The flu season: How cocktail viruses and their overlapping symptoms are flooding OPDs

As 15 more patients wait at his OPD with similar complaints, Dr Chatterjee has learnt to sift through symptoms at the beginning of flu season every year. Except this year is a swamp. “The extended monsoon in September and humidity have provided ideal breeding conditions for all kinds of virus and bacteria. So there is a cocktail of microbes in the air that’s causing swine flu, influenza, Covid, dengue, chikungunya, cholera and typhoid. There has been a more than the usual surge of viral and respiratory diseases and the number of infection-related admissions in hospitals has risen across the city,” he says. Swine flu cases have risen significantly over the last two weeks.

Since most viral fevers have overlapping symptoms, identifying the cause becomes difficult without a diagnostic test. Also with one virus weakening the immune system, the patient becomes vulnerable to other viruses floating around. Sometimes, two different viruses may affect the patient concurrently. For example, in cases of co-infection, the severity of the H1N1 virus or swine flu may be less obvious because of the immune suppression caused by dengue. Both viruses can cause organ damage, so it’s important to evaluate such patients on the basis of laboratory tests.

Cocktail viruses and their overlapping symptoms.

WHEN DENGUE GETS WORSE

On his round of the dengue ward, Dr Chatterjee stops to evaluate Yogesh Gupta, 46, from Shahjahanpur in Uttar Pradesh (UP), who is being discharged after five days. His condition became severe because he has Type 2 diabetes. Explaining why dengue can worsen among diabetics, Dr Chatterjee says, “Such a patient already has a much weakened immunity, fragile blood vessels and a higher risk of hemorrhage. Dengue can cause a stress response that increases the amount of hormones that work against insulin, which regulates the use of sugar for energy. This can lead to high blood sugar levels. Diabetes with obesity can exacerbate dengue symptoms too by increasing the permeability of the endothelial cells or lining of blood vessels and causing fluid shifts.” This is the reason why dengue patients are advised to maintain fluid balance and hydrate themselves.

Another 46-year-old patient from Panipat is critical in the ICU. Dr Chatterjee says, “She was given drugs without, I suspect, being tested. Sometimes, you might be infected with a different type of dengue virus after an initial infection and your immune response can worsen symptoms. She was taken to different OPDs before her condition deteriorated and she came to us. Her blood vessels may have become leaky and her platelets are dropping sharply,” he says. The fever may go between the third and the fifth day but that doesn’t mean the virus is on the wane. “The severity of dengue depends on your disease management. One has to be vigilant for bleeding gums, blood in vomit, breathlessness and seek medical attention immediately,” says Dr Chatterjee.

THE SWINE FLU SWAMP

However, his concern at the moment is swine flu. “The problem is that symptoms of viral infections mimic each other, including runny nose, sneezing, sore throat, loose motions, fever and vomiting. Swine flu is also a respiratory tract infection,” says Dr Chatterjee.

Swine flu, caused by the influenza virus H1N1, which has been around since 2009, may last for three to five days, with a cough lasting for a slightly longer time. The condition of some patients with comorbidities can become serious. “The trouble with swine flu is that though it is usually confined to the upper respiratory tract, it can, in weakened immune systems, get down into your lungs. The air sacs in your lungs then get infected, inflamed and fill up with fluid. There is a sudden fall in oxygen saturation and the patient has to be admitted to hospital. Besides, while fighting the virus, the patient may contract a secondary bacterial infection that can attack a weak lung, causing pneumonia,” says Dr Chatterjee.

Some of the severe manifestations of the disease is because people start taking antibiotics and certain pain medications on their own without consulting the doctor. “What patients need are antivirals but only when the doctor thinks their use is warranted. Antibiotics won’t take care of the virus and can complicate the infection by compromising your immune system’s ability to fight the virus and also building resistance to future bacterial infections,” says Dr Chatterjee.

He attributes the swine flu wave to the fact that with post-Covid social distancing norms not adhered to, these viruses spread through droplets from coughing or sneezing by the infected. “It is good to mask up in public places and focus on hand hygiene,” suggests Dr Chatterjee.

OTHER TROUBLING FEVERS

There are some cases of acute febrile illness, where patients have a high fever lasting five to seven days. Usually these are milder viral infections and patients recover with a standard line of treatment. Some bacterial infections may be severe and need injectable antibiotics and hospital admissions. “There is a lot of gastroenteritis infections, including cholera and typhoid, primarily due to waterborne bacteria that affect people in poorly drained urban areas. A person gets affected by ingesting contaminated water and food in the rainy season,” says Dr Chatterjee. He advises hydration as a key treatment strategy for all infections to maintain electrolyte balance and flush out toxins or phlegm (in cases of chest infections).