Tropical fever…two common causes and management

Fever is a very common symptom which everyone of us experiences often. If one is not cautious enough, this fever can lead to life threatening complications. How can a simple fever lead to difficult situation, one may wonder. Thats because, this fever can just be a presentating symptom of potentially dangerous diseases like dengue or scrub typhus. Alarming, isnt it ?

This year we have seen an outbreak of these diseases in a major way. Many patients have died due to the same in recent times. Both diseases have overlapping signs and symptoms, to confuse us all the more.

Hence it is imperative to know salient features of this disease, so as to be able to suspect them if our kith and kin develops fever.

Dengue :

⁃           Caused by dengue virus and propagated through Aedes egypti mosquitoes. Infection occurs, when the mosquitoes bite the dengue infected person.

⁃           The incubation period ( time from the mosquito bite to development of symptoms) is around 4 to 10 days. That means, a patient can get infected,yet remain without fever or any other symptoms till almost a week.

⁃           Dengue can be manifested as mild fever to severe infection with low platelets and bleeding, severe respiratory distress, heart dysfunction, liver and kidney failure. It can also affect brain ( either there can be bleeding in the brain or direct infection of brain cells) and cause coma.

⁃           Fever may settle down in two to three days and  platelets continue falling even after that. Platelets are important cells in the body which play a pivotal role in clotting of blood. Decrease in number of platelets, therefore pre disposes any patient to the risk of bleeding. Bleeding can happen externally on skin or internally in stomach, intestines, brain or lungs.

⁃           If there’s fever, one should always be vigilant about any rash over body, which can give a clue to bleeding possibility. These can be tiny red, purple or brown spots, especially seen on lower limbs or chest, called as “petechiae “.

⁃           There’s no definitive drug for treatment of dengue. Maintaining hydration, close watch on platelets and if needed transfusions of platelets is essential. Hospitalisation helps in keeping a watch on complications listed above and preventing them as far as possible.

Scrub typhus :

–   It is caused by orentia tsugsugamushi. It is transmitted through bite of a mite. Incubation period is 6 to 10 days.

⁃           It also presents with high grade fever. Symptoms are more or less similar to dengue fever. It causes drop in platelet counts and  affect liver, lungs, heart and brain.

⁃           Unlike dengue, there s a classical mark at the site where the person is bitten by the mite, called “eschar”. It is typically seen near groin, chest, abdomen. However this is seen in just 30 percent of scrub typhus patients.

–  Scrub typhus has a definite treatment and the drug of choice is doxycycline.

⁃           This has been an uncommon infection which has re surfaced in recent times, hence awareness of this entity has become mandatory.

⁃           Dengue and scrub typhus can co exist, meaning thereby that same patient can be affected by dengue as well as scrub typhus at the same time.

⁃           Hence if fever is not subsiding after treatment with doxycycline for 48 to 72 hours, one must look for other causes like dengue, etc.

Both dengue and scrub typhus are not contagious, that is they do not spread via human contact. Any fever which is associated with severe body ache, headache and generalised weakness, lasting for more than 48 hours needs immediate medical attention. It is the need of this hour to be aware of these menacing fevers. It is also important to follow measures to keep our surroundings clean and mosquito free.