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What happens in dengue fever?

Answered by
Dr. Rakesh Madhyastha


Practicing since :2009

Answered : 4361 Questions

Posted on Thu, 21 Aug 2014 in Medicines and Side Effects
Question: On 28th July 2014, Blood report of my niece shows following values:
Symptoms: Low grade fever with chills, weakness. This is happening for two months especially during the time of her periods. She is 13 years old.
Widal slide tests:
Salmonella Typhi O is 1: 80
Salmonella Typhi H is 1: 80
Salmonella Para Typhi AH and BH are both negative.
Malaria parasites not detected.
RBC Parameters:
Haemoglobin – 10.7 gm/dl
PCV/HCT – 32.1%
MCH – 25.5 pg
RDW – 16.2%
Platelet count – 113000 per cubic mm
ESR – 40 mm
SGOT – 58 iu/l
SGPT – 50 u/l
Dengue IgG – Positive
Dengue IgM – Positive
Method used rapid immunocromotography assay.
Urine examination: S. Hazy (see below)
Puss cells – 4-5 hpf
Rbc – 1 -2 hpf
Proteins – Trace
Ocult blood – Trace (she has her periods)
I understand that from this test that she has Dengue, However I want to know is that it or is there anything else. Please note, last month when she was hospitalised, the dengue test was negative.
Please could you tell me what is she suffering from and the appropriate treatment?
Doctor XXXXXXX XXXXXXX (Radiologiist, reply to my question above...
Brief Answer:
She is suffering from dengue fever.
Detailed Answer:
Hello XXXX
Thanks for writing to HCM
She is suffering from dengue fever with low hemoglobin,low platelet level and slightly raised SGOT,SGPT.
Low hemoglobin,low platelet and slightly raised SGOT,SGPT are complications of dengue fever.She need periodic assessment of hemoglobin and platelet level.
There is no specific treatment for dengue fever. Patient only need supportive therapy.Your doctor may recommend to take plenty of fluids to avoid dehydration.
Blood and its component like platelet may be transfused depending upon condition.
Don't worry,her present condition is easily manageable and she will be fine.
She is getting right medicines and she should continue it.
Other findings are within normal limit.
Her urine report can be considered as normal.
Up to 5 pus cells in urine are normal.
Few RBC may be due to contamination during menstruation.
Widal test and malaria parasite test are also negative.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Replied by Dr. XXXXXXX XXXXXXX , 1 day ago     
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.

My follow up question for today,
As of yesterday 29 July 2014, she was been given the following medication:

Syrup tixylix cough linctus
becosule forte
tab Augmentin 375
Inj cefotaxime
inj zanocin
inj ondem
inj dexona
inj aciloc
(Injections thru IV)
At home, we gave her one teaspoon of papaya leaf juice extract to increase her platelet count.

On 30 July (today) early morning, blood sample showed the following:
Haemoglobin: 9.9 gm/dl
Total WBC Count: 4700 per cumm
Platelet - 126000 per cu. mm
SGOT - 44
SGPT - 40
When compared to the blood report of 28th July (sent to you earlier), the Haemoglobin and WBC count was better. The present result shows deteriorated counts.

As of today, 30 July 2014, she has been given the following medication:
inj zanocin
inj Taxim
inj ondem
inj dexona
inj aciloc
syrup Tonoferon

We are very tensed because of the decreased count in Haemoglobin and WBC. Although platelets have increased and SGOT and SGPT counts have decreased.
Please advise your suggestion and necessary action.

Thank you.
Answered by Dr. Rakesh Madhyastha 3 hours later
Brief Answer:
Nothing to worry

Detailed Answer:

Thanks for the query

I have gone through the reports in detail. You will be pleased to know that I have published a journal article on Dengue where I have seen the blood parameters and outcome of over 500 dengue patients.

Here is what you should expect

1. Lower WBC count is expected not only in Dengue but all other viral infections. It will improve spontaneously.
2. Improving platelet count only shows that the child is improving and she is in the recovery phase
3. Lowered Hemoglobin is also part of dengue, that should also improve in time
4. Traces of blood in urine could be due to her periods

I suggest the following

1. Inj Zanocin is not necessary, you can suggest this to your treating doctor
2. Hydrate the child well with lots of fluids and fruit juices
3. keep a watch on her blood pressure and pulse. Pulse is usually low in dengue
4. Watch out for bleeding from nose, small pin point rashes on the skin and also bleeding from stools

I hope I was of help, if you have any further queries please get back to me

I wish your child a speedy recovery


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rakesh Madhyastha 3 hours later
Dear Doctor,

Thank you for your reply. It indeed is very helpful. We have got the urine culture report. I am attaching the same. The name of the file is 30 Jun Report 1, 30 Jun Report 2 and 30 Jun Report 3.

The report shows bacterial infection. I have questions below:

1. What is the 30 Jun Report 2 all about? I haven't understood what this report is trying to tell us.

2. Does her medication need to change due to the urine infection?

3. Blue nails when shivering after which there is fever. What is the reason of blue nails? I understand it is due to lack of oxygen through the constricted arteries, but I want to know why is this happening with her? It has not happened before (Just last month when she was admitted). At present her nails are normal however during the shivering episode this and last month, her nails have had turned blue.

Awaiting your reply.
Answered by Dr. Rakesh Madhyastha 9 hours later
Brief Answer:
No urine infection

Detailed Answer:

Thanks for getting back, sorry for the short delay in my reply I was on call at my hospital.

I have only received 1 attachment, '30th XXXXXXX report 1'. According to this report there is no urinary tract infection

I'll be answering your questions 1 by 1

1. Could you please re attach 30 jun report 2, it has not got attached, you could even type it out like the previous time
2. There is no urine infection in 30 jun report 1 so no medication change is required
3. Blue nails are because of cold and also because her Hb is on the lower side there could be some amount of reduced blood supply to the peripheries. When this happens two things are important i. To check the blood pressure of the child ii. To check the breathing pattern of the child. I also recommend she gets an ECHO done as some congenital issues like tetrology of fallot and ventricular septal defect can also cause blue nails.

I hope I was of help, please get back to me with the reports

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rakesh Madhyastha 7 hours later

Dear Doctor,
Thank you for your quick response. I totally understand that you have work and you also need to rest.
We are a little perplexed with today’s report. I have written yesterday and today’s report.
Please find yesterday’s report details below:
•     5 ml of patient’s venous blood, injected into selective, enriched blood culture broth. At 48 hours of incubation, no growth was detected. No Microorganisms seen.
•     25 ml, yellow, slightly hazy specimen of clean catch, mid-stream urine received. Culture: SHEEP BLOOD AGAR, C.L.E.D., MAC CONKEY’S AGAR, 37 C/ 48 HRS/ AEROBIC. A pure moderate growth of Escherichia coli, G N bacilli, LF coliform, Biochem, typed. Remarks: Colony Counts: 40,000 C.F.U/ml
•     Investigation: Urine: - Routine Culture and Sensi tests
Organism/s isolated – E. Coli ( E S B L producing strain)

o     AMOXY + CLAV – R
o     AMPI + SULBACT – R

o     CEFACLOR – R
o     CEFDINIR – R
o     CEFIXIME – R
o     CEFEPIME – S

o     AMIKACIN – S
o     IMIPENEM – S
{I don’t know why this was done. What I understand is that she is resistant to the above antibiotics. Is there anything else I should know from this chemical report?}

Today’s report from Metropolis has a new story to tell us. Please find the details below:
Dengue IgM – Negative (5.01) PanBio Units
Dengue IgG – Negative (4.41) PanBio Units
1.     False negative Dengue IgM antibody may be observed in case the blood is collected earlier than 5th day of fever
2.     Dengue NS1 antigen test is available for very early detection – Day 0 to 4
3.     Dengue Real Time PCR Test is available for early detection
4.     Dengue IgM antibodies can persist for more than 60 days. False positive can be seen as cross reactivity to other flavi viruses (west nile, yellow fever, Japanese encephalitis), malaria and Rheumatoid Arthritis

Please could you tell us the following:
1.     What is she really suffering from?
2.     With your experience, how would you treat her (in this case)?
3.     I understand that the above antibiotic susceptibility test is for antibiotic allergies.. Is it for anything else?
4.     Does her medication need to change due to the E. Coli bacteria in the Urine?
5.     I understood the answer you gave about her blue nails. It has only happened during the last two months. Is this an indication of a congenital heart disease? It hasn’t really been long term. Please advise.
Answered by Dr. Rakesh Madhyastha 42 minutes later
Brief Answer:
Follow up

Detailed Answer:

Thanks for getting back

1. She is suffering from Dengue, there is no doubt about it
2. In my experience most patients have recovered spontaneously, 30% requiring platelet transfusion, less than 5% requiring care in intensive care unit
3. The antibiotic susceptibility test is not for antibiotic allergies. It is to see which antibiotic works best against the E coli which was isolated. Looking into the report that is why they have started her on Zanocin which is ofloxacin.
Strictly speaking UTI is treated only if the colony count is above 100,000. If the child is not spiking fever and she is not having symptoms like burning micturation or pain while passing urine then we could repeat a urine routine after a few days
4. She is already on appropriate antibiotics, there is no need to change the antibiotic
5. I understand that this has happened only during the last two months, this is the right time to get her screened for congenital heart disease

I hope I was of help, please be free to get back to me.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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