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Prevention of Dengue

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  1. 1. DENGUE FEVER Dr.N.C.Nanda Jt.Director, HOD- Paediatrics IGH,Rourkela
  2. 2. Aedes Mosquito
  3. 3. Burden of Dengue Illness• Predilection for Paed- age group& high mortality• One disease entity with wide spectrum of Clinical Presentation• Unpredictable clinical evolution & outcome• WHO System for classifying DEN. Syndromes to 5 grades• Three arbitrary phases (DHF/DSS) (Febrile Leaky Congestive)
  4. 4. World Distribution of Dengue Fever and the Principal Epidemic Vector, Aedes aegypti
  5. 5. Average Annual No. Of DF & DHF CasesReported to WHO & Countries Reporting Dengue
  6. 6. Dengue Case Classification & Levels of Severity Non Severe Dengue
  7. 7. Course of Dengue Illness Febrile Phase Defervescence Defervescence Phase Phase Critical Phase Critical PhaseRecovery Phase Recovery Phase RecoveryNormal Death Normal Death
  8. 8. WHO System for Classifying Dengue Syndromes
  9. 9. The Course of Dengue Illness
  10. 10. Clinical Observation• Febrile Phase - Fever,Hepatomegaly Bleeding Sites• Leaky Phase - Restlessness,Serous effusion, (Around defervescence) Oligaria,Hypotension,Shock, DIVC,MOI• Congestive Phase - 12-24 Hrs• Convalescence - Bradycardia Confluent Rash• Unusual Manifestation- Hepatic and Cardiac failure CNS involvement
  11. 11. Diagnosis• Clinical• Haematological - TLC,Platelet count, HCT, Se.protein,Enzymes, Coag.profile,E/O DIC• Virological Virus isolation - Mosquito Antigen detection - NS1 DV ag (ELISA) Molecular Method - PCR Serology - HAI, CF,NT,EIA, MAC-ELISA, IF,Immunoblot.• Others : ECG – Bradycardia CXR – PL.Effusion
  12. 12. Frequently ObservedClinical Sign Lab Findings• Fever • HCT, Thrombocytopenia• Flushing • SGPT & SGOT• Hepatomegaly • Hypoalbuminimia• Vomiting• Ascitis & Pl.Effusion • Hyponatrimia• Pain Abd. • Hyperkalimia• Bleeding SIGNS • Hypernatrimia• Encephalitis • Hyperkalimia• Bradycardia • + ve CRP• ARDS
  13. 13. Differential Diagnosis of Dengue Fever
  14. 14. Warning Signs
  15. 15. Admission Criteria
  16. 16. Haemodynamic assessment: Continuum of Haemodynamic Changes
  17. 17. Management• Entirely symptomatic and supportive but early• Careful monitoring of physical signs and Lab result• Early recognition and active intervention of ominous signsOPD SETTINGS : Limited drugs Counsel parentsHOSPITAL MANAGEMENT :IV line and CVP line Lab sample IV fluid therapy Clinical monitoring Transfusion of platelet/blood Use of vasopressor and steroids Monitor and intervene in
  18. 18. Algorithm For Fluid Management In Hypotensive Shock
  19. 19. Algorithm For Fluid Management in Compensated Shock
  20. 20. Good Clinical Practice & Bad Clinical Practice
  21. 21. Prognosis Favourable• High index of suspicion• Early recognition of plasma leak• Close monitoring Thrombocyte count and HCT• Early transfusion of platelet when needed
  22. 22. REASONS OF MORTALITY DHF/DSSFAILURE TO RECOGNISE: Shock Concealed haemorrhage Congestive failure
  23. 23. MESSAGE• A complex disease, has a set clinical pattern and fixed time bound course of events.• Management relatively simple, inexpensive & very effective in saving lives - so long as high index of suspicion, early recognition understanding different phases, correct timely monitoring leading to rational supportive management leads to good clinical outcome
  24. 24. Breeding Sites of Dengue Vectors
  25. 25. PREVENTION• Dengue is preventable.• Information, Education and Communication• Key Messages Prevent Mosquito breeding (Proper water storage, Dry water storage containers, Remove disposables, Fill up ditches, Cover water with oil, Larvivorous fish) Prevent Mosquito biting (Proper clothing, Wiring doors and windows, ITB)• Local Health Department Involvement. Observe One dry Day Every Week
  26. 26. THANK YOU