Appetite loss may be symptom of dengue fever in elderly

By Rob Goodier

Dengue fever usually manifests as a fever, as the name implies, but among elderly patients it might strike without fever at all, but rather as appetite loss and weakness.

Those two symptoms were the most common complaints among 10 elderly patients who were diagnosed with dengue fever at a clinic in Belize, and only two actually had a fever, according to new research.

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"Once I realized that was what was happening I started to look at the disease differently for our geriatric population. My advice to physicians, when investigating dengue in a geriatric population, is to not rule out dengue in the absence of a fever, especially nocturnal fever," Dr. Ajay Hotchandani, Head Physician in the Department of Geriatrics at Mercy Clinic in Belize City, Belize, who conducted the research, told Reuters Health by email.

Dr. Hotchandani published his findings on February 6 online in the journal Tropical Doctor.

His treatment advice for these patients is to serve sports drinks and high calorie foods (there are no antiviral drugs for dengue).

"The key to treatment is patience. Substituting meals with high calorie shakes and soups, something that can be consumed with minimal expenditure of energy, is a good start," Dr. Hotchandani says.

In tropical regions where dengue is endemic, doctors are trained to look for fever but not for anorexia, Dr. Hotchandani writes in his paper.

Anorexia and appetite loss are not even listed as symptoms of the disease on several major medical information Web sites, including the Web site US Centers for Disease Control and Prevention.

But eight out of Dr. Hotchandani's 10 elderly patients (mean age, 72) diagnosed with dengue presented with appetite loss, and nine presented with weakness, according to the report.

The average weight loss was 7.3 pounds. In the two most extreme cases, one patient lost 24 pounds and another lost 15 pounds in one month or less.

The patients represented every case of dengue diagnosed at the clinic in a six-week period during Belize's rainy season. Cases spike at that time along with the populations of dengue-spreading mosquitoes.

Worldwide, the disease afflicts 100 million people each year.

Dr. Hotchandani first treated a patient with energy drinks when his mother was diagnosed with dengue and stopped eating well.

"It gave her just enough of an energy boost to eat properly, get her daily activities done and overall, improve her psychological outlook on her condition," Dr. Hotchandani says.

SOURCE: http://bit.ly/Op5vqC

Tropical Doctor 2014.

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