Guidelines for Siddha practitioners for clinical management of Dengue fever

Introduction

Dengue is considered to be one of the anthropod borne human viral infections. Aedes aegypti is the vector that spreads dengue fever. In Asian region, the death of most of the children is due to the dengue hemorrhagic fever. Dengue viruses belong to Fflaviviridae family. Dengue has four serotypes such as DNEV - 1, DENV - 2, DEVN - 3, DEVN - 4 which is mapped after the antibodies produced by the body after infection.

Transmission of the Dengue

The dengue Virus is transmitted by the mosquitoes Aedes aegypti and Aedes albopictus, which are found throughout the world. Insects that transmit disease s are called vectors. Symptoms of infection usually begin 4 - 7 days after the mosquito bite and typically last for 3 - 10 days. For transmission to occur the mosquito must feed on a person during 5 - day period when large amounts of virus es are in the blood; this period usually begins a little before the person becomes symptomatic. Some people never have significant symptoms but can still be infected by mosquitoes . After entering the mosquito the virus will require an additional 8 - 12 days of incubation period before it gets transmitted to another human. The mosquito remains infected for the remaining period of its life, which may be days or a few weeks.

Clinical Stages and management

Phases in Dengue

• Febrile Phase
• Hyperpyrexia, dehydration
• Critical Phase
• Severe hemorrhage, Plasma leakage and organ impairment
• Recovery Phase
• Recovering from illness

Febrile Phase

• Fever with head ache
• Fever - "biphasic pattern"
• Muscle and Joint pain
• Generalized maculopapular rash
• Abdominal discomfort – Abdominal pain, nausea, vomiting and diarrhea
• Hemorrhagic rash
• Clinically, the platelet count will drop until after the patient's temperature is normal.

Critical Phase

• High fever
• Thrombocytopenia (<100,000 platelets per mm³)
• Hematocrit - more than 20%
• Encephalitic occurrences
• Dengue shock syndrome
• Weak speedy pulse
• Narrow pulse pressure (Less than 20 mm of Hg)
• Cold clammy skin and restlessness
• Dengue shock syndrome as it is an emergency should be hospitalized immediately.

Dengue in Siddha

Siddha system of Medicine describes all types of pyrexia under a heading Suram. It includes the vector borne diseases like malaria, dengue.

Siddha correlates dengue to Pitha Suram. Siddha literature, ‘Aga stiyar sura nool 300’ describes that the ‘Pitha suram’ can cause bleeding and it can be correlated to the hemorrhage in dengue fever. The symptoms described by the above mentioned text can also be correlated to those given in the definition of Dengue Fever .

Treatment in Siddha System

• Nilavembu Kudineer – 30 ml two times a day for 7 days.
• Papaya Leaf Juice – 10 ml two times a day for 7 days.

Prevention

• Nilavembu kudineer - 30 ml two times a day for 3 days.

Management of Fever

Prevention of Hemorrhagic symptoms

• Imbural vatakam
• Padiga poongavi Chenduram
• Kavikkal Chooranam
• General health improvement
• Nellikai lehyam – 5 Gm BID
• Triphalachooranam tablet – 2 BID
• Amukkara chooranam tablet - 2

Prevention of recurrence

• Regular usage of Nilavembu Kudineer and Adathodai Kudineer will help much.
• Haemorrhage - Papaya leaf juice 5 ml Daily increases platelet production.

Vector control

• Application of Karpoorathy Thylam
• Neem leaves Fumigation
• Usage of Poonkarpooram instead of Mosquito repellent mats
• Closed Storage of Water.
• Spraying of Mosquito Cidal spray in Water logged areas.

Source: Central Council for Research in Siddha