Diagnosing Dengue

[tlock]

I've been bedridden for the last 5 days with a high fever, severe headache, pain behind my eyes, and general soreness all over my body. Then yesterday I broke out in a pretty huge rash. I checked around on the internet, and it sounded like I have dengue fever. The part that rings the most true is the "broken back fever" description, my back feels broken. I live in pattaya but just got back from 10 days in issan.

i went to the doctor today, and he seemed to refuse to entertain the idea that it was dengue. His main reasoning was the type of rash that I had. He did a blood test and said that although my platelet count was low, I had the measles. I'm sure i was vaccinated against the measles as a child. I wasn't able to communicate too clearly with him, but my understanding of the blood test is it wasn't a definitive test for "dengue" or "measles", it was just a standard blood workup. Does anyone know if there is a definitive "dengue or not" blood test? Or "measles or not" blood test?

And does it matter? Either was i just gotta stay in bed, drink water, and take paracetamol, right?

thanks

[beammeup]

I've been bedridden for the last 5 days with a high fever, severe headache, pain behind my eyes, and general soreness all over my body. Then yesterday I broke out in a pretty huge rash. I checked around on the internet, and it sounded like I have dengue fever. The part that rings the most true is the "broken back fever" description, my back feels broken. I live in pattaya but just got back from 10 days in issan.

i went to the doctor today, and he seemed to refuse to entertain the idea that it was dengue. His main reasoning was the type of rash that I had. He did a blood test and said that although my platelet count was low, I had the measles. I'm sure i was vaccinated against the measles as a child. I wasn't able to communicate too clearly with him, but my understanding of the blood test is it wasn't a definitive test for "dengue" or "measles", it was just a standard blood workup. Does anyone know if there is a definitive "dengue or not" blood test? Or "measles or not" blood test?

And does it matter? Either was i just gotta stay in bed, drink water, and take paracetamol, right?

thanks

My son had it and from what I gathered there is no test for it. They can check your blood while sick then check it after you recover then they can tell you if you had it by comparing the samples. There is no treatment for it either. If you get a high fever they will put you on a drip and keep an eye on you for sezures.

Good luck

[Gary A]

I've been bedridden for the last 5 days with a high fever, severe headache, pain behind my eyes, and general soreness all over my body. Then yesterday I broke out in a pretty huge rash. I checked around on the internet, and it sounded like I have dengue fever. The part that rings the most true is the "broken back fever" description, my back feels broken. I live in pattaya but just got back from 10 days in issan.

i went to the doctor today, and he seemed to refuse to entertain the idea that it was dengue. His main reasoning was the type of rash that I had. He did a blood test and said that although my platelet count was low, I had the measles. I'm sure i was vaccinated against the measles as a child. I wasn't able to communicate too clearly with him, but my understanding of the blood test is it wasn't a definitive test for "dengue" or "measles", it was just a standard blood workup. Does anyone know if there is a definitive "dengue or not" blood test? Or "measles or not" blood test?

And does it matter? Either was i just gotta stay in bed, drink water, and take paracetamol, right?

thanks

I had about the same symptoms. My blood platelet count was very low, if I remember, well below 100,000. I had been taking aspirin for the severe headache. The doctor told me that I was lucky to be alive and that I certainly had no ulcers because I would have bled to death. Aspirin is the worst thing to take. My treatment was an intravenous for a couple of days. I don't know what was in it. When my blood platelet count started coming up, I was released from the hospital.

I never had a rash but the joint pain and headache was severe. Sweating one minute and shivering the next minute. I don't think it is easy to diagnose. The doctor had insisted that Bangkok had no dengue fever but eventually he decided it was dengue fever.

[Samuian]

I've been bedridden for the last 5 days with a high fever, severe headache, pain behind my eyes, and general soreness all over my body. Then yesterday I broke out in a pretty huge rash. I checked around on the internet, and it sounded like I have dengue fever. The part that rings the most true is the "broken back fever" description, my back feels broken.

And does it matter? Either was i just gotta stay in bed, drink water, and take paracetamol, right?

thanks

As has been written already - difficult to detect - and 5 days later ... even more so. I think there is a test... not so sure, my infections are too long ago, but I think the Doc took a blood sample and had a look at it under a microscope.

The rash comes sometimes WITH Dengue...and the rest of your description of symptoms sounds very much like Dengue! if the doctor has no experience with Dengue - he won't know... simple as that!

Drink as much as possible and yes PARACETAMOL under NO Circumstances Aspirin it may cause internal bleeding/hemorrhage!

You're through the worst already, last 5-7 Days... but full recovery may take 3 weeks and more - take good care!

Incubation takes anything between 2-6 weeks - unlikely you caught it in Isaan!

Had it myself 3x if you live in Pattaya, maybe you should consider a move - is there a Kloong, Pond or anything near your home? After I moved from the place where I came down with it 3 x times within 4 years - always in the rainy season - Now more and still live on Samui!

Ahh... and Yes, regarding your question: It will be, but only at a proper Institute - like a Institute for tropical diseases! Not at any Practitioners Place!

Edited June 27, 2008 by Samuian

[mervyn]

I am just recovering from Dengue Haemmorage Fever and I live in Pattaya.I developed a high fever on June 8th and thought that it was flu.I took paracetemol and plenty of fluids but I was no better after 2days so I went to Bangkok Pattaya Hospital.By that stage I had developed a slight rash and my doctor recognised the symptoms immediately.He said he had 4 patients with dengue and that there was a lot of it about.I had a blood test and dengue was 80% confirmed after 45 minutes.The full confirmation and type took more than 24 hours.

I was admitted to the hospital and spent 5 days there on an IV.I had daily blood tests and my platelets kept dropping until day 5 when they started to rise again so I could be allowed home.After a week my blood was back to normal but I am still lacking in energy.The care in BPH was excellent and I was extremely lucky to have been seen by such an experienced physician

[chakatee]

In a quality lab with Dengue experience RT-PCR 89-100% sensitive / specific, 48-72hrs before getting the results, therefore initial dx usually based on symptoms and level of platelets. DEN-1 and DEN-2 give the best scores in being detected by RT-PCR, DEN-3 and DEN-4 some less.

Also the kind of PCR-kit the lab uses makes a difference, the better ones use nested or TaqMan, the cheaper ones use some German 'Light Cycler' commercial kit with results dropping to 60-65%.

Finally labs without too much Dengue experience have results dropping to no more then 33%.

Beammeup: correct about the treatment (or lack of treatment), not correct about the diagnostics.

Gary A: correct, Bangkok has Dengue fever, as the whole rest of Thailand has. This year the central was hit more severely, next year maybe another region.

Samuian, you would be happily living without Dengue in about every area now, there's only 4 strings (DEN-1 to DEN-4) and you've already gone through 3 of them ... Every string can hit you only once. Above that, maybe you've been through them all since a first 'attack' sometimes passes by as a flue, the patient doesn't even know he had DHF.

[Sheryl]

As noted above, there are lab tests but based on antibdoies so positive only well intio the illness and this plus the time it takes to get the results back makes it essentially useless in terms of treating the patient; it is also expensive. Mainly used not for individual case management but to identify the strain involved in outbreaks.

tlock, what you describe sounds like classic dengue to me. Fluids, paracetemol and it would be wise to recheck your platlets after 1-2 days, sooner if you notice any bruising, gums bleeding easily etc.

Be warned that the convalesnce is slow, you feel wiped out for a long time after the acute illness is gone, and also that depression is very common during that period and may be severe. It goes away after a couple of weeks, but if you don't know to expect it you may think you've really lost it. You haven't, it's the disease.

[uhuh]

I agree that PCR as well as IgM and IgG tests are too slow to be of practical value(you get positive results when the worst is over).

NS1 is faster and by many hospitals considered useful.

[MekongCombat]

Unfortunately the majority of fevers in Thailand are never diagnosed even at the best hospitals, they just call it Southeast Asia Fever and hope you don't die. I spent a week in hospital last year and have also dealt with multiple family fevers including the near death of a nephew from a confirmed case of Dengue.

If your fever is at or above 102 F. you should be in hospital, connected to IV Fluids and monitored by nurses. The big danger is going into shock alone or with someone taking care of you with no medical experience who will not know to get you to hospital when you are no longer able to get yourself there.

The biggest danger with Dengue is with kids, they will run high fever for a time, possibly 3 days, then seem to recover. That's when the real danger begins but most Thais think its all over so when the kid crashes and even begins hemorrhaging out they do not know what is happening and do not react.

In one case last year a woman I know did not go to the hospital with her fever. She ended up confused and walking around town and the people thought she was just drunk. 2 weeks, 80,000 baht, 4 international tickets for family, and treatment for encephalitis she was released to begin 6 months of recovery but was changed forever by the experience and will never again be the same person.

Farang + Fever = Hospital

[prakhonchai nick]

I have just recovered from Dengue haemmoragic fever, which I caught earlier this month.

After 3 days of fever, pain behind the eyes, and a severe itching on my body on day 3, I took myself to the local government hospital (well used to seeing dengue fever) for a test. I told the Dr I was 90% sure it was dengue, and he sent me for a blood test.

20 minutes later, he told me I had an STD and prescribed tablets for gonnorhea!

Later that day I went to the main private hospital in Buriram, who very quickly diagnosed dengue, which became haemmoragic the following day.

3 days in hospital, a drip, 6 hourly blood tests and I was discharged. Weak, with a low platelets count, but an assurance from the Dr that all would improve. A week later returned for a blood test and all was OK.

Cost me 8,300bt for 3 nights in hospital. Interested to learn how much Mervyn paid for his stay in Bangkok Pattaya. Perhaps just a little bit more!

[Trevor]

this will knock out malaria and dengue within hours. i take it myself.

http://www.mmsmiracle.com/

[malai]

I have been reading all this - thinking that you have named every symptom my boyfriend has told me on the phone. I'm convinced he has dengue fever. He's currently in Koh Samet with what sounds like high fever and aching pains in his legs, neck and a constant headache. Over the last week he has complained of itching and and eye pain. He did go to the hospital last weekend while he was in chonburi but they didnt say anything about dengue fever. Things have got worse but he refuses to go back to the doctors. I have told him to drink as much water as possible, paractemol but NO ASPIRIN. Is there anything else that would help? It sounds like all they do in hospital is put you on a saline drip and paracetemol - if thats the case then he might be better off just staying where he is and resting?

Thanks

p.s I have to say this outbreak has not been helpful in convincing my family that my move to thailand is a good idea. its been reported in the british papers and my family are suddenly fretting!

[Sheryl]

Concerns about someone with these symptoms self-treating at home are as follows;

1 - Need to rule out other infectious diseases as the possible cause. True that for uncomplicated Dengue it's just a matter of hydration and paracetemol (or paracetemol plus codeine, which is what he would likely be given in a hospital). But were nough tests done in Chonburi to be sure it is not something else e.g. typhoid or (if he has been in a place with transmission) malaria? These can and need specific treatment.

2- Hydration can be very hard to assure in this climate with fever. As long as someone is with him and keeping on eye on his fluid intake and hydration status (best indication being frequency and color of urine) that's OK, but you would not want someone to be alone in this condition.

3- Risk of developoing hemorrghaic (complicated) dengue . In a hospital they would monitor the platlet count in order to detect this very early, being at home it might go undewtected until severe.

Of course you can't force someone to go to a health facility. But at a minimum try to ensure a reliable person is with him and knows to be alert to any sign of bleeding (including easy brusing) and to stay on top of his hydration status. And if the fever continues beyond a week, or if his level of consciousness changes for the worse or there are signs of bleeding, then to get hep immediately.

[malai]

Fortunately his mum is there to take care of him. I gave him a lot of advice from here and I think he may go to the doctor tomorrow if he feels worse. He says he feels hot and cold at the same time which i take to mean he has the fever and he said he nearly fell down this afternoon because he feels so very weak. Its hard to know a) without being a doctor and just being on the end of the phone but given he's been staying in chonburi in a house that hasnt been occupied a while (im thinking perfect breeding place for mossies) and the symptoms...its likely to be dengue. I will let you know how it pans out, thanks for your advice.