THE catchy title does not mean the two diseases are fighting. Your columnist is responding to the many requests of our readers, students mostly who wanted that the two diseases are discussed together, after all they are both mosquito borne. On the side, the urgency of the request may also be reaction to the sad news that the incidence of dengue in the Cordilleras, particularly Benguet, has significantly increased in the recent months, based on local health statistics.
Dengue is caused by a virus, malaria is a protozoal disease; some doctors call it a parasitic disease. The dengue virus has four strains, hopefully, as claimed, would be inhibited by the vaccine Dengvaxia, currently being administered to children , 9 years and above- in public schools, in regions where dengue problem is alarming. The causative organism of malaria is the Plasmodium which has four species, vivax- the most common, ovale, malariae and the feared Falciparum.
Their mosquito vectors are females which have the very nasty habit of biting, sucking blood and later on spit into the bloodstream of an unwilling victim. The malaria mosquito is the Anopheles flavirostris which bites at night and likes to multiply in slow flowing waters of brooks, streams and shallow rivers, rivulets and usually are found in the foot of the mountains. The dengue-carrying mosquito is the striped and dotted Aedes aegypti which bites on early morning and late afternoon hours, which love to multiply in collected waters either from rain fall or in vases and other household containers. Lately, it has been shown that even the Aedes albopictus mosquito also carries the dengue virus.
In terms of signs and symptoms, there is fever- flu like symptoms in dengue, followed by a rash which as it worsens in the hemorrhagic phase may manifest as epistaxis- nose bleeding and gum bleeding especially after brushing the teeth, and as it worsens some more lead to the dreadful dengue shock syndrome in which there may be internal bleeding, with very low blood pressure which if not attended to, leads to death. In malaria, there is the so-called " rigor' or chills followed by excessive sweating and fever. As previously stated, the recurrence of the periodic chill is called tertian, if the chills occur every 48 hours- seen in vivax and ovale species- and quartan if chills occur in 72 hours. The falciparum specie has the quotidian pattern which may occur anywhere between 36-72 hours.
In dengue, the blood element that is affected most are the platelets or thrombocytes ( normal is 150,000 to 300,000/cu.mm.) whereas in malaria, the chills and fever occur during the massive rupture and breakdown of red blood cells or erythrocytes, which would have become very big and swollen because of the presence of the plasmodium parasites inside them.
Serious signs and symptoms , which could be fatal are associated more with Plasmodium falciparum which causes cerebral malaria - which could mimic a stroke- and the so-called Blackwater fever, in which the renal tubules are filled and congested with the debris and remnants of the ruptured red blood cells with the patient passing a Coca-cola-like dark urine, which might lead to acute renal or kidney failure.
Diagnosis also differs. All of us now are familiar with the dengue-DOT test. For malaria, blood test, that is, extraction of blood specimen is ideally done, when there is chills- obviously a very inconvenient if not awkward situation- because that's when the parasites are in the blood stream. The med tech is requested to study the plasmodium either with the so-called thin Smear or Thick smear to identify the species.
Treatment of dengue, being viral infection does not include antibiotics, at most it is supportive and symptomatic. For malaria, some doctors give antibiotics combined with anti-malarial drugs ranging from quinine to chloroquine to mefloquine depending on the species isolated or identified; and of course supportive treatment like anytipyretics to lower fever and dextrose fluids to replace the excessive sweating.
Hopefully, these basic facts, in a nutshell have somehow satisfied the request of our dear readers and patients. Read on. Cheers!