Many people think of dengue fever as a mild disease, given that severe dengue is estimated to only occur in one out of 20 cases. But the consequences of severe dengue can be dire, with patients often requiring extended hospitalisation and facing higher likelihood of internal bleeding, plasma leakage, organ damage, respiratory problems – and even death.

For Bahwanee Muthusamy, getting dengue fever was the start of a long and arduous journey that has lasted for more than six months, with no end in sight.

“This was my second time getting dengue fever, with the first time happening around five years ago,” she recalled. “At first, I just had a mild fever and the test done at the clinic didn’t detect dengue. I was told it was just a viral fever.

“However, by the next day, I had a terrible headache, with vomiting and diarrhoea, and my platelet count had dropped to 40. I felt so sick that I don’t even remember my trip to the hospital – my brother took me to the A&E where he was told I was in critical condition; by then, my liver was already affected. I was so weak I could not walk and was unable to eat for five days.”

In total, Bahwanee was hospitalised for two weeks and remained on medical leave for another two months. During this time, she was unable to drive or even sit up for long periods due to compressed nerves in her lower back.

“Bahwanee’s experience is known as post-dengue syndrome (PDS), which is the clinical manifestation of dengue fever that persists for more than six weeks after the acute phase is over,” consultation physician and intensivist Dr Shanthi Ratnam explained.

“It is unclear how commonly this occurs, but as it becomes more recognised, some studies have estimated its prevalence as ranging between 18% and 50%.”

Those who experience PDS are likely to have symptoms such as fatigue that can range from mild to overwhelming; musculoskeletal symptoms like muscle and joint pain or swelling of the joints; and neurological signs like poor concentration or dizziness.

However, there is no specific test to definitively identify PDS. This presents a challenge for patients and healthcare practitioners alike.

At present, clinicians who perform follow-up in hospitals are more likely to identify cases of PDS. “We conduct weekly follow-ups with patients for four weeks, by which time most will have fully recovered. In rare cases, however, we encounter patients who suffer symptoms for six weeks or longer,” Shanthi said.

To eliminate other possible causes, blood or imaging tests may be carried out. Only after excluding all other causes would a doctor conclude that a patient is experiencing post-dengue syndrome.

A long and arduous road to recovery

For Bahwanee, PDS has lasted for more than six months, and the ordeal is far from over.

“The whole experience has been a nightmare. It’s affected everything I do – even simple things like climbing the stairs is a major exertion now, and I can’t work like I used to because I get tired too easily.

“To top it off, I’m dealing with hormonal issues and haven’t had my period since getting sick. Hair loss has been another major blow. Also, my immune system is so badly affected that I fall sick easily, and even antibiotics don’t help. I also have asthma that seems to be flaring up more frequently.”

Physical issues aside, the consequences of PDS can also affect an individual’s mental health. “The experience can cause a person to get depressed, especially those who had expected that their experience with dengue would be mild,” Shanthi noted.

“For example, a young and active person may find it debilitating to be constantly tired, dizzy or in pain, have poor appetite, and be unable to resume their normal activity for weeks or even months, by which time they would have experienced loss of muscle mass and other consequences of a long illness.

“Some patients may even be in denial, unable to accept these symptoms, as they would not have heard of post-dengue syndrome before.”

With this in mind, Bahwanee advocates for ongoing vigilance, educational awareness, and a shift in public perception when it comes to dengue.

“Dengue is often dismissed as ‘just’ a fever, but look at what happened to me. I am so glad there is a dengue vaccine now, because dengue is everywhere so no one is safe. This is why we need to take it seriously, and be proactive so we can combat this threat together,” she concluded.