
But
the one that had the most cases is those over 80
, followed by those from 70 to 79, then those from 60 to 69 and those from 30 to 39.
He relates severe dengue to "a constellation of symptoms."
It is a virus that does not warn and that also betrays.
In the list of manifestations in the first paragraph, López adds
"drowsiness (lethargy)"
and
"irritability"
.
This can also appear when the fever goes down.
" The patient
must be well controlled when the temperature drops
, because it can evolve into severe dengue. But, in reality, mortality from dengue is not high, it is 2.5% in the 4 serotypes of the causal virus. If treated at patient well, that percentage is reduced to less than 1%," he points out.
There are more cases of dengue than those reported
Dengue is a disease with
high morbidity
.
That is, it affects many people.
According to the epidemiological consensus, for every person with symptoms there are between 5 and 7 asymptomatic people, who are also sensitized to be reinfected by the transmitting mosquito.
"You can have dengue, you have antibodies for the serotype that made you sick, and there are no long-term consequences. At least, for now," he says, and recommends "
dirty vaccination"
- for everyone equally, not It matters having had the virus – in areas where outbreaks are recurrent.
López says that
we can have dengue and not notice it
, because the defining thing is that "if you were bitten by a female mosquito (they are the ones that do it) that had serotype 1, you develop immunity for DEN1, as you can do every time with the 4 serotypes, but if you are bitten by another that does not have the same serotype that you originally got sick with, you can have symptomatic and even severe disease.
He warns that those who have dengue, without knowing it, and take ibuprofen or aspirin to combat fever or body pain, promote blood anticoagulation and the development of a serious condition.
In this critical time, then, it is particularly important to avoid self-medication.
Underdiagnosis and day 4 with dengue
"Severe dengue is more common in those who had a previous strain," says Roberto Hirsch, infectious disease specialist at Muñiz Hospital.
With a simple explanation, he once again gives the complex epidemiological example of encountering a different serotype of the same virus.
"A person who had dengue DEN1 is protected for four months and then
becomes sensitized
. Any subsequent dengue serotype, that is, DEN3 or DEN 4, because DEN 2 itself is always tougher
,
can cause severe dengue
from the start
. ".
What is being seen in cases confirmed by diagnosis is a small sample of the dengue crisis in the country.
"Those who had
diarrhea,
two vomiting or who had 37.8°, or whose back hurts because
'it always hurts'...
in many cases they are patients who had subclinical dengue (without medical attention or diagnosis)," Hirsch points out.
The specialist speaks of that entire universe that does not develop serious symptoms, and continues, in any case, to be a reservoir of dengue.
"An
effective vaccine
is one that can prevent transmission. The current one (referring to the one applied in the country) prevents serious illness," he reinforces.
When do you see patients get seriously ill?
"After the fourth day. The temperature drops sharply, abdominal pain appears, the spleen grows, signs of dehydration appear, signs of
shock
, gingival bleeding (in the gums), petechiae (small red spots on the palate), women have losses, as if they were menstruating," he responds.
Before that day, all
dengue fevers
are the same.
"Bonebone fever and body ache."
A blood test can give more answers about the development of severe dengue.
You can see how much platelets and white blood cells drop.
That is why early attention to compatible symptoms is decisive.
Severe dengue
comprises three models.
"The so-called
shock
due to dengue,
hemorrhagic dengue
and the so-called
severe organ dengue,"
details Tomás Orduna, former head of the Tropical Medicine and Travel Medicine Service in Muñiz.
The third model, he says, "is seen in patients with involvement in the brain, dengue encephalitis, in the heart, dengue myocarditis, or
dengue hepatitis
, which occurs when liver enzymes exceed 1,000 units."
But long before, these patients go through more benign conditions.
"These are the warning signs. Intense abdominal pain, persistent vomiting, being lethargic or, on the contrary, irritable, bleeding gums when brushing our teeth. If an immediate consultation is made, with intravenous hydration, a brake is put on the to a complicated picture," he concludes.
The medical protocol to prevent this progression of the virus in the body has three legs:
hydration
–orally or by serum–,
shock treatment
(or "support", to maintain pressure, continue urinating and not have to enter to dialysis; or, depending on the case, also plasma transfusions "to increase blood density and prevent hemorrhages") and
paracetamol
.
In severe dengue, which due to the fall of platelets reduces coagulation and causes those red spots to be seen on the skin, what is known as
"third space"
also occurs .
Plasma that is not in the blood vessels.
What happens to other parts of the body.
MG