Clinial Manifestations of Dengue Fever

Clinical Manifestations of Dengue Fever/DHF/DSS Dr. S. Aswini Kumar. MD Professor of Medicine Govt Medical College Hospital Thiruvananthapuram 1

Dangerous Dengue Dengue classic Dengue Hemorrhagic Fever Dengue Shock Syndrome Death 2

Dengue is a scare! It is so Can be agonizing potentially to endure fatal It is Antibiotics caused by are of no a virus help 3

Definition • Acute febrile viral illness characterized by – Fever – Headache – Bone pains – Muscle pains – Nausea & vomiting – Maculopapular Rash – Leucopenia & thrombocytopenia – Hemorrhagic manifestations 4

Dengue Virus – Flaviviridae Infection with one serotype produces life long immunity DEN 1 DEN 3 4 SEROTYPES 50nm DEN 2 DEN 4 11Kb But only temporary & partial immunity against other types 5

Vector - Aedes Egypti Mosquito Otherwise called as Tiger Mosquitoes because of dark lines Once infected mosquito remains infected for life and able to transmit to susceptible individuals 6

How do you get it? Bite by Bites Prefers Aedes usually human Egyptii by day beings 7

Epidemiology 250 250 Aedes.Aegypti is a tropical and subtropical 8 species of mosquito

Dengue Epidemic – Every 2-3y 9

Cyclical pattern - transmission Coincides with summer season Cool temperature affects mosquito survival 10

Transmission and Replication 11

First Infection 12

Second Infection 13

More serious infection Practically no antibodies are formed to 14 neutralize the DEN 2 viruses

Infected monocytes  Vasoactive Mediators  increase Vasular Permiability 15

Immunity determination 1. Enhancing and nonneutralizing antibodies • Transplacental maternal antibody • Antibody elicited by previous heterologous dengue infection 5. Infecting 2. Age serotype • Susceptibility to • Type 2 is DHF/DSS drops apparently more considerably after dangerous than 12 years of age other serotypes 4. Sequence of 3. Nutritional infection status • Serotype 1 followed by 2 • Malnutrition is more dangerous than protective. serotype 4 followed by 2 16

WHO Case Definition An acute febrile illness of 2- 7 days duration with two or more of the following manifestations: Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations 17

Dengue Clinical Syndromes 18

Clinical Spectrum Children, Travelers, Adults 19

Undifferentiated Fever May be the most common manifestation A prospective study found that more than 87% of students infected were either asymptomatic or only mildly symptomatic Other prospective studies including all age groups also demonstrated silent transmission • DS burge et al. A prospective study of Dengue infections in Bangkok – Am Jn of Trop Med Hyg 1988; 38: 172-80 20

Classical Dengue Infection Generalized Maculo-papular Rash Characteristic of Dengue Fever; uncommon in DHF & DSS 21

Hemorrhagic Meanifestations Skin hemorrhages • Petechiae, purpurae, echymoses Gingival bleeding Nasal bleeding Gastrointestinal bleeding • Hemetemesis, malena, hematochezia Hematuria Increased Menstrual flow 22

Visible Petechiae in legs A common hemorrhagic manifestation of Dengue Fever 23

Clinical case definition for Dengue Hemorrhagic fever 4 essential criteria Fever or recent history of acute fever Hemorrhagic manifestations Low Platelet count – 1,00,000/mm3 or less Objective evidence of “leaky capillaries” • Elevated hematocrit (20% or more above baseline) • Pleural or other effusions 24

Polyserositis Common in DHF Associated with Plasma Leakage 25

Temperature & Virus Positivity The relation of fever, virus titer and antibody titer with time Anti Dengue IgM by Fever Day for 55 patients with Dengue IgM only reaches levels positive 2 to 3 days after the fever falls below 38°C. This is about the 6th day of illness 26

Four grades of DHF Grade 1 • Fever and non-specific constitutional symptoms • Positive Tourniquet test is the only hemorrhagic manifestation Grade 2 • Grade 1 manifestation + spontaneous bleeding Grade 3 • Signs of circulatory failure Grade 4 • Profound shock 27

Dengue Hemorrhagic Fever 28

Thrombocytopenia in Smear Platelets are seen singly and the count is reduced 29

The Tourniquet Test for Dengue May be mildly positive or neative in Severe case of DSS 30

Clinical case definition for Dengue Shock Syndrome 4 criteria of DHF + Evidence of circulatory failure manifested indirectly by all of the following: • Rapid and weak pulse • Narrow pulse pressure< 20mmHg OR Hypotension for the age • Cold clammy skin • Altered mental status Frank shock is direct evidence of cir. failure 31

Signs and Symptoms of encephalitis/encephalopathy Associate with Acute Dengue Infection Decreased level of conciousness Lethargy, confusion, coma Nuchal rigidity Seizures Paresis 32

Dengue Encephalopathy 33

Warning signs -Dengue Shock 34

Other Fevers for Diagnosis 35

Thank You For The Patient Listening 36

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Clinial Manifestations of Dengue Fever

by Prof. Dr. Aswini Kumar

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