Tuesday, August 18, 2015

Parliamentary Election - 2015 & Post Viral Fatigue Syndrome (PVFS) in Dengue Infection

Election results are coming in and I'm at home trying to find houses to rent. I have not been feeling well lately. Don't have motivation to do anything and mostly I feel tired and lazy nowadays. It's been a while since I posted anything to my blog and I have been avoiding to go to gym or to do any physical exercises. I thought that the fact that I had dengue fever last year might have do something with how I feel recently and was googling this morning to find about the aftereffects of dengue.

Photo credits: gettyimages, Buddihika Weerasinghe

It's been well over an year since I got dengue fever and you might remember me crying about it on my earlier post "Everything is a miracle". In the state of my mind I was, just after having experienced dengue fever, I might have felt as if everything is a miracle, but certainly I don't feel that way now. I want to feel as if everything is a miracle and be happy about the things to be happy about, yet I find myself in a position where it's very difficult to feel that way and which brings me to the 'thing' I would like to share and enrich our knowledge. Or, maybe just trying to reflect upon my observations and responses to the after effects of dengue as I experience it. In this post I intent to document the effects dengue have on me now.

PVFS, this is obviously a self-diagnosis after having read a lot on the internet and the symptoms ain't to such a degree that they limit my ability to carry out ordinary daily activities, however, it is affecting me to a level I'm unable to function to my optimum capacity or at least to a level how I was performing before suffering from dengue; physically, mentally and socially. Symptoms I identify include not having refreshing sleep, sore throat, headaches of a type not previously experienced, malaise after exertion, cognitive difficulties (specially memory and attention), widespread muscle and joint pain, mental and physical exhaustion and stress or depression(mild).

As this has been so far very manageable and does not severely affect my day-to-day functioning, I like to identify this as Post Viral Depression instead of CFS(chronic fatigue syndrome). From what I read, exactly what causes this is unknown, but there are several studies and in one of them the experts think a viral infection such as dengue fever can trigger the condition. Certain bacteria have also been suggested as a cause. According to the NHS UK site, it's unclear as to why symptoms persist or get worse over time or as to why sometimes develop gradually. And other suggested causes are 1) Problems with the immune system 2) a hormone imbalance 3) psychiatric problems – some cases have been linked to mental exhaustion, stress, depression and emotional trauma 4) genes – some people may have an inherited tendency to develop. it's more common in some families 5) traumatic events – some cases have been linked to events such as surgery or a serious accident. And the site notes that it's possible that cause can be a combination of factors. The suggestion is that if you experience similar symptoms, it's best to consult a doctor as there are some other medical help sites indicate that diabetes, kidney or liver dysfunction can also be the case.

From my experience the worst part is that, it's a circle and one trigger other - a chain reaction sort of thing. The anxiety and mood disorders associated makes me sick and the sickness makes me stressed. Few of my colleagues also have had infected with Dengue Virus, yet they don't think they have any significant fatigue symptoms beyond the acute phase of infection and hospitalization.

Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore has done a study on post-infectious fatigue syndrome in dengue infection in February 2008 and they prospectively studied the incidence and factors associated with fatigue in a cohort of patients following dengue infection. They included patients with serologically confirmed dengue infection admitted to the Hospital during a dengue outbreak from Oct-Nov 2005. Their follow-ups with the patients for two months following hospital discharge, where a Fatigue Questionnaire was administrated, revealed that the significance was assessed at P < 0.05 when presence of significant fatigue was considered as the main outcome measure. Their site published the following results and concluded that the first systematic evidence that dengue can result in clinical disease beyond the acute phases of infection.

One hundred twenty-seven patients, 71 (55.9%) males and 56 (44.1%) females, of mean age 36.06 years (range, 16–70; S.D., 13.722), participated in this study. Twenty-five (19.7%) patients had dengue haemorrhagic fever and the remaining 102 (80.3%) had dengue fever. In multivariate analysis, increased age, female sex, the presence of chills, and the absence of rashes were significantly associated with the development of fatigue post-dengue infection. There was no significant association between fatigue and dengue severity. 

www.epid.gov.lk published a post stating that during the last 8 month of the year 2015, 18830 suspected dengue cases have been reported to the Epidemiology Unit from all over Sri Lanka. Approximately 49.63% of dengue cases were reported from the Western province. The highest numbers of dengue cases were reported during the fourth week of 2015. This was the time I had dengue fever and most of my colleagues from Gampaha district seem to have had Dengue fever at some point in their lives. If you like to check out the statistics, visit http://www.epid.gov.lk/web/index.php?option=com_casesanddeaths&Itemid=448&lang=en

Photo Credit : ipsnews.net

Despite of the efforts made by the Health Ministry of Sri Lanka to prevent dengue and provide information to general public (http://www.dengue.lk & http://www.dengue.health.gov.lk ) and the funding of Seventh Framework Programme of the European Community (http://www.denguetools.net), we don't seem to have the awareness required. The prevention methods used in Sri Lanka seems very ineffective and iffy. I don't really think the street posters and handouts given in the hospitals are enough to prevent dengue.

The government should at least try to strictly impose policies on Housing and Maintenance of properties in polluted areas and highly-populated cities. The drainage system is an essential part of living in a city or urban area, as it reduces flood damage by carrying water away, and in Sri Lanka, we seem to use a system almost a century old without proper maintenance. Local businesses should manage the local drainage network, including street gutters and drains. Individual property owners should be responsible for drainage systems on their property such as roof gutters, downpipes and pipelines, which generally connect to council drainage systems.

 If we don't look for a government which strictly imposes these and instead just talking about price deduction on goods and play race/ethnic card to win elections, I don't know. this will be a country full of fools.


Bennett, A., Fagioli, L., Komaroff, A., & Raoult, D. (1994). Persistent Infection with Bartonella (Rochalimaea) henselae or Afipia felis Is Unlikely to Be a Cause of Chronic Fatigue Syndrome.Clinical Infectious Diseases19(4), 804-805. doi:10.1093/clinids/19.4.804
Epid.gov.lk,. (2015). Dengue update. Retrieved 18 August 2015, from http://www.epid.gov.lk/web/index.php?option=com_content&view=article&id=171:dengue-update&catid=51:message-for-public&Itemid=487&lang=en
Forums.prohealth.com,. (2015). Postinfectious fatigue syndrome in dengue infection | ProHealth Fibromyalgia, ME/CFS and Lyme Disease Forums. Retrieved 18 August 2015, from http://forums.prohealth.com/forums/index.php?threads/postinfectious-fatigue-syndrome-in-dengue-infection.193179/
ME Association,. (2008). Post-infectious fatigue syndrome in dengue infection (revised 21/03/08). Retrieved 18 August 2015, from http://www.meassociation.org.uk/2008/03/post-infectious-fatigue-syndrome-in-dengue-infection/
MedicineNet,. (2015). Patient Comments: Dengue Fever - Describe Your Experience - Viewers Share Their Medical Experiences - MedicineNet. Retrieved 18 August 2015, from http://www.medicinenet.com/dengue_fever/patient-comments-159.htm
Mørch, K., Hanevik, K., Rivenes, A., Bødtker, J., Næss, H., & Stubhaug, B. et al. (2013). Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course.BMC Gastroenterol13(1), 28. doi:10.1186/1471-230x-13-28
Seet, R., Quek, A., & Lim, E. (2007). Post-infectious fatigue syndrome in dengue infection. Journal Of Clinical Virology38(1), 1-6. doi:10.1016/j.jcv.2006.10.011