What the mind doesn’t know, the eye cannot see
What you need to know:
- The Dengue virus is spread by the female Aedes mosquito. It is common along the Coastal region of Kenya, where outbreaks occur periodically. The last one was reported in the first half of 2021.
- 75 per cent of those infected get asymptomatic disease. Mild symptoms include fever, headache, joint pains and nausea, easily mistaken for malaria.
Tevin* sat on the bench outside the morgue. His legs felt weak and he struggled to hold down the guttural cry welling up inside him. His eyes misted over in pain. He had landed that morning and made his way from the airport to the mortuary. He couldn’t believe that his only sibling, his little sister, was no more. He was a broken man.
Catie* was 12 years younger than Tevin, barely a teenager when they lost their parents in a grisly road accident. Tevin became Catie’s parent. It therefore took a lot of convincing for Tevin to take up a lucrative opportunity to further his studies in Australia. He never left Catie alone, despite the fact that she was almost done with university. Tevin buried his face in his hands allowing the guilt to wash over him for the umpteenth time. He was right, she wasn’t safe without him!
Catie had called him complaining of feeling sick. She was convinced she had malaria, with nausea, vomiting and extreme fatigue for a week. She had been in Mombasa the previous week. He teased that she sounded pregnant. The same evening, Catie called back with the unexpected news that he was right! She was almost seven weeks along.
They had mixed feelings about it but Tevin categorically told Catie know that he got her back. His fellowship was ending in the next four months and he would be home to complete the journey with her.
Two days later, Catie’s condition worsened with drenching fevers. In the night, she developed vaginal bleeding, terrified she was losing her baby. Tevin woke up his best friend Oliver, a doctor, to check on Catie. Within the hour, they were in the hospital.
At the emergency department, everyone kept asking Catie whether she had procured an illegal abortion. She was too weak from the bleeding to protest. She was whisked off to surgery to clean out her uterus and stop the bleeding but this did not seem to work. Oliver started making frantic calls to mobilise blood donors while a hysterical Tevin struggled to get a flight home.
It was a rapid downhill for Catie. By morning, she was in the intensive care unit ; having lost her uterus in an effort to stem the tide. Tevin wasn’t able to make it in time. By the time he arrived, she was already stone cold in the morgue. He was all alone. He had lost his sole reason for living.
The doctors thought Catie had a septic abortion, which was complicated by disseminated intravascular coagulation (DIC), a condition where the blood is unable to clot, resulting in uncontrollable bleeding. The fevers wouldn’t stop either, despite the strong antibiotics. Oliver wasn’t convinced and he insisted on a postmortem.
The pathologists were not convinced either. Her womb was clean, with no obvious signs of infection. Further evaluation of Catie’s body organs and fluids was done and the results revealed the most unlikely culprit, Dengue haemorrhagic fever.
This was not a diagnosis that would even have been considered. Dengue is listed as one of the neglected tropical diseases; a viral haemorrhagic fever affecting over a hundred million people annually around the globe. Though severe cases like Catie’s are rare, they do happen, with fatal outcomes.
The Dengue virus is spread by the female Aedes mosquito. It is common along the Coastal region of Kenya, where outbreaks occur periodically. The last one was reported in the first half of 2021. 75 per cent of those infected get asymptomatic disease. Mild symptoms include fever, headache, joint pains and nausea, easily mistaken for malaria.
Severe disease affects less than five per cent, resulting in multi-system organ failure, causing the liver and kidneys to shut down, meningo-encephalitis especially in children, and bleeding disorders due to breakdown of platelets and DIC.
Any severe febrile illness greatly increases the risk of miscarriage, as was the case for Catie. The infection triggered the miscarriage, then precipitated the bleeding disorder. She never stood a chance, even with the concerted effort to give her blood and blood products. The fact that Dengue is mostly confined to the Coastal region, it wasn’t even a consideration among Catie’s doctors here in Nairobi. What the mind doesn’t know, the eye truly won’t see!
Dr Bosire is an obstetrician/gynaecologist
