December 9, 2022

Dengue fever: Why should we stick to Paracetamol? Painkillers increase the risk of internal bleeding and affect the liver

There has been an upward trend in dengue fever cases across the country, with the disease map now spreading across India, as far as Jammu and Kashmir. In fact, there is no state or union territory left with zero cases. According to data from the National Vector Borne Disease Control Program (NVBDCP) through the end of August, there have been more than 30,627 cases and 12 deaths. Karnataka (5,392), Maharashtra (2,927) and Kerala (2,007) have the maximum cases. New additions to the dengue map are Jammu and Kashmir (96) and Nagaland (two). In 2021, there were 1.93 lakh cases of dengue fever and 346 deaths across the country while 2020 had seen a decline, likely because of the focus on treating COVID 19. Worrying this year , it is the emergence of unusual symptoms in focal areas, leading to a rapid descent to dengue hemorrhagic fever.


This year, there have been patients with complications. In Delhi, where cases have increased over the past two weeks, people are presenting to hospital with internal bleeding, shock (sudden drop in blood pressure) and liver complications. Dr Rommel Tickoo, director of internal medicine at Max Healthcare, said: “Although the numbers are not as high as what Delhi saw in 2015 and 2016, we are seeing more people with complicated dengue fever. Those with liver damage have symptoms of jaundice, but these cases resolve on their own.

Some Maharashtra patients have reported severe complications. According to Dr. Sanjay Pujari, an infectious disease specialist, there is cause for concern if the rate of complications is higher than in previous years. Dr. Rajesh Gadia, a consultant physician at KEM Hospital who has been involved in the management of dengue fever for more than two decades, says most cases have a mild presentation. However, complications can arise due to the prevalent serotype and in some cases, which are mainly from Baramati and Phaltan, patients have arrived with shock and fluid in their lungs. “Clinical manifestations vary from undifferentiated fever to florid hemorrhage and shock. Clinical presentations depend on age, host immune status, and viral strain,” Dr. Gadia noted.

Among some of the rare complications is hemophagocytic lymphohistiocytosis (HLH), which is an inflammatory condition that can be triggered by infections or other immune disorders, usually in those with an underlying genetic predisposition. It is not only seen in dengue fever but also in other infections, Dr Pujari said. “Capillary fluid leakage from the blood enters the interstitial compartment and can lead to fluid accumulation in the lungs or abdomen – once fluid enters the extra blood space there is a drop in blood pressure and therefore a shock occurs,” explained Dr Pujari. Meaning all blood cells in the body are affected, causing liver and heart damage, low platelet count, abnormal clotting system, massive drop in blood pressure. This leads to refractory shock in the patient.

A specific rare case of dengue-induced acute respiratory distress syndrome (ARDS) has been spotted in Arush Wandhekar, a four-year-old boy from Ahmednagar, Maharashtra. His breathing became difficult and his oxygen level dropped.


“Overall, there is no reason to panic. However, getting treatment early is extremely important,” says Dr Parikshit Prayag, an infectious disease expert at Deenanath Mangeshkar Hospital. When the hidden dengue virus is diagnosed at the very end, it inevitably ends up causing other health problems.

Onset involves an acute febrile illness between two and seven days, with symptoms including headache, retro-orbital pain, myalgia, arthralgia, rash, and hemorrhagic manifestations. These should be monitored carefully. The febrile phase of illness is when the fever can last for a week, after which most people recover. There will be post-viral recovery and the patient has weakness and fatigue.

Since COVID-19 and dengue are circulating in the city simultaneously, Dr. Tickoo warned against people consuming painkillers without seeing a doctor. “With COVID-19, many people take painkillers without seeing a doctor, but it can be dangerous if they have dengue fever. Combiflam and painkillers such as diclofenac can increase the risk of internal bleeding and affect the liver. Paracetamol is the only medicine they need to take for the fever,” Dr Tickoo said.

HLH is a life-threatening disease and diagnosing it can be difficult as early symptoms can mimic other problems such as persistent fevers, skin rashes, enlarged liver, low platelet count and impaired mental functions.

There are four virus serotypes designated as DENV-1, DENV-2, DENV-3, and DENV-4. Infection with any serotype confers lifelong immunity to the virus serotype.


With researchers and studies linking dengue fever to rainfall patterns, experts like Dr Gadia have warned that the monsoon and post-monsoon months are crucial for the vulnerable lot. The Aedes aegypti mosquito has an average adult survival of 15 days. During the rainy season, when survival is longer, the risk of virus transmission is greater. The dengue mosquito feeds during the day and can fly up to a limited distance of 400 meters. Aedes aegypti breeds almost entirely in artificial household water containers found in and around homes, construction sites, and factories. Natural larval habitats are tree holes, leaf axils and coconut shells. Unused tires, flower pots, and desert coolers are among the most common home breeding sites.