Clinical Manifestations
           of
Dengue Fever/DHF/DSS
         Dr. S. Aswini Kumar. MD
          Professor of Medicin...
Dangerous Dengue




            Dengue classic
      Dengue Hemorrhagic Fever
     Dengue Shock Syndrome Death


        ...
Dengue is a scare!

           It is so    Can be
         agonizing    potentially
         to endure       fatal



    ...
Definition
• Acute febrile viral illness characterized by
  – Fever
  – Headache
  – Bone pains
  – Muscle pains
  – Nause...
Dengue Virus – Flaviviridae
         Infection with one serotype produces life long immunity



     DEN 1                ...
Vector - Aedes Egypti Mosquito
         Otherwise called as Tiger Mosquitoes
                because of dark lines




   ...
How do you get it?




     Bite by    Bites    Prefers
     Aedes     usually   human
     Egyptii   by day    beings



...
Epidemiology




  250

  250




        Aedes.Aegypti is a tropical and subtropical
                                    ...
Dengue Epidemic – Every 2-3y




                           9
Cyclical pattern - transmission
             Coincides with summer season




         Cool temperature affects mosquito s...
Transmission and Replication




                           11
First Infection




                  12
Second Infection




                   13
More serious infection




        Practically no antibodies are formed to
                                               ...
Infected monocytes
      Vasoactive Mediators




                        increase Vasular Permiability
                ...
Immunity determination
                        1. Enhancing and
                        nonneutralizing antibodies
       ...
WHO Case Definition

   An acute febrile illness of 2-
   7 days duration with two or
   more of the following
   manifest...
Dengue Clinical Syndromes




                            18
Clinical Spectrum

                    Children, Travelers, Adults




                                                  19
Undifferentiated Fever

    May be the most common manifestation


    A prospective study found that more than
    87% of...
Classical Dengue Infection



           Generalized Maculo-papular Rash




     Characteristic of Dengue Fever; uncommon...
Hemorrhagic Meanifestations

    Skin hemorrhages
    • Petechiae, purpurae, echymoses

    Gingival bleeding

    Nasal b...
Visible Petechiae in legs




      A common hemorrhagic manifestation of Dengue Fever
                                   ...
Clinical case definition for
Dengue Hemorrhagic fever

                  4 essential criteria

    Fever or recent history...
Polyserositis Common in DHF




       Associated with Plasma Leakage
                                        25
Temperature & Virus Positivity
       The relation of fever, virus titer and antibody titer with time

          Anti Deng...
Four grades of DHF
    Grade 1
     • Fever and non-specific constitutional symptoms
     • Positive Tourniquet test is th...
Dengue Hemorrhagic Fever




                           28
Thrombocytopenia in Smear




     Platelets are seen singly and the count is reduced
                                    ...
The Tourniquet Test for Dengue




       May be mildly positive or neative in Severe case of DSS
                        ...
Clinical case definition for
Dengue Shock Syndrome

    4 criteria of DHF +

    Evidence of circulatory failure manifeste...
Signs and Symptoms of
encephalitis/encephalopathy

    Associate with Acute Dengue Infection

    Decreased level of conci...
Dengue Encephalopathy




                        33
Warning signs -Dengue Shock




                          34
Other Fevers for Diagnosis




                             35
Thank You For The Patient Listening




                                      36
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Clinial Manifestations of Dengue Fever

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  • plz mail this ppt on khyatitomar@gmail.com plz......
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  • can you send this presentaion plz.im working in dengue.Dr S.K.DHAR.e mail.drskdhar@yahoo.com
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  • Hi! It would be my greatest pleasure if you will allow me to use your presentation for my compilations as a community health nurse. Thank you for sharing such a very nice work! God bless! my email is windarwin10@yahoo.com or windarwin1079@gmail.com -Darwin B. Dar, RN
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  • Great power point! Can you please send it to bisacrbisaceer@hotmail.com? Thank you very much.
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  • Please Please we are in Yemen living under infectious diseases like dengue. Community needs these information to prevent themselves....Please send it back to my email:
    doctortammam@gmail.com
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Clinial Manifestations of Dengue Fever

  1. 1. Clinical Manifestations of Dengue Fever/DHF/DSS Dr. S. Aswini Kumar. MD Professor of Medicine Govt Medical College Hospital Thiruvananthapuram 1
  2. 2. Dangerous Dengue Dengue classic Dengue Hemorrhagic Fever Dengue Shock Syndrome Death 2
  3. 3. Dengue is a scare! It is so Can be agonizing potentially to endure fatal It is Antibiotics caused by are of no a virus help 3
  4. 4. Definition • Acute febrile viral illness characterized by – Fever – Headache – Bone pains – Muscle pains – Nausea & vomiting – Maculopapular Rash – Leucopenia & thrombocytopenia – Hemorrhagic manifestations 4
  5. 5. Dengue Virus – Flaviviridae Infection with one serotype produces life long immunity DEN 1 DEN 3 4 SEROTYPES 50nm DEN 2 DEN 4 11Kb But only temporary & partial immunity against other types 5
  6. 6. Vector - Aedes Egypti Mosquito Otherwise called as Tiger Mosquitoes because of dark lines Once infected mosquito remains infected for life and able to transmit to susceptible individuals 6
  7. 7. How do you get it? Bite by Bites Prefers Aedes usually human Egyptii by day beings 7
  8. 8. Epidemiology 250 250 Aedes.Aegypti is a tropical and subtropical 8 species of mosquito
  9. 9. Dengue Epidemic – Every 2-3y 9
  10. 10. Cyclical pattern - transmission Coincides with summer season Cool temperature affects mosquito survival 10
  11. 11. Transmission and Replication 11
  12. 12. First Infection 12
  13. 13. Second Infection 13
  14. 14. More serious infection Practically no antibodies are formed to 14 neutralize the DEN 2 viruses
  15. 15. Infected monocytes  Vasoactive Mediators  increase Vasular Permiability 15
  16. 16. Immunity determination 1. Enhancing and nonneutralizing antibodies • Transplacental maternal antibody • Antibody elicited by previous heterologous dengue infection 5. Infecting 2. Age serotype • Susceptibility to • Type 2 is DHF/DSS drops apparently more considerably after dangerous than 12 years of age other serotypes 4. Sequence of 3. Nutritional infection status • Serotype 1 followed by 2 • Malnutrition is more dangerous than protective. serotype 4 followed by 2 16
  17. 17. WHO Case Definition An acute febrile illness of 2- 7 days duration with two or more of the following manifestations: Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations 17
  18. 18. Dengue Clinical Syndromes 18
  19. 19. Clinical Spectrum Children, Travelers, Adults 19
  20. 20. Undifferentiated Fever May be the most common manifestation A prospective study found that more than 87% of students infected were either asymptomatic or only mildly symptomatic Other prospective studies including all age groups also demonstrated silent transmission • DS burge et al. A prospective study of Dengue infections in Bangkok – Am Jn of Trop Med Hyg 1988; 38: 172-80 20
  21. 21. Classical Dengue Infection Generalized Maculo-papular Rash Characteristic of Dengue Fever; uncommon in DHF & DSS 21
  22. 22. Hemorrhagic Meanifestations Skin hemorrhages • Petechiae, purpurae, echymoses Gingival bleeding Nasal bleeding Gastrointestinal bleeding • Hemetemesis, malena, hematochezia Hematuria Increased Menstrual flow 22
  23. 23. Visible Petechiae in legs A common hemorrhagic manifestation of Dengue Fever 23
  24. 24. Clinical case definition for Dengue Hemorrhagic fever 4 essential criteria Fever or recent history of acute fever Hemorrhagic manifestations Low Platelet count – 1,00,000/mm3 or less Objective evidence of “leaky capillaries” • Elevated hematocrit (20% or more above baseline) • Pleural or other effusions 24
  25. 25. Polyserositis Common in DHF Associated with Plasma Leakage 25
  26. 26. Temperature & Virus Positivity The relation of fever, virus titer and antibody titer with time Anti Dengue IgM by Fever Day for 55 patients with Dengue IgM only reaches levels positive 2 to 3 days after the fever falls below 38°C. This is about the 6th day of illness 26
  27. 27. Four grades of DHF Grade 1 • Fever and non-specific constitutional symptoms • Positive Tourniquet test is the only hemorrhagic manifestation Grade 2 • Grade 1 manifestation + spontaneous bleeding Grade 3 • Signs of circulatory failure Grade 4 • Profound shock 27
  28. 28. Dengue Hemorrhagic Fever 28
  29. 29. Thrombocytopenia in Smear Platelets are seen singly and the count is reduced 29
  30. 30. The Tourniquet Test for Dengue May be mildly positive or neative in Severe case of DSS 30
  31. 31. Clinical case definition for Dengue Shock Syndrome 4 criteria of DHF + Evidence of circulatory failure manifested indirectly by all of the following: • Rapid and weak pulse • Narrow pulse pressure< 20mmHg OR Hypotension for the age • Cold clammy skin • Altered mental status Frank shock is direct evidence of cir. failure 31
  32. 32. Signs and Symptoms of encephalitis/encephalopathy Associate with Acute Dengue Infection Decreased level of conciousness Lethargy, confusion, coma Nuchal rigidity Seizures Paresis 32
  33. 33. Dengue Encephalopathy 33
  34. 34. Warning signs -Dengue Shock 34
  35. 35. Other Fevers for Diagnosis 35
  36. 36. Thank You For The Patient Listening 36

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