Role of Anti-Miasmatic or Intercurrent Remedy  In Dengue Shock Syndrome

dengue fever

Drs. Rakesh Gupta, Parizad Damania and Komal Gupta share a case of dengue shock syndrome to demonstrate the role of an anti-miasmatic or intercurrent remedy in dengue shock syndrome

Rakesh Gupta, Parizad Damania, Komal Gupta

Abstract:  Miasm often influences the clinical behaviour of the contracted disease as seen in this case. Understanding the miasmatic background from the clinical presentation of the disease and prescribing an anti-miasmatic remedy is one of the methods of prescribing. When a well indicated remedy fails to complete the cure, adminstration of anti miasmatic remedy revived the depleted state of susceptibility (shock syndrome) and restored back the sensitivity of the indicated remedy to complete the cure. Integrated understanding of clinical disease behaviour, concept of pathogenicity, concept of host immunity and application of theory of miasm in the light of modern medical knowledge widens the role of homoeopathy in various febrile diseases.

Key words: Deaf Dumb, Dengue, Shock, miasmatic influence, fulminant course, Tubercular miasm, Platelet count, Thrombocytopenia, ARDS, Boenninghausen’s approach.

Case Study

A 14 years old, deaf and dumb female arrived with complaints of fever with chills since 3 days and was admitted in the hospital on 8/9/17 at 10 pm. History was explained by the patient in sign language to her father and later the father reported all the symptoms to the physician.

History of Present Complaints:

CHILL All over the body; wants covering, no thirst during chills.
HEAT:   Thirst extreme 3+

Headache – forehead >pressure 3+

>cold application 2+ body ache >pressure 3

Vertigo 3+ > lying down < opening eyes

SWEAT :No thirst

Pain in limbs > pressure 3+

Generals:

 

Tongue-  Thick white coated. (See Figure 1)

Sleep- sleeplessness since 3 days,

Thermally – Hot, Desires fan in general.

Examination findings General examination

Pulse: 116/min       SPO2- 99%      RR: 27/min

Temperature:103 F                        BP: 100/70 mm Hg

Systemic examination

CNS: Conscious and Well oriented ; CVS: Normal

RS: AEBE clear ;   P/A: Liver just palpable.

Investigations

(September 8, 2017)

CBCHb- 12.2   WBC- 3, 340,   N- 71      L-24                                                                                RBC- 4.89            Platelets- 94,000

SGPT- 22; Urine routine   PC- 2-4/hpf , EC- 2-4/hpf

Malarial Parasite: Negative

Dengue Ns1ag: Positive

        Figure 1

Classification of Disease:  Acute dynamic disease with fully developed symptoms.

Approach: Boenninghausen’s:

  • Principal of generalization
  • Prime importance of modality
  • Importance of physical general.
  • Concept of totality- location sensation and modality.
  • Doctrine of concomitant.

This particular case is rich in concomitants and modalities, so Boenninghausen’s approach can be used.

Totality and Repertorization: Radar Software

Figure 2

DateSymptomsTreatment given
8/9/17 night  Bryonia 200 1st dilution every 10-15 minutes
9/9/17 (Morning)Bodyache minimal relief; Fever minimal relief; Headache was better.

Temp 101oF

RS – Air entry bilateral Normal.

INVESTIGATIONS:

Hb- 13.8,     RBC- 5.30

WBC- 5,800, Platelets: 16,000 (fig 3)   

SGPT: 104,

S. Bilirubin: 0.5 (D-0.2, I- 0.3)

S. Creatinine: 0.9

S. Electrolytes: Na+- 131,

K+ – 4.1,  Cl – 103

Bryonia 200 1st dilution every 15 minutes continued

IVF : RL à DNS à RL over 6 hrs – 8 hrs each.

09.9.17  10 pm

 

Patient was in toxic state, dull, drowsiness2+

Pain in retrosternal region

Urine output reduced

BP: 80/60 mm Hg; Temp: 104o F

RS: AE reduced in right basal area;  CVS: S1 S2 Heard.

USG Abdomen: Gall bladder is showing thickening with small ascites and Small right pleural effusion.

Hb 13.8  Wbc: 5800  Platelets: 12,000 (fig 3)

Tub 1M 1dose given

Bryonia 200 1st dilution every 05 mins

HEAD LOW was given

IVF

RL à DNS 4 Hourly

 

 

 Interpretation of the clinical state:

Generals of the case like fever, body ache were better after starting Bryonia 200 first dilution with frequent repetition and intravenous fluids. There was clinical shock evident on 9th Sept 2017 evening as seen from following clinical signs: Drowsiness, Hypotension, Tachycardia, Urine output had reduced.

Discussion:  When a particular remedy helps partially, followed by a state of clinical shock, it is interpreted that there is sudden change in the clinical behaviour of the disease state as seen from the following facts: 1.Shock   2. Overnight drop in the platelet count from 94000 (8/9/17 evening) to 16000 (9/9/17 morning) and later to 12000 (9/9/17 evening); Overall platelet had decreased by 82000 in 24 hrs.

This phenomenon of deterioration in the clinical state (shock state) after initial amelioration and sudden drop in platelet count,  reflects a fulminant state of susceptibility and the role of the Tubercular miasm.

Brief understanding of the Clinical course of Tubercular Miasm

1.     Tardy convalescence and protracted recovery from acute and chronic infections.

2.     Easy suppuration and delayed healing.

3.     Healing through fibrosis, scarring, scars break down often; periodicity of such experience;

4.     Diabetic acceleration of these processes.

5.     Reduced resistance to infections following an attack of respiratory infection, pertussis, measles and other viral infections.

6.     Patient seems to be apparently recovering but suddenly febrile paroxysm reappears.

7.     Unusual exhaustion or post infections, difficult convalescence.

8.     Depletion of resources and exhaustion.

So, a dose of Tuberculinum was introduced in order to revive the susceptibility

and remove the identifiable block from the case.

Caution:  As the patient was in the state of shock, there is a possibility of over infusion of the intravenous fluid if not monitored properly, which can worsen the pulmonary edema and result in complication. So proper respiratory auscultation should be done in order to diagnose the onset of pulmonary edema before the complications sets in.

10.09.17

Morning

No Headache

No vertigo

Pain in abdomen better

Cough same

Pain in legs better

Temp 100F

Bryonia 200 1st dilution every 15 mins.

IVF– DNSà RLà DNSà RL over 6 hourly.

Hb: 14.9   WBC: 13,900   RBC: 5.69 Platelets- 21,000 (fig 3)

Urine Routine: Pus cells- 2-4/ hpf , EC- 1-2/ hpf.

S. Proteins; Total- 4.9; S.Albumin- 2.9; S.Globulin- 2.0

X ray chest PA: Increased bronchovascular markings;

It was done in view of rising WBC count, in order to rule out ARDS or any pulmonary infection.

11.09.17

Morning

Fever better but still persistent,

Cough was better,

Abdominal Pain mild

Leg pains are better since fever is reduced.

Temp – 100 – 99 f

Bryonia 200 1st dilution every 15 mins

 

IVF– DNSà RLà DNSà RL over 6 hourly.

Hb: 11.9       WBC: 9,500                  RBC: 4.31             Platelets: 23,000 (fig 3)
12-9-17Symptoms were better

Temp 99o F

Bryonia 200 1st dilution every 30 mins

IVF– DNSà RLà DNSà RL over 6 hourly.

Hb- 14.9                 WBC- 8,200               RBC- 4.30       Platelets- 62,000

(fig 3)

13-9-17

Morning

Symptoms completely better

Temp 98 F

Bryonia 200 1st dilution every 60 mins

No IVF – encouraged plenty of fluids.

13/9/17: Hb- 11.2       WBC- 8,700            Platelets- 1,50,000. (fig 3)

Patient was discharged because there was overall improvement at subjective level, objective level, Clinical Parameter and Investigations. Treatment on discharge – Bryonia 200 1st dilution every three hourly.

 

Figure 3

Discussions & Conclusions:  Dengue shock state in case of dengue fever often occurs in patients where there is secondary infection with the other serotype (total four serotypes) of the dengue virus other than in primary infection. Primary infection with a particular type serotype of virus often confers immunity against all the four serotype dengue viruses for three months. In this particular case, there was no past history of any form of acute febrile illness in the last one year, which makes it less likely that current infection is secondary infection of dengue virus. This kind of disease phenomenon is suggestive of fulminant viral infection or compromised host immunity. If proper homoeopathic interpretation is done than it means, there is impaired state of host susceptibility which is directly dependent on the miasmatic influence on the host individual. The effective conceptualization of tubercular miasm and intervention with Tuberculinum in this particular case has helped to remove the miasmatic block by resolving the shock state and reviving the vitality.

Learning:

  • History taking in deaf and dumb patient and role of objective history taking.
  • Identifying the block in the due course of treatment and intervening with appropriate therapeutic strategy.
  • Role of miasmatic understanding based on clinical behavior of the disease in Acute diseases.
  • Concept of Boenninghausen’s approach.
  • Role of auxiliary and ancillary line of treatment in order to maintain the hemodynamic vitality of the patient
  • Concept of pathogenesis in cases of fever.

Acknowledgement

Dr Mohanbhai Pa Hon Chairman, The Homeopathic Education Society, Smt Chandaben Mohanbhai Patel Homeopathic Medical college, Mumbai.

Dr Asmita Parikh: Hon General Secretary, The Homeopathic Education Society, Smt Chandaben Mohanbhai Patel Homeopathic Medical college, Mumbai.

Figure 4

Figure 5

 

About the author

Rakesh Gupta

Rakesh Gupta

Dr Rakesh Gupta MD (HOM) BHMS (SMT CMPH Medical College) practices in Mumbai . He had nine years clinical experience in OPD and IPD in a hospital and was a homoeopathic consultant at Satva Homoeopathic Clinic and Masjid Bunder Clinic. He was also junior homoeopathic consultant in the Department of Medicine, Casualty, ICU and Ophthalmology at the M.L.Dhawale Memorial Trust Hospital. From 2004 to the present he has given numerous case presentations. He is currrently Head Of Department Forensic Medicine and Toxicology, Smt C.M.P.H. Medical college, Vile Parle (West), Mumbai & Honorary Homoeopathic Consultant Shree Mumbadevi Homoeopathic Hospital, Vile Parle (West), Mumbai.

About the author

Parizad Damania

Dr. Parizad Damania - MD(Hom) Principal, Smt CMPH Medical College (20th Feb 2016 –present. Head of Department and Professor of Pharmacy (2005 till 2016). Academic Council – Faculty of Homoeopathy – Mumbai University – Ad hoc Committee Member from 8th January 1999 – 2002. On panel for selection of examiners for BHMS degree course – 7thJanuary 2000 till August 2002. Examiner and Convener – Homoeopathic Pharmacy – I BHMS; M.D. (Hom) – University of Mumbai and MUHS, Nashik. Project Director for
homoeopathic pathogenetic trial - Carica papaya, Influenzinum, Cortisone, Histaminum.

About the author

Komal Gupta

Dr Komal Gupta BHMS, PGDPC - Resident Medical officer at Sangeeta Maternity Hospital and Nirmaya Homeopathic Clinic.

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