Dengue fever often goes unrecognised

Infecting 50 to 100 million people each year and causing symptoms ranging from a rash to haemorrhaging, dengue virus is categorised by the World Health Organization (WHO) as both a major international public health problem, and a neglected one.

A new study published in the Medical Journal of Australia has revealed that the mosquito-borne virus is indeed flying under the radar. It revealed that a significant number of Australian travellers bringing home the unwanted souvenir – predominately those returning from Indonesia and Thailand – presented warning signs that were not recognised by clinicians, with more than 20% of patients prescribed medication that could in fact increase their risk of haemorrhage.

In a collaborative project conducted by researchers from Austin Health, Monash Health, Monash University, the University of Melbourne, the Victorian Infectious Diseases Services in Melbourne, and the Royal Darwin Hospital, 208 hospitalised patients from January 2012 to May 2015 were included in the study.

Analysing the archives of four health care networks in Australia, the researchers searched the hospitals’ databases to see what symptoms dengue sufferers were presenting with, where they had travelled, and what the response of their health care facility was.

They found that WHO guidelines for the classifications of dengue – designed to make classification of the condition simpler to better determine a patient’s treatment plan – were followed in only 10 of the 208 cases.

They also found that only 14% of the patients had a complete fluid balance chart for at least one day. The authors write that “managing the patient’s fluid balance is vital when treating dengue,” calling this lack of fluid monitoring “concerning”.

Yet “even more worrying,” according to the researchers, was the discovery that 22% of patients were prescribed NSAIDs – a family of common anti-inflammatory drugs, including aspirin – which can worsen the impact of dengue on patients through risk of bleeding complications.

As Australian travel to Asia continues to increase, the researchers urge Australian GPs and clinicians to increase their familiarity with the variety of clinical manifestations of the disease to ensure treatment errors, including the prescription of NSAIDs, are avoided.

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