Dengue Fever And Homeopathic Management

Overview of Dengue fever

• Generally, It is endemic in Asia, the Pacific, Africa and the Americas
• Furthermore, Approximately 50 million infections occur annually and dengue is the most rapidly spreading mosquito-borne viral illness.
• The principal vector is the mosquito Aedes aegypti, which breeds in standing water, collections of water in containers, water-based air coolers also  tire dumps are a good environment for the vector in large cities.
• In detail, Aedes albopictus is a vector in some South-east Asian countries.
• There are four serotypes of dengue virus, all producing a similar clinical syndrome, type-specific immunity is life-long, but immunity against the other serotypes lasts only a few months.
• Besides this, Dengue hemorrhagic fever (in other words, DHF) and dengue shock syndrome (DSS) occur in individuals who are immune to one dengue virus serotype and are then infected with another.
• All in all, Prior immunity results in increased uptake of virus by cells expressing the antibody Fc receptor and increased T-cell activation with resultant cytokine release, causing capillary leak and disseminated intravascular coagulation. (1)

Causes of Dengue fever

• The causative agent, a flavivirus with 4 serogroups, is transmitted by the bite of Aedes mosquitoes.
• The virus circulates in the blood of infected humans for 2 to 7 days, Aedes mosquitoes may acquire the virus when they feed on humans during this period. (1)

Types of Dengue Fever

The type of dengue fever in this case of viral disease specifically means the kind of causative agent that is infecting the person.

The virus that causes this kind of viral disease belongs to the family named Flaviviridae. This Flaviviridae family of the viruses basically has 4 serotypes. The kind of serotype that infects the person basically indicates the type of dengue that infected person is having. The four serotypes of this kind of virus family that is responsible for causing this kind of viral infection are listed below :

• DENV – 1
• DENV – 2
• DENV – 3
• DENV – 4

These are the major serotypes that are responsible for causing this kind of viral infection. (6)

Risk factor 

People who live in or travel to high-risk areas including:

• Indonesian archipelago into northeastern Australia
• South and Central America
• Southeast Asia
• Sub-Saharan Africa
• The risk of severe disease from secondary infection actually increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2.
• Severe disease is more common in babies and young children,
• Risk factors for severe disease include female sex, high body mass index, and viral load
• Polymorphisms in particular genes have been linked with an increased risk of severe dengue complications.
• Dengue can be life-threatening in people with chronic diseases such as diabetes and asthma. (5)

Pathophysiology of Dengue fever

• Dengue virus infects blood monocytes, lymphocytes also endothelial cells.
• These initiates complement activation also consumptive coagulopathy including thrombocytopenia.
• The entire process takes place rapidly also may evolve over a period of a few hours.
• If patient is treated appropriately at this stage, there is rapid also dramatic recovery. (3)

But in untreated cases, dengue shock syndrome develops and death occurs. (3)

Sign & Symptoms of Dengue fever

Incubation period i.e.:

• 2–7 days

Prodrome i.e.:

• 2 days of malaise and headache

Acute onset i.e.:

• Fever, backache, arthralgias, headache, generalized pains (‘break-bone fever’), pain on eye movement, lacrimation, scleral injection, anorexia, nausea, vomiting, pharyngitis, upper respiratory tract symptoms, relative bradycardia, prostration, depression, hyperesthesia, dysgeusia, lymphadenopathy

Fever i.e.:

• Continuous or ‘saddle-back’, with break on 4th or 5th day and then recrudescence; usually lasts 7–8 days

Rash i.e.:

• Initial flushing faint macular rash in first 1–2 days. Maculopapular, scarlet morbilliform blanching rash from days 3–5 on trunk, spreading centrifugally and sparing palms and soles, onset often with fever defervescence. May desquamate on resolution or give rise to petechiae on extensor surfaces.

Convalescene i.e.:

• Slow and may be associated with prolonged fatigue syndrome, arthralgia or depression.

Complications i.e.:

• Dengue hemorrhagic fever and disseminated intravascular coagulation
• Dengue shock syndrome
• Hepatitis, cerebral hemorrhage or Oedema, encephalitis, cranial nerve palsies, rhabdomyolysis, myocarditis
• Vertical transmission if infection within 5 weeks of delivery. (2)

Clinical examination of Dengue Fever

Pulse and Blood Pressure

Tachycardia, postural hypotension, a narrow pulse pressure (<20 mm Hg) and / or frank hypotension could indicate intravascular volume depletion due to either dehydration or capillary leak. The presence of any of the above is a warning sign of severe disease, and the patient should be hospitalized for observation.

Urine Output

If the patient is not urinating at least every 6 hours, this may reflect intravascular volume depletion due to capillary leak, and the patient should be observed for the development of severe disease.

Skin

If the patient has poor perfusion, the skin may be cold and clammy.

Erythema of face, maculopapular rash and Petechiae may be present. The tourniquet test can used to elicit petechia. A blood pressure cuff is applied and inflated to a point between the systolic and diastolic blood pressures for five minutes. The test is positive if there are more than 20 petechiae per square inch

Mental Status

Lethargy and restlessness are warning signs that the patient should be monitored for the development of severe disease.

HEENT

• Mucosal bleeding is a warning sign that the patient may have thrombocytopenia and should be monitored for the development of severe disease.
• Pharyngeal inflammation
• Retinal hemorrhage may occur.

Lungs

• Pleural effusion is a warning sign the capillary leak may be occurring, and that the patient should be monitored for the development of severe disease.

Abdomen

• Abdominal pain or tenderness are warning signs and the patient should be monitored for the development of severe disease.
• Liver enlargement >2 cm is a warning signs and the patient should be monitored for the development of severe disease.
• Ascites is a warning sign, and the patient should be monitored for the development of severe disease.

Extremities

• Pedal edema or evidence of fluid accumulation is a warning sign, and the patient should be monitored for the development of severe disease.(5)

Diagnosis of Dengue fever

• In endemic areas, mild dengue must be distinguished from other viral infections.
• The WHO recently revised its clinical classification of dengue and is evaluating the usefulness of these categories in guiding diagnosis and treatment.
• The diagnosis can be confirmed by seroconversion of IgM or a fourfold rise in IgG antibody titers.
• Serological tests may detect cross-reacting antibodies against other flaviviruses, including yellow fever vaccine.
• IgM/IgG ratios may be used to distinguish primary from secondary infection.
• Isolation of dengue virus from blood or detection of dengue virus RNA by PCR is available in specialist laboratories.
• Commercial enzyme-linked immunosorbent assay (in other words, ELISA) kits to detect the NS1 viral antigen, although less sensitive than PCR, are becoming more widely available in endemic areas.(1)

Differential Diagnosis of Dengue fever

• Dengue fever is suspected in patients in endemic areas if they develop sudden fever, headache, myalgias, also adenopathy, particularly with the characteristic rash or recurrent fever.
• Evaluation should rule out alternative diagnoses, especially malaria and leptospirosis.
• Diagnostic studies include serologic testing, antigen detection, also PCR of blood.
• Serologic testing involves hemagglutination inhibiting or complement fixation tests using paired sera, but cross-reactions with other flavivirus antibodies are possible.
• Antigen detection is available in some parts of the world (not in the US), and PCR is usually done only in laboratories with special expertise.
• Although rarely done and difficult, cultures can be done using mosquitoes or specialized cell lines in specialized laboratories. (2)

Investigation of Dengue fever

• CBC may show leukopenia by the 2nd day of fever; by the 4th or 5th day, the WBC count may be 2000 to 4000/μL with only 20 to 40% granulocytes.
• Urinalysis may show moderate albuminuria and a few casts.(1)

Treatment of Dengue fever

• Supportive care Treatment is symptomatic.
• Acetaminophen can be used, but NSAIDs, including aspirin, should be avoided because bleeding is a risk.
• Aspirin increases the risk of Reye’s syndrome in children and should be avoided for that reason. (1)

Prevention of Dengue fever

• People in endemic areas should try to prevent mosquito bites.
• To prevent further transmission by mosquitoes, patients with dengue should be kept under mosquito netting until the 2nd bout of fever has resolved.
• Vaccines are being evaluated. (1)

Homeopathic Treatment of Dengue fever

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Dengue fever:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Eupatorium Perfoliatum

• The leading characteristic is violent aching, bone breaking pains.
• Aching of bones also soreness of muscles of the lower limbs.
• Either Thirst or nausea, then violent shaking chill; begins in the small of the back.
• Bitter vomiting especially after chill or during heat.
• Burning heat.
• Sweat; additionally relieves all the symptoms except the headache.
• Sweat scanty
• Patient is restless, chilly also nauseated. (4)

Belladona

• Basically, High fever with comparative absence of toxaemia.
• Internal coldness, with external pungent, burning, steaming heat.
• Hot Head, with cold limbs.
• Skin hot, but moist also dry alternately.
• No thirst with fever
• Fulness, Congestion especially to head and swelling are other characteristic features.
• Lastly, Pain is throbbing, sharp, cutting, shooting, or clawing, of maddening severity, coming and going in repeated attacks. (4)

Rhus Tox

• Easily chilled aggravation least uncovering; additionally with pain in limbs.
• Chill as if dashed with either cold water or cold water in the veins; preceded by cough, alternating with heat.
• Chill in single parts.
• Heat, with busy delirium.
• Sweat, agg. during also pain, with sleepiness.
• Urticaria during fever.
• Wants to yawn and stretch during chill.
• Awakes either tired or nervous.
• Lastly, Dreams, of great exertion, of blood, or fire (4)

Bryonia Alba

• Chill with hot head and red face, agg. warm room.
• Dry burning heat, with agg. of all the symptoms.
• Blood seems hot.
• Painful continued fevers.
• Sweat, either sour or oily (4)

Aconite

• Chill passes through him in waves.
• Either Chill or coldness alternating with heat.
• High fever; in detail dry burning heat; in eyelids, nose, mouth, throat, lungs and palms, must uncover.
• Sweat drenching, wants to uncover.
• Sweat on uncovered parts or affected parts
• Complaints caused specifically by exposure to cold, dry weather, especially respiratory affections. (4)

Gelsemium

• Chill with aching also languor, mixed with heat or alternating with heat, chill up and down back.
• Cold hands and feet.
• Heat, with drowsiness.
• Thirst absent; additionally with trembling.
• Cold sweat.
• Bilious remittent; malarial; typhoid; cerebro-spinal fevers. Measles.
• Nervous, shuddering, chill; preceded by visual disturbances. (4)

Arsenic Album

• Externally cold, with internal burning heat.
• Coldness; in spots.
• Sensitive to cold, yet amel. in open air.
• Chills irregular, shaking; craves hot drinks during chill; Dyspnoea during chill.
• Heat as of hot water in veins; or they burn like lines of fire.
• High fever, hectic fever.
• Sweat, with great thirst, Dyspnoea or exhaustion.
• Sweat cold.
• Waves of icy coldness in blood vessels or intense boiling heat.
• Intermittent fever, yellow fever(4)

Diet & Regimen of Dengue feve

Regimen and diet for Dengue fever

Diet:

• • Water
     
  • Oral rehydration solutions (ORS) 
     
  • Coconut water   
     
  • Fresh fruit juices (avoid sugary drinks) Hydration is Key: Dengue often causes fever and sweating, leading to dehydration. Drink plenty of fluids like:
   
  • Fruits and vegetables: Excellent sources of vitamins and minerals. Papaya and pomegranate are especially helpful as they may help increase platelet count.
     
  • Lean protein: Chicken, fish, eggs, and tofu provide essential amino acids for recovery.
     
  • Easy-to-digest carbohydrates: Rice, porridge, and boiled potatoes provide energy without upsetting your stomach.Nutrient-rich foods: Your body needs energy and nutrients to fight the virus. Focus on:
• Foods to avoid:
  • Oily and spicy foods: Can irritate your stomach and worsen nausea. 
     
  • Caffeinated drinks: Can dehydrate you.
  • Alcohol: Can interfere with your recovery and medications.   
     

Regimen:

• Rest: Your body needs rest to recover. Get plenty of sleep and avoid strenuous activities.
   
• Fever management: Use over-the-counter medications like paracetamol to reduce fever and body aches (avoid aspirin or ibuprofen as they can increase the risk of bleeding).
   
• Monitor your symptoms: Watch for warning signs like severe abdominal pain, persistent vomiting, bleeding, or difficulty breathing.Seek medical attention immediately if these occur.
   

References 

1. Merk Manual of Medicine
2. Davidson’s Principles and practice of medicine
3. Textbook of Pathology by Harsh Mohan
4. Textbook of Homoeopathic materia medica by Dr. S.R. Phatak
5. Dengue fever risk factors – wikidoc
6. DENGUE : TYPES, STAGES, SYMPTOMS, CAUSES AND MORE (alkabirhealthcare.com)

7. Bhatt, S., Gething, P. W., Brady, O. J., Messina, J. P., Farlow, A. W., Moyes, C. L., … & Hay, S. I. (2013). The global distribution and burden of dengue. Nature, 496(7446), 504-507.

8. Dengue infection in India: A systematic review and meta-analysis. (2018). PLOS Neglected Tropical Diseases, 12(8), e0006618.

9. National Vector Borne Disease Control Programme. (2021). Dengue situation in India. National Center for Vector Borne Diseases Control, Ministry of Health and Family Welfare, Government of India.

10. Gubler, D. J. (2011). Dengue and dengue hemorrhagic fever. In Tropical Infectious Diseases: Principles, Pathogens, and Practice (3rd ed., pp. 643-676). Saunders Elsevier.
11. Principles and Practice of Homoeopathy" by Dr. M. L. Dhawale
12. A Concise Repertory of Homoeopathic Medicines" by Dr. S. R. Phatak

To search for information on Dengue Fever, people can use several methods:

1. Search Engines: Use Google, Bing, or other search engines. Simply type "Dengue Fever" into the search bar to find articles, research papers, and general information.

2. Medical Websites: Visit reputable medical websites such as:
– [Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/dengue/)
– [World Health Organization (WHO)](https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue)
– [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/dengue–fever/symptoms-causes/syc-20353078)

3. Online Journals and Databases: Access scholarly articles through databases like PubMed, Google Scholar, or JSTOR.

4. Library Resources: Use online or physical libraries to access books and academic papers on dengue fever.

5. News Websites: For recent outbreaks or news, check major news websites like BBC, CNN, or Reuters.

6. Health Apps: Some mobile apps provide detailed information on diseases, including dengue fever.

7. Social Media and Forums: Platforms like Twitter, Reddit, and specialized health forums can provide personal stories, discussions, and recent developments.