Bengaluru: Dengue scare swats a city full of mosquitoes

Bengaluru: “My son suddenly fell ill and the general physician near my house, suspects dengue,” says 48-year-old Kumaramurthy, father of a teenager patiently waiting for his son’s turn at Bowring Hospital. Kumaramurthy is just one in that long list of patients awaiting their turn at Bowring and fearing that they might have dengue. 43-year-old Sreedevi working as a house maid at Murugeshpalya who earlier went to government-run Victoria Hospital fearing the viral fever, is now getting her son treated at CV Raman Nagar Hospital for dengue. “He is fine now after medicines and transfusion,” says Sreedevi.

With 1,250 confirmed cases being reported by the State health department and hospitals seeing roughly 20  to 25 suspected dengue cases every day, the burden and patient load is more at government hospitals as many patients are from the low-income group and cannot afford treatment at private hospitals. “My daughter had dengue and it took me Rs 20,000 for her treatment at Manipal for a week,” informs Parvathi a housewife at Murugeshpalya. “Sadly, the dengue mosquito does not bite depending on the economic strata of a person and the disease burden is huge on both the rich and poor but at the lower strata the awareness and education is less when it comes to prevention of dengue and hence there is a huge lot pouring in hospitals which might be dengue positive cases,” informs Dr Chikkanarasappa Reddy, Assistant Professor of Paediatrics Bowring Hospital which has three dengue patients at the pediatric ICU  between the age-group of eight to eleven.

“All the cases need not require admission and we see some 25 suspected dengue cases daily and we send samples for test and start with the symptomatic treatment,” adds Dr Reddy who informs that for a BPL card holder treatment is free.

Government-run Victoria Hospital on the other hand witnesses some 20-30 OPD patients everyday with dengue. “On Monday we admitted about 15 dengue patients in my unit. The number has definitely increased in the last two-three weeks. Luckily, there has been no deaths,” says Dr Veerannagowda, professor and HOD, medicine, Victoria hospital which treated almost 100 dengue patients this month.

Dr Veerannagowda also adds, “Despite this huge inflow of dengue patients from other PHCs and hospitals, we are trying not to refuse any patient and wherever there is bed we are admitting cases. The inflow is huge because not everyone can afford a private hospital which charge huge sums of money.”

A week’s charge for the treatment of dengue is definitely breaking the middle-income group's back. A platelet transfusion is costing the city somewhere from Rs 20,000-30,000. “The Single Donor Platelets (SDP) costs somewhere from Rs 13,000-18,000 per packet and some patient might require one packet and some might require two or three packets. The demand is huge for it as the platelet count increases by twenty thousand or thirty thousand. On the other hand Random donor platelet increases count by 5,000 to 10,000 and requires 8-10 packets of it,” informs Dr Ambanna Gowda, Consulting physician and diabetologist, Fortis hospital, Cunningham road who sees at least three dengue patients everyday. “The cost of dengue treatment is definitely huge on patients who are from the low-income group or even the middle-income group which sees it as a sudden and huge money outflow,” adds Dr Ambanna.

“The only way to control is prevention, BBMP should take notice and educate people about the virus and how it can be stopped from spreading. Fresh water breeding should be stopped,” informs Dr K.G. Suresh, senior specialist, general medicine at KC General Hospital which has witnessed out of 143 suspected dengue cases, 42 positive dengue cases this September who says that hospital is trying to give its best with the resources available considering the huge inflow of patients.

Symptoms

Symptoms, which usually begins four to six days after infection and lasts for up to 10 days, may include:

• Sudden, high fever
• Severe headaches
• Pain behind the eyes
• Severe joint and muscle pain
• Fatigue
• Nausea
• Vomiting
• Skin rash, which appears two to five days after the onset of fever
• Mild bleeding (such as nose bleed, bleeding gums, or easy bruising)

Treatment

There is no specific medicine to treat dengue infection. If you think you may have dengue fever, you should use pain relievers with acetaminophen and avoid medicines with aspirin, which could worsen bleeding. Drink plenty of fluids, and see your doctor. If you start to feel worse in the first 24 hours after your fever goes down, you should get to a hospital immediately to be checked for complications.

Blood transfusion not needed in all cases

City doctors are not only bearing the brunt of surging dengue cases but are also burdened by pressure from family members of dengue patients. Thanks to dengue panic, many patients are now suffering from another unique syndrome called Transfusion-Related Acute Lung Injury (TRALI). “Normally we go ahead with platelet transfusion when the platelet drops down to less than 10,000 and despite WHO recommending limit as 5,000 to go ahead with blood transfusion, as practising pediatricians we are scared when the platelet drops to 20,000 and if it is a high-risk patient we go ahead with transfusion,” informs Dr Shankar V, MD (Internal Medicine) Manipal Hospital Malleswaram and Apollo hospital Sheshadripuram who has treated more than thousands of dengue patients this season.

Sadly, city doctors are being pressurised to conduct blood transfusion after a low platelet count among patients and many of them are suffering with this new malady. “The panic is huge and awareness is low and the public become panicky if the platelet drops from 72,000 to 30,000 and they are fighting with us and demanding transfusion and unnecessary platelet transfusion will produce reaction causing injury to the lungs and can also cause Transfusion-Related Acute Lung Injury (TRALI),” adds Dr Shankar who explains, “it is a syndrome characterised by acute respiratory distress following transfusion.”

“In general blood transfusion should be given only after there is an absolute requirement and this panic element is causing more harm than help to the patients. TRALI is one of the many harmful effects of blood transfusion and we have been very conservative in going for blood transfusion for dengue patients with low blood count,” says Dr Vivek Anand Padegal, Director, Pulmonology at Fortis Hospital who also warns that, “patients should not get overenthusiastic about transfusion”.

Speaking about the symptoms Dr Shankar adds, “Patients will develop sudden breathlessness, low blood pressure, their pulse volume will become high and oxygen requirement will increase, restlessness, profuse sweating, vomiting, rashes all over the body.” Dr Shankar also informs that, “this year two patients were diagnosed with TRALI, thankfully both recovered because it was recognised in one hour.”