Dengue Hemorrhagic Fever Management

7. Grading the Severity of Dengue Infection Guidelines for Treatment of DF/ DHF in Small Hospitals WHO, New Delhi, 1999 DF / DHF Grade Symptoms Labs DF Fever with two or more of the ff: headache, retro-orbital pain, myalgia, arthralgia Leukopenia Thrombocytopenia < 100,000 No evidence of plasma loss DHF I Above signs plus positive tourniquet test Thrombocytopenia <100,000 Hct rise >20% DHF II Above signs plus spontaneous bleeding Thrombocytopenia <100,000 Hct rise >20% DHF III Above signs plus circulatory failure (weak pulse, hypotension restlessness) Thrombocytopenia <100,000 Hct rise >20% DHF IV Profound shock with undetectable blood pressure and pulse Thrombocytopenia <100,000 Hct rise >20%

40. Aggressive Management of Dengue Shock Syndrome May Decrease Mortality Rate : A Suggested Protocol by: Ranjit Suchitra, Kissoon Niranjan, Jayakumar Indira Pediatric Critical Care Medicine, Vol 6 (4), July 2005, 412 - 419 W group P group Mean time of death (days) 1.4 4.5 Mortality Rate 22% 7% # of patients dying within 24 hours of admission to the ICU 13 out of 19 2 out 6 Causes of death 7 - Refractory shock 10 - MODS (ARDS and DIC) 2 - Fulminant hepatic failure 5 – Refractory shock 1 - Fulminant hepatic failure

43. Protrombin & Partial Thromboplastin Time as a Predictor of Bleeding in Patients w/ patients with DHF Chua MN, Molanida R, et al South East Asian Journal Tropical Medicine & Public Health,1993; 24(1): 141-143

51. RECOMBINANT ACTIVATED FACTOR ( rFV11a )

62. OXYGEN THERAPY

64. ROLE OF IV Ig

66. ROLE OF STEROIDS

68. DENGUE VACCINE