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 –
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 –
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.
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.
Do’s and Don’ts:
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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