New Delhi: Whenever there is high fever, there is always confusion in the mind of the patient about whether he’s suffering from a viral infection or is it
a bacterial infection. Now classically at the moment there is influenza or flu which is quite rampant including H1N1 and H3N2. This presents with fever, which may be variable.
Some people may have very mild or no fever at all whereas other people may have very high hectic fever. Along with that, there is throat pain, a runny nose and sneezing. Predominantly, this is associated with a lot of body pain and body aches happening and the fever starts to break after 48 to 72 hours.
The cough lasts for a longer period of time, and the malaise and fatigue can last anywhere up to two weeks. To distinguish this from dengue fever, dengue would typically have headache, pain behind the eyes and severe back pain, and there would be an absence of cough and cold in a patient with dengue. Later on, in the course of illness of dengue, the fever subsides, but at this point of time the patient may develop a generalised reddish rash on the body and may develop a bleeding tendency if the platelets go down at this phase of the illness.
Both dengue and influenza are viral illnesses, and there is no role for antibiotics in this. The treatment remains very similar in terms of rest, hydration and paracetamol. Painkillers are to be avoided in both situations.
Now there are certain alarm symptoms in a patient with influenza, which means that if the fever is not subsiding, there is a productive cough with colored sputum, breathing difficulty, drowsiness, tightness in the chest or inability to take an adequate amount of liquids and food. Then these are symptoms of either a secondary bacterial infection on top of influenza which may be getting complicated in the form of pneumonia or it may be that practically this patient has a bacterial pneumonia rather than in terms of a viral infection going on. So any alarm symptoms or red flag signs mean that you should not be sitting at home and you should immediately consult a doctor.
At the same time, children and the elderly, people with liver, kidney and heart problems and asthmatics are more vulnerable to complications. So this subset of people should not really wait, they should go and report to the hospital early in the course of a fever related illness. Dengue typically causes complications in the form of low blood pressure, dehydration and a tendency to bleed because of low platelets.
The platelets tend to fall more after the fever subsides. Again, the main treatment in dengue remains in terms of hydration, rest and avoiding painkillers like ibuprofen-containing compounds. The patient needs to go to the hospital if they notice any kind of excessive drowsiness, severe abdominal pain, breathing difficulty, inability to take liquids and any sort of symptoms which are indicative of low blood pressure.
It is best to actually get a medical consult done if there is any doubt in your mind because the course of the illness, both for influenza and dengue, is variable and at the same time the complications associated with both are very different from each other. If there is any suspicion of a bacterial infection and the blood counts are high, and there are symptoms of unsubsiding fever, then this indicates that medical attention needs to be sought early. Gastroenteritis, burning in the urine, reduced urine quantity, drowsiness, severe headache, and vomiting, these are symptoms which should not be ignored.
Ultimately, it is the doctor who will order the required adequate testing to reach a conclusion on whether you are suffering from a viral infection or a bacterial infection. So it is better that a medical consult is done before randomly ordering investigations for any sort of fever.
(By Dr Monica Mahajan, Principal Director & HOD, Internal Medicine, Max Hospital, Saket)
