Post-Dengue Swelling: An Atypical Presentation and Diagnostic Dilemma Resolved with Herbal Decoction
DOI:
https://doi.org/10.52783/jns.v14.3130Keywords:
Dengue fever, DHF, DHS, Cellulitis, Intramuscular cysticercosis, Artemisia absinthium, Swertia chirata and Tinospora cortifoliaAbstract
Dengue fever is an important arboviral disease, transmitted by mosquitoes especially those of the Aedes genus, primarily by Aedes (Stegomyia) aegypti (Linnaeus, 1762) and in some rare cases by Aedes (Stegomyia) albopictus (Skuse) with a wide clinical spectrum, ranging from self-limiting mild sickness to life threatening conditions like dengue hemorrhagic fever (DHF) and eventually dengue shock syndrome (DSS). In the past decade, the emergence of dengue has been linked to unusual coinfections.The transitory reduction of host innate immunity could be the most likely cause of dengue-associated co-infections and/or super-infections. Furthermore, the dual infection can aggravate the clinical course of dengue fever. We are reporting an unusual case of intramuscular calf swelling in a 27-year-old male patient following dengue.The swelling yielded conflicting radiological interpretations, including intramuscular cysticercosis, cellulitis, abscess and hematoma. This diagnostic ambiguity posed significant challenges in managing the swelling. Despite these diagnostic challenges, the swelling was effectively managed with a herbal decoction made from three Unani herbs: Artemisia absinthium, Swertia chirata, and Tinospora cortifolia.
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Patel JP, Saiyed F, Hardaswani D. Dengue fever accompanied by neurological manifestations: challenges and treatment. Cureus. 2024 May;16(5)
de Almeida RR, Paim B, de Oliveira SA, Souza AS, Gomes AC, Escuissato DL, Zanetti G, Marchiori E. Dengue hemorrhagic fever: a state-of-the-art review focused in pulmonary involvement. Lung. 2017 Aug;195:389-95.
Rico-Hesse R. Molecular evolution and distribution of dengue viruses type 1 and 2 in nature. Virology. 1990 Feb 1;174(2):479-93
World Health Organization. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. New Delhi, India: World Health Organization Regional Office for South-East Asia; 2011. p. 196.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature 2013;496:504-7.
Mondal N., The resurgence of dengue epidemic and climate change in India, The Lancet. (2023) 401, 727–728, https://doi.org/10.1016/s0140-6736(23)00226-x
Dash PK, Parida MM, Saxena P, Abhyankar A, Singh CP, Tewari KN, Jana AM, Sekhar K, Rao PL. Reemergence of dengue virus type-3 (subtype-III) in India: implications for increased incidence of DHF & DSS. Virology journal. 2006 Dec;3:1-0.
Jayawickreme KP, Jayaweera DK, Weerasinghe S, Warapitiya D, Subasinghe S. A study on knowledge, attitudes and practices regarding dengue fever, its prevention and management among dengue patients presenting to a tertiary care hospital in Sri Lanka. BMC infectious diseases. 2021 Dec;21:1-4
Guo C, Zhou Z, Wen Z, Liu Y, Zeng C, Xiao D, Ou M, Han Y, Huang S, Liu D, Ye X. Global epidemiology of dengue outbreaks in 1990–2015: a systematic review and meta-analysis. Frontiers in cellular and infection microbiology. 2017 Jul 12;7:317.
See KC, Phua J, Yip HS, Yeo LL, Lim TK. Identification of concurrent bacterial infection in adult patients with dengue. Am J Trop Med Hyg 2013;89:804-10.
Trunfio M, Savoldi A, Viganò O, D’Arminio Monforte A. Bacterial coinfections in dengue virus disease: What we know and what is still obscure about an emerging concern. Infection 2017;45:1-10
Ngoi ST, Lee YW, Niek WK, Kan FK, AbuBakar S, Ponnampalavanar SS, et al. Atypical presentation of methicillin-susceptible Staphylococcus aureus infection in a dengue-positive patient: A case report with virulence genes analysis. Pathog Basel Switz 2020;9:1-6.
Trunfio M, Savoldi A, Viganò O, d’Arminio Monforte A. Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern. Infection. 2017 Feb;45:1-0.
Wasik D., Mulchandani A., and Yates M. V., A heparin-functionalized carbon nanotube-based affinity biosensor for dengue virus, Biosensors and Bioelectronics. (2017) 91, 811–816, https://doi. org/10.1016/j.bios.2017.01.017, 2-s2.0-85012240341
Tayal A, Kabra SK, Lodha R. Management of dengue: an updated review. Indian Journal of Pediatrics. 2023 Feb;90(2):168-77.
Ibn Sina., 2010. Al qanoon fit tib. (Urdu Translation by Ghulam Hussain Kantoori) New Delhi: Idara Kitabulshifa,Vol. 3, pp. 854-864.
Malavige GN, Jeewandara C, Ogg GS. Dysfunctional innate immune responses and severe dengue. Frontiers in cellular and infection microbiology. 2020 Oct 23;10:590004.
Ibn Rushd.,1987. KitabulKulliyat. (Urdu Translation by C.C.R.U.M) New Delhi: C.C.R.U.M, pp. 26,35,46,49.
Razi MBZ.,1991. KitabulMansuri(Urdu Translation). New Delhi: C.C.R.U.M, pp.132.
Khare,C.P.,Encyclopaedia of Indian Medicinal Plants, Springer Berlin, Heidenberg, NewYork. 2004; 75-76.
Ivanov M, Gašić U, Stojković D, Kostić M, Mišić D, Soković M. New evidence for Artemisia absinthium L. application in gastrointestinal ailments: ethnopharmacology, antimicrobial capacity, cytotoxicity, and phenolic profile. Evidence‐Based Complementary and Alternative Medicine. 2021;2021(1):9961089.
Bisht D, Kumar D, Kumar D, Dua K, Chellappan DK. Phytochemistry and pharmacological activity of the genus artemisia. Archives of Pharmacal Research. 2021 May;44(5):439-74.
Szopa A, Pajor J, Klin P, Rzepiela A, Elansary HO, Al-Mana FA, Mattar MA, Ekiert H. Artemisia absinthium L.—Importance in the history of medicine, the latest advances in phytochemistry and therapeutical, cosmetological and culinary uses. Plants. 2020 Aug 19;9(9):1063.
Swati K, Bhatt V, Sendri N, Bhatt P, Bhandari P. Swertia chirayita: A comprehensive review on traditional uses, phytochemistry, quality assessment and pharmacology. Journal of ethnopharmacology. 2023 Jan 10;300:115714.
Roy P, Abdulsalam FI, Pandey DK, Bhattacharjee A, Eruvaram NR, Malik T. Evaluation of antioxidant, antibacterial, and antidiabetic potential of two traditional medicinal plants of India: Swertia cordata and Swertia chirayita. Pharmacognosy research. 2015 Jun;7(Suppl 1):S57
Kapil A, Sharma S. Immunopotentiating compounds from Tinospora cordifolia. Journal of ethnopharmacology. 1997 Oct 1;58(2):89-95.
Bishayi B, Roychowdhury S, Ghosh S, Sengupta M. Hepatoprotective and immunomodulatory properties of Tinospora cordifolia in CCl4 intoxicated mature albino rats. The Journal of toxicological sciences. 2002;27(3):139-46.
Friesner RA, Banks JL, Murphy RB, Halgren TA, Klicic JJ, Mainz DT, Repasky MP, Knoll EH, Shelley M, Perry JK, Shaw DE. Glide: a new approach for rapid, accurate docking and scoring. 1. Method and assessment of docking accuracy. Journal of medicinal chemistry. 2004 Mar 25;47(7):1739-49.
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