Case 41: Dengue Fever
NATIONAL JOURNAL OF HOMOEOPATHY 2006
Dr Mahesh Chevva
'Ars-alb / Rhus-tox / Nux-vom / Sul / Gels / Eup-perf / Phos

Sero Diagnosis is made based on a rise in antibody titer in paired immunoglobulin G (IgG) specimens or immunoglobulin M (IgM). Results vary depending on whether the infection is primary or subsequent. The IgM capture enzyme-linked immunosorbent assay (MAC-ELISA) has become the most widely used assay, although other tests, including complement fixation (CF), neutralization test (NT), hemagglutination inhibition (HI), and IgG ELISA are also used. Cultures of blood, urine, CSF, and other body fluids should be performed as necessary to exclude or confirm other potential causes of the patients' condition.

Activity: To help with recovery, health care experts recommend:

·         Getting plenty of bed rest

·         Drinking lots of fluids

·         Taking regular medicines to reduce fever and other symptoms

Deterrence/Prevention
No vaccine is available for the prevention of dengue infection. Prevention of Dengue Fever is easy, cheap and better. It requires some simple measures for

·         Preventing breeding of Aedes mosquitoes

·         Protection from Aedes mosquitoes’ bites.

For Protection Against Mosquitoes:

1.     Mosquito breed only in water sources such as stagnant water in drains and ditches, room air coolers, broken bottles, old discarded tyres, containers and similar sources.

2.     Don't allow water to remain stagnant in and around your house.

3.     Fill the ditches. Clean the blocked drains. Empty the room air coolers and flower vases completely at least once in seven days and let them dry. Dispose off old containers, tins and tyres etc properly.

4.     Keep the water tanks and water containers tightly covered so that the mosquitoes can not enter them and start breeding.

5.     Wherever it is not possible to completely drain the water off from room cooler, water tanks etc., it is advised to put about two tablespoons (30 ml) of petrol or kerosene oil into them for each 100 liters of water. This will prevent mosquito breeding. Repeat it every week.

6.     You can also put some types of small fish (Gambusia, Lebister) which eat mosquito larvae into these water collections. These fish can be obtained from the local administrative bodies (eg, Malaria Officer's office in the area).

7.     Wherever possible, practicable and affordable, prevent entry of mosquitoes into the house by keeping wire mesh on windows and doors.

8.     Use mosquito repellent sprays, creams, coils, mats or liquids to drive away/ kill the mosquitoes. Use of googalsmoke is a good indigenous method for getting rid of mosquitoes.

9.     Wear clothes which cover the body as much as possible. This is more relevant in case of children. Nickers and T-shirts are better avoided during the season of Malaria and Dengue fever, ie from July to October.

10.  Don't turn away spray workers whenever they come to spray your house. It is in your own interest to get the house sprayed.

11.  Use insecticidal sprays in all areas within the house at least once a week. Don't forget to spray behind the photo-frames, curtains, calendars; corners of house, stores.

12.  Keep the surroundings of your house clean. Don't litter garbage. Don't allow wild herbs etc to grow around your house (at least in a radius of about 100 meters. around your house). They act as hiding and resting places for mosquitoes.

13.  Do inform and take help from your local health centre, panchayat or municipality in case you notice abnormal density of mosquitoes or too many cases of fever occurring in your area. It is good to remember that Aedes mosquitoes bite even during daytime and hence you should take precautions against their bite during day time too.

14.  If fencing of the doors and windows is not possible due to any reason, spray the entire house daily with pyrethrum solution. Dengue fever occurs most frequently in India in the months of July to October because this season provides very suitable conditions for breeding of mosquitoes. Hence all these preventive steps must be taken during the season.

15.  Lastly, it is advisable to always keep the patient of Dengue fever under a mosquito net in the first 5-6 days of the illness so that mosquitoes don't have an access to him/her. This will help in reduction in spread of Dengue fever to other persons in the Community.

Complications 

·         Neurologic manifestations such as seizures and encephalitis/encephalopathy have been reported in rare cases of dengue infection. Some of these cases did not manifest other typical features of dengue infection. Other neurological complications associated with dengue infection include neuropathies, Guillain-Barré syndrome, and transverse myelitis.

·         Liver failure has been associated with DHF/DSS epidemics. Whether this is a viral effect or a product of prolonged liver hypoperfusion remains unclear.

·         Overhydration is a well-recognized complication of DF and DHF/DSS.

Prognosis: The prognosis of patients with DF is excellent, with complete recovery being the norm. Patients with DHF or DSS who do not die usually recover without sequelae.

Patient Education: Educate patients, especially those who have experienced prior DF, to avoid mosquito bites when traveling to dengue-endemic areas. Current evidence suggests that those with a history of DF are at highest risk for DHF or DSS if they are infected with a different dengue strain.

Homoeopathic Management
Homoeopathic treatment always stands supreme in prevention of control of all Epidemics. Our Master Dr Hahenmann has given clear cut instructions in Organon of Medicine in aphorisms 100-102 sections of 5th edition about "GENUS EPIDEMICUS". The selection of "Genus Epidemicus" need not be a single drug but a group of drugs. It need not be an exact similimum. A near similar will work.

Please Note: Genus Epidemicus depends on the totality available in a particular area. So these suggested medicines are not universally applicable wherever Dengue fever is prevailing. Please consider totality of symptoms available in a group of cases and decided upon the preventive medicines in your locality.

The above rubrics are related to disease picture to decide upon preventive medicines. If you are getting a specific totality in a given case don’t neglect. Please repertories and prescribe the indicated medicines.

Remedies which can be thought for preventive are: Ars-alb, Rhus-tox, Nux-vom, Sul, Gels,Eup-perf,Phos etc.

In Hemorrhagic type we can think of remedies like: Phos, Nat-phos, Lach, Crot-horr etc. Delhi Govt. has already started giving Eupatorium perf 200 as preventive for Simple Dengue fever and for Hemorrhagic type Ipecac 200.In Hyderabad we have started giving Ars-alb which is followed up with Phos depending upon the symptom similarity.

Here I am suggesting some of the medicines which can be thought of Dengue fever cases. Please once again note these are only suggestive and not the only medicines for prevention but one thing is guaranteed, once you form proper totality the indicated medicine does miracles.

Sources

1.     "Diseases and Conditions with Epidemic Potential" by Dr Bir Singh, VHAI, 2000

2.     www.delhihomeo.com

3.     www.emedicine.com

4.     www.health.gov.au

5.     www.microscopy-uk.org.uk

6.     www.who.int

7.     en.wikipedia.org/wiki/Dengue_fever

8.     niaid.nih.gov