Dengue-it! A Fever Dream

God’s timing is perfect. I am sure you have heard this before, but I was blessed with how things worked out these last few weeks.  As I mentioned in a previous blog, a couple of the SMs had been fighting dengue and I had been caring for them. I had been caring for the SMs in an airconditioned room in town. Finally, when they were over the virus and regaining strength in the aftereffects, we all returned to Familia Feliz. The night we got back, I began to have a low temperature, but I figured it was from the sleepless nights and exhaustion from the past few days.

Since I have been treating dengue for a bit, I have been able to learn a lot about the virus and some of its pathophysiology, so let me fill you in on what it is. Now, the virus itself is not contagious person-to-person but instead spread via the mosquito vector, the Aedes species (Aegypti and Albopictus). This mosquito commonly bites around dusk hours and is native to the warm tropics such as Bolivia. Compared to last year, the number of global suspected dengue cases has more than tripled, and the numbers are increasing at an alarming rate. The virus itself attacks the stem cells in the bone marrow that develop into various blood cells. This may result in leukopenia (decreasing in white blood cells), lymphocytopenia (a decrease in lymphocytes), and most dangerously, thrombocytopenia (a decrease in platelets). Since the virus is attacking the bone marrow, there is the manifestation of bone pain, commonly in the joints and back. The danger of dengue comes with the risk of hemorrhaging. Since there is a drop in platelets, which are key in blood clotting and the virus has the potential to weaken blood vessel walls, in a severe infection both can give way and cause hemorrhagic shock if not intervened with prompt medical treatment. However, this is not as common on a first infection with the virus. There are four strains of the dengue virus, with full immunity after the first infection and partial immunity to the other strains for a limited amount of time. Other symptoms of dengue include severe headaches around and behind the eyes, uncontrollable high fevers (lasting 2-7 days), nausea, diarrhea, stomach aches, rashes, and easy bruising. The virus can only be definitively diagnosed by a blood test for antibodies (IgM and IgG) and the non-structural protein 1 (NS1) of the dengue virus. Other tests are potential diagnostic tests such as the tourniquet test, which involves inflating a blood pressure cuff for a marked amount of time and then looking for petechiae in that region after deflation, with present petechiae as a positive sign. This test, I was able to perform on one of the SMs before getting a definitive blood test. Dengue is a self-limiting virus, and people usually recover well on their own with proper hydration and fever treatment. To say the least, it is not a virus I would recommend ever experiencing.

Now, after that brief rundown on dengue, I am back to tell you that my symptoms were not, in fact, from exhaustion. I began to develop a jabbing headache and back pain. I finally realized how bad I felt when I had to take care of the gate for visiting day and could not get out of bed due to the pain. I called the director and let him know that I was not feeling well.

The next day, I had a scheduled procedure in town for one of the kids, named Eliana, that was semi-urgent. I believe God gave me the energy that morning and I ended up loading up on Tylenol for the pain and fever and took Eliana into town for their procedure. I will pause here with the “me sickness” and tell you guys about my run-in with the insane curiosity of a child. A little background, someone gifted me a pepper spray keychain for my time here in Bolivia, and I have kept it on my keychain, so I have it whenever I go into town. This day, as usual, I had my pepper spray keychain on my water bottle as we waited in the hospital waiting room to go in to see the doctor. The doctor asked me to run and grab something he needed for the procedure, so I explained to Eliana that I was going quickly to pick up the supplies and I would be right back (which looking back was a mistake on my part). After about two minutes, I returned with the needed supplies, and sat down next to Eliana. Oddly, she asked me if she could go wash her hands, I replied that I did not know where the bathroom was and she could wait to was her hands. Then she pointed at my water bottle to my keychain and asked what the pepper spay was for. That is when I noticed that the safety had been unlocked and the spray had been completely emptied. I then looked at her hands and realized that they were covered in the contents of the pepper spray container. I now understood why she wanted to wash her hands. I knew that the doctor had a sink in his office, so I told her we would have to wait to go in. When we finally went in, she went to rinse her hands, but while doing so, decided to wash her face. And I’m sure you can imagine how that ended. She began crying and screaming in pain. I then tried to rinse her eyes out. I explained to the doctor what had happened and apologized for delaying the procedure. She finally calmed down, and the doctor and I had a good laugh at where her curiosity had gotten her. At first, I was angry that she had touched what was not hers, and thought that it served her right. But I realized that that was not the greatest mindset for the situation and realized that God does not get angry with us when we do things we are not supposed to, instead He must be disappointed and saddened for our disobedience. So I tried my best not to be angry and show sympathy for her pain, but I did remind her that she should not touch other people’s things without asking.

Anyways, while in town, I got a quick blood test on myself, just to rule out dengue (since I had been around dengue patients in a mosquito-populated area for so long). As a side note, I had been to the lab numerous times in the last week with the other two sick SMs, so I got to know the desk worker. As I walked into the lab, he laughed and joked that it was my turn to be sick. Thankfully, he gave me a discount on my test and agreed to send me my results so I could go back to Familia Feliz to rest. When I got back, I immediately crashed and could feel the Tylenol wearing off and my temperature rising. My test results ended up coming back positive for dengue. After this, I lay in bed for days with high fevers that would not go down much with Tylenol, severe headaches, and back pain.

It did not help that the temperature outside was in the high 90s and there was only so much a fan could do to cool me down, so I took numerous cold showers to bring down my fever. I was miserable and prayed so much on sleepless nights that God would just take the fever away and thought about how much easier it would be to deal with being sick at home in air-conditioning. The fever and back pain lasted for a little over six days during which I developed severe nausea, vomiting, and diarrhea.

A key thing during dengue fever is to stay hydrated, and with the GI symptoms, this became quite difficult. If it had been someone else, I could easily hook them up to some IV fluids to rehydrate, but that is not easy to do on oneself. Eventually, I had to go into town to check my blood labs, and there they ended up giving me some IV fluids, vitamins, antiemetics, and pain meds (fun fact: these were illegal in the States due to unwanted side effects). My front desk friend at the lab was kind enough to run some extra tests at no cost since I was back yet again, and so I learned that I had developed salmonella on top of the dengue. When I left the lab, they left the IV cannula in so that I could run fluids if I got worse again, and they prescribed me antibiotics for the salmonella. After this, I felt much better, until the nausea meds wore off. Then I had the worst bout of nausea and vomiting yet.

The problem was that the antibiotic I had started had the potential to interact with the nausea medication, so it was a waiting game till the antibiotic kicked in. This caused me to lose even more fluids, dropping my blood pressure again. I was at 98/46 and felt awful. It was an experience trying to hook up a bag of fluids and prime my own tubing, but the most difficult was trying to access the port (which was obviously different from the ones in the US, pictured below) while shaking and having fuzzy vision from the fever. I ran fluids through the night and the next day I finally began feeling better. Thankfully, a couple of days later, my fever broke, and I was left feeling so weak. It has been three or four days since my fever broke and I am still regaining my strength but feeling great. I thank God for giving me the strength to make it through dengue and salmonella.

While I was down, two other SMs came down with the same symptoms. I taught one of the other SMs how to take blood pressure and remotely monitored the SMs. At this point, one SM is over the virus and the other is still in the fever stages but doing well. While I was sick, the campus was calm, and there were no major medical emergencies, and I praise God’s timing for that.

I am glad to be back treating the kids (even if it is just giving out Band-Aids) and helping the other SMs. My favorite moment after being sick was visiting each house and seeing the kids’ faces when they saw that I was better. As I walked to Los Leones (the younger boys’ house), several of them saw me and started running at me, they ended up group hugging me which was so cute, yet terrifying watching them all run full speed at me while I was still very weak.

In closing, I would not wish dengue or salmonella on anyone. :)