Dengue fever overview 2013

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Dengue Fever

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Dengue fever overview 2013

  1. 1. Dengue Fever Mahadevappa Hunasikatti MD DPM DCR, FCCP President, Global Health Care Consultants MD PC 2826 Old Lee highway # 250, Fairfax, VA 22031 Tel: 703-573-9212: Fax: 703-573-9219 drhunasikatti@yahoo.com
  2. 2. Definition: • Most common arhtropod viral –Arboviral illness in humans. • 50-100 Millions are affected • 4 types of Flavirus • Its is transmitted by mosqitoes of the genus Aedes-aegypti
  3. 3. Epidemiology: • Most are asymptomatic 50-90% • Some result in non-specific febrile illness • Rarely –may result in complex of classic dengue fever ( DF) • Some-may result in bleeding-Dengue Hemorrhagic Fever ( DHF).
  4. 4. Spread: • Epidemic Spread: Isolated event-single viral strain. Infection incidence of 25-50%. Transmission begins in urban centers and then spreads to rest of the country • Hyper endemic Spread: Continuous circulation of multiple viral serotypes –predominant pattern of global transmission. Antibody prevalence increases with age. Most adults are immune.
  5. 5. Pathophysiology: • Mosquito borne illness • Serotypes DENV 1-4 • Aedes aegypti- is the predominant vector globally • Others: Aedes albopictus ( tiger mosquito) • Hosts: • Humans are primary reservoir for dengue.
  6. 6. Pathophysiology.. • Patients can remain infectious for 6-7 days • The viruses replicate in the salivary gland of mosquitos • Once infected- the dengue has an incubation period of 3-14 days • Replicate in dendritic cells, hepatocytes and endothelial cells
  7. 7. Clinical Features: • Recent travel to endemic region • Symptoms that begin more than 2 week after travel from endemic region-is unlikely to be Dengue fever • Prodrome: Chills • Classic: Fever, chills and severe aching ot head, back and limbs • Fever last 2-7 days –may be as high as 41 degree celsius
  8. 8. Clinical Features: • Aches all over the body ( Breakbone syndrome)-Arthralgia, Myalgia • Headache • Nausea , vomiting • Rash-maculo papular • Weakness • Sore throat • Anorexia
  9. 9. Clinical Features:-• Bleeding: Petechae, Bleeding gums, epistaxis, and hematuria • Lymphadenopathy • Saddleback fever: Fever abates for a day only to return next day • Second rash: later: lasting 1-5 days: morbilliform, maculopapular , and spares palms and soles.
  10. 10. Clinical Features:--• Recovery is generally slow –but usually complete recovery takes place. • At the time of defervescence: Danger! • --This is the time development of dengue shock or dengue hemorrhagic fever can take place.
  11. 11. Signs to watch for Dengue Hemorrhagic Fever:-• • • • • Abdominal pain Hypothermia Thrombocytopenia Altered mental state Restlessness
  12. 12. Differential Diagnosis: • • • • • • • • • • • • Malaria Ebola virus Chikungunya fever West Nile Encephalitis ITP Influenza Hepatitis Meningitis Yellow fever Rocky Mountain Spotted fever Leptospirosis Rickettsial infection
  13. 13. Diagnosis: • • • • • • • • Blood-Isolation of virus Ig G and Ig M titers to dengue virus antigens PCR in CSF or Serum CBC CMP Serum patient and albumin Liver Panel DIC Panel
  14. 14. Diagnosis Dengue Fever:-• • • • Characteristics: -Thrombocytopenia -Leukopenia -Moderate AST and ALT elevation
  15. 15. Dengue Hemorrhagic Fever:• • • • • • • • Increased HCT Hypoprototeinenia Increased PT Increased PTT Decreased Fibrinogen Increased Fibrin Split Products Stool: OB UA
  16. 16. Dengue Fever—Work Up:-• • • • • Chest X Ray ABG-in sever cases CT Scan of Brain-if any altered mental state Biopsy of skin lesion EKG-Non-specific
  17. 17. Reportable illness in United States: • • • • • • Remember to report to authorities in USA: -Demographics -Travel hisotry -Date of onset of illness -Hospitalized or not -Outcome
  18. 18. Work up… • Most common electrolyte abnormality: Hyponatremia • Correct metabolic acidosis • Low Albumin • Increased Transaminases • DIC
  19. 19. Case definition Dengue fever:-• • • • • • • • Serology: IgG or IgM titres -NS1 Tournquet test: postive Petechae, echymosis Purpura Bleeding from any site Thrombocytopenia Plasma leakage-Increased HCT
  20. 20. Case definition; Dengue Shock Fever:-• Narrow Pulse Pressure: < 20 mm HgElevated Diastolic pressure • Cool, Clammy skin • Hypotension • Altered Mental state
  21. 21. Treatment of Dengue Fever:--• • • • • • Self limited disease –usually Analgesia: Acetaminophen Avoid: -NSAID -ASPIRIN Corticosteroids
  22. 22. Treatment of Dengue fever:--• • • • • • IV Fluids: NS preferred: Isotonic fluids Treat any hemorrhage -PRBC -Platelet Bed rest Treat Shock –asap with adequate fluids
  23. 23. Prevention: • Mosquito Repellent: DEET: N, N Methylbenzamide • Protective clothing: Permethrine insecticide impregntion is preferable. • Mosquito netting: limited value. Aedes are active in day time • Indoor spray-eliminate mosquito vector
  24. 24. Vaccination: • No vaccine is currently available • CDC: • Tel: 1-800-232-4636
  25. 25. Thank You • If you have any questions feel free to email me: • drhunasikatti@yahoo.com

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