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Dengue fever overview 2013
 

Dengue fever overview 2013

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Dengue Fever

Dengue Fever

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    Dengue fever overview 2013 Dengue fever overview 2013 Presentation Transcript

    • Dengue Fever Mahadevappa Hunasikatti MD DPM DCR, FCCP President, Global Health Care Consultants MD PC 2826 Old Lee highway # 250, Fairfax, VA 22031 Tel: 703-573-9212: Fax: 703-573-9219 drhunasikatti@yahoo.com
    • Definition: • Most common arhtropod viral –Arboviral illness in humans. • 50-100 Millions are affected • 4 types of Flavirus • Its is transmitted by mosqitoes of the genus Aedes-aegypti
    • Epidemiology: • Most are asymptomatic 50-90% • Some result in non-specific febrile illness • Rarely –may result in complex of classic dengue fever ( DF) • Some-may result in bleeding-Dengue Hemorrhagic Fever ( DHF).
    • Spread: • Epidemic Spread: Isolated event-single viral strain. Infection incidence of 25-50%. Transmission begins in urban centers and then spreads to rest of the country • Hyper endemic Spread: Continuous circulation of multiple viral serotypes –predominant pattern of global transmission. Antibody prevalence increases with age. Most adults are immune.
    • Pathophysiology: • Mosquito borne illness • Serotypes DENV 1-4 • Aedes aegypti- is the predominant vector globally • Others: Aedes albopictus ( tiger mosquito) • Hosts: • Humans are primary reservoir for dengue.
    • Pathophysiology.. • Patients can remain infectious for 6-7 days • The viruses replicate in the salivary gland of mosquitos • Once infected- the dengue has an incubation period of 3-14 days • Replicate in dendritic cells, hepatocytes and endothelial cells
    • Clinical Features: • Recent travel to endemic region • Symptoms that begin more than 2 week after travel from endemic region-is unlikely to be Dengue fever • Prodrome: Chills • Classic: Fever, chills and severe aching ot head, back and limbs • Fever last 2-7 days –may be as high as 41 degree celsius
    • Clinical Features: • Aches all over the body ( Breakbone syndrome)-Arthralgia, Myalgia • Headache • Nausea , vomiting • Rash-maculo papular • Weakness • Sore throat • Anorexia
    • Clinical Features:-• Bleeding: Petechae, Bleeding gums, epistaxis, and hematuria • Lymphadenopathy • Saddleback fever: Fever abates for a day only to return next day • Second rash: later: lasting 1-5 days: morbilliform, maculopapular , and spares palms and soles.
    • Clinical Features:--• Recovery is generally slow –but usually complete recovery takes place. • At the time of defervescence: Danger! • --This is the time development of dengue shock or dengue hemorrhagic fever can take place.
    • Signs to watch for Dengue Hemorrhagic Fever:-• • • • • Abdominal pain Hypothermia Thrombocytopenia Altered mental state Restlessness
    • Differential Diagnosis: • • • • • • • • • • • • Malaria Ebola virus Chikungunya fever West Nile Encephalitis ITP Influenza Hepatitis Meningitis Yellow fever Rocky Mountain Spotted fever Leptospirosis Rickettsial infection
    • Diagnosis: • • • • • • • • Blood-Isolation of virus Ig G and Ig M titers to dengue virus antigens PCR in CSF or Serum CBC CMP Serum patient and albumin Liver Panel DIC Panel
    • Diagnosis Dengue Fever:-• • • • Characteristics: -Thrombocytopenia -Leukopenia -Moderate AST and ALT elevation
    • Dengue Hemorrhagic Fever:• • • • • • • • Increased HCT Hypoprototeinenia Increased PT Increased PTT Decreased Fibrinogen Increased Fibrin Split Products Stool: OB UA
    • Dengue Fever—Work Up:-• • • • • Chest X Ray ABG-in sever cases CT Scan of Brain-if any altered mental state Biopsy of skin lesion EKG-Non-specific
    • Reportable illness in United States: • • • • • • Remember to report to authorities in USA: -Demographics -Travel hisotry -Date of onset of illness -Hospitalized or not -Outcome
    • Work up… • Most common electrolyte abnormality: Hyponatremia • Correct metabolic acidosis • Low Albumin • Increased Transaminases • DIC
    • Case definition Dengue fever:-• • • • • • • • Serology: IgG or IgM titres -NS1 Tournquet test: postive Petechae, echymosis Purpura Bleeding from any site Thrombocytopenia Plasma leakage-Increased HCT
    • Case definition; Dengue Shock Fever:-• Narrow Pulse Pressure: < 20 mm HgElevated Diastolic pressure • Cool, Clammy skin • Hypotension • Altered Mental state
    • Treatment of Dengue Fever:--• • • • • • Self limited disease –usually Analgesia: Acetaminophen Avoid: -NSAID -ASPIRIN Corticosteroids
    • Treatment of Dengue fever:--• • • • • • IV Fluids: NS preferred: Isotonic fluids Treat any hemorrhage -PRBC -Platelet Bed rest Treat Shock –asap with adequate fluids
    • Prevention: • Mosquito Repellent: DEET: N, N Methylbenzamide • Protective clothing: Permethrine insecticide impregntion is preferable. • Mosquito netting: limited value. Aedes are active in day time • Indoor spray-eliminate mosquito vector
    • Vaccination: • No vaccine is currently available • CDC: • Tel: 1-800-232-4636
    • Thank You • If you have any questions feel free to email me: • drhunasikatti@yahoo.com