CLINICAL FEATURES OF DENGUE

DENGUE MANIFESTATIONS
ASYMTOMATIC- majority CLINICAL DISEASES - 2 Types I. CLASSICAL DENGUE: in majority not previously exposed to virus II. DHF: may or may not progress to DSS

IP: from being bitten by infected vector 2 to 7 days

CLASSICAL DENGUE
Prodrome 2days of malaise & headache Acute onset- fever, back ache, arthralgia, headache, gen.pains(BREAK BONE FEVER), Retroorbital pain, lacrimation, anorexia, nausea & vomiting, relative bradycardia,prostration, depression, lymphadenopathy, scleral injection. Fever- continous or saddle-back with break on 4 or 5th day and recrudescence- 7 to 8 days

 Rash initial flushing faint macular rash- 1 to 2 days Maculo papular, scarlet, morbilliform rash from 3 to5 d on trunk, spreading centrifugally, sparing palms & soles Onset often with fever defervescence May desquamate on resolution or give rise to petechiae on extensor surfaces

 Convalescence slow Complication minor bleeding from mucosal sights, hepatitis, cerebral hemorrhage or edema, rhabdomyolysis

DHF/DSS
More severe disease seen in children in SE Asia Mild forms: thrombocytopenia & hemoconcentration Most severe forms: after 3-5d of feverhypotension & circulatory failure develop with pleural effusion, ascites, hypoalbuminemia & features of ARDS Minor (petechiae, ecchymosis, epistaxis) or major (GI or CVS) haemorrhagic signs may occur

ARDS
The acute, diffuse pulmonary inflammatory response to either direct ( via airway, chest trauma) or indirect ( blood borne) insults that originate from extra pulmonary pathology characterised by I. Neutrophil sequestration in pulm. Capillaries II. Increased capillary permeability III. Protein rich pulm edema with hyaline membrane IV. Damage to type 2 pneumocytes leading to surfactant depletion V. Alveolar collapse VI. Reduced lung complaince

WHO CLASSIFICATION OF DHF

GRADE I CLINICAL DESCRIPTION Fever with non specific constitutional symp & only haemorrhagic manifestion being a +ve tourniquet test As for G I, accompanied by more haemorrhagic manifestions Signs of circulatory failure or hypotension Prolonged shock, pulse & BP undetectable (DSS)

II
III

IV

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