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Dengue fever


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Dengue fever

  1. 1. Dengue FeverA World Wide Problem
  2. 2. IntroductionDengue is an arthropod-borne disease caused byany one of four closely related viruses. Infectionwith one serotype of dengue virus providesimmunity to that serotype for life. A person can beinfected as many as four times, once with eachserotype. Dengue viruses are transmitted fromperson to person by Aedes mosquitoes (mostoften Aedes aegypti) in the domestic environment.Endemic in Asia for many years, In the past 20years, dengue transmission and the frequency ofdengue epidemics has increased greatly in mosttropical countries of the American region
  3. 3. The Culprit ! Aedes aegypti,
  4. 4. Distribution
  5. 5. Symptoms and Signs Fever Pain Anorexia Abdominal Pain Nausea and Vomiting Petechial Rash
  6. 6. Exam Appearance Fever range 102 to 105 Tourniquet Test Liver/Epigastric Tenderness Lab Findings: CBC, UA special tests XRAY: Pleural Effusions,
  7. 7. Clinical Case Definition forDengue Hemorrhagic Fever 4 Necessary Criteria: Fever, or recent history of acute fever Hemorrhagic manifestations Low platelet count (100,000/mm3 or less) Objective evidence of “leaky capillaries:” – elevated hematocrit (20% or more over baseline) – low albumin – pleural or other effusions
  8. 8. Laboratory Tests in Dengue Fever Clinical laboratory tests – CBC--WBC, platelets, hematocrit – Albumin – Liver function tests – Urine--check for microscopic hematuria Dengue-specific tests – Virus isolation – Serology
  9. 9. Pleural Effusion PEI = A/B x 100 B AVaughn DW, Green S, Kalayanarooj S, et al. Dengue in the early febrile CENTERS FOR DISEASE CONTROLphase: viremia and antibody responses. J Infect Dis 1997; 176:322-30. AND PREVENTION
  10. 10. Positive Tourniquet Test
  11. 11. Clinical Course 4 to 7 Days Bimodal Course (? Multiple strains) Recovery When to worry
  12. 12. Warning Signs for Dengue Shock Alarm Signals: Alarm Signals: •• Severe abdominal pain Severe abdominal pain •• Prolonged vomiting Prolonged vomitingFour Criteria for DHF: Four Criteria for DHF: •• Abrupt change from fever Abrupt change from fever•• Fever Fever•• Hemorrhagic manifestations Hemorrhagic manifestations•• Excessive capillary permeability Excessive capillary permeability••≤ 100,000/mm33platelets ≤ 100,000/mm platelets to to hypothermia hypothermia Initial Warning Signals: Initial Warning Signals: •• Disappearance of fever ••WhenPatients Develop Change in levelof Patients of Change in levelDevelop When Disappearance of fever consciousness (irritability consciousness (irritability •• Drop in platelets DSS: DSS: Drop in platelets •• Increase in hematocrit Increase in hematocrit •• 3 to 6 days after onset of 3 to 6 days after onset of or or somnolence)
  13. 13. Treatment Careful watch of Vital Signs IV Hydration Monitoring of CBC (Esp HCT and Platelet Cnt) “Judicious use of platelets” “ICU” care
  14. 14. Post Dengue Syndrome Depression Chronic Fatigue Neuropathy Arthritis/Arthalgia