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Dengue
- 1. D R . SA N TOSH SA H MB B S DENGUE Moderators: Dr. Keshar Bahadur Gurung Dr. Augraj Uprety
- 2. DENGUE• Dengue virus = RNA virus (SS) • Serotypes (DEN1 to 4). • Genus: Flavivirus • Family: Flaviviridae • Vector: Aedes aegypti • It is the most rapidly spreading mosquito-borne viral disease in the world. • Incubation Period: 4-10 days
- 3. • The first significant outbreak of dengue in Nepal was reported in 2006 when around 35 cases occurred. • In 2016, 5769 persons with symptoms consistent with dengue disease visited various hospitals and clinics in Nepal. Among those, 1473 were dengue-positive based on laboratory confirmation representing a marked increase compared to previous years. • The highest number of cases was in Chitwan district followed by other southern Nepal districts Jhapa, Rupandehi and Makwanpur; however clinical dengue cases were reported over a wide geographic area, in 32 of Nepal’s 75 total districts.
- 4. As observed in previous outbreaks as well, there was a sharp increase in both the number of mosquitos and number of dengue disease cases during and soon after the monsoon season of June–September. Recent outbreak in Eastern Nepal In total, 560 people have been diagnosed with dengue in Jhapa, Morang and Sunsari districts so far this year. As many as 368 people have been diagnosed with the mosquito borne disease in Dharan alone.
- 5. AEDES AEGYPTI • This mosquito is a tropical and subtropical species widely distributed around the world, mostly between latitudes 35º N and 35º S. • Most favourable is 25º C ± 5º C. • Also, because of lower temperatures, Ae. Aegypti is relatively uncommon above 1000 metres.
- 6. • Breeds near Human habitation • Water Storage Container, Water Reservoirs, • Overhead Tanks, Under Refrigerator Tray • Desert Coolers, Air cooler Tray • Domestic Junks, Flower pots and plates • Unused Tyres found in and around households. • The eggs can remain viable for many months in the absence of water and emerges within 24 hours once it comes in contact with water. • Daytime feeder.
- 7. BREEDING OF AEDES AEGYPTI
- 9. CASE DEFINITION • Suspected case: An acute febrile case with any of clinical presentation from tropics or with travel history within a last two weeks. • Definite cases: Clinical suspicion with positive antigen detection test (NS1) or PCR or four fold rise in IgM/IgG titre. • Severe dengue: Definite dengue case with any one of the warning signs (Mucosal bleeding, Worsening abdominal pain, On going vomiting, Hepatomegaly, High haematocrit with low platelets).
- 11. Dengue Rash
- 13. DENGUE HAEMORRHAGIC FEVER • WHO criteria for DHF • Fever or recent H/O fever lasting 2-7 days • Any haemorrhagic manifestation • Positive tourniquet test/ Petechiae/Hematomas • Epistaxis/Gingival bleeding/Hematuria • Hematemesis/Melena/Vaginal bleeding/Intracranial bleeding • Thrombocytopenia (<100,000) • Evidence of increased vascular permeability (Plasma leakage) Presence of any one of following confirms plasma leakage • Hct rises ≥ 20% • Hct declines by ≥ 20% of the baseline Hct after volume replacement • Pleural Effusion/Ascites • Hypoproteinemia or Hypoalbuminemia
- 14. DENGUE SHOCK SYNDROME • Any case that meets the criteria for DHF with evidence of circulatory failure • Rapid weak pulse • Narrow pulse pressure (≤ 20 mmHg) • Hypotension • Restless • Cold clammy skin • Oliguria/Anuria
- 22. PREVENTION
- 25. Hom Prasad Limbu, 78 yr Male from Dharan Admitted in CCU on 02/03/2076 through ER C/C: Fever since 7 days Malaise, Headache NS1 positive with haemorrhagic manifestations Presented in DHF Grade III Past H/O: Ca. Sigmoid colon diagnosed 4 months back Sigmoidectomy done 2 months back and under Chemotherapy (2 cycles completed) On admission Platelets count was 18000 Managed with IV fluids and PRP 7 pints/ FFP 2 pints/ PCV 3 pints Today’s Platelet count is 40000 Vitals are stable.
- 26. Concluded