Dengue virus is transmitted by mosquitoes and causes dengue fever. It has four serotypes. Symptoms include fever, rash, and bleeding. During the critical period after fever subsides, plasma leakage can cause dengue shock syndrome. Treatment involves rehydration and careful fluid management to avoid further plasma leakage. Outcomes depend on virus serotype and patient immune status.

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
DF IS FOUND MOSTLY
DURING AND SHORTLY
AFTER THE RAINY SEASON

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 – SADDLEBACK
PATTERN ( TEMP RISES UP TO
40-41.5 C
 PROTRACTED
NAUSEA/VOMITING ,
DEHYDRATION

14. RASH (DURING ILLNESS)
(MACULOPAPULAR RASH OR
MACULAR)

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

16. 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

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

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

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

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

21. 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

22. 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

23. DONT GIVE PLATLET
TRANSFUSIONS FOR A LOW
PLATLET COUNT – NEVER TO BE
GIVEN AS PROPHYLACTIC
BEACAUSE ANTIBODIES ARE
PRESENT IN PATIENT , THEY
WOULD DISTROYED THE
PLATLETS

24. PLT COUNTS <25000 WITH
BLEEDING
PLT COUNT <10000 WITHOUT
BLEEDING

25. 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

26.  CBC – LEUKOPENIA ,MAINLY
NEUTROPENIA AND MILD
THROBOCYTOPENIA &
SEVERE THROBOCYTOPENIA
MAY OCCUR IN DHF
 NS-1 ANTIGEN ( POSITIVE ON
THE FIRSTDAY

27. MAC -ELISA- IGM 4TIMES
HIGHER (POSITIVE ON DAY 4 OF
ILLNESS)
NUCLEIC ACID AMPLIFICATION
TEST

28. FOR GROUP A
 AWRNESS OF CRITICAL
PERIOD
 DEHYDRATION – SUNKEN
EYEBALL,DRY ORAL MUCOSA,
COLD CLAMMY EXTREMITIES

29. FEVER- PCM ( COX 1 INHIBITORS
ARE C/I AS THEY ARE
INTERFERE WITH THE
FUNCTION OF PLATELETS)
ON ARRIVAL MONITOR
PATIENT’S CCTV-R
• C-COLOR OF PTS –PALLOR

30. C-CAPILLARY REFILL TIME (N -
<3 SEC)
T-TEMPERATURE(COLD
CLAMMY LIMBS)
V-VOLUME OF PULSE
R – RATE OF PULSE
WOULD HELP TO DECIDE IF
PTS REQUIRE AGGRESSIVE
FLUID RESUSCITATION OR NOT

31. GROUP B (WARNING
SIGN+&RISK FACTOR+)
4 HOURLY VITAL MONITORING
I-O MONITORING
CRYSTALOIDS:NS/RL
5-7 ML/KG/HR: 2 HR(FIRST)
3-5 ML/KG/HR: 2HR(NEXT 2 HR)

32. HCT –REDUCING TO NORMAL
C/F : IMPROVING
3ML/KG /HR *4HR
SWITCH TO ORAL FLUID

33. IF HCT HIGH
C/F- NO IMPROVEMENT
IVF 10 ML /KG/HR*2 HRS

34. HCTHIGH HCTDECREASE
BOLUS 1-10ML/KG/HR
*1 HR BLEEDING
BOLUS2- 10ML/KG/HR
*15MIN PRBC/BT
COLLOIDS;ALBUMIN

35. AFEBRILE FOR 24 HR WITHOUT
ANTIPYRETIC
GOOD APPETITE, CLINICALLY
IMPROVED CONDITION
ADEQUATE URINE OUTPUT
STABLE HAEMATOCRIT LEVEL

36. AT LEAST 48 HRS SINCE
RECOVERY FROM SHOCK
NO RESP DISTRESS
PLT COUNT>50000 CELL/UL

37. DENGVAXIA – CYD-TDV IS A
TETRAVALENT , LIVE ATTENUATED
THE SCHEDULE THAT HAS IN
PHASE 3 CLINICAL TRIALS
INCLUDES 3 DOSES - AT 0,6,12
MONTHS
