Kokila Gulati (41) died of dengue shock syndrome at Max Super Specialty Hospital in Saket on October 13.
The hospital dutifully reported the death to the Delhi government but it did not figure in Municipal Corporation of Delhi’s (MCD’s) list of dengue deaths.
Here’s the explanation: For confirmed dengue diagnosis, the patient must test positive for both antibodies IgG and IgM.
Gulati’s test reports — a copy of which is with HT — show she was antibody IgG positive, but antibody IgM was not detected. Her diagnosis was secondary dengue infection.
“Most private hospitals give a dengue diagnosis based on an IgG test alone, hence we do not count them,” said Dr N.K. Yadav, the civic agency’s medical health officer.
But medical experts do not agree with the civic agency.
“According to the World Health Organization (WHO) protocol, if the patient meets any three of the following criteria — history of fever, high concentration of blood, low platelet count or internal bleeding, which manifests itself as clots, rashes, swelling or bleeding, then the patient is considered dengue positive,” said a senior doctor at the All India Institute of Medical Sciences (AIIMS), unwilling to be quoted.
“A lot of times, after prolonged fever, the virus may not be detected in the blood. But that cannot be counted as negative,” said the doctor,
Gulati’s last recorded platelet count was 1,05,000, (1.05 lakh), which is below the normal 1,50,000-4, 50,000, but not low enough to cost her her life.
She also had prolonged fever and high blood concentration according to her medical reports.
Dengue patients are usually hospitalised when their platelet count falls below 20,000 and they develop symptoms of bleeding.
The MCD insists on antibody IgM capture ELISA tests to consider confirmed dengue cases but private hospital do not agree.
“We at Max Healthcare do NS1 antigen test which detects the dengue virus in the blood. The antigen is found circulating from day 1- 9 after the onset of fever. We also conduct dengue rapid IgM and IgG test,” said Dr Poonam Das, director, laboratory medicine.
“These tests do the same thing as ELISA, just that NS1 antigen test detects the problem early, thereby allowing treatment to start early. Importantly, screening tests have to be interpreted along with clinical signs and symptoms by the physician.”
The Delhi government is also upset with the MCD for poorly tracking dengue cases.
They have recently started a parallel database to keep track of dengue cases to avoid underreporting.
Till date, the civic agency has only reported two confirmed dengue deaths in the Capital, while the Delhi Government insists the number of deaths has touched four.