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Monday, 10 March 2014


DENGUE – ITS HOMEOPATHIC MANAGEMENT
DR. DINESH  A. KOWSHIK
                             MD(HOM)
LECTURER -BHARATESH HOMEOPATHIC MEDICAL COLLEGE
BELGAUM, KARNATAKA,  INDIA

Dengue – the dreaded `Bone breaking fever’ is a vector borne affliction, transmitted by the Aedes Egypti mosquito. The patient presents with mild to high grade fever of sudden onset attended with pain in the head or retro-orbital pain, joint and muscle pains. The pains can be severe, incapacitating the patient. The paroxysm can last for 4-7 days, often subsiding without any specific treatment. In patients who may have had multiple infected mosquito bites, the platelet count begins to drop, invariably after 4 days and may reach life-threatening low levels, below 20,000/ul. Such severe thrombocytopenia may trigger echymotic patches under the skin and frank hemorrhage from G.I. tract or elsewhere. A fall in the BP and/or increased pulse rate may be a sign of severe hemorrhagic episode in the G.I.tract or elsewhere. This hemorrhage requires immediate platelet transfusions and supportive treatment in a referral hospital.
Dengue fever is well documented in Homeopathic literature.
Center for Disease Control & Prevention publishes the following:
With more than one-third of the world’s population living in areas at risk for infection, dengue virus is a leading cause of illness and death in the tropics and subtropics. As many as 400 million people are infected yearly. Dengue is caused by any one of four related viruses transmitted by mosquitoes. The most effective protective measures are those that avoid mosquito bites. When infected, early recognition and prompt supportive treatment can substantially lower the risk of medical complications and death.
Serious problems include dengue hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system. The symptoms may progress to massive bleeding, shock, and death. This is called Dengue Shock Syndrome (DSS).
People with weakened immune systems as well as those with a second or subsequent dengue infection are believed to be at greater risk of developing dengue hemorrhagic fever.
Diagnosing Dengue Fever
 A rapid chromatographic test can detect NS1 antigen, IgM or IgG antibodies in the blood.
The presence of NS1 antigen indicates active infection. IgM indicates present recent infection. IgG antibodies indicate old infection. The last must be correlated with the findings in the CBC.
             CASES
I here-by publish records of ten cases of Dengue fever, some with platelet counts well below the normal. The follow-up demonstrates the almost immediate response to the medication with an uneventful recovery. Not a single case in the series required anything more than the simillimum – no IV fluids or any other interventional therapy was used at any time. This is a serial study and no cases have been eliminated or selected for publication.
1.      25/07/2012. 8:00pm. Mr. B.B. 64 yrs/M an old case of Ca rectum presented with Chills, fever since 7 days. He had shown a physician who had got his CBC and Dengue test done. He tested +ve for Dengue IgM and IgG. His platelet count was 1.46 Lakhs/ul. HCT 36%. He was advised hospitalization to be observed for 2 days. Mr.B.B. preferred to take homeopathic treatment.
SYMPTOMS: Extremely chilly, then heat burning with intense thirst. Woke up past midnight with these symptoms and fearsome- thoughts of death. Wanted to see the doctor immediately. Intense weakness, unable to sit in the waiting room. Since 2 days, continuous dry heat with painful cervical glands. Face red, vomiting bitter. Desire to eat but nausea on attempting. Can drink only water but vomits soon after. PR. 94/min. BP 110/80mm Hg
Prescription: Arsenic alb1M 4 globules every half hour for 3 hours. 2 hourly from next day.
FOLLOW UP: 27/7/2012. Hb 10.5gm/dl; Platelet count: 1.71 Lakhs/ul. Treatment continued two hourly.
31/7/2012. Platelet count 1.87 Lakhs/ul. Patient asymptomatic. Treatment stopped. Advised appropriate diet to correct anemia.

2.      2/12/2012 2:00pm. G.R. 18yrs/M presented with high grade fever. Irregular paroxysms since 6 days, controlled with frequent intake of Paracetamol. Symptoms scanty. The only thing that stood out was his nightly aggravation of fever with intense thirst and nausea with disproportionate weakness. Fever with headache. PR 106/min BP 120/70mm Hg. Hb 13.5gm/dl, WBC 2780/cu.mm; Platelet count: 59000/ul; HCT 38%. Dengue NS1 +ve; IgM & IgG nonreactive.
Prescription: Arsenic alb 1M 4 globules hourly on first day, later 4 globules 2 hourly till fever subsides.
FOLLOW UP:  3/12/2012. 11am. Vomiting soon after eating. Dry cough, throat pain< night, lying on back, with desire for warm drinks. Phosphorus 30 four doses given at 2 hourly intervals.
8/12/2012: Patient comes after 5 days, unmindful of the severe warning I had given to be regular with his follow up and medication. He says he is asymptomatic since 4 days. Refuses treatment but is willing to get his blood tested. Hb 13.0gm/dl; WBC 4900/cu.mm; P60/L35/M4/E1. Platelets 1.63 Lakhs/ul. HCT 40%.

3.      18/4/2013. 9:00pm. Miss D.K. 11yrs/F
Chills on first day, then continuous dry heat with headache since 4days. Fever < midnight and after. Tongue red edges and tip. Intense thirst for small quantities but unable to eat anything- no desire for food. Pain in limbs especially legs and hip region. PR 89/min. BP 120/70mm Hg.
 Investigations done elsewhere on 17/4/2013 showed:
Hb 13.7gm% WBC 4100/cu.mm P47/L53/M0/E0. Platelets 42,000/ul.
Clinical diagnosis: Dengue. Patient advised to come with blood reports next day.
Prescription: Arsenic alb 1M every half hour 6 times, Second day:  2 hourly.
FOLLOW UP: 19/4/2013. 11:00am. Fever subsided partially. Repeat investigations showed: Hb 13.2gm% WBC 4760/cu.mm; P42/L57/M1/E0. Platelet 61000/ul. HCT 40%. Dengue test: NS1- Nonreactive, IgM – Reactive, IgG- Nonreactive.
20/4/2013: Patient asymptomatic. Treatment stopped.
21/4/2013. Patient is very emaciated weight- 22Kg. Hb 13.3gm%, WBC 5390/cu.mm; P 40/L54/M2/E4. Platelet count: 1.8 Lakhs/ul. HCT 41%.
Patient advised high Carbohydrate and Protein diet. Gentiana Q given in drop doses twice daily to improve appetite.

4.      27/07/2013  11:00am. Mr.S.M. 14yrs/M
Sudden onset of high grade fever since 4days; began at 1:00pm on first day. Chills, heat, perspiration. Tongue coated white, thirst +++ cold water, small quantities. Severe nausea but no vomiting. Water tastes bitter. Sinking, empty sensation in the stomach but cannot eat anything. Sore pain in both lower extremities, especially thighs. PR 106/min. BP 110/70mm Hg.
Hb 12.8gm% WBC 1830/cu.mm; P67/L32/M1 Platelets 87000/ul; HCT 41%
Dengue test. IgM – Nonreactive; IgM – Reactive; IgG-  Nonreactive
PRESCRIPTION: Arsenic alb 1M 2 hourly
FOLLOW UP: 28/07/2013: Throat pain persists.
WBC 2710/cu.mm Platelets: 89000/ul.
FOLLOW UP: 29/07/2013. Throat pain persists. Shallow, spreading mouth ulcers noted on inner cheeks. Bleeding on touch. Fetor oris.
WBC TC 3420/cu.mm, Platelets 1.86Lakhs/ul
PRESCRIPTION: Merc cor 30 3globules size 30- every 6hrs. Ars alb to be continued after.
FOLLOW UP: 02/08/2013. No complaints except loss of appetite.
PRESCRIPTION: Gentiana Q drop doses twice daily.

5.      18/09/2013. 10:30am B.S. 45yrs F
Fever since 8 days. Dry severe heat < 11 am. Thirst severe for cold water – small sips. Averse to any food. Mild nausea. Malaise and intense weakness, difficulty getting out of bed. Moderate head pain temporal region with nausea.PR 95/min BP 100/60mm Hg.
Hb 8.8gm% WBC 1760/cu.mm P62/L30/M2/E5 Platelets 89,000/ul;
RBC 3.47 million/ul; HCT 28%.
Widal test: Nonreactive. Dengue test: Nonreactive.
I have included this case due to the likely-hood that the Dengue test was a false negative test due to limitations of specificity. The case clinically speaking was very likely a case of Dengue since there plenty of cases in the village where she lived and the remarkable similarity of both symptoms and test results of the CBC.
PRESCRIPTION: Arsenic alb 1M 2 hourly for 1 day, then 4 times a day for the second day.
FOLLOW UP : 20/09/2013. Hb 9.1gm% WBC 4980/cu.mm. P61/L33/M6. RBC 3.89 mill/ul; Platelets 1.76 Lakhs/ul. Patient has no complaints hence no medication was prescribed.

6.      03/09/2013. 2:00pm.  R.G. 28 yrs/M
H/o fever 12 days ago, Severe bodyache, pain in the legs and back remain. Pain behind the eyes. Pains come and go irregularly- no specific modalities. PR 74/min; BP 120/80mmHg.Although the patient had no fever, I decided to do his Dengue test: NS1 antigen- Nonreactive. IgM – Nonreactive; IgG- Reactive. Hb 13.8gm% WBC 6300/cu.mm P65/L30/M5. Platelets 2.33 Lakhs/ul
PRESCRIPTION: Eup.perf 30 daily thrice for 3 days followed by placebo.
FOLLOW UP: 10/09/2013. Backpain persists but all other symptoms relieved.
PRESCRIPTION: Rhus tox 30 daily 3 doses for 1 week.
FOLLOW UP: 13/09/2013, Patient called to say he is OK and requires no treatment.

7.      20/08/2013. 7:00pm. S.M. 46yr/F
Fever since 1 day. Severe chills followed by dry heat< night 10:00pm. Moderate thirst with malaise, slight hoarse voice, pain throat, watery nasal discharge. Mild cough with yellow expectoration. Pain and weakness felt especially in lower limbs and back. Constant pain in the eyes since last night. PR 80/min BP 120/84mm Hg. Patient hurried, wants to go back home- says he will get his blood tests done next day.
Given Ars alb 1M in repeated doses.
FOLLOW UP: 23/08/2013. Patient has come a day late. No change. Hb 11.9gm%  WBC 6140/cu.mm P62/L34/M4. RBC 4.5 mill/ul. Platelets 2.37 Lakhs/ul. HCT 38%
Dengue test- NS1 Reactive. IgM- Nonreactive. IgG- Nonreactive
PRESCRIPTION: Rhus tox 200 in repeated doses for 3 days
FOLLOW UP: 27/08/2013. Body pain severe, felt more in the back, thighs. Pain head especially eyes. Unable to get out of bed.
 Platelet count 1.05 Lakhs/ul HCT 38%
PRESCRIPTION: Eup. Perfoliatum 30  at hourly intervals – ten doses.
FOLLOW UP: 28/08/2013. Much better, pain less, head pain minimal, no fever; has managed the kitchen herself. Decided to wait before repeating blood tests as patient was subjectively and objectively very much better.
PRESCRIPTION: same as above at 4 hourly intervals
FOLLOW UP: 29/08/2013. Patient is cheerful, comfortable and afebrile.
Hb 12.0 WBC 8900/cu.mm P62%/L30%/M5%/E3%. RBC 4.4 mill/ul Platelets 2.08 Lakhs/ul. HCT 38%.
Treatment stopped.

8.      15/08/2013. 10:30am M.J. 3yr/F
Patient came to me for fever following severe watery diarrhea and vomiting. For 5 days. Now, patient has Chills since yesterday afternoon, intense burning heat, drowsiness and intense weakness. Child complains of pain in thighs, legs, hips and back. Severe thirst for cold water. Pain in the legs as if they will break. Face red. PR 112/min. BP 90/70mm Hg
Patient has brought blood test reports done on 14/08/2013
WBC 10,800/cu.mm. Platelet count: 1.21 Lakhs/ul
Dengue test: NS1 Reactive, IgM Nonreactive; IgG Nonreactive
PRESCRIPTION: Ars alb 1M 4 doses ½ hourly; later 2 hourly for 1 day.
FOLLOW UP: 16/08/2013. Patient afebrile. PR 89/min. BP 96/80mm Hg.
WBC total count 9000/cu.mm. Platelets 2.06 Lakhs/ul
PRESCRIPTION: Continue same at 4 hourly intervals.
FOLLOW UP: No fever, no complaints. PR 82/min. BP 110/80mm Hg.
PRESCRIPTION: Placebo

9.      01/09/2013. 8:15 pm. C.H. 38yr/M
Presented with burning heat since 4 days. Continuous fever with nightly aggravation. Patient is restless and intensely anxious and delirious. Fear of death- feels he may never pull through this illness. Keeps asking only for water. Refuses to eat, says sight of food is repulsive. Gets up and walks about at night despite the fever. Severe pain in legs, thighs and head- temporal region. Taken allopathic treatment in his village including many IV fluids and injections for vomiting. PR 112/min. BP 110/70 mm Hg
Hb 13.4gm% WBC total count 3530/cu.mm. P56%/L38%/M4%/E2%. Platelets 0.77 Lakhs/ul. RBC 5.2 mill/ul. HCT 40%. Dengue NS1 Reactive
IgM Reactive. IgG Reactive.
PRESCRIPTION: Sulph 200 1 dose every 2 hours – 4 doses. This short course was deemed necessary to tackle what I interpreted as abuse of medicaments (Complete Rep. Generalities)
Followed by Ars. Alb 1M a dose every two hours.
FOLLOW UP: 03/09/2013. Patient is afebrile and asymptomatic. Says he is OK wants only his blood tests done. PR 87/min. BP 114/80 mm Hg
Hb 13.2gm% WBC 6200/cu.mm P67%/L32%/M1%. RBC 5.00 mill/ul Platelets 1.47 Lakhs/ul;  HCT 41%.

10.   21/1/2014 12:45pm. A.W. 26yr/M
Patient presented with severe chills, heat, perspiration since 7 days. Thirst although the stages of fever. Backpain severe < morning on getting up. Pain in thighs and knees <R. knee. Slight throat pain with mild cough. Not many symptoms due to steroids and anti-inflammatory drugs. PR 88/min BP 110/80 mm Hg. Taken allopathic treatment and had brought his investigation reports as follows: Hb 11.4gm%, WBC TC 9240/cu.mm; P61%/L28%/M3%/E8%. Dengue test: NS1 Nonreactive, IgM Reactive, IgG Reactive.
PRESCRIPTION: Rhus tox 30 at 2 hourly intervals
FOLLOW UP: 30/01/2013. Patient has diarrhea and cramping pains in abdomen. No explanation as to why he has come late. Says he is OK. Refuses investigations.
PRESCRIPTION: Sulphur 200 every 4 hourly 6 doses for 1 day.
Patient did not return for follow up.

OBSERVATION
Total number of cases treated were 10 in number
Age groups: Pediatric- 3/ Adult- 7/ Geriatric- 0
NS1 +ve: 3 cases                   NS1/IgM/IgG +ve: 1 case
IgM +ve: 2 cases                   IgM/IgG +ve: 1 case
IgG +ve: 2 cases                    Clinically indicative, Dengue test –ve: 1 case


            ANALYSIS & DISCUSSION
Of the 10 cases seen by me, except one who did not come for follow-through, all the remaining patients recovered both clinically and pathologically within the shortest possible time. The recovery time of the patients was remarkable and they suffered no sequelae of the disease. None of the patients in this serial study required hospitalization or platelet transfusions despite 6 cases having moderate to severe thrombocytopenia and 2 cases with severe Leucopenia.
The weakness out of proportion to the duration of illness, excessive thirst, red face during heat stage of fever, Nausea and aversion to food, Vomiting even water, Sinking sensation in stomach are all pointers to Arsenic alb. in the above cases. Most of the cases required Arsenic alb which may be designated as a Genus epidemicus in this case study – 8 out of 10. I may add, in such critical cases, treated invariably by allopathic medicines, modalities, stages of fever, even entire symptoms may be masked. Hence key notes and thus zig zag cures are inevitable.
4 cases required intercurrent remedies, 2 of which due to other symptoms intervening, which were probably accessory symptoms. One case I have given Sulphur at the beginning of treatment due to the patient receiving plenty of allopathic medicines with reference to the rubric in Complete Repertory: Generalities: abuse of; poisoning with: medicaments.

           CONCLUSION
Homeopathy is certainly an ideal and complete treatment for the management of Dengue even in its severe form, although transfusion of platelets cannot be avoided once the hemorrhagic symptoms manifest. Skills of clinical judgment and correct interpretation of signs of the disease, monitoring vital signs, as also pathological correlation must be developed and honed to near perfection while handling such critical cases. The expertise when combined, results in correct case selection, which is the key to success and essential to avoid medico-legal complications

Though ten cases may not have generated sufficient data, further serial studies of a larger patient sample are merited on the basis of this study. This study shows that with good clinical assessment and laboratory support, critical cases may be handled by experienced Homeopaths who can then train juniors to carry on the good work without feeling intimidated by the severity of the affliction.
ACKNOWLEDGEMENT: To Dr.Anand Hosur -Vice Principal BHMC for his encouragement, editing and graphs

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