Dengue PPT

2. Introduction
 Dengue fever (Bone Breaking Fever) is a vector borne
fever, caused by a virus known as arbovirus which is
spread by the bite of mosquitoes (Aedes-aegypti, main
vector of the disease).
 Is a single-stranded RNA viruses that belong to the family
Flaviviridae and the genus Flavivirus.

3.  This is also known as Break bone fever, because this fever produces
very much pain in bones and joints.
 Dengue fever is systemic disease caused by one of four sero-types of
virus from the genus Flavivirus, which also includes the pathogens
responsible for yellow fever and Japanese encephalitis.
Principal Mosquito Vector:- Aedes aegypti
Other vectors of less importance:-
 Ae albopictus , Ae polynesiensis , Ae scutellaris
 DENV 1,2,3,4 – ARE 4 Serotypes of Flavi virus
 Once affected person acquires a life long serotype specific immunity,
but only short-term protection against the remaining 4 strains.
 The first known cases of dengue fever occurred in Batavia in 1779,
and Benjamin Rush, a prominent American Revolutionary War
physician and signer of the Declaration of Independence gave the
first detailed description of the disease when it caused an epidemic
in Philadelphia in 1780.

4.  A small percentage of persons who have previously
been infected by one dengue serotype develop
bleeding and endothelial leak upon infection with
other serotype
 This syndrome is termed as Dengue Haemorrhagic
Fever(DHF) or Dengue Vasculopathy.
 Vascular leakage in these patients results in
haemoconcentrations and serious effusions and can
lead to circulatory collapse
 This, in conjuction with severe haemmorhagic
complications, can lead to Dengue Shock
Syndrome(DSS).
 Which poses greater fatality risk than bleeding.

5. Problem Statement
 The global incidence of dengue(DHF &DSS) and their epidemics has
increased dramatically in recent decades.
 Found in:- Tropical and Sub-tropical regions around the world
 DHF is endemic in more than 100 countries in the WHO regions.
 The South-East Asia and Western pacific regions are most seriously
affected
In India:-
 Dengue is endemic in 35 states
 During 2017 157,996 cases were reported with 253 deaths
 Case fatality rate- 0.16%
 Cases peak after monsoon
 Highest no. of cases-Tamil Nadu, Kerala, Karnataka, Punjab, West
Bengal

6. Epidemiological Determinants
(a) Agent
 Aedes aegypti- Most common
 Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus
Flavivirus. Most are transmitted by arthropods (mosquitoes or ticks), and are
therefore also referred to as arboviruses (arthropod-borne viruses).
 Four Serotypes( DEN-1,2,3,4)
(b) Vector
 Aedes aegypti and Aedes albopictus has high susceptibility to infecting virus.

7. © Host:-
Human All age, monkey

8.  More likely to occur in
person who have recently travelled to affected areas.
Enviornmental Factors:-
 Urban place
 Uncontrolled population growth without appropriate water
management

9. When you see these sights, know for
sure..you have invited dengue..its near !!

11.  When a mosquito bites a person who has dengue virus in
his or her blood, the mosquito becomes infected with the
dengue virus.
 An infected mosquito can later transmit that virus to
healthy people by biting them.
 Dengue cannot be spread directly from one person to
another, and mosquitoes are necessary for transmission of
the dengue virus. This is called human-to-mosquito-to-
human cycle of transmission.
 Initially when mosquito bites a person there is no sign and
symptoms for four days.
 After four days virus multiplies in to blood stream, this
condition known as viremia. It lasts for 3- 10 day in which
patient presents classical dangue fever symptoms.
 Once the mosquito becomes infective, it remains so for life.

13. Classical Dengue Fever
 Incubation period- 3-10 days
 Fever b/w- 39 c-40 c
 Skin eruptions lasts- 1-2 days

15. Dengue Haemorrhagic Fever 3 phases

16.  Febrile [duration: 2-7 days]
 High fever (>40 degrees Celsius) associated with headache,
arthralgias & myalgias. The pain is often severe, resulting in
Dengue’s alternative name: “Break-bone fever”.
 Most individuals recover spontaneously, but some individuals will
progress to the critical phase despite resolving fever.
 Critical [duration: 1-2 days]
 Significant diffuse leakage of plasma secondary to endothelial
dysfunction which can lead to pulmonary edema, ascites,
hypovolemia & shock.
 Significant bleeding can also occur, typically from the GI tract.
 Recovery [2-3 days]
 Occurs in patients who’ve experienced the critical phase and is
characterized by resorption of leaked fluid back into the
vasculature. The recovery phase can be complicated by fluid-
overload. The most significant complication is cerebral edema.

17. Criteria for clinical diagnosis
Probable diagnosis:-
 Nausea and vomiting
 Generalized pain
 Rash
 Leukopenia
 Positive tourniquet test (A blood pressure cuff is inflated for 5 minutes,
causing petechia. A positive test is defined as at least 10-20 petechiae per
2.5cm2.)
 Any warning signs of Dengue:
 Severe abdominal pain
 Persistent vomiting
 Hepatomegaly
 Mucosal bleeding
 High hematocrit + thrombocytopenia
 Lethargy or restlessness
 Serosal effusion

18. Confirmed diagnosis:-
 Viral antigen is >90% sensitive during the febrile phase.
 Dengue virus specific antibodies (IgM and IgG) can only
be used to confirm the diagnosis during the later stages of
the infection (after 5-7 days).
 Children are at greater risk for complications even if they
have mild symptoms.
 Other risk factors for severe disease include: female sex,
high BMI, high viral load, secondary infection, and co-
morbid chronic conditions.

19. Criteria for:-

21. Laboratory Diagnosis

24.  Grading of severity of dengue Infections:-
 Presence of thrombocytopenia with concurrent
haemoconcentration differentiates Grade 1 and Grade
2 DHF from DF

26. Management:-
Of Dengue fever:-
 Encourage intake of Oral Rehydration Solution(ORS)
 Give paracetamol for high fever. Interval should not be
less than 6 hr. Sponging is adviced
 Pt. should be brought to hosptial if- no clinical
improvement, severe abdominal pain, persistent
vomiting, cold and clammy extremeties, bleeding(eg.
Black stools or coffee ground vomiting), not passin
urine for more than 4-6 hrs.

27. Of DHF(Febrile phase):-
 Paracetomol to keep temp. below 39 deg c
 Copious amount of fluid intake, ORS, IV fluid
 Pt. is closely monitored for initials signs of shock
Of DHF grade 1 & 2
 Pt. needs to be hospitalised
 Keep under observations for sign of shock
 Rise of haemoconcentration indicates IV fluid therapy
 If despite treatment the pt. develops fall in BP, dec. in urine output
 Grade 3 & 4 management should be immediately started.

29. Control Measures
Vaccines:-
 CYD-TDV- Prophylactic, tetravalent, Live attenuated viral vaccine
 Developed by:-Sanofi Pasteur in December 2015
 Dosage:- 3 injections of 0.5 ml at 6 months interval by subcutaneous
route
 Shelf life-36 months when stored b/w 2-8 deg c
 Contraindicated in:-
1. History of Severe allergic reactions to any component of dengue
vaccine
2. Individuals with congenital or acquired immune deficiency that
impairs cell mediated immunity
3. HIV

30.  Pregnant or Breast feeding women
Global strategy for dengue prevention and control
2012-2020:-
 To reduce dengue mortality by at least 50% by 2020
 To reduce dengue morbidity by at least 25% by 2020
 To estimate the true burden of the disease by 2015

31. Homeopathic Therapeutics
Eupatorium perfoliatum –
 it’s the best suited homeopathic medicine for dengue fever, where platelet
count get low and there is intense pain in joints.
 * Known as “Bone-set”, from the prompt manner in which it relieves pain in
limbs and muscles that accompanies some forms of febrile disease, like
dengue, malaria and influenza.
 Chill between 7 and 9 a.m., preceded by thirst with great soreness and aching
of bones.
Rhus toxicodendron
 wonderful action in dengue fever with chill and red vesicular eruptions, and
also acts very well in joints pain in fever
 Influenza, with aching in all bones. [Eup. perf.]

32. Arsenic album
 acts very nicely in all types of fever with restlessness mentally and
physically. This homeopathic medicine is often used as a preventive
drug for Dengue fever.
China Officinalis
 suitable homeopathic remedy in all fever with debility in body due to
loss of vital fluids.
 Debility from exhausting discharges, from loss of vital fluids…, calls
for this remedy.
 Periodicity is most marked.
Gelsemium sempervirens
 well known homeopathy remedy in fever cases with chill in spine and
also known as 3D medicine i.e. for DULLNESS DIZZINESS
DROWSINESS.
 Fever with stupor, dizziness, faintness; thirstless, prostrated.

33. ACONITUM NAPELLUS
 Acute acting homeopathic remedy in sudden fevers.
 A state of fear, anxiety; anguish of mind and body.
 Physical and mental restlessness, fright, is the most characteristic
manifestation of Aconite. Acute, sudden, and violent invasion, with
fever, call for it.
 First remedy in Inflammations and Inflammatory Fever
Crotallus horridus
 it’s a suitable homeopathic medicine in dengue fever case having
hemorrhagic tendency. It is often suggested for Dengue hemorrhagic
fever, where the platelet count goes very low.
 – Diseases caused by a previous low state of the system; low septic
typhoid or malarial fever; chronic alcoholism; exhausted vital force;
genuine collapse.
 – Hemorrhagic or broken down constitutions.
 – Hemorrhagic diathesis; blood flows from eyes, ears, nose, and every
orifice of the body; bloody sweat.

34. Belladonna
 we can think of this homeopathy medicine when the fever is of sudden and
violent nature.
 Fever
 Pulse: Ordinarily quick, often full, hard and tense, but sometimes also it is full.
 Throbbing carotid and temporal arteries.
 Other remdies:-
 Bryonia and Arnica- Lot of Ms pain and Joint pain worse with motion
and sore, lame, bruised feeling all over the body
 Phosphorus, Lachesis- Haemmorhagic diathesis
 Sulphur
 Carbo Veg
 Sillicea
 Pyrogenium

35. Thank You
 Department of Community Medicine
 Guided by:- Dr. Tejal Shah
 Presented by:- Mahima Trivedi
 Roll No:- 59