McXtra Care Newsletter | July 2020

Section A

 Recognizing Mosquito borne Infections and Fevers


When the rains come in, so do the mosquitoes, heralding the season of mosquito-borne fevers and infections. The most common infections spread by mosquito bites are Malaria, Dengue and Chikungunya prevalent mainly in Asia, Africa, and Central-Southern America. While Malaria is caused by a parasite (Plasmodium), Dengue and Chikungunya are caused by viruses.

Symptoms usually develop 5-15 days after the mosquitoes bite and transmit the infection. Most of these mosquito-borne fevers manifest in a very similar way with –

  • – High fever (usually>101 deg F), sometimes with chills and sweats.
  • – Body ache (muscle pains, joint pains, headache, or eye pain),
  • – Fatigue and Weakness.

It is often difficult to clinically differentiate the mosquito-borne fevers from each other and even from Viral Flu (Influenza) or from the currently spreading COVID19.  One can even suffer from Dengue and Chikungunya simultaneously. Mostly differentiation is done based on lab tests, and also experience of the prevalent disease and mosquito breeding patterns in a particular region or geographical area.  Sometimes there are differentiating clues in the clinical symptoms as below:

How does one confirm which disease it is?

Most of the time blood tests are required and are often the only way to differentiate these conditions and confirm the diagnosis. A drop in the Platelet and White blood cell count is typical of Dengue. In Malaria, the parasite is usually visualized in the Red blood cells under the microscope, confirming the diagnosis. There are Rapid Diagnostic Tests for Antigen detection as well as Serological tests for Antibody detection available now in most labs for these conditions, which help to establish the diagnosis.

It is important to get tested for COVID and Flu, along with Mosquito fevers during the monsoons, as often symptom presentation is similar and difficult to differentiate clinically.

What is the treatment?

Among these conditions, specific treatment is available only for Malaria as it is caused by a parasite (called Plasmodium) for which Anti-malarial drugs are available. The other conditions are all caused by viruses, therefore treatment mainly consists of controlling fever and pain (with Paracetamol), and maintaining hydration with adequate fluids. It is important to avoid NSAID group of drugs (like Ibuprofen, Diclofenac etc.) which reduce pain and fever but can also increase bleeding risk.

What are the Complications? When is hospitalization required?

Severe dehydration, shock (due to increased fluid leakage from blood vessels) and multiple organ failure are the complications that can be life-threatening or lead to fatalities. This is especially seen in Dengue (Dengue Shock Syndrome).

In Dengue, a drastic fall in platelets can also lead to bleeding and hemorrhage in vital organs causing death (Dengue Hemorrhagic Fever).

In Malaria, bursting of red blood cells and release of hemoglobin in the blood can cause kidney failure and death (called Blackwater fever as Urine appears black). Severe anemia due to malaria is a complication often seen in children. When blood cells filled with the malarial parasite block small blood vessels of the brain, a complication called Cerebral malaria can develop due to swelling and damage of the brain. This can present with disorientation, delirium, seizures, and even coma.  It is seen with the Plasmodium falciparum type of malarial parasite.

Complications and death are quite rare in these mosquito-borne fevers but there are certain vulnerable high-risk groups vulnerable, who should seek medical attention immediately once symptoms appear, and preferably be hospitalized, or closely monitored.

Most otherwise healthy adults can be treated at home or on an out-patient basis with rest, adequate fluid intake (plenty of water), soft diet and Paracetamol for fever-pain.

Hospitalization should be considered in these patients if there is –

  • – persistent vomiting and abdominal pain,
  • – reduced oral fluid intake
  • – signs of dehydration (reduced urination, cold clammy extremities, dry lips and mental disorientation
  • – breathlessness
  • – neurological signs like fits, altered mental state, restlessness or delirium
  • – drop in blood pressure
  • – severe anemia
  • – platelet count falls critically low (<20,000/m3) or presence of bleeding from any site


Once having had the disease can one get it again?

There are 4 types of Dengue Virus (DENV 1,2,3,4) and Malarial Parasite Plasmodium (vivax, falciparum, ovale, and malariae).  Since there are more than one type of Dengue virus, one can get re-infected with another type but not the same type of Dengue virus. One Malaria infection does not confer immunity to another one, and sometimes the malarial parasite can remain dormant for many years in the liver and cause recurrence. Usually once having suffered from Chikungunya, one is not likely to get it again.

Malaria vaccine (against Plasmodium falciparum) is available but efficacy is low, therefore it is mainly in use for children in Africa. Dengue vaccine though developed is not used routinely due to concerns with the development of severe dengue in previously uninfected people.



Section B

 Protecting oneself and community from mosquitoes 

Anopheles mosquitoes breed in hot-moist weather inside shallow stagnant or slow-flowing water collections like puddles, pools and streams in the rainy season. Aedes mosquitoes breed in holes in trees, angle of plant stems and in wide, preferably dark-colored or shaded containers (Aedes mosquito being small and dark-colored) especially also containing decaying leaves or algae.



  • – Use of Insecticide-Treated mosquito Nets (ITN) for sleeping especially for children
  • – Indoor Residual Spraying (IRS) with mosquito insecticides in houses, common corridors, around buildings (especially gardens and potted areas), workplace and public transport
  • – Use appropriate mosquito repellents indoors and outdoors (see below)
  • – Only using Plug in vaporizing Mats and Liquids (containing Transfluthrin/Prallethrin), without regular IRS or applying mosquito repellents, has limited effectiveness.
  •  – Avoid burning coils.
  • – Waste disposal in closed bins
  • – Covering water storage containers
  • – Cleaning storage tanks every 3 months and using mosquito proof strainers/screens and flap valves.
  • – At least once a week emptying or throwing out items holding stagnant water like flowerpots, trash-bins, containers, tires, buckets, tubs, toys, or pools.
  • – Wearing protective water-proof footwear in rain and puddles.
  • – Permethrin can be used to treat clothes to keep them mosquito proof – usually lasts for 3-4 washings (do not use on skin)




  • – Use appropriate mosquito repellents indoors and outdoors, available as skin creams/lotions/gels/sprays, and as fabric patches/roll on
  • – Some common mosquito repellents in use for long and well studied for their safety and effectiveness are the chemicals N N Diethyl Benzamide (most common), and Picaridin, along with Plant based (natural) ones like Citronella, Eucalyptus, Peppermint, and Lemon.


Do’s and Don’ts:

  • – Apply repellent creams/lotions/sprays on exposed skin, not under clothing.
  • – Do not apply repellent creams/lotion near eyes, mouth and ear opening. If using repellent spray, first spray on hand then apply on face (do not spray on face directly)
  • – Apply sunscreen first, then mosquito repellent if using both together.
  • – Avoid insect repellent in babies and use clothing covering arms and legs instead, and cover baby strollers with mosquito net
  • – For children<3 years, do not use a mosquito repellent which mentions oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on its label in the composition.
  • – Do not use repellents over cuts, wounds, or irritated skin.
  • – Avoid inhaling repellent spray mist and do not use near food



Section C

 Differentiating Common cold, Flu and COVID

Common Cold also spreads more in the monsoons as well as in the coming winters. Due to the apprehensions related to COVID, symptoms of common cold may instill doubts of whether it is related to Coronavirus. This may lead to many people panicing and also increasing health-care burden.

Here are a few handy differentiators which can reassure you,if you have only a common cold. Flu and COVID can present similarly and are called ILI- Influenza like Illness. However there are subtle clinical differentiators. For asymptomatic people who suspect exposure to COVID, monitoring for loss of smell or taste can be useful.


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