High fatality adds to dengue sting....... Dengue triggering stomach ailment?

Sumati Yengkhom & Saibal Sen | TNN | Sep 19, 2016, KOLKATA: Reeling under the severest spell of dengue in over half a decade, Bengal is fighting another battle this year -the high fatality rate of the vector-borne disease.

Till September 11 this year, provisional data released by the National Vector Borne Disease Control Programme has reported 24 deaths from among the 6,650 affected; in 2015, only 14 people had died among 8,516 affected.

Contrary to the Union health ministry's numbers, unofficially , Bengal's dengue toll has touched 38 in 2016. For every 277 affected by dengue in Bengal, one person died this year.Nationally , there was one death in every 515.8 people diagnosed with the disease.

Before this, Bengal's worst dengue spell had been in 2015. That year, the number of affected in the state stood only after Delhi (15,867) and Punjab (14,128). For every 608.2 people affected in Bengal in 2015, one died. This rate was much higher in Delhi: one death in every 264.45 people affected. That 2016 has been worse for Bengal partly explains the state's unwillingness to reveal the exact numbers.

World Health Organization (WHO) says about 0.5% of people affected with symptoms of dengue haemorrhagic fever may die if adequate medical care is not provided. According to official figures, Bengal's fatality rate so far is 0.36%, which is still lower than WHO estimates. Amiya Hati, former director of School of Tropical Me dicine, Kolkata, said: "The official dengue figures are much less as there is less reporting.It should be taken with a pinch of salt." The state health department has stopped disseminating dengue data since August 31.

Experts say the death rate could be high this time because of numerous reasons like secondary infection, inadequate medical care and also because a new strain has emerged.

"Talks about secondary infection causing more deaths could be true. It is also important to investigate if a different strain of virus has emerged. Otherwise, we are not doing justice in our efforts to combat the menace. I also feel that we are not following certain norms for early detection. In addition to exercising vector control measures much before the mosquito breeding season starts, early detection of dengue should be stressed upon so that the affected gets medical attention in time," Hati said.

It isn't only Bengal that is reeling under the dengue ons laught. This year, the number of affected in Bengal may be the highest in the country , but Odisha with 6,258 affected, Kerala with 5,638 and Karnataka with 4,065 have faced a severe crisis.But the death toll has been much higher in Bengal than anywhere. Odisha has only reported 10 deaths; so has Kerala. Of all dengue deaths reported in the country , 34.2% are from Bengal this year.

Prithvijit Mitra | TNN |KOLKATA: The dengue outbreak in Kolkata is not only refusing to slow down, but has showed up with a new symptom and renewed intensity over the last two weeks. While the number of patients across hospitals has remained stable, many have been struck by a virulent gastrointestinal bug triggered by the mosquito-borne virus. Experts claim that stomach disorders are not very common in dengue patients.

"Both the number of cases and the new symptom have been extremely worrying. Usually, we witness a downslide in cases by mid-September. By early-October, it comes down to a trickle since the volume of rain goes down. But this time, we are having more sporadic showers which have probably kept the number high. There has been no let-up in the number of new admissions," said Shyamasis Banerjee, consultant at Apollo Gleneagles Hospital. The hospital has 50 dengue patients now.

Equally intriguing was the new symptom that has been a feature of recent dengue cases, pointed out Banerjee. "A mild diarrhoea is normally associated with dengue but not this virulent stomach disorder. It is kicking off with a pain in the stomach and is being followed by a severe bout of diarrhea with loose motion. More than half the patients admitted at Apollo over the last fortnight have had a gastrointestinal issue," said Banerjee.

It has even pushed many patients to the brink, including a teenaged girl who is now being treated at Bellevue Clinic. Her gastrointestinal disorder led to severe vomiting and loose motion, making the girl lose fluids rapidly. She was revived with a heavy dose of intra-venous fluids. "It could have been fatal. We didn't expect the stomach disorder to be so severe. While there have been many such cases this time, nervous tension could also be one of the reasons. There are instances of patients suffering a nervous breakdown on learning that they have dengue. While the vital parameters like blood pressure and platelet count have remained steady, the gastrointestinal disorder has been very severe," reasoned Samarjit Naskar, critical care expert at Belle Vue.

The late-season surge in the number of patients has left hospitals grappling to accommodate patients. "There has indeed been a second spurt last week. While the first one happened in mid-July with the number of patients shooting up to 70, this time it has been a relatively mild one. But we still have 50 patients which is a very high number considering that we are in mid-September. Alarmingly, the symptoms seem to be virulent this time," said Rupali Basu, CEO, Apollo Gleneagles.

It was important to screen patients more carefully since the recent spurt is characterized with new symptoms, warned Debashish Saha, consultant at AMRI Hospital, Salt Lake. "Liver functioning, particularly the SGPT and SGOT levels, renal condition, blood pressure, oxygen saturation and sepsis should be monitored on a day-to-day basis. Gastrointestinal disorder has been more frequent in dengue patients this month. We also need to guard against sepsis (infection in blood) which has proved fatal in several cases. Dengue patients are vulnerable to sepsis due to their lower immunity," said Saha.