.

2. DENV IS THE CAUSE OF
DENGUE FEVER
MOSQUITO BORNE ,SINGLE
POSITIVE STRANDED RNA
VIRUS
FAMILY – FLAVIVIRIDAE
GENUS – FLAVIVIRUS

3. FOUR SEROTYPES(DEN-1 TO
DEN -4)
SMALL 40-50 NM SPHERICAL
PARTICLES COMPOSE OF
LIPOPROTEIN ENVELOPE AND
NUCLEOCAPSID
MAJOR ENVELOPE GLYCOPROT-
EIN – E WHICH IS EXPOSED ON
THE VIRION SURFACE

4. THE MAIN VECTOR ARE AEDES-
AEGYPTI, AEDES ALBOPICTUS
AND TO A LESSER EXTENT
AEDES POLYNESINESIS.
FRESH WATER BREEDERS .
THE BITES MAY BE PAINLESS &
DO NOT FLY LONG DISTANCE

5. INCUBATION PERIOD – 8-14
DAYS

6. FIRST ATTACK OF DENGUE-
AFTER THE BITE OF AN
INFECTED MOSQUITO ,THE
VIRUS REPLICATES IN
REGIONAL LYMPH NODE AND IS
DISSEMINATED VIA THE
LYMPHATICS AND THE BLOOD
TO OTHER TISSUES.

7. REPLICATION IN THE
RETICULOENDOTHELIAL
SYSTEM AND SKIN PRODUCES
VIREMIA , WHICH BEGINS 3-7
DAYS AFTER INFECTION.
AFTER THE CLEARANCE OF THE
VIREMIA THE VIRUS PERSIST IN
THE INFECTED MONONUCLEAR
CELLS .

8. SUBSEQUENT ATTACKS OF
DENGUE – THERE IS NO CROSS
IMMUNITY BETWEEN THE
DIFFERENT SPECIES THERFORE
REINFECTION WITH DIFFERENT
SEROTYPE CAN OCCUR.
THE SPEED AND EXTENT OF
VIRAL SPREAD IS MUCH
HIGHER COMPARED TO THE
FIRST ATTCK

9. THE IMMUNE STATUS OF THE
HOST PLAYS AN IMPORTANT
ROLE IN DENGUE INFECTION
AND SUBSEQUENT
COMPLICATIONS.

10. NON NEUTRALIZING AB +
DENGUE VIRUS
VIRUS –AB COMPLEX
ENTRY OF DENGUE VIRUS INTO
THE MONONUCLEAR CELLS &
VIRAL MULTIPLICATION
(ANTIBODY DEPENDENT
ENHANCEMENT)

11. RELEASE OF CYTOKINES LIKE
TNF α & COMPLEMENT
ACTIVATION
ENDOTHELIAL SWELLING
PERIVASCULAR EDEMA,
MONONUCLEAR CELL
INFILTRATION

12. EXTENSIVE LEAKAGE OF FLUID
FROM THE INTRAVASCULAR
COMPARTMENT.

13.  RETRO ORBITAL PAIN
/MYALGIA/BREAK BONE
FEVER
 PROTRACTED
NAUSEA/VOMITING ,
DEHYDRATION
 RASH (DURING ILLNESS)

14.  WARNING SIGNS ONLY 1
 POSITIVE TOURNIQUET TEST
:> 20 PETECHIAE / SQ INCH
 LEUCOPENIA
 DX – FEVER AND ANY 2/6
FEATURES +

15. DURING DEFERVESCENCE
WHEN FEVER COMES DOWN I.E
AFTER 2-7 DAYS . IT IS CRITICAL
PERIOD
LOOK FOR
1. DENGUE SHOCK SYND –
HEMATOCRIT INCREASE
2. DENGUE HEMORRHAGIC
FEVER – PLATELET DECREASE

16. PLASMA LEAKAGE / FLUID LOSS
– PLEURAL EFFUSION , ASCITES
DECREASE BP ,HYPOTENSIVE,
SHOCK
BLEEDING
ORGAN MALFUNCTION
INCREASE SGPT

17. COMPENSATED : THREADY
PULSE , BP DECREASE
HYPOTENSIVE : PULSE (-) , BP
DECREASE

18. RESTLESSNESS/OBTUNDATIOIN
(UNDER PERFUSION OF BRAIN)
CAPILLARITIS 3 RD SPACE
LOSS ASCITES
EPISTAXIS
NAUSEA/VOMITING
PROTRACTED -DEHYDRATION

19. PLEURAL EFFUSION –
SHORTNESS OF BREATHING
HEPATOMEGALY ASCITES
HEMATOCRIT RISE >20%
ADMISSON VALUE & PLATELET
DECREASE

20. DONT USE CORTICOSTEROIDS .
THEY CAN INCREASE THE RISK OF
BLEEDING , HYPERGLYCEMIA
AND IMMUNOSUPPRESSION
DONT GIVE HALF NORMAL(0.45%)
SALINE. BEACUSE IT LEAKS INTO
3RD SPACES & MAY LEAD TO WORSE
OF ASCITES

21. DONT ASSUME THAT IV FLUID
ARE NECESSARY , FIRST CHECK
IF PATIENT CAN TAKE IT
ORALLY . USE ONLY THE
MINIMUM AMOUN T OF IV
FLUID TO KEEP THE PATIENT
WELL PERFUSION. DECREASE IV
FLUID RATE AS HEMODYNAMIC
STATUS IMPROVES

22. DENGUE WITHOUT WARNING
SYMPTOMS : A , OPD
DENGUE WITH WARNING
SYMTOMPS OR WITH
RISKFACTORS (INFANTS , >65
YRS , DM, CKD : B , IPD
DENGUE WITH PLASMA
LEKAGE OR ORGAN
MALFUNCTION : C ICU/IPD