Dengue Outbreak

[wilcopops]

Dengue doesn't show up in test till after 2 days I believe. They can do a simple tournique test, cut/limit the blood flow for 5 minutes, to see if you will show red spots, which would indicate dengue. That can be done in an earlier stage.

I"m reliably told that the period is in fact 4 days and there is more than one test for Dengue. But 4 days after WHAT?? - first signs, the bite itself? I'm not clear on this. As I'm not the tester it isn't important for me to know, but for the doctor, it is and frequently they simply don't know.

BUT - this isn't the point I'm trying to make - the point is that doctors and technicians cannot be relied on to carry out the tests correctly and then diagnose the results- also test results are usually given a Percentage" to indicate the likelihood of accuracy......

We alreadty have one example of someone who was tested and told they DIDN"T have the disease...because the type of test was carried out too rely - a later test showed the person did in fact have Dengue. (As I said this kind of basic incompetence is not restricted to Dengue alone)

[wilcopops]

So how knowledgeable are Thai doctors about Dengue?

There has been a lot of research into all aspects of Dengue in the last 2 decades so Thai doctors should know about it - but most of them don’t, why? The answer is quite simple.......

For any doctor to keep up to date he has to read IN DEPTH the medical journals and papers published therein....something that very few doctors do in any country, let alone Thailand.

This is a problem that affects not just Dengue but ALL ASPECTS of the Thai medical industry......

The majority of these papers wherever they originate (even Thailand) are published in ENGLISH; the problem for a Thai doctor (alone in his surgery) is that no matter how "good" his conversational English may be, it isn't on average good enough to read the original papers.

So he can do what most doctors do; the medical journals often have summaries or reviews of research posted for doctors and other scientists to get a quick idea of the latest developments - which the doctors can then follow up any aspect that interests them (do you think they often do this?) but of course these articles are, in the vast majority of cases, published in English and are difficult enough to understand even for a native English speaker. So the next step is to read the Thai translation of the English review of the original paper............and anyone who has seen an English into Thai translation of anything will know what sort of standard to expect there!

....and in reality, most doctors don’t even bother to do this - but eve if they do it is unlikely that they will get the whole picture. Information in hospitals and clinics is too often just dispersed by word of mouth (gossip) or picked up from the public media which is notoriously bad at understanding scientific issues surrounding any topic.

Doctors don’t leave the training hospital with an encyclopedic knowledge of all things medical, primarily they have the tools to deal with medical situations as and when they arise - critical thinking to research and understand; their careers should be a constant learning and evolving process.....but sadly it is far to easy for a largely unsupervised doctor to sit back (alone) and take it easy and let the world of medical science slowly leave him behind....especially in Thailand where everything a doctor does or says is regarded as gospel.So how knowledgeable are Thai doctors about Dengue?

There has been a lot of research into all aspects of Dengue in the last 2 decades so Thai doctors should know about it - but most of them don’t, why? The answer is quite simple.......

For any doctor to keep up to date he has to read IN DEPTH the medical journals and papers published therein....something that very few doctors do in any country, let alone Thailand.

This is a problem that affects not just Dengue but ALL ASPECTS of the Thai medical industry......

The majority of these papers wherever they originate (even Thailand) are published in ENGLISH; the problem for a Thai doctor (alone in his surgery) is that no matter how "good" his conversational English may be, it isn't on average good enough to read the original papers.

So he can do what most doctors do; the medical journals often have summaries or reviews of research posted for doctors and other scientists to get a quick idea of the latest developments - which the doctors can then follow up any aspect that interests them (do you think they often do this?) but of course these articles are, in the vast majority of cases, published in English and are difficult enough to understand even for a native English speaker. So the next step is to read the Thai translation of the English review of the original paper............and anyone who has seen an English into Thai translation of anything will know what sort of standard to expect there!

....and in reality, most doctors don’t even bother to do this - but eve if they do it is unlikely that they will get the whole picture. Information in hospitals and clinics is too often just dispersed by word of mouth (gossip) or picked up from the public media which is notoriously bad at understanding scientific issues surrounding any topic.

Doctors don’t leave the training hospital with an encyclopedic knowledge of all things medical, primarily they have the tools to deal with medical situations as and when they arise - critical thinking to research and understand; their careers should be a constant learning and evolving process.....but sadly it is far to easy for a largely unsupervised doctor to sit back (alone) and take it easy and let the world of medical science slowly leave him behind....especially in Thailand where everything a doctor does or says is regarded as gospel.

[Sheryl]

Part of the confusion is that when people talk about blood tests for dengue they refer to more than one thing.

Anyone with dengue-like symptoms will have a complete blood count which measures the red and white cells and platlets. Among other things, this is necessary to rule out a bacterial infection.

In dengue, despite high fever, the white count is not elevated and in fact is usually a little low. The platlets may also be on the low side of normal initially. So a CBC with a slightly low WBC and platlets is typical of dengue and together with the clinical picture (and if necessary a negative malaria test -- needed only if the person has been in an endemic area) are sufficient to diagnose probable dengue and this is in fact all that is usually done. Then thereafter the platlet count is monitored as it may drop to a dangerous level.

Any laboratory can do the above, and the results will directly guide clinical management.

The other type of testing is serology, checking for antibodies to the various strains of dengue. Not all laboratories have this capability, and the antibodies take time to form. While some people will have measurable antibodies earlier, it is usually 5-7 days before they are detectable, hence a negative result in the first week doesn't mean anything and the test would need to be repeated later. The test is thus of no real help in the clinical management of an individual patient, which together with the fact that not all labs have the capacity to do it, is why it is not always done.

There are in existence other tests which measure the actual presence of the virus and thus are both more accurate and positive earlier but these are extremely expensive and very few labs have the ability to do them.

[wilcopops]

Sorry deleted this post - something is wrong with the reply window.........

Edited August 15, 2013 by wilcopops

[wilcopops]

 

Part of the confusion is that when people talk about blood tests for dengue they refer to more than one thing.

Anyone with dengue-like symptoms will have a complete blood count which measures the red and white cells and platlets. Among other things, this is necessary to rule out a bacterial infection.

In dengue, despite high fever, the white count is not elevated and in fact is usually a little low. The platlets may also be on the low side of normal initially. So a CBC with a slightly low WBC and platlets is typical of dengue and together with the clinical picture (and if necessary a negative malaria test -- needed only if the person has been in an endemic area) are sufficient to diagnose probable dengue and this is in fact all that is usually done. Then thereafter the platlet count is monitored as it may drop to a dangerous level.

Any laboratory can do the above, and the results will directly guide clinical management.

The other type of testing is serology, checking for antibodies to the various strains of dengue. Not all laboratories have this capability, and the antibodies take time to form. While some people will have measurable antibodies earlier, it is usually 5-7 days before they are detectable, hence a negative result in the first week doesn't mean anything and the test would need to be repeated later. The test is thus of no real help in the clinical management of an individual patient, which together with the fact that not all labs have the capacity to do it, is why it is not always done.

There are in existence other tests which measure the actual presence of the virus and thus are both more accurate and positive earlier but these are extremely expensive and very few labs have the ability to do them.

 

"Any laboratory can do the above, and the results will directly guide clinical management."

THere is a chain here and my contention is that the chain is only as strong as its weakest link.

first the Doc has to decide to do the right test at the right time and carry out the blood sample or whatever.

THen the sample has to be stored and transported correctly to where it has to be handled and tested appropriately.

Then the results - if they are correct and unadulterated have to be returned to the Doc in question (or may be a colleague on duty) who then has to decide the correct clinical management.

my impression is that in Thailand this chain has an unacceptable number of weak links.

[jrtmedic]

Interestingly the Thai government is currently running an attractive and informative television advert about Dengue.

The advert encourages Thais to clean up their immediate environment with special emphasis on eliminating stagnant water !

Edited August 15, 2013 by jrtmedic

[wilcopops]

Interestingly the Thai government is currently running an attractive and informative television advert about Dengue.

The advert encourages Thais to clean up their immediate environment with special emphasis on eliminating stagnant water !

Currently? Better late than never........

THis sort of advert would be useful 10 years ago...was there one then?

In some countries it is illegal to have ponds in you garden without fish in them........effective probably not directly, but it DOES help to raise awareness - and it seems to me that the Thai authorities have been far too laid back over this for far too long.

Edited August 15, 2013 by wilcopops

[jrtmedic]

The Thai government has, I believe, run Dengue education campaigns for many years !

The reason for my comment is that the TV advert is particularly well presented.

Glad I do not live in a country with garden pond " fish police"

Edited August 15, 2013 by jrtmedic

[dm120]

was up in CM and believe I got this. My insurance just lapsed, does anyone know how much the lab tests to diagnose cost in full? I know there are varying prices, but a roundabout figure would be appreciated. A reasonably-priced competent place to get testing done in BKK would be appreciated as well!

[Sheryl]

All that is really essential to clinical management is a CBC (complete blood count) and, if it seems cvonsistent with dengue, then repeat platlet counts. A few hundred baht at most. Any lab can do it, but what is important is the interpretation of results in light of clinical symptoms, for which you need a doctor. Doctor visit plus labs, depending on the hospital you go to, 500 - 1500 baht approximately. If it is dengue, the only med is paracetemol, make sure to decline it at the hospital pharmacy where mark up is considerable.

To be certain of the diagnosis, need a serology test that will not be accurate until at least 4 days into the fever and thus has little clinical utility, that would cost more and be available only at larger hospitals.

Assuming you have significant fever along with muscle aches/headache, I suggest yo usee a doctor specializing in infectious diseases or an internist. where in Bangkok are you located?

[dm120]

Thanks for that. I'm over in Onnut and know of Bumrungrad, but am wondering if there are any other clinics/hospitals near that have well trained staff at a reasonable price?

[Sheryl]

You might try Sikarin Hospital nera Bang Na, very reasonable. http://www.sikarin.com/images/map.jpg

[dm120]

excellent, I'll check it out. One last thing, anyone know where can I buy a mosquito net here in BKK? I checked Big C, but could only find spray and such.

I think Paragon may have them, though it'd be more convenient if someone has seen them in Tesco/Big C?

Edited August 26, 2013 by dm120

[Sheryl]

Big Cs and Tesco both carry them in the provinces but not sure in Bkk since most places are screened.

[francescoassisi]

I think if you look you'll find mozzie nets in just about any of the super markets. I carry a couple when travelling and I think I found them either in bedding or camping.