This document describes the case of a 70-year-old diabetic and hypertensive male who presented with fever, difficulty breathing, and drowsiness. Clinical examination found signs of pneumonia and sepsis. Investigations revealed dengue infection (positive IgM, IgG, NS1), metabolic encephalopathy, and hemorrhagic pleural effusion. The patient was diagnosed with dengue with acute lung injury and pneumonia. He received IV antibiotics, fluids, bronchodilators and supportive care. His condition improved with resolution of pneumonia seen on follow up imaging. The document then discusses dengue infection, its types and manifestations, diagnostic evaluation, and management including fluid resuscitation and symptomatic treatment.
2. HISTORY
A 70 Years old Diabetic and Hypertensive,Old CVA male
came to Emergency department with Complaints of Fever
since 5 days with difficulty in breathing since 1 day,
Drowsiness and Restless+.
Fever was
Intermittent
chills & Rigor
No h/o Vomiting / Loose stools
No h/o burning Micturition
Past history : Diabetes and Hypertension of over 12 years
duration on OHA.
3. EXAMINATION
O/E:
Conscious, Febrile- Temp- 100 F, BP-150/80,
HR-88/mt, RR-24/mt, Spo2- 84%,restless,dehydrated
Pale ,Not Icteric, No Lymphadenopathy / Pedal odema
Systemic Examination:
RS- BAE+,Rt Lower zone Minimal basal crepts
CVS- S1 S2+
P/A- Soft,Non tender,No organomegaly,
CNS- No signs of Meningeal irritation,Drowsy,Mild
Restless
8. Course in the Hospital
On admission to ER ,Patient was given Nasal O2,
Started on Empirical Antibiotic therapy Meropenem &
Moxifloxacin, Bronchodilators,Caripill(Papaya
Extract),Nilavembu Kashayam and 3%NS.
Percutaneous USG Guided Pleural Tapping
done,250ml of Hemorrhagic Pleural fluid apirated.
Strict Diabetic and Hypertension control
Adequate Hydration
Fluid C/S Showed No growth,
Gram stain- No organism
9. FINAL DIAGNOSIS
DENGUE WITH ACUTE LUNG INJURY
PNEUMONITIS WITH HEMORRHAGIC PLEURAL EFFUSION(RT)
METABOLIC ENCEPHALOPATHY
COMORBID :
> Type II DM/HTN/old CVA.
11. DISCUSSION
DENGUE
Dengue fever is a mosquito-borne tropical disease caused
by the dengue virus (Flavi virus – Aedes egyptii Mosquito)
Incubation period: 1-10 days
Symptoms typically begin three to fourteen days after
infection.
This may include a high fever, headache,
vomiting, muscle and joint pains , and a characteristic skin
rash . Recovery generally takes two to seven days.
In a small proportion of cases, the disease develops into the
life-threatening dengue hemorrhagic fever, resulting
in bleeding, low levels of blood platelets and blood
plasma leakage, or into dengue shock syndrome,
where dangerously low blood pressure occurs.
14. DENGUE HEMORRHAGIC FEVER
Any Patient with Following 4 criteria
1) Acute Onset of fever for 2-7 days
2)Hemorrhagic Manifestation,atleast one
(-ve tourniquet test,Petechiae,echymosis or
GI Bleed)
3) Thrombocytopenia(<1 lakh)
4) Evidence of plasma leak (Hematocrit>20%,
Pleural effusion, low serum albumin)
15. DENGUE SHOCK SYNDROME(DSS)
All Criteria of DHF + evidence of Circulatory
Failure like
1)Rapid and weak pulse
2)Narrow pulse pressure(20mm hg)
3) Hypotension(<80/60)
16. WHO GRADING OF DHF
Useful in case of Epidemics
Grade 1-No shock only +ve tourniquet
Grade 2-No shock,Spontaneous bleeding
Grade 3-Shock
Grade 4-Profound Shock
17. INVESTIGATIONS
Physical Examination
Tourniquet test
Hb,TC.DC,ESR,Platelet Count,Hematocrit
Fever Panel(MP,Widal,Ck,Dengue,H1N1)
Sugar,Urea,Creatinine
Liver Function test
Chest X ray
USG Abdomen
CT Chest if necessary
18. Treatment
Oral Rehydration Therapy
IV Fluid therapy
NSAIDS for fever
Bronchodilators
Papaya Extract
FFP/Platelet Transfusion, If Hematocrit is decreasing –
Packed cell or Whole blood is recommended.
Can use Loop diuretic(if fluid overload)
Symptomatic treatment- pleural or Ascitic tap.
19.
20.
21. Take home message
Dengue infection is preventable
disease
No direct person to person
transmission
Prevent Man-Mosquito contact to
prevent the disease.
Treatment is Rest, Fluids and
Antipyretics.
Tetravalent vaccine in development.