Cockroach of Mosquitoes

Last year a medical representative of a multinational company was absent from his regular visits for about two months. On his next visit, he appeared very weak and tanned. He explained that he had experienced a sudden high fever, severe body aches, loss of appetite, and extreme weakness. A blood test diagnosed him with dengue fever. He was admitted to a private hospital, where he received paracetamol tablets and daily intravenous fluids. After about a week, his fever subsided, but he remained weak and noticeably tanned.

Dr. Munawar Aziz

Decades ago, when I was in medical college, dengue fever was taught as a routine topic and given little importance because it was not prevalent in our country at the time. In fact, the word was pronounced “dangoo” () by our professors, though it was written as “dengue,” rather than the now-common pronunciation “dangee” (). In the 1980s, increased trade opportunities due to extensive sea and air travel led to the importation of the dengue mosquito (Aedes aegypti), particularly through secondhand tyres, where water can remain trapped for long periods. Unlike the malaria-causing mosquito (Anopheles), which breeds in ponds, stagnant water, and marshy areas and bites primarily at night, Aedes aegypti is a domestic mosquito. Larger in size with white spots, it lives in and around houses, much like cockroaches, earning it the nickname “cockroach of mosquitoes.” It can bite at any time of day, especially in the early morning and evening.

Dengue is a viral disease transmitted from human to human by the Aedes aegypti mosquito. It presents with sudden high fever, severe “breakbone” aches and pains, intense frontal headaches, and retro-orbital pain along with body rash, Dengue has two forms: dengue fever and dengue hemorrhagic fever. In the latter, very low platelet counts can lead to bleeding, which can be fatal. (An important note: avoid using ibuprofen, aspirin, or Ponstan, as these medications can increase bleeding risk due to their antiplatelet effects.)
The drug of choice for fever and pain in dengue is paracetamol. The age old dictums, “Prevention is the best medicine,” and “Prevention is better than cure” is key to avoiding dengue. To reduce the risk, avoid storing unused items, such as old tyres, on rooftops. Drain accumulated water from flowerpot saucers. Cover water storage containers .Use mosquito nets when sleeping outdoors. Apply insect repellents and use mosquito coils. Avoid wearing short-sleeved shirts or shorts, especially during the monsoon season.
If dengue is suspected, consult a healthcare facility for testing and a complete blood count to monitor platelet levels. At the slightest sign of bleeding, seek hospital admission for possible platelet transfusion. Rest, increased fluid intake, and intravenous fluids aid in speedy recovery and help prevent complications.

An important point: Infection with one dengue serotype does not confer lifelong immunity. There are four serotypes (1, 2, 3, and 4), and immunity is only developed against the specific serotype contracted. Thus, a person infected with serotype 1 remains susceptible to the other three serotypes.

Tailpiece: A non-doctor friend once asked why dengue patients in hospital wards are kept under mosquito nets when they already have the infection. This is an excellent and observant question. The answer is simple: the nets prevent mosquitoes from biting infected patients and spreading the virus to healthy individuals.

• Dr. Munawar Aziz
  Abbottabad, Pakistan.
  aziz.munawar@gmail.com