Antipyretic drugs in the practice of a pediatrician: tactics of choice and rational treatment of fever in children

Author:

Amelicheva Alena Aleksandrovna medical editor

Quick transition Treatment of fever of unknown origin

Fever of unknown origin (FOU) is a condition characterized by a prolonged increase in temperature - more than 38.3 ° C - in the absence of an obvious cause, i.e. not established during the surveys.

"Gifts of Nature" - to Man

There is nothing superfluous or ill-considered in nature. The human body is also a part of nature, so an increase in body temperature is not just an unpleasant sensation, which we often try to get rid of by taking medications, but a signal of a problem in the system and at the same time a defensive reaction. It is a nonspecific coordinated response to disease. When a “stranger” invades (be it bacteria, viruses, protozoa or non-microbial foreign substances - antigens), the blood cells responsible for our immunity - leukocytes - are activated. This "army" of defenders consists of "units", each of which performs its own task. Lymphocytes, monocytes, neutrophils, eosinophils enter into the fight and secrete a special substance - leukocyte or endogenous pyrogen. When this substance acts on the thermoregulation center located in the brain, namely, in the anterior hypothalamus, body temperature rises. Against this background, numerous body defense mechanisms are activated: the phagocytic activity of macrophages increases, the production of interferons and antibodies increases. This is the so-called “pyrogenic” mechanism for increasing body temperature. This is why doctors do not recommend lowering body temperature without good reason.

When the temperature creeps up

The cause of an increase in body temperature is not always an infectious disease. Tumor cells are also capable of producing endogenous pyrogen, which is most often the cause of fever, rather than the inflammation or decay that accompanies the tumor process. In the case of the non-infectious nature of the disease and the occurrence of aseptic inflammation during mechanical and chemical damage, leukocytes also migrate to the site of damage and produce endogenous pyrogen. In all cases, the mechanism for increasing body temperature is the same. When the diagnosis is clear, the underlying disease is treated and the problem of increased body temperature is resolved simply: the disease has disappeared - body temperature has returned to normal. In these situations, normalization of body temperature is a criterion for recovery.

Principles of thermometry

The most accurate measurement of body temperature is possible only by recording the core temperature, i.e. temperature of deep tissues. Mercury thermometers and axillary temperature measurements allow you to record the temperature of superficial tissues. Recording body temperature with their help takes time, sterilization is required after each use, and they are dangerous for restless children. Mercury thermometers can be used to monitor the readings of electronic thermometers.

Measuring body temperature using liquid crystal strips applied to the forehead allows you to obtain readings only from superficial structures. The measurement accuracy is low: in some cases it is not possible to record a moderate increase in temperature. The temperature in the oral cavity is much closer to the true temperature of the deep parts of the body. But measuring oral temperature requires the child to remain calm. The temperature in the rectum almost completely corresponds to the temperature of the core. However, children react negatively to this procedure; the presence of feces in the rectum affects the accuracy of measurements.

The gold standard is measuring temperature with a tympanic thermometer, which detects infrared radiation from the eardrum. The accuracy of measurements corresponds to rectal ones, but the procedure lasts no more than 2 s and does not require the child’s cooperation [3, 4].

Fever percentage

Things are more complicated when doctors are faced with a disease called “fever of unknown origin” (FOU). Unlike a simple increase in body temperature, fever is characterized by disruption of all body systems. You may experience rapid heartbeat, profuse sweating, joint and muscle pain, headaches, lack of appetite, and increased blood pressure. We can talk about LNG when fever is the main or only sign of the disease, body temperature reaches 38 degrees Celsius or higher, lasts for three or more weeks, and the diagnosis remains unclear even after a week-long examination using routine (generally accepted ) methods. Doctors have to deal with a variety of pathologies, which may initially be designated as LNG. With a more detailed examination, up to 50% of cases are due to infectious and inflammatory processes; 20-30% - on tumors; a pathology difficult to diagnose, united under the name “systemic connective tissue lesions” ranges from 10% to 20%; another 10-20% falls on diseases of various origins; and the share of undeciphered fevers remains 5-10%.

Fever of unknown origin

Fever is an increase in body temperature above its normal fluctuations as a result of changes in the thermoregulatory center - the hypothalamus. But not every increase in temperature can be considered a fever. Hyperthermia, or overheating of the body with an increase in body temperature, occurs with so-called heat diseases (heat stroke, hyperthyroidism, poisoning with certain poisons (muscle relaxants, ephedrine, caffeine, anesthetics), with artificial therapeutic hyperthermia).

Fever of unknown origin (FOU) means body hyperthermia above the individual norm (more than 37.8°C), lasting continuously for more than 3 weeks, documented by medical workers, when after a complete examination of the patient there is no reliable diagnosis.

True fever occurs with infectious diseases and some non-infectious diseases (tumor decay, diffuse connective tissue diseases, acute hemolysis). And, on the contrary, some infectious diseases can occur without an increase in body temperature (cholera, botulism). Therefore, in any patient with fever, specific infectious diseases must be excluded at the beginning of the examination. In this case, temperature fluctuations of up to 0.5°C during the day can be considered normal. The temperature in the mouth is usually 1°C higher than in the armpit, and in the rectum only 0.5°C.

In adolescents, fever reaches high levels (up to 42°C) more easily than in older people. The exceptions are fevers due to heatstroke, stroke and postoperative malignant hyperthermia. At the same time, a rise in temperature in older people above 39°C can cause impaired consciousness and disorientation.

Most febrile reactions are mediated by the effect of leukocyte pyrogen on the thermoregulatory center, therefore hyperthermia in many diseases of different mechanisms has essentially the same origin. Based on severity, fever is distinguished: low-grade (37.1-37.9°C), moderate (38-38.9°C), high (39-40.9°C) and hyperpyretic (41°C and above). The duration of the fever is often more important in the differential diagnosis than the height of the fever. When observing a patient, it becomes clear that the longer the fever lasts, the smaller the range of diseases to which it is characteristic. Therefore, careful monitoring of the dynamics of fever increases its differential diagnostic value.

Nosological forms do not have a direct connection with a specific type of fever, however, in some infectious diseases the temperature curve is so characteristic that it actually determines the diagnosis, for example, in malaria, relapsing fever and some others.

The following types of temperature curves are distinguished:

– Constant fever (febris continua) in which body temperature is increased to 39°C or more constantly (typhoid-paratyphoid fever, typhus);

– Laxative L. (f. remittens) with daily fluctuations of more than 1°C but not more than 2°C (ornithosis);

– Intermittent fever (f. intermittens), when there is a regular change between high and normal temperature with daily fluctuations of 3-4 ° C (malaria, etc.);

– Relapsing fever (f. reccurens) is a regular alternation of high-fever and fever-free periods of several days (relapsing fever);

– Wavy, or undulating L. (f. undulans) – a gradual increase in temperature to high numbers, followed by a gradual decrease to normal (subfebrile); then after 2-3 weeks the cycle repeats (visceral leishmaniasis, brucellosis, lymphogranulomatosis);

– Hectic, or debilitating (f. hectica) – long-term L. with very large daily fluctuations of 3-5°C with a decrease to normal (subnormal) numbers (sepsis, generalized viral infection);

– Irregular, atypical L. (f. irregularis) with large daily ranges with varying degrees of temperature increase and uncertain duration (sepsis, etc.);

– Perverted, or inverted L. (f. inverta), when the temperature is higher in the morning than in the evening.

A number of diseases are characterized by a short-term increase in temperature (acute dysentery). However, the diagnostic value of L. decreases if the same type of temperature curves can be recorded for various diseases (diffuse connective tissue diseases, tuberculosis, sepsis).

In addition to fever, patients usually have general, nonspecific symptoms: chills, general malaise, headache, sweating, palpitations, and less commonly, myalgia, arthralgia, anorexia, weight loss. Moderate anemia, increased ESR, acute phase reactions, and slight proteinuria (febrile) are often observed.

If the origin of the fever is unclear, the most complete diagnostic information about the patient is collected: an in-depth anamnesis, physical examination, a standard set of laboratory and instrumental studies. When a diagnostic hypothesis emerges, additional studies may be required based on individual indications.

The huge number of causes of fever makes it impossible to formulate a unified scheme for examining patients with LNG. Clinical experience convinces that LNG is most often of infectious origin, less often it is evidence of a tumor process, and even less often it is a manifestation of diffuse connective tissue diseases. These three groups of diseases account for up to 90% of all fevers.

Causes of prolonged elevated body temperature (fever of unknown origin)

Infectious diseases

• 1.1. Typhoid fever and paratyphoid fever
• 1.2. Brucellosis
• 1.3. Psittacosis
• 1.4. Yersiniosis and pseudotuberculosis
• 1.5. Malaria
• 1.6. Q fever
• 1.7. Tsutsugamushi fever
• 1.8. Tick-borne spirochetosis
• 1.9. HIV infection

Nonspecific infectious (purulent-septic) processes

• 2.1. Subphrenic abscess
• 2.2. Liver abscess
• 2.3. Other purulent processes in the abdominal cavity and pelvic area
• 2.4. Apostematous nephritis
• 2.5. Abscess and carbuncle of the kidney
• 2.6. Paranephritis
• 2.7. Cholangitis
• 2.8. Caroli disease
• 2.9. Osteomyelitis
• 2.10. Sepsis
• 2.11. Infective endocarditis

Tuberculosis

• 3.1. Hematogenously disseminated tuberculosis
• 3.2. Tuberculosis of mesenteric and retroperitoneal lymph nodes
• 3.3. Liver tuberculosis
• 3.4. Tuberculosis of the uterine appendages

Malignant neoplasms

• 4.1. Kidney cancer
• 4.2. Liver cancer
• 4.3. Colon cancer
• 4.4. Lymphomas
• 4.5. Acute leukemia

Systemic connective tissue diseases

• 5.1. Systemic lupus erythematosus
• 5.2. Septic variant of rheumatoid arthritis
• 5.3. Periarteritis nodosa
• 5.4. Horton's disease
• 5.5. Wissler-Fanconi subsepsis
• 5.6. Nodular panniculitis

Periodic illness

Chronic hepatitis

Recurrent thromboembolism of small branches of the pulmonary artery

Drug disease

Thermoregulation disorders of hypothalamic origin

Artificial fever of patients with hysteria

There is a person, but there is no diagnosis?

It is in the latter case that the diagnosis remains as LNG. This is the official term, and it is included in the ICD-10 (International Classification of Diseases, Tenth Revision), so the doctor who made such a diagnosis based on the results of the examination is often, to the patient’s displeasure, absolutely right. It makes more sense to leave the patient under dynamic observation than to treat him for invented chronic bronchitis or pyelonephritis, often completely unsuccessfully, or even to the detriment of the patient. LNG entails a number of problems: unclear diagnosis and, as a consequence, delay of treatment for an indefinite period, length of hospital stay, a large (often expensive) volume of examinations, and loss of patient confidence in the doctor.

Shaking, chilling, pounding... Whose fault?

Let's look in more detail at the causes of LNG. Infectious-inflammatory diseases are the largest section, which includes, in addition to infectious diseases themselves, caused by bacteria, viruses, protozoa, fungi, and purulent-inflammatory diseases of internal organs, such as abdominal abscesses, kidney diseases, and biliary tract diseases. Many infectious diseases today behave differently than they did decades ago. In the age of antibiotics and a changed ecology, microorganisms are also modified, adapting to new conditions. Tuberculosis is again relevant, which does not occur with changes in the lungs, but affects other internal organs, bones, lymph nodes, often manifested only by prolonged fever. A once forgotten disease, malaria, reappeared with fever. Only fever can manifest viral diseases - herpes, mononucleosis (Epstein-Barr virus), hepatitis B and C, human immunodeficiency virus. Due to the increased activity of ixodid ticks, Lyme disease, caused by Borrelia, which is transmitted by a tick bite, has become more frequent. Among tumors, fevers most often manifest as blood diseases or hemoblastoses, in particular, lymphoproliferative diseases (lymphogranulomatosis, lymphosarcoma), however, tumors of various organs can be accompanied by fever. Systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, systemic vasculitis and others) are a large group of diseases in which the process can begin with fever. In these cases, long-term follow-up and repeated laboratory examinations are often required. Other pathologies include diseases of the intestines, lungs, liver, thyroid gland, blood vessels of various etiologies, as well as allergic diseases, including drug fevers that occur in response to taking various drugs. In addition, there is a group of hereditary diseases that manifest themselves in adulthood with fever.

Diagnosis with test tube and microscope

The problem of LNG affects many areas of medicine and requires the attention of doctors of various specialties. And since the mechanism for increasing body temperature in the vast majority of cases is the same (we will not discuss vague subfebrile conditions, when the body temperature rises no higher than 380C for a long time and in most cases is a consequence of autonomic dysfunction or organic brain damage), then significant difficulties arise in the differential diagnosis of diseases. Selective rather than total screening is recommended. And only an experienced doctor can determine the required scope of examination after analyzing complaints, medical history, and examination results. The specialist will pay attention to paraneoplastic signs, that is, symptoms that may accompany the tumor process - specific changes in the skin, joints, blood vessels (migratory thrombophlebitis). In modern practice, the possibilities of laboratory methods are used - blood testing for specific tumor markers. To clarify the diagnosis, if infectious diseases are suspected, in addition to routine methods, serological and bacteriological tests of blood, urine, feces, and the polymerase chain reaction (PCR) method, which has 100% specificity, are used. To confirm the diagnosis of systemic connective tissue disease, repeated additional laboratory examinations (rheumatoid factor, antibodies to DNA, etc.) may be required. And in order to confirm the syndrome of autonomic dysfunction, that is, functional changes with unclear low-grade fevers, it is also necessary to conduct an examination to exclude a more serious pathology. The issue of treatment for LNG is decided individually in each specific case. In the meantime, the diagnosis is unclear, you should refrain from treatment. Only in cases of poor tolerance and possible complications (in the elderly, children and with concomitant pathologies) are drugs used to reduce body temperature, preferably paracetamol in appropriate doses.

Principles of interpretation of measurement and examination results, risk groups

In case of infectious diseases, it does not allow even untreated body temperature to rise above 41.1 °C. Hyperthermic brain damage does not develop at temperatures below 41.7 °C. There is no reliable connection between serious bacterial infections and the level of fever until it exceeds 40 °C. Teething never results in hyperthermia above 38.4°C.

Febrile seizures occur in 4% of children with high fevers and in 3% of previously healthy children over the age of 6 months. up to 6 years old. The faster the temperature rises, the higher the likelihood of febrile seizures. Repeated febrile seizures during the same episode of the disease are recorded in 10–15% of children. 40% of children later develop relapses of febrile seizures under similar conditions. The earlier the seizure episode, the more likely it is to recur. With the first episode of febrile seizures before the age of 1 year, they recur in 50% of cases, with the first episode at the age of 2 years - in 30%. Frequently ill children with high hyperthermia during each episode of illness, children with concomitant or chronic diseases are predisposed to febrile convulsions. If one of the parents had febrile seizures in childhood, the risk of seizures in the child increases by 10-20%. If 2 parents and 1 of their children had febrile seizures in childhood, the likelihood of seizures in the other child increases by 30-40%.

The likelihood of afebrile seizures (epilepsy) in the future is high if there is a family history of epilepsy, neuropsychological development disorders, craniofacial anomalies, atypical febrile seizures (long-term, focal), an episode of febrile seizures at a temperature below 39 ° C.

Among febrile children, the high-risk group [4] with a high probability of developing life-threatening conditions includes children:

- less than 3 months of age;

- with a fever of more than 40 °C (more than 38 °C for children in the first 3 months of life);

- with signs of “white” fever;

- with severe general condition;

- with a history of severe hypoxia during childbirth, prematurity, head injury and/or seizures; an episode of seizures;

— with cardiovascular or respiratory failure, stage II;

- with dehydration;

- with incessant screaming, screaming at the slightest movement or touch;

- if the child is sleeping and it is difficult to wake him up;

- with purple spots on the skin;

- with stiff neck;

- with tension of the large fontanelle;

- if the child is unable to swallow, saliva comes out of the mouth;

- if breathing is difficult and does not improve after clearing the nasal passages;

- with a high temperature that persists for more than a day.

The low-risk group [8] includes the following children, incl. early age:

- general good condition of the child; appetite is preserved, sleep is not disturbed;

- the child was born full-term;

— antimicrobial therapy was not carried out during the perinatal period;

— there was no hyperbilirubinemia;

- the child was discharged from the maternity hospital at the same time as the mother;

- the child has not been previously hospitalized;

— antibiotic therapy has not been previously administered;

— no chronic or concomitant diseases; no infections of the ear, skin, soft tissues, bones, joints;

— in blood tests, the number of leukocytes is 5000–20,000/mm3; in urine tests, the number of leukocytes is no more than 10 per field of view;

- in stool tests in children with diarrhea, the number of leukocytes is no more than 5 in the field of view.

However, even if the child’s condition is apparently good, the pediatrician must always remember the likelihood of unfavorable dynamics. Thus, at least 10% of children in the first 3 months of life with a fever above 38 °C and an initially favorable condition later manifest severe bacterial infections, including meningitis [9, 10].

Quality + quantity = the key to successful treatment

Thus, a prolonged increase in temperature is a reason to consult a doctor. In order to complete the examination as quickly as possible with an extremely informative result, it makes sense to contact multidisciplinary medical institutions, which is what CELT is. The combination of an integrated approach to the problem and a high professional level of specialists in specific areas allows the attending physician to be flexible in the choice of remedies. If necessary, doctors of various specialties gather simultaneously, without any bureaucracy, to solve a complex “borderline” problem. But if necessary, literally in the next minute you can “switch” this task to a “narrow” specialist. In the diagnostic and treatment department, in 2-3 days, you can carry out both routine tests, such as clinical blood and urine tests, biochemical blood tests, ultrasound and X-ray diagnostics of various organs, endoscopic studies of the gastrointestinal tract (esophagogastroduadeno- and colonoscopy), and special studies according to indications (blood tests for various infections, hormones, specific tumor markers, immunological studies, rheumatic tests, blood and urine cultures, computed tomography, laparoscopic diagnostics, etc.). All consultations are conducted by competent, highly specialized specialists who are able to correctly interpret research results and either exclude one or another pathology or prescribe effective treatment. But the main advantage of this approach is the participation of a therapist, who combines and summarizes all the information that comes to him about the prescribed treatment and chooses the optimal tactics to combat the disease.

Horror on mosquito wings. Dengue fever epidemic

Is there anyone who has never wanted to go on vacation to hot countries? Where are those jungle-covered islands, magical golden beaches, where the ocean surf roars and juicy pineapples, bananas, coconuts and very tasty, although overly aromatic prickly balls - durians grow? But any medal also has a reverse side, a reverse, as numismatists and falerists say. These are various tropical diseases that can attack a careless traveler and turn his trip into a very sad and edifying example. We will tell you about one of those ailments that travelers suffered many hundreds of years ago. These are tropical fevers, thanks to the light hand of some unknown scribbler, they are now called “forgotten”. The list of them is quite long, and there are at least a dozen names in it. Today we will talk about one of the most disgusting ones - dengue fever.

This disease has several frightening names, and some of them quite accurately tell us the most painful symptoms of this disgusting disease: bone crush fever, giraffe fever, joint fever, five- and seven-day fever, date disease... Initially, British doctors called it “Dandy fever” “, since the plasticity and motor skills of the patients’ movements when walking resembled the pretentious behavior of London “dandies” - idle and chic dandies. Already in the colonies this word was distorted into the Indian way. The first description of symptoms appeared in the last quarter of the 18th century during a severe epidemic on the island of Java in its capital, Batavia, as Jakarta was then called. The symptoms were somewhat different from those of malaria, yellow fever, Pappataci fever, or Zika virus. This fever, transmitted by striped mosquitoes of the species Aedis aegupti and Aedis albopictus (the former mainly attack people, the latter - monkeys), killed many people. The inhabitants of New Caledonia and French Guiana were then killed literally in the thousands.

During the American Revolutionary War in the eighteenth century, this fever afflicted the unfortunate Hessian mercenaries of Lord Cornwallis, who fought against the rebel Americans in South Carolina. During the rains - the season of their greatest prevalence - mosquitoes disabled up to half of his soldiers. It cannot be said that it was tropical fevers that drove the British out of America. But the fact that they contributed very seriously to this is a fact. Mosquito-borne fevers struck the British during the siege of Cartagena in Venezuela in the first half of the eighteenth century, as well as during their siege of Santiago de Cuba. It was because of the incredible losses that the siege of these cities was lifted, although the defenders tried a lot. In the next war, the British defeated and even took Havana. But, as the prominent British scientist S. Johnson wrote, “let not another curse of such a conquest befall my country!” At peace negotiations, the British asked the Spaniards to take Havana back.

Mosquitoes traveled with people on ships, bit sailors and passengers, were removed from ships in ports... It is known that at the beginning of the Conquest, many types of tropical fevers did not exist; they came on ships from the countries of the Old World. The soldiers of the East India Company who fought in India died from dengue fever. The epidemic decimated both the Indians who fought for their freedom during the Sepoy Rebellion and the British soldiers who came to suppress it. Thousands of French and Spanish soldiers of Admiral de Ginouille, who fought with the troops of the Vietnamese emperor in Cochin China, died from dengue fever. Epidemics affected Indonesia, Malaysia, Laos, Cambodia, India, Burma, Siam, and African countries. Mosquitoes came to Hawaii, the islands of Tonga and Fiji. They with visible pleasure bit both Europeans and black Africans or residents of Asia and Latin America. Dengue fever, along with other tropical viral fevers, has spread to almost the entire tropical and subtropical zones of the planet. Recently, the epidemic attacked Japan. And in the countries where Russian tourists especially like to go on vacation - India, Bali, Sri Lanka, Vietnam, Thailand - these mosquitoes are simply swarming with them!

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Many experts consider them just like “pets”, like bedbugs, rats and mice. The fact is that mosquitoes of the above species live not only in open reservoirs, puddles and swimming pools, but quite willingly lay their eggs in an old tire filled with water, a trough, a tank or just an uncovered bucket of water... Even in an abandoned shaving basin one of Colonial British diplomats in Siam the next morning were amazed to see vile translucent larvae. People learned to fight this scourge at the beginning of the 20th century. Destruction of swamps, cleaning and deepening of ponds, adding oil and kerosene to water, extermination and pollination of mosquito habitats with insecticides, destruction of those objects in the urban environment where mosquitoes can reproduce and breed - all these methods are suitable for controlling insects. The containers were closed, puddles and basements, flooded cellars were drained. Fines were imposed for abandoned containers.

But two world wars shifted attention to more serious problems. After World War II, dengue fever spread to 120 countries. Every year, depending on a number of factors, dengue fever infects from 50 to half a billion people and kills tens of thousands. But after the 1980s, as a result of tough measures being taken in many countries, the situation improved. In fairly developed countries, the number of cases was no longer frightening, but in developing countries few people were interested. These diseases were called “forgotten fevers” and calmed down for a couple of decades. Epidemics occurred only in poor Latin American, Asian and African countries and did not cause any particular concern among the general public.

Now, unfortunately, the issue has become acute. Warming has expanded the habitat boundaries of dangerous insects. They have already been caught in Batumi and Sukhumi. During the Olympics, only timely measures - equipping rooms with air conditioning and mosquito nets - prevented the occurrence of the disease. Potential mosquito breeding sites have been treated with excellent results. But the Russian south is not the traditional habitat of these species, so WHO is sounding the alarm. Dengue fever came to Europe. The outbreak of the epidemic first occurred in Japan. Not to mention traditional regions. We will not go into detail about scientific descriptions and explain about flavio and abroviruses; there is plenty of this information on the Internet pages. Let's talk only about the disease itself in the simplest words.

Dengue is difficult: there is intoxication, a rash, enlarged lymph nodes, severe aching and pressing pain in the muscles and even more severe pain in the joints. People who suffered from this fever, especially in its severe hemorrhagic form, unanimously claim that they have never experienced anything more disgusting and terrible in their lives. The disease develops into this severe form in only 1-2 cases out of 10. But if this happens, then there is a real danger to life - the survival rate is only 50%. In other cases, after about a week the person feels better. A severe form often occurs with re-infection and leads to a decrease in the level of platelets in the blood, “leakage” of plasma, shock, and a drop in pressure. Not long ago, two tourists from Russia died from dengue. Dengue is extremely dangerous for weakened organisms, for children, pregnant women, elderly and unhealthy people, diabetics and cardiac patients, as well as overweight people who are not able to run away or fight off mosquitoes using the newest means - an electric fly swatter.

There are four known types of dengue virus. After an illness, someone who has been affected by one type of virus receives immunity from this type of virus for a couple of years and immunity from the other three types for 2-3 months. This is usually enough to pack your suitcase and buy a ticket back to Europe. Although there are proven cases of re-infection. Most often, severe fever affects a person who has already had a mild illness. The symptoms of the disease are only partially reminiscent of the common flu. This includes an increase in temperature up to 40 degrees several times with an amplitude of 2-3 days. An increase and then a sharp decrease in heart rate, chills, pain in muscles and joints, pain in the bones and spine, a complete lack of desire to eat and drink, up to the need for fluid infusion. Loss of strength, nausea and vomiting, insomnia, swelling, redness of the face, eyes, throat, skin, rash gradually affecting the entire body, pinpoint hemorrhages, disgusting pink blisters reaching the size of a 5-ruble coin or more, itching. And this is a mild, just a mild form... Hemorrhagic fever also brings a cough that ends in bloody vomiting, an enlarged liver and lymph nodes, and severe abdominal pain. In this case, blood comes from the gums, gastrointestinal bleeding, cyanosis of the skin, and a drop in pulse and blood pressure begin. Often the patient falls into a comatose state.

At the first symptoms, you need to contact an infectious disease specialist at a medical facility, take a blood test, and detect the RNA of the dengue fever virus using the PCR method, which allows you to differentiate between different types of viruses. Doctors categorically do not advise dengue patients to take diclofenac, ibuprofen and aspirin, but advise using paracetamol and similar drugs. This is due to the low level of platelets in the blood and the blood thinning effect of the drugs mentioned. Prescribe antihistamines, support the patient with vitamins and relieve pain with analgesics. In this case, the patient should drink at least 2.5-3 liters of fluid per day: freshly squeezed juices, milk, and preferably sports drinks that maintain the balance of electrolytes in the body. In severe cases, treatment is only possible in a hospital. The administration of plasma, glucocorticoids, oxygen therapy, administration of coagulants, and the supply of fluids through a dropper are used. Today there are no specific remedies against dengue, although the vaccine developed by the well-known company Sanofri has almost passed tests, but its effect is ambiguous. They are also working on the vaccine in Japan, where over one hundred million Japanese yen were spent on this research...

But today there is no reliable cure for dengue fever. By the way, one of the tourists who died from dengue owed Thai doctors 2,000,000 rubles, and his relatives are having serious problems with this. Therefore, for everyone who is going to hot and humid countries, this is my advice: buy the best medical insurance, put clothes in your suitcase that cover your entire body. Use hotels where there are mosquito nets (mustikers). If you go into the jungle, take mosquito repellent clothing with you. After all, mosquitoes eat not only people, but also monkeys and bats, so you can catch dengue in nature. A regular air conditioner and screens on the windows are excellent protection, and a fan will simply blow away the mosquitoes and prevent them from getting closer. And, of course, use repellent. They practically guarantee your safety, as well as the absence of open containers with stagnant water nearby. Hostels in slums are not the best place to stay, although they are inexpensive. Having taken all possible measures, you can have fun and greedily eat juicy and fragrant durians. But remember that the list of “forgotten fevers” contains at least a dozen diseases similar to dengue...