1462. Dengue haemorrhagic shock syndrome in Singapore

A 20-year-old Singaporean, Mr Ang Yong Han was the first dengue death in Singapore in 2013 (Straits Times, Home B1, Jun 1, 2013). He died one week after falling ill. Another man died.  8,305 people were infected as at May 31, 2013 for the year.

Signs: fever, headache, muscle or eye pain, vomiting and diarrhoea - see a doctor
Don't take aspirin or non-steroidal anti-inflammatory drugs (Nsaids, e.g. Ibuprofen or Synflex) as they make the person more ill. Pannadol is said to be safe.

No drugs to cure. Must drink a lot of isotonic drinks as there is a loss of electrolytes in vomiting and diarrhoea. Patients given fluids intravenously, blood transfusion, plasma and platelet transfusion and pain killers (pannadol). If blood pressure keeps dropping, goes into shock and die.

BLOOD TEST. Virus caused liver and brain inflammation.

Liver inflammation.
Enyzme (AST) Aspartate transaminase levels are 10-40 units/litre of serum. 200-500 units are common in dengue patients. In Mr Ang's case, they were "way off the charts", being 1,000 and then 4,000. 

Platelet counts are usually very low. Below a certain level, patient is hospitalised and given platelets. Blood test said to be useful only when the patient has fever for one week. 

BRAIN SCAN
Brain inflammation (confused) - brain scan done. Patient complained about stomach pain.

Blood pressure continued falling despite being given strong medication. Due to blood vessels leaking fluid. Blood becomes concentrated and pressure falls.

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The PURPLE dengue alert banner is a recent introduction in coloured banners by town councils. It is deployed in areas with HIGH Aedes mosquito populations.