DENGU

E
MARK NICHOLAS B. REYES
 DENGUE (Etiology)

•
Family Flaviviridae
•

➢
Single-stranded positive-sense RNA
•
Dengue viruses 1-4 (DENV 1-4)
•
Vectors: Mosquitoes (Aedes aegypti, A. albopictus)
 DENGUE (Etiology)

•
Vectors are infected when they feed on viremic hosts
•

•
Horizontal transmission
 DENGUE (Epidemiology)

• Aedes aegypti – principal vectors

•

➢ Breed near human habitation

➢ Using relatively fresh water
➢ Bites during the day
•

• Incubation Period: 4-7 days

Aedes aegypti Breeding Sites
Replication and Transmissionof Dengue
Virus
1. Virus transmitted 1
to human in mosquito
saliva
2
2. Virus replicates 4
in target organs

3. Virus infects white

3
blood cells and
lymphatic tissues

4. Virus released and

circulates in blood
Replication and Transmission of Dengue
Virus
• Second mosquito ingests
virus with blood
•

• Virus replicates in mosquito

midgut and other organs,
infects salivary glands
•

• Virus replicates in salivary

glands
 DENGUE (Signs and Symptoms)

st
• 1 day:
•

➢ Transient macular rash, adenopathy, palatal vesicles,

scleral injection
➢

• 3rd – 5th day:

•

➢ Maculopapular rash (trunk, extremities, face)

➢ Epistaxis, scattered petechiae, pre-existing GI lesions may
bleed
 Dengue (Signs and Symptoms)

• Dengue infection ranges from Dengue fever to more severe

dengue hemorrhagic fever.
•

• Dengue fever occurs after primary infection whereas

dengue hemorrhagic fever follows secondary infection.
 Course of Dengue Illness

• Febrile phase: Viremia-driven high fevers

•

• Critical/plasma leak phase: Plasma leak into the pleural

and abdominal cavities
•

• Recovery phase: Reabsorption of extravasated plasma and

fluids
 Febrile Phase

• Sudden high grade fever (2-7 days)

• Anorexia
• Nausea and vomiting
• Mild hemorrhagic manifestations may be present
• Progressive decrease in total white cell count
 Critical Phase

• Sudden onset of varying degrees of plasma leak

(24-48h)
• Presence of warning signs mark the beginning of
critical phase
• Progressive leukopenia
• Rapid decrease in platelet count
• Rising hematocrit level
 Dengue Warning Signs

• Abdominal pain or • Lethargy or

tenderness restlessness
• Persistent vomiting • Liver enlargement
• Clinical fluid >2cm
accumulation • Increase in hematocrit
• Mucosal bleed concurrent with rapid
decrease in platelet
count
 Recovery Phase

• Gradual reabsorption extravascular compartment fluid (48-

72h)
• General well-being improves
• Confluent erythematous or petechial rash with small areas
of normal skin
 Recovery Phase

• Hemodynamic status stabilizes

• Hematocrit stabilizes
• WBC count rises
• Platelet count rises
 Medical Complications

Febrile Dehydration: febrile seizures

Critical Shock: Severe hemorrhage: organ impairement

Recocvery Hypervolemia: acute pulmonary edema

WHO Classification of Dengue
Dengue Fever Warning Signs Severe Dengue

Probable Dengue
Abdominal pain or tenderness Severe plasma leakage
Persistent vomiting Clinical fluid
• Lives in/travels to collection Mucosal bleed Lethargy,
• Leads to shock and fluid
dengue endemic area restlessness Liver enlargement accumulation with
• Fever and any of 2 of the >2cm Increase in Hct with rapid respiratory distress
decrease in platelet count
following:
• Severe bleeding
• Nausea, vomiting
• Rash Severe organ involvement
• Aches and pains • Liver: AST or ALT >/=
• Positive Tourniquet 1000
test • CNS: Impaired
• Leukopenia consciousness
• Any warning signs • Heart and other organ
involvement
• Laboratory confirmed
Dengue
https://www.cdc.gov/dengue/clinicallab/