A small bite can be dangerous – prompt assistance is key! Assisting an elderly patient with dengue fever

When we venture into a new country, we not only encounter an unfamiliar landscape, but also a complex ecosystem comprised of various species, genes, viruses, and ecological functions that can sometimes pose health risks, especially for patients with comorbidities.

On 3 November 2023, we received an activation to assist a 75-year-old Italian man located in San Cristóbal de las Casas, in Chiapas, southern Mexico. The patient had a fever of 40°C and intense muscle pain.

Suspecting dengue fever – a disease common in the area – we directed him to the nearest medical clinic for medical attention. After some initial studies, the diagnosis of uncomplicated dengue was confirmed. Following protocols, the necessary treatment was provided to the patient, and rest was recommended.

A worsening condition

The next day, however, we received news that the patient was suffering from a high fever again. Although it is normal for dengue symptoms to persist for some days after treatment, we decided to transfer the patient to a hospital with a multidisciplinary team and adequate resources. This was due to the patient’s past clinical history, and because medical provision in rural areas is often limited. Thus, we coordinated his transfer by ground ambulance to a hospital in the state capital of Tuxtla.

During his hospitalisation, the patient remained without alarm signs, but with usual symptoms of the disease. However, the following days showed an intermittent condition, with persistent pain in specific areas of his body.

Although subsequent results indicated conditions typical of a man his age, none of them posed a vital risk. Therefore, the possibility of discharging him after several days of symptomatic stability was considered.

Moved to Mexico City

In medical care management, we acknowledge that apparent stability can change rapidly, so it is essential to remain alert and prepared for any eventuality, regardless of its magnitude.

After an unexpected new relapse, we were requested to transfer the patient to a hospital that met European Union (EU) standards. As many of the hospital options that met this standard were located in Mexico City, we coordinated the immediate transfer – which involved complex logistics, including land and air ambulances. The entire team was focused on minimising response times and ensuring the patient’s safety during transfer.

Within the high-specialty hospital, the approach began in the infectious disease and pulmonology units, where cardiac complications associated with the initial dengue presentation were identified. Therefore, the patient was transferred to the cardiac care unit, where an infectious endocarditis of the artificial aortic valve was ultimately diagnosed, requiring immediate valve replacement surgery.

Time to return home

After days of observation and monitoring, the patient showed continuous improvement. We knew it was time to plan his return home, so we organised his transfer, accompanied by his wife, and trusted doctor, from the hospital to the Mexico City airport.

This case reminds us that multiple uncertain factors can affect a clinical picture in unpredictable ways, underscoring the importance of having a team with the knowledge, equipment, and tools to respond promptly and effectively to each situation.