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The fever differentiator

You’ve got fever and you are sick with worry. Is it just seasonal flu, you wonder, or are you in the clutches of swine flu, dengue, malaria or chikungunya?

delhi Updated: Jul 18, 2009 00:18 IST
Sanchita Sharma

You’ve got fever and you are sick with worry. Is it just seasonal flu, you wonder, or are you in the clutches of swine flu, dengue, malaria or chikungunya?

It could be any, say doctors, because all five diseases are characterised by fever and some amount of aches and pains. But you can rest easy as the chances of it being anything other than the seasonal flu are one in a hundred.

Dengue, malaria or chikungunya are mosquito-borne, but flu spreads though close contact. Still, chances of your being safe from swine flu are high even if you have been in the same classroom or boardroom as an infected person.

“Only very close contact with an infected person results in influenza A H1N1 infection (swine flu). Children sitting in the same class as an infected child are not likely to get infected, unless they sat together or spent the day in each other’s company. Talking across a table or walking down the corridor does not lead to infection,” said Dr Suresh Chandra Sharma, Consultant (medicine), Ram Manohar Lohia (RML) Hospital, one of Delhi government’s designated hospitals with an isolation ward for people with swine flu. Delhi and NCR have 74 confirmed cases of swine flu.

A rise in cases of seasonal flu and malaria is further adding to the confusion.

“There’s panic all right and most people with fever don’t know what to do. Though there is one confirmed dengue case in the city, we’ve got several suspected dengue cases at RML. That apart, there’s always the danger of travellers to chikungunya-hit Andhra Pradesh, Karnataka and Kerala coming back with infection,” said Sharma.

Experts say you should look for what doctors call “localising symptoms” that indicate the underlying cause of the fever. A cough, runny or blocked nose and a sore throat indicate an upper respiratory tract infection, while diarrhoea, vomiting and stomach ache are symptoms of a gastrointestinal infection usually caused by rotavirus. Since viruses cause these infections, the illness takes about five days or a week to subside on its own.

There is no need for treatment, certainly not antibiotics. The symptoms can be treated to make the patient feel comfortable, and may include paracetamol to bring down the fever or an oral rehydration solution (ORS: water with sugar and a pinch of salt) for a stomach infection.

Even if it’s dengue, there’s no need to panic. Transfusion is considered only if the patient starts bleeding from the gums, mouth or nose. In most cases, the count comes up to normal on its own.

“Less than 10% need hospitalisation only if fluid leaking from capillaries causes sudden fall in blood pressure and the platelet count goes below 50,000 (normal platelet count is 1.5-4 lakh). In most other cases, the fever gets better on its own,” said Dr JN Pande, senior consultant medicine, Sitaram Bhartia Institute in south Delhi’s Qutab Institutional Area.

Treatment varies in the mosquito-borne diseases.

“Malaria may cause anaemia or jaundice because of the loss of red blood cells. Plasmodium falciparum is more deadly and can lead to complications, such as cerebral malaria, respiratory distress and shock,” said Pande.

“Malaria caused by P vivax can recur several months after the person got infected as some parasites can lie dormant in the liver for up to four years. All parasites need to be destroyed completely to stop infection,” said Dr Pande.

“You need a doctor only if high fever does not go down for over three days and you develop secondary symptoms, such as rashes (dengue), severe joint pains (chikungunya), chills (malaria) or cough and fever after being in contact with someone who has travelled overseas (swine flu),” said Dr Sharma.

If it’s just fever and a cold, it’s probably just that: seasonal flu.