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DENGUE

PEDIA WARD WORK (GROUP 3)

DENGUE

Also called Break bone fever, Dengue Fever

Dengue viruses (DENV 1, DENV 2, DENV 3, or


DENV 4)

Transmission: Mosquito bite

Vector: Aedes aegypti

Incubation Period: 3-14 days

Epidemiology

40% of worlds population: Risk of dengue


transmission

Endemic: Pacific Asia, America, Africa, Carribean

50-100 million infections yearly

500,000 DHF cases

22,000 deaths, Mostly among children

Source (WHO, 2014)

Pathophysiology

Clinical Manifestations

Signs and symptoms

chills
erythematous mottling of the skin
facial flushing, which may last for 2-3 days.
a nonspecific febrile syndrome
a maculopapular rash.

Accompanying symptoms in patients


with dengue may include any of the
following:

Headache
Retro-orbital pain
Severe myalgias
Arthralgias
Nausea and vomiting (diarrhea is rare)
Rash: A maculopapular or macular
confluent rash
Weakness
Altered taste sensation
Anorexia
Sore throat
Mild hemorrhagic manifestations
Lymphadenopathy

Diagnosis

Laboratory criteria for the diagnosis of dengue


include 1 or more of the following:
Isolation of the dengue virus from serum, plasma,
leukocytes, or autopsy samples
Demonstration of a fourfold or greater change in
reciprocal immunoglobulin G (IgG) or IgM antibody
titers to 1 or more dengue virus antigens in paired
serum samples
Demonstration of dengue virus antigen in autopsy
tissue via immunohistochemistry or
immunofluorescence or in serum samples via enzyme
immunoassay (EIA)
Detection of viral genomic sequences in autopsy
tissue, serum, or cerebral spinal fluid (CSF) samples
via polymerase chain reaction (PCR) assay

laboratory tests should also be performed in the


workup of patients with possible dengue:

Complete blood count (CBC)


Metabolic panel
Serum protein and albumin levels
Liver panel
Disseminated intravascular coagulation
(DIC) panel

Characteristic findings in dengue


fever are as follows:
Thrombocytopenia (platelet count < 100 x
109/L)
Leukopenia
Mild to moderate elevation of aspartate
aminotransferase and alanine
aminotransferase values

In patients with dengue hemorrhagic fever,


the following may be present

Increased hematocrit level secondary to


plasma extravasation and/or third-space
fluid loss
Hypoproteinemia
Prolonged prothrombin time
Prolonged activated partial thromboplastin
time
Decreased fibrinogen
Increased amount of fibrin split products

Imaging studies

Chest radiography
Head computed
tomography (CT) scanning
without contrast
Ultrasonography:

Differential
Diagnosis

Chikunggunya
Typhoid Fever

Chikunggunya
In Chikungunya the onset of the disease is
more acute and the duration of fever is
much shorter.
A maculopapular rash is more frequent in
Chikungunya, while petechia may occur in
dengue fever.
In Chikungunya the pain is much more
pronounced and localized to the joints and
tendons in comparison of dengue fever,
which the pain is generalized.

Symptoms
Chikunggunya
headache
rash
arthralgias
myalgia
Bleeding dyscrasia

Typhoid fever
An acute illness associated with fever
caused by the Salmonella typhi bacteria.
It can also be caused by Salmonella
paratyphi, a related bacterium that usually
caused a less severe illness

Mode of transmission
Typhoid fever is contracted by drinking or
eating the bacteria in contaminated food or
water.
People with acute illness can contaminate the
surrounding water supply through stool, which
contains a high concentration of bacteria.
Bacteria can survive for weeks in water or
dried sewage
About 3-5% of people become carriers of the
bacteria after an acute illness

Typhoid fever
fever
Headache
Generalized aches and pains
Poor appetite
lethargy
diarrhea

Treatment and
Management

www.cdc.gov/dengue/resources/DENGUE-clinician-

Group A

Febrile state 2-7 days and subsequent


critical phase(1-2 days) check for:
CBC
Hydration
Watch out for warning signs and decreasing
hematocrit and platelet
Watch for defervescence

www.cdc.gov/dengue/resources/DENG
UE-clinician-guide_508.pdf

OUTPATIENT Managemenet

Control fever
Acetaminophen (do not give ibuprofen, aspirin,)

Prevent dehydration
Watch out for signs of dehydration

Prevent spread of dengue in the house


Watch for warning signs as temperature
decline 3-8 days after symptom begin

Signs of bleeding and abdominal pain

www.cdc.gov/dengue/resources/DENG
UE-clinician-guide_508.pdf

Group B Patients with


warning signs

www.cdc.gov/dengue/resources/DENGUE-clinician-

www.cdc.gov/dengue/resources/DENGUE-

Group C Emergency
management

www.cdc.gov/dengue/resources/DENGUE-clinician-

www.cdc.gov/dengue/resources/DENG
UE-clinician-guide_508.pdf

Prevention
Environmental: Get rid of mosquito breeding
places
Vaccine: May be available in the near
future.

Thank you!