SHORT DESCRIPTION ABOUT DENGUE BY DR. ANAND SINGH BHADORIYA (MBBS)

1. DR. ANAND SINGH BHADORIYA
MBBS

2. Introduction
• Acute febrile illness
• Characterised by biphasic fever
• Associated with myalgia, arthralgia, rash
and possible hemorrhagic manifestations

5. Dengue viruses
• SS-RNA arbovirus (Flavivirus)
• 4 serotypes (DEN-1, 2, 3, 4)
– Based on envelop glycoprotein
– DEN-1 and 3 are more closely related
– DEN-4 less closely related to others
– Virulent variants (genotypes) within serotype
• Infection with any serotype confers specific
lifelong immunity
• Transient cross-protection to other serotypes
• Any serotype can cause severe / fatal disease

6. Epidemiology
• Vector
• Host
• Environmental factors

7. Aedes aegypti
Aedes albopictus

8. Transmission of viruses
Incubation
Period:
4-10 days
Viraemia & Fever: 5-7 days
Vector
Humidity:
Rainfall & Temp.
Susceptible hosts,
(population)
Source patients
Extrinsic
Incubation Period:
1-2 weeks

9. Pathogenesis
• Virus infects the blood mononuclear cells
with in few days of infective mosquito bite.
• Two pattern of immune response follows:

12. Pathogenesis
• Excessive cytokine release
• Increases vascular
permeability
• Plasma leakage
• Thromobocytopenia
• Excessive internal/external
bleeding
• Disseminated intravascular
coagulation

13. Spectrum of dengue

17. Clinical course
• Incubation period 3-7 days
• Three distinct phases
– Febrile phase
– Critical phase
– Recovery phase

19. Critical phase

20. Differentials
• Measles
• Chikungunya
• Meningococcal infection
• Rickettsiae
• Infectious mononucleosis
• Bacterial sepsis
Beware of co-infections
Beware of secondary HLH

24. NS-1 Antigen
• Non structural protein
• Can be detected in plasma, especially during
the first five to six days of illness.
• Initial high levels: associated with DHF
• Sensitivity : 93.4%
• Specificity :100%
• Sensitivity low in secondary infections and
after day 5 of illness.

26. Clinical evaluation
• Sensorium/Warning signs
• Hydration status: capillary refill time
• Pulse: rate, volume
• BP
• Evidence of bleeding in skin/ other sites.
• Evidence of ↑ed vascular permeability: pleural
effusions, ascites.
• Tourniquet test

28. Lab inv..
Additional tests in patients with co-
morbidities and severe disease :
• LFT
• Glucose
• RFT & serum electrolytes
• Bicarbonate or lactate
• CXR
• ECG

29. Admission criteria
• Warning signs
• Hypotension
• Bleeding
• Organ impairment
• Inv : Rising HCT, pleural effusion, ascites
• Others: pregnancy, peptic ulcer, extremes of
age

30. Treatment
• Rest
• Fluid rehydration
• Antipyretics (PCM –Drug of choice, no
aspirin/brufen)
• Monitor BP, HCT, plt, RFT, LFT, sensorium,
signs of bleeding
• Oxygen, sedation and blood product transfusion
as required
• No role of antibiotics

34. Clinical & lab criteria for pt who can
be treated at home.

38. Choice of IV fluids for resuscitation
• Crystalloids
– 0.9% saline
– Ringer’s Lactate
• Colloids
– gelatin-based,
– dextran-based
– starch-based
– albumin
• Colloids may be the preferred choice if the BP has to be restored
urgently, i.e. in those with pulse pressure less than 10 mm Hg.

39. Transfusion
• In case of severe bleeding, give 5-10 ml/Kg of PRBC or fresh
whole blood 20 ml/kg.
• WHO recommends use of PRBC or whole blood and avoid
prophylactic platelet transfusions.
• Give platelet rich plasma transfusion EXCEPTIONALLY
when platelet counts are below 5,000–10,000/ mm3 AND
CHILD IS BLEEDING

40. IV fluids---- when to stop

41. Discharge criteria

42. Monitoring chart

43. PUBLIC HEALTH
STRATEGIES
STOPPING
DENGUE

44. PUBLIC HEALTH STRATEGIES
• Vector Control
• Surveillance
• Preparation for outbreaks
• Research

45. NON-BIOLOGICAL MEANS OF
DECREASING THE
INCIDENCE OF DENGUE

46. w3.whosea.org/extrelations/ images/Bed%20net.jpg
MOSQUITO NETS

47. NO MORE MOSQUITOES!
www.mosquitobarrier.com/ images/tincan.jpg

48. Future advances

49. THANK YOU