By Henrylito D. Tacio
As dengue cases continue to increase, the Department of Health (DOH) is set to declare a countrywide outbreak of the virus spread by mosquitoes. The health department reported a total of 150,354 dengue cases nationally, or an average of 4,700 cases each week, using its most recent statistics from January 1 to August 10.
If there’s a deadly disease these days that needs no introduction, it’s dengue fever and its lethal form, dengue hemorrhagic fever (DHF).
Dengue fever is characterized by high fever, severe headache, pain behind the eyes, and muscle and joint aches. Many people, including doctors, mistake dengue for influenza and flu-like diseases, so it often goes untreated until symptoms become severe and the patient goes into shock.
It happens when DHF strikes in. “There’s often a rash in dengue while there’s none in flu,” explained Dr. Allan Schapira, an epidemiologist who was then with the regional office of the World Health Organization (WHO) when interviewed by this author. “Fever caused by dengue tends to last almost a week, while that of flu disappears after three to five days.”
After a dengue patient goes into shock, it’s usually a matter of time before multi-organ failure occurs and death becomes inevitable. This terrifying scenario is characterized by high continuous fever (40-41 degrees) lasting up to seven days that may be accompanied by loss of appetite, nausea, vomiting, abdominal pain and bleeding from the skin, nose or gums.
In the worst cases, the patients’ condition may suddenly deteriorate after a few days of fever, and they may die within 24 hours. “Death often results from bleeding in the brain, intestines or other organs,” said Dr. Lulu Bravo, a professor at the University of the Philippines College of Medicine.
Dengue strikes mostly children although adults are not spared. As such, parents whose children are infected with the dengue virus resort to using unproven means to raise the blood platelets.
Among the reported medications used are tawa-tawa (Euphorbia hirta), balut, papaya leaves, camote tops, and magic balls. These are “effective,” according to some of those who have tried them.
A study conducted by students of the University of Sto. Tomas showed that administering tawa-tawa decoction to animal models helps improve their healing mechanisms. “Tawa-tawa was able to promote cell production, and prevent platelet destruction,” the study found out. “Likewise, the improvement in the cell bleeding time and clotting time provided evidence that the indigenous plant can preserve and promote the hemostatic function of platelets.”
Although tawa-tawa capsules are currently registered with the Food and Drug Administration (FDA), the health department is not promoting it as a cure for dengue. The FDA’s registration is “only as a supplement with no therapeutic claims,” according to DOH Undersecretary Eric Domingo. He added that it has still to “undergo a lot of clinical trials before their therapeutic values can be proven.”
Actually, it’s not about low platelets that counts when it comes to dengue. “Low platelet is not the main problem during dengue infection,” clarifies Dr. Anna Nina Natalia L. Tayo, an internist, neurologist and psychiatrist. “It is just one of the warning signs of a possible transition of a mild dengue fever to its severe form but not the hallmark of dengue hemorrhagic fever.”
Based on available studies, “there is a mild to moderate decrease in platelets of dengue patients between the third to the seventh day and a significant decrease on day 4. However, it starts to go up on its own on the eighth or ninth day of the disease. With or without herbal medications, platelets will naturally increase during the recovery phase.”
The problem actually lies in plasma leakage. “This phenomenon is the hallmark of severe dengue and at the same time a life-threatening complication that results in dehydration and low blood volume that may progress into circulatory collapse (shock) if not treated adequately,” Dr. Tayo explained. “Once shock has set in, the patient is now classified as having dengue shock syndrome. If shock is not reversed, it leads to disseminated intravascular coagulopathy, multiple organ failure, and/or death.”
Plasma, medical science tells us, makes up more than half (55%) of the total blood volume and 20% of the total body water. “In the event of continued leakage,” Dr. Tayo said, “this results in dehydration and low blood volume.”
Dr. Richard T. Mata, one of the country’s foremost experts on dengue, says dehydration occurs when a person loses more fluid and his body doesn’t have enough water and other fluids to carry out its normal functions.
Dehydration causes intestinal ulcers that cause bleeding. “And because the platelets are low, the bleeding becomes severe. But if there was no dehydration, there would be no ulcer and thus no bleeding – even if the platelets are low,” he explains. “So, it still boils down to dehydration.”
Dehydration also causes kidney failure, which results from the decrease in urine output. “This causes the water to be retained in the lungs thereby creating congestion that can kill the patients,” he says.
A joint statement by the Philippine Pediatric Society and the Pediatric Infectious Disease Society of the Philippines advised “judicious use of intravenous fluid” among hospitalized patients “should be observed as over hydration places the patient at risk of pulmonary edema and other grave complications.”
This brings us back to plasma leakage. “If plasma leaks into lung tissues, it causes accumulation of fluid resulting in pulmonary edema (swelling) which makes breathing difficult,” Dr. Tayo said. “When worse comes to worst, the patient might need mechanical ventilation (respirator) to support breathing and alleviate low oxygenation (hypoxemia).”
If the fluid accumulates in the abdominal cavity, ascites results. “The abdomen distends because of the fluid formation in the abdominal cavity which can lead to several life-threatening complications,” Dr. Tayo pointed out.
Tayo’s endpoint: “Low platelet is not the bad guy in dengue fever. The real culprit for deaths in dengue is plasma leakage and treatment for this dreaded complication remains to be timely calculated intravenous fluid replacement and not tawa-tawa or papaya extracts or any herbal concoction.”
An ounce of prevention is better than a pound of cure, so goes a popular saying. “Prevention is crucial,” Dr. Bravo said. “Unless we take concerted action to educate our people now, dengue will continue to take its toll in the country.”
The best way to beat dengue fever is not to be bitten by dengue-carrying mosquitoes. When going out, people are advised to wear long-sleeved shirts and long pants. When indoors, it is advisable to stay in air-conditioned or screened areas. All windows and doors must have screens to avoid mosquitoes from getting in. Children must not play near still water.
Meanwhile, the EcoWaste Coalition appealed to the general public to properly manage their discards to prevent mosquito habitats in and around homes and communities.
The environmental health group likewise requested the country’s over 42,000 Barangay Councils to show leadership in mobilizing their constituents towards the spirited implementation of Republic Act 9003, or the Ecological Solid Waste Management Act, in every household, institution, establishment, and neighborhood.
RA 9003 requires the mandatory segregation of discards at source to facilitate the reuse, recycling and composting of resources in an ecological manner to “ensure the protection of public health and the environment.” Considered one of the country’s major environmental legislation, RA 9003 prohibits and penalizes “littering, throwing, dumping of waste matters in public places.”
“We appeal to the general public to mind their trash and avoid the reckless disposal of discards, which can collect water and serve as breeding sites for dengue-causing mosquitoes,” said Ochie Tolentino, Zero Waste Campaigner, EcoWaste Coalition.
Plastic bags, bottles and cups, bottle caps, tin cans, broken appliances, used tires and other discarded stuff can collect water where Aedes aegypti mosquitoes can lay their eggs and multiply.
“We request all the barangay councils and Barangay Ecological Solid Waste Management Committees to take the lead in educating and mobilizing their constituents about the eco-friendly and healthy way of managing discards to prevent dengue and other diseases,” Tolentino said.
“We can succeed in eliminating dengue vectors if family and community members will do their share in removing mosquito breeding sites and in keeping our surroundings waste-free,” she added. – ###Graphics courtesy of Dr. Richard T. Mata and World Health Organization
