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FROM
DR.MONIKA
INTRODUCTION
Dengue fever is the most prevalent arthropod
borne disease caused by flavivirus.
4
serotypes of DENV (DENV 1-4) are
transmitted to humans primarily by the bite of
Aedes aegypti mosquito.
Risk of disease is higher with areas having
multiple endemic serotypes
DENV 2 and 3 Severe Disease (Epidemic
DHF)
1.
Undifferentiated fever;
2.
3.
4.
EPIDEMIOLOGY
GEOGRAPHICAL DISTRIBUTION
GEOGRAPHICAL DISTRIBUTION
Risk factors:
Construction activities
Water-storage
practices
Population movement
Heavy rainfall
Vector abundance
VECTOR OF DENGUE
Dengue is transmitted by the bite of female Aedes
mosquito
Female Aedes mosquito deposits eggs singly on
damp surfaces just above the water line. Under
optimal conditions the life cycle of aquatic stage of
Ae. Aegypti (the time taken from hatching to adult
emergence) can be as short as seven days
The eggs can survive one year without water. At
low temperature, however, it may take several
weeks to emerge.
During the rainy season, when survival is longer,
the risk of virus transmission is greater. It is a day
time feeder and can fly up to a limited distance of
400 meters. To get one full blood meal the mosquito
has to feed on several persons, infecting all of them.
PATHO-PHYSIOLOGY OF DHF
CLINICAL FEATURES
Dengue feverIncubation Period : 7-10 days
Fever : 5-7 days associated with retroorbital pain, myalgias, backpain,
polyarthralgias (break bone fever)
Rash Centrifugal distribution
Erythematous/Urticarial /
Scarlitiniform
Palmo Plantar edema and pruritus
CLINICAL FEATURES
CLINICAL FEATURES
Dengue Hemorrhagic FeverWHO classification of DHF
CLINICAL FEATURES
Dengue Shock Syndrome SBP <90mm
Narrow pulse pressure <20mm
Fluid accumulation
Severe bleeding
AST /ALT Elevation > 1000
Neurological involvement
MODS
Persistent vomiting
Mucosal bleeding
Lethargy
Hepatomegaly >2 cm
DIAGNOSIS
Diagnosis of Dengue falls in two stages :
Stage I : Fever and viremia accompanied by NS1
antigens in blood
Stage II :Early post-febrile period lasting a few weeks
when IgM and IgG antibodies are in excess.
NS1
IgM
DIAGNOSIS
Rapid Diagnostic tests Rapid
Produces
Sensitivity/specificity
MANAGEMENT
AIMS OF TREATMENT
Assess the severity of Dengue Infection.
Assurance Usual clinical outcome good
Intercept the progression early by prompt fluid
replacement
Use of Blood /Plasma substitute/ Platelets in
patient with falling hematocrit. or continuous
bleeding.
Daily Record Of
Parameters
During
Hospitalization
FLUID CHARTS
FLUID CHARTS
SIGNS OF RECOVERY
Stable pulse, blood pressure and breathing rate
Normal temperature
No evidence of external or internal bleeding
Return of appetite
No vomiting
Good urinary output
Stable haematocrit
Convalescent confluent petechiae rash
COMPLICATIONS
Hepatitis - 11%
Meningitis
Encephalitis
DIC
Myositis with Rhabdomyolysis
Increased amylase levels and pancreatic enlargement
on USG in 45%
ARDSAcute onset; Pa02/FiO2<200; Bilateral Infiltrate
on CXR
Myocardial dysfunction
Gram negative sepsis 0.5%
Fatality rate for DHF/DSS 15%
WHEN TO DISCHARGE ?
Absence of fever for at least 24 hours without the
use of antipyretics
Return of appetite
Visible clinical improvement
Good urine output
Stable haematocrit
Passing of at least 2 days after recovery from
shock
No respiratory distress
Platelet count of more than 50,000 per mm 3