Change in dengue symptoms keeps Kolkata doctors worried

Kolkata: With a change in symptoms being noticed among patients, health experts feel that dengue is taking a different form this time.

While a significant drop in platelet count was seen among the infected during the previous outbreaks, such a trend is seen only in a handful of patients this time. Some are getting into shock syndrome abruptly and developing sepsis and multi-organ dysfunction.

While doctors are coming across manifestations like macrophage symptoms, which is a condition of acute inflammation due to either primary or secondary conditions, some are encountering conditions like cytokine storm capillary leakage.

"Dengue this time seems to have taken a different form, causing high toxicity. While platelet count remains normal, some are getting into shock and septicemia. We need to find out why this is happening," said senior physician Sukumar Mukherjee.

From a handful of cases per day in August, cases have started rising steadily. Currently, the state is reporting daily fresh cases in the 500s. Kolkata has reported at least eight dengue deaths, which health officials said will go through an audit.

"We are coming across cases where patients are getting macrophage activation syndrome, which is detected by high ferritin levels. These patients usually go into shock when their blood pressure and oxygen level drop drastically, which can lead to dengue shock syndrome. Fatality can be high in these patients," said CMRI critical care specialist Anirban Chattopadhyay.

So far, DEN 3 strain has been found predominantly in dengue-positive samples that have been serotyped. Even as the number of dengue cases was relatively low last year, health officials said the predominant serotype was DEN 2. Health experts said a different strain of dengue striking this time could be the reason behind the deaths.

"If a patient had been affected by DEN 2 during the previous infection and is now struck by DEN 3, this can cause immune-mediated enhancement of organ damage, causing cytokine storm, capillary leakage and dengue shock. We are getting cases of hypotension shock within three days," said Ajoy Sarkar, critical care head at Peerless Hospital.

"Haemorrhagic symptoms are not very common this time. We are also getting dengue patients with manifestations like nausea and abdomen pain. We even got a patient with a high-grade fever with the upper respiratory syndrome. He was found positive for dengue," said internal medicine specialist Rahul Jain of Belle Vue Clinic.

Sauren Panja, the critical care specialist at RN Tagore International Institute of Cardiac Sciences, said the drastic drop in platelet count was not very common this time. "Only a couple of patients have required platelet transfusion in our unit so far," he said.