Professional Documents
Culture Documents
• Genus Flavivirus
• Family Flaviviridae
• Single-stranded RNA
• 4 serotypes (DEN-1 to 4)
• Aedes mosquitoes
• A. aegypti
• A. albopictus
• A. polynesiensis
• Tropical and
subtropical species
• Urban places
• Immature stages are
found in water-filled
habitats
The Host
Viral Replication
WBC and
Lymphatics
Replication and Transmission
Replication in
the salivary
gland
Female mosquito
ingests infected
blood
Dengue Fever
• Three phases
• Febrile phase
• Critical phase
• Recovery phase
Grade 1: fever, non specific constitutional symptoms; (+) TT- only hgic manifestation
Grade 3: signs of circulatory failure (rapid weak pulse, narrow pulse pressure, hypotension, cold
clammy skin)
◼ facial flushing
◼ skin erythema
◼ generalized body ache
• Sudden onset of
◼ myalgia and arthralgia
high-grade fever ◼ headache
• Lasts for 2-7 days ◼ sorethroat, injected pharynx,
and conjunctival injection
◼ anorexia, nausea and
vomiting
Febrile Phase
• (+) hemorrhagic
manifestations
earliest abnormality: progressive decrease
in total• wbc
enlarged and tender liver
Critical Phase
Disease notification
• In dengue-endemic countries, cases of suspected, probable
and confirmed dengue should be notified
• Public health measures
– suspected cases
• lives in or has travelled to a dengue-endemic area
• fever for three days or more
• low ordecreasing white cell counts
• thrombocytopaenia ± positive tourniquet test.
Approach to the Management
Management Decisions
Groups A Groups B
• may be sent • referred for in- Groups C
home hospital • require
• tolerate management emergency
adequate • with warning treatment and
volumes of oral signs, co- urgent referral
fluids and pass existing • severe dengue
urine at least conditions, (in critical
once every 6 • with certain phase)
hours social
Group A Action Plan
monitor:
temperature pattern, volume of fluid intake and losses, urine output, warning signs, signs of plasma
leakage and bleeding, haematocrit, and white blood cell and platelet counts
Group B (with warning signs)
Action Plan
reassess:
• haematocrit remains the same or rises only minimally 2–3 ml/kg/hr for
another 2–4 hours
• worsening vital signs and rising haematocrit rising 5–10 ml/kg/hour for 1–2
hours
Group B (with warning signs)
Action Plan
monitor:
• vital signs and peripheral perfusion (1–4 hourly until the patient is out
of the critical phase)
• urine output (4–6 hourly)
• hematocrit (before and after fluid replacement, then 6–12 hourly)
• blood glucose
• organ functions (renal profile, liver profile, coagulation profile)
Group B (without warning signs)
Action Plan
• Fluid Overload
Causes:
– excessive and/or too rapid intravenous fluids;
– incorrect use of hypotonic rather than isotonic crystalloid solutions;
– inappropriate use of large volumes of intravenous fluids in patients with
unrecognized severe bleeding;
– inappropriate transfusion of FFP, platelet concentrates and
cryoprecipitates;
– continuation of IVF after plasma leakage has resolved
– co-morbid conditions such as congenital or ischaemic heart disease, chronic
lung and renal diseases
Management of Complications
Clinical Features:
Other investigations:
– respiratory distress, difficulty in
breathing; • CXR
– rapid breathing;
– chest wall in-drawing; •ECG
– wheezing (rather than crepitations);
– large pleural effusions;
•ABG
– tense ascites;
Management of Complications
• Oxygen therapy
• Stop IVF
• When to discontinue IVF:
– stable blood pressure, pulse and peripheral perfusion;
– haematocrit decreases in the presence of a good pulse volume;
– afebrile for more than 24–48 days (without the use of antipyretics);
– resolving bowel/abdominal symptoms;
– improving urine output
• If the patient has stable haemodynamic status but is still within the critical phase,
reduce the intravenous fluid accordingly. Avoid diuretics during the plasma
leakage phase
• Patients who remain in shock with low or normal haematocrit levels but show
signs of fluid overload may have occult haemorrhage.
• Careful fresh whole blood transfusion
• repeated small boluses of a colloid solution
Criteria for Discharge
Dengue Vaccine
J. Ancheta, MD