Medical literature says that you must suspect dengue if you have fever accompanied any two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands or rash. But she didn't have any of them; only fever.
Her illness gave me an opportunity to learn about the disease. Here are some points. I have sourced the following from doctors and web pages of recognized health institutions.
(A diary of my wife's case is below the FAQs)
What is dengue?
It is a viral infection caused by the bite of a mosquito (female Aedes aegypti mosquito), which has previously bitten a dengue patient. The disease is transmitted this way: patient-mosquito-healthy person. The symptoms surface 3 to 14 days after the bite.
When should I suspect it could be dengue?
If you have fever that doesn't go with paracetamol tablets within 2 days, go to a doctor. You may or may not have other symptoms like headache, pain behind the eyes, muscle and joint pain, nausea, vomiting or rashes.
Is low blood platelet count, a sign of dengue?
As a first test, doctors order a blood test. The result would give lot of clues on why you have fever. A drop in platelet count could be a sign of dengue. The normal range is between 1.5 lakh and 4 lakh. But a drop in platelet count is no confirmation of dengue, as the count drops with any infection. So, a specific test for dengue is ordered.
After dengue is confirmed, with the specific test, the disease is monitored by looking at the count of the platelets. Typically, in a dengue patient, the platelet count keeps dropping. How fast and how much depends on many factors like immunity of the person and the severity of the attack.
Blood platelets help the blood to clot. When the count drops, there's a risk of bleeding. So patients are advised even not to brush teeth, because the gums could bleed. There are also dangers of internal bleeding.
The platelet count is monitored every 24 hours. But once the count goes below 50,000, every 12 hours the count is checked. Doctors won't let the count drop. Once it reaches a threshold level -- around 15,000 to 20,000, or even 25,000 -- platelets are injected.
Once the infection is out of the body, the platelet count starts increasing: at first slowly and then rapidly. The rate depends on the general health of the patient.
Is dengue dangerous, fatal?
If detected and treated early it is not. There is no need for panic or fear. A severe form of dengue can be dangerous, and even fatal without early medical intervention. So don't ignore the flu-like symptoms. Visit a doctor.
What is the cure for dengue?
There are no medicines for dengue. Doctors give medicines for the symptoms; and intravenously administer fluids. Patients are told to have plenty of fluids, like water and fruit juice; and have normal food. Nausea and vomiting reduces food intake; and that, combined with the infection, makes the patient weak. The infection lasts about a week. Even after fever is gone, the patient takes about one or two weeks to recover from the tiredness. Fluids, and more fluids, is the only way out.
How beneficial are papaya leaves?
Word has gone around that pomegranate and papaya; and the juice taken out of crushed pomegranate skin, papaya and neem leaves are said to be good for generation of platelets. Doctors merely advise patients to have any fruit. Though benefits of pomegranate and papaya have been well known, the benefits of papaya leaf juice is a new development.
People who have taken papaya leaf juice have spoken of dramatic rise in blood platelet count: for example, from 30,000 to 2 lakh; and from 80,000 to 3.5 lakh, within 24 hours. In Kerala, I am told that not just ayurvedic doctors, but allopathic doctors too, are advising patients to have the papaya leaf juice. I was advised by a couple of nurses to give the juice to my wife. I am also told that tender papaya leaves are being sold at a premium in Kerala.
In the hospital where my wife was being treated, a patient was being given papaya leaf juice right from day one. But that didn't help much, it looks like, since her platelet count went down to 15,000 and she had to be administered platelets twice. But after she was cured of the infection, the count went up dramatically fast: from 55,000 to 1,30,000.
There is no well-validated and documented scientific backing for this. It's merely an anecdotal evidence. Allopathic doctors are not very forthcoming in giving any credence to this. Ayurvedic doctors say there is an urgent need to research thoroughly the correlation.
Doctors say once the virus is out of the body and the infection is over, the platelet count will naturally increase with normal food. But most patients tend to have lot of pomegranate and papaya, as part of the diet; and some go a step further and include the juice from crushed papaya leaves. So whether the rise in platelet count is a natural phenomenon or aided by fruit and juice is not clear.
One way of looking at it is: any way the platelet counts will increase once the infections is gone; and the other way of looking at it is: the fruit and juice have played a role. Until a proper scientific investigation is carried out, we wouldn't know for sure the effect.
The effect of any medicine depends a lot on the individual's health. The effect of such remedies vary a lot from individual to individual.
(November 30, 2015 Update: My uncle has been admitted to Chaya Hospital, with viral infection and fever. Though dengue was ruled out, his platelet count is down to 65,000 because of the infection. Doctors have prescribed Caripill, which is made of papaya leaf extracts, in order to boost the platelet count. This means allopathic doctors are recommending this ayurvedic solution.)
How to prevent dengue?
Tough. since it's very easy for a mosquito to bite you, and it's very difficult to keep that one mosquito away. But the following steps could be helpful.
- Don't allow yourself to be bitten by mosquitoes.
- Regularly spray mosquito repellents.
- If you are in a mosquito-prone area, apply some mosquito repellent on your skin.
- If there are too many mosquitoes, cover your body; and while sleeping use mosquito net, since the effect of the repellent may not last too long.
- Don't allow water to stagnate. Keep changing the water in plant pots.
- World Health Organization on dengue
- Wikipedia entry on dengue
- Indian Council of Medical Research on dengue
- Papaya leaf juice helps fight dengue (Indian Express)
- Papaya leaf juice helps stop destruction of platelets (The Times of India)
- Neem-papaya juice passes dengue test (The Times of India)
- Home remedies for dengue (Udayavani)
MY WIFE'S CASE
Wednesday, June 5
She got fever on Wednesday (June 5) morning. She had Crosin. The fever didn't go.
Saturday, June 8
After 72 hours, we went to Manipal Hospital at 9 am on Saturday. She was asked to take a blood and urine test. When we got the results at 12.30 pm, we found that all her parameters were normal, except the blood platelet count. It was 1,20,000. It should be at least 1,50,000. She was advised to get admitted to hospital. A specific test for dengue was also ordered.
Manipal Hospital has been seeing a rush of dengue cases. A lot of patients were also being referred to the hospital by smaller hospitals and clinics. There was no bed available and we were asked to call up at 5 pm. Luckily we got. She was admitted around 7.30 pm.
She was put on IV fluids, and given Dolo 650 (Paracetamol) and Folvite (folic acid) tablets. Her appetite had reduced to near nil.
Sunday, June 9
She had nausea and wasn't able to eat solid food. So the dietician ordered semi-solid food like kanji (porridge) of rice, rava, raagi etc, and soup. She was also having pomegranate and papaya.
On Sunday at 5 am, her platelet count come down to 90,000. By evening the fever and blood pressure, which was low, had satablilized.
Seeing the way her platelet count was dropping, I networked among my friends to look for papaya leaves. I thought, if papaya leaf juice has to be taken, then why not early enough, rather than when her condition had serious.
Monday, June 10
On Monday at 5 am, the count dropped to 35,000. In retrospect, arranging for papaya leaves the previous day, was a good move. Since her count had dropped below 50,000, her blood sample was taken at 5 pm. Her count hadn't dropped in 12 hours. It was the same 35,000.
By evening, I got the papaya leaves. Since we couldn't mash it and get the juice then, around 5.30 pm, she took three leaves and chewed them to get the juice out, and spat out the leaves, like bubble gum.
Since she had the leaves after the blood sample was taken, the leaves didn't have any role in arresting the fall of platelet counts. May be pomegranate and papaya and the water she had did.
Tuesday, June 11
The next day, Tuesday morning at 5 am, the count had gone up to 38,000. She had a teaspoon of papaya leaf juice around 11 am. Blood sample was taken at 5 pm. The count had gone up to 54,000. She was also regularly having lots of pomegranate and also papaya, and lots of water.
Wednesday, June 12
On Wednesday, at 5 am, her count went up to 65,000. I thought she would be discharged on Wednesday. But doctor said it was better her count goes up to at least 80,000. No sample was taken in the evening.
Thursday, June 13
Thursday, at 5 am, the sample was again taken at 5 am. Her count had gone up to 1,28,000. May be the juice had some effect in boosting the platelet count by 90,000 in 48 hours. She was discharged yesterday around 2 pm.
She is very weak. Recovery will take a lot of time. She will have to take a lot of fluids, and may be another round of papaya leaf juice.
- If you get fever, especially when there are lot of dengue cases in your city, don't ignore fever. If it doesn't subside within two days, go to a doctor.
- Don't panic. Even if the doctor suspects it's dengue, and later it is confirmed it's so, don't panic. Do get admitted to a hospital, where your platelet count can be regularly monitored.
- Drink lots of fluids -- water and fruit juice.
- Have lots of pomegranate and papaya. If you can get papaya and neem leaves, do arrange for them. Wash the leaves very well. Mash them in mixie with a little water, filter it, and have the juice. Even if there may not not be any good, there won't be any harm.
- Recovery will take its time. Eat whatever you feel like. Drink lots and lots of fluid.