Japanese Encephalitis and Dengue are caused by the flaviviruses transmitted by the bite of mosquito. Both the infections are clinically important as they are more prevalent.
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Clinical feature and diagnosis of japanese encephalitis and dengue (1)
1. Clinical feature and diagnosis of
Japanese Encephalitis and Dengue
PRESENTER:- SACHIN CHAUDHARY
RESOURCE FACULTY:- DR. PRASHANT MANI TRIPATHI
MODERATOR:- DR. SAMYOG UPRETY
2. OBJECTIVES
Clinical features of Japanese Encephalitis
Diagnosis of Japanese Encephalitis
Clinical features of Dengue
Diagnosis of Dengue
4. Clinical feature of Japanese
Encephalitis
Incubation period ranges between 5 and 15 days
1. Most of the infections occurs in childhood
2. Adult infections are less frequent
3. Mostly the disease is asymptomatic or mildly
symptomatic
5. Clinical Features
In symptomatic patients the disease
manifests in three phases:
1. Acute prodromal phase: before CNS entry by the
virus - fever, G.I. disturbances, headache, malaise etc
2. Encephalitic phase: After CNS entry by the virus-
rapid onset of high fever, neck stiffness, seizures,
spastic paralysis and death
3. Recovery phase: complete or partial recovery with
neurological deficits, cranial nerve palsies occurs
6. Prodromal Stage
It is characterised by
• Fever
• Rigors
• Headache
• Nausea & Vomiting
The Prodromal stage usually
lasts for 1 to 6 days. It can
be as short as less than 24
hours or as long as 14 days .
7. An Acute Encephalitic Stage:
Begins by the third to fifth day. The symptoms
include:
• Convulsions
• Altered sensorium, unconsciousness, coma
• Mask like face
• Stiff Neck
• Muscular Rigidity
• Tremors in fingers, tongue, eyelids and eyes.
• Abnormal movements of limbs
• Speech impairment
8. Late Stage
Characterized by the persistence of signs of
CNS injury such as,
• Mental impairment.
• Increased deep Tendon reflexes
• Paresis either of the upper or lower motor
neuron type.
• speech impairment
• Epilepsy, Abnormal movements, Behaviour
abnormalities.
11. Biochemical test
(CSF analysis)
Protein content is elevated
Glucose content may be normal
CSF usually contain excess of lymphocytes but
polymorphonuclear cells may predominant in early
stage
12. Radiology
Imaging by CT scan show low density lesions in
temporal lobe
MRI is more sensitive in detecting early abnormalities
13. Isolation of virus
It can be preformed ,but it is slow and
technically difficult ,and is often negative
because the virus has cleared by the
time the patients present to the hospital
15. Clinical Features of Dengue
fever
Fever
Pain: Headache, retro-orbital
pain, joint pain, myalgia,
arthralgia (Breakbone fever)
Rash(3-5 days)
Enlarged lymph nodes
Bleeding manifestations in
some
16. Fever
Fever is usually biphasic, temperature subsiding on
about the 3rd day and rising again about 5-6 day after
onset (saddleback form) usually last for 7-8 days.
17. Rash
1. Initial flushing faint macular
rash in first 1–2 days.
2. Maculopapular, scarlet morbilliform blanching
rash from days 3–5
on trunk, spreading centrifugally and sparing palms
and soles, onset often
with fever defervescence. May desquamate on
resolution or give rise to
petechiae on extensor surfaces
18. Clinical Criteria of Dengue
Dengue is defined by fever as reported by the patient or healthcare
provider and the presence of one or more of the following signs and
symptoms:
Nausea/vomiting
Rash
Aches and pains (e.g., headache, retro-orbital pain, joint pain,
myalgia, arthralgia)
Tourniquet test positive
Leukopenia (a total white blood cell count of <5,000/mm3), or
Any warning sign for severe dengue
19. Warning sign for severe
dengue:
Abdominal pain or tenderness
Persistent vomiting
Extravascular fluid accumulation (e.g., pleural or
pericardial effusion, ascites)
Mucosal bleeding at any site
Liver enlargement >2 centimeters
Increasing hematocrit concurrent with rapid decrease in
platelet count
20. Dengue Haemorrhagic Fever
Four cardinal feature of DHF (WHO)
• Increased vascular permeability (plasma leakage
syndrome) – evidence by hemoconcentration ≥20%^
in hematocrit, pleural effusion, or ascites
• Marked thrombocytopenia (<100,000/mm3)
• Fever lasting 2 to 7 days
• A hemorrhagic tendency (as demonstrated by
tourniquet or spontaneous bleeding : >20 petechiae in
one square inch)
21. Tourniquet test
Inflate the cuff to a
point midway
between systolic
and diastolic
pressure for
5minutes.
Positive test: 20 or
more petechiae
per sq. inch (6.25
sq cm)
22. Dengue Shock Syndrome
Criteria for DHF with shock manifested by:-
Sudden deterioration
Fall in temperature
Signs of circulatory failure
Metabolic acidosis
Internal organ bleeding
Electrolyte imbalance
23. Other uncommon symptoms
Liver failure
CNS dysfunction – encephalopathy, seizure, acute pure
motor weakness
Acute abdomen pain
24. WHO Grading of DHF
This is especially useful in epidemics.
Grade I: No shock only +ve tourniquet
Grade II: No shock, spontaneous bleeding
Grade III: Shock
Grade IV: Profound shock
25. Laboratory diagnosis
Sample Collection:
Early stages of the disease:
After the onset of illness, virus can be
detected in blood (serum, plasma)
or tissues.
At the end of acute phase of infection:
Serology is the method of choice.
26. Serological Test
Serological tests are the mainstay in the diagnosis of viral
infections.
Detection of Viral Antigen: Dengue NS1
Antigen detection
Detection of Anti-dengue antibodies
IgM/IgG ELISA: IgM detection is useful for the diagnosis
of primary Dengue infection and in distinguishing dengue
from other flavivirus infections.
Hemagglutination Inhibition Test
Rapid diagnostic kits
28. Isolation of Virus
Virus isolation in cell culture is difficult &
not the commonly used method in
diagnostic laboratories
Virus may be recovered from serum, plasma
and peripheral blood mononuclear cells.
Inoculation of a mosquito cell line with
patient serum, coupled with nucleic acid
assays to identify the recovered virus is
commonly used approach.
30. References
Davidson's Principles and Practice of Medicine 23rd
Edition
Harrison's Principles of Internal Medicine, 20th Edition
https://wwwn.cdc.gov/nndss/conditions/dengue-virus-
infections
