Guidelines for Unani practitioners for clinical management of Dengue

Introduction

Dengue fever is known as Hummā Danj in Unani medicine. It is one of the Wabā’ī Amrāz experienced in the past and treated on the pattern of other Wabā’ī Amrāz .

Prevention and treatment of Wabā’ī Amrāz has been well described in Unani system of medicine. Hummā Danj (Dengue Fever) is an acute febrile illness caused by a flavivirus transmitted by the Aedes mosquito and characterized by sudden onset of high fever, severe muscle and joint pain, headache, rash, sore throat, lymphadenopathy and depression.

Aetiology

The causative agent of Dengue Fever is dengue virus which belongs to genus Flavivirus. There are four serotypes of dengue virus – DEN - 1, 2, 3 and 4; all produce a similar clinical syndrome and all are transmitted by Aedes aegypti mosquitoes which bite in the daytime and breed in standing water. Infection with one serotype provides life - long immunity to that serotype but not to the other three serotypes. Humans are infective during the first 3 days o f the illness (the viraemic stage). Mosquitoes become infective about 2 weeks after feeding on an infected individual, and remain so for the rest of their lives.

Clinical Features

The incubation period is 4 to 6 days (range 3 to 14 days) following the mosquito bite Asymptomatic or mild infections are common.  Two clinical forms are recognized:

• Classic Dengue Fever
• Dengue Haemorrhagic Fever (DHF).

Prodrome: 2 days of malaise and headache

Acute onset

• Fever: Continuous or 'saddle -back', with break on 4th or 5th day and then recrudescence; usually lasts 7-8 days.
• Break-bone aching ('break-bone fever’):  severe headache, backache, myalgias and arthralgias
• Retro-orbital pain (pain on eye movement)
• Skin rash: Initial flushing faint macular rash in first 1-2 days. Maculopapular, scarlet morbilli form rash from days 3-5 on trunk, spreading centrifugally and sparing palms and soles, onset often with fever defervescence.  May desquamate on resolution or give rise to petechiae on extensor surfaces.
• Relative bradycardia
• Anorexia, Nausea, and Vomiting
• Lymphadenopathy
• Haemorrhagic manifestations:
1. A positive tourniquet test
2. Petechiae, ecchymoses, purpura
3. Bleeding per mucosa, GIT, other
4. Haematemesis, melaena.
5. Thrombocytopenia <100,000/mm³
• Convalescence: Slow
• Complications: Minor bleeding from mucosal sites, hepatitis, cerebral haemorrhage or oedema, rhabdomyolysis

Preventive Measures for Dengue

• Primary prevention of dengue is currently possible only with vector control and personal protection from the bites of infected mosquitoes.
• Be aware of countries or areas where dengue fever is endemic.
• Mosquitoes may be in more number close to or on spaces with plenty of trees, so keep away from such spaces.
• Don’t allow any kind of water around your environment.
• Changes to vector habitats: Management of “essential” containers
• Frequently empty and clean the purposely-filled household containers such as water-storage vessels, flower vases and desert room coolers
• Recycle or properly dispose of the rain-filled habitats –including used tyres and discarded food and beverage containers
• Shelter stored tyres from rainfall
• Manage or remove from the vicinity of homes the plants such as ornamental or wild bromeliads that collect water in the leaf axils
• Actions to reduce human-vector contact
• Install mosquito screening on windows, doors and other entry points
• Use insecticide-treated mosquito nets while sleeping during daytime (e.g. infants, the bedridden and night-shift workers)
• Wear covered clothes to minimize skin exposure during daylight hours when mosquitoes are most active
• Apply mosquito repellents containing DEET, IR3535 or Icaridin to exposed skin or to clothing.
• Use household insecticide aerosol products, mosquito coils or other insecticide vaporizers to reduce biting activity.

Treatment and Management

• Bed rest during the acute phase
• Try to keep temperature below 102°F.
  • Use antipyretics to lower the body temperature:
    • Habb-e-Ikseer Bukhar: 400 mg thrice a day with lukewarm water (NFUM-VI, page 15)
    • Sharbat-e-Khaksi: 25-50 ml (NFUM-V. page 140)
    • Malerian: Adult: 6 ml BD, Children: 3 ml BD with warm water, contraindicated for pregnant women (NFUM-VI, page 122
  • Use cold sponging

• Try to avoid Dehydration:
  • Use Oral rehydration solution (ORS)
  • Use fruit juices like pomegranate juice
  • Sharbat-e-Anar Shirin: 25-50 ml (NFUM-I, page 221)
• Use the Unani drugs possessing immunomodulatory activity to boost your immunity:
  • Khamira Marwareed: 3-5 g (NFUM-I, page 111)

• Use the Unani drugs with hepato-corrective and hepato-protective activity to normalize the functions of the liver:
  • Majun Dabid-ul-Ward:5g BD (NFUM-V. page 90)
• Use Jawarishat to relieve the gastrointestinal symptoms including anorexia, nausea, and vomiting:
  • Jawarish Amla Sada: 5 g BD (NFUM-V, page 71)
  • Jawarish Amla sada:5 g BD (NFUM-V,Page 71)

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Source: The Central Council for Research in Unani Medicine