Dhaka. bangladesh

1. DENGUE
Prepared by:
1

2. Dengue
Dengue virus (RNA Virus), flavivirus,
Arbovirus (arthropod borne virus)

May lead to –
 Classical dengue fever
 Dengue hemorrhagic fever without shock
 Dengue hemorrhagic fever with shock

2

3. 

Dengue fever is self limiting
Prevalence of Aedes aegypti and Aedes
albopictus together with circulation of
dengue virus of more than one type in
any particular area tends to be
associated with outbreaks of DHF/DSS
3

4. 2/21/2014
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5. 5

6. 


It is most common among arthropod
borne viral diseases
One of the most important emerging
disease of tropical and sub tropical
regions, affecting urban and peri urban
areas
50 million infections; 500,000 cases of
DHF; 12000 deaths.
2/21/2014
6

7. 2/21/2014
Disease Presentation- TETANUS
7

8. 


Endemic in Bangladesh, India,
Indonesia, Maldives, Myanmar, Srilanka
and Thailand.
Among 4 subtypes DEN-2, DEN-3
reported in Bangladesh and Maldives.
In SEA region, next to diarrhoeal disease
and ARI, leading cause of hospitalization
and deaths among children.
2/21/2014
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9. SEAR counties



Category A (Indonesia, Myanmar,
Thailand- major PH problem)
Category B (India, Bangladesh,
Maldives, Srilanka- emerging disease,
cyclical epidemics)
Category C (Nepal, Bhutan- no reported
cases, endemicity uncertain)
Category D (DPR Korea, non endemic)
2/21/2014
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10. Classical Dengue Fever




‘Break bone fever’, acute viral infection
Caused by 4 serotypes (1, 2, 3, 4) of
dengue virus.
Epidemics are explosive and often start
during rainy season, low in lower
temperature (below 26°c).
Reservoir – man and mosquito
2/21/2014
10

11. 
Aedes aegypti is the main vector.
Becomes infective by feeding on a
patient from the day before onset to the
5th day (viraemia stage) of illness. After
an extrinsic incubation period of 8-10
days, the mosquito becomes infective
and able to transmit the infection for life
long.
2/21/2014
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12. Clinical features:


IP 5-6 days. Onset is sudden with chills
and high fever, intense headache,
muscle and joint pains which prevent all
movements.
Within 24 hours- retro orbital pain on eye
movement or eye pressure develops
photophobia.
2/21/2014
Disease Presentation- TETANUS
12

13. 

Extreme weakness, anorexia,
constipation, altered taste sensation,
colicky pain and abdominal tenderness,
dragging pain in inguinal region, sore
throat, general depression.
Tempearture-102° to 104°. Fever is
typically followed by a remission of a few
hours to 2 days (biphasic curve).
2/21/2014
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14. 

Rash appears during remission or during
2nd febrile phase. Rash- diffuse, flushing,
mottling or fleeting pin point eruptions on
the face, neck or chest. Rash lasts for 2
hours to several days and may be
followed by desquamation.
Fever lasts for 5 days, rarely exceeds 7
days.
2/21/2014
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15. 2/21/2014
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16. Dengue Hemorrhagic fever


Severe form of Dengue, caused by
infection with more than one dengue
virus. Transmitted by A. aegypti.
Double infection with dengue virus; first
infection probably sensitizes the patient,
second produces immunological
catastrophe
2/21/2014
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17. 
IP: 4-6 days, abrupt onset with high fever
accompanied by facial flushing,
headache, anorexia, vomiting, epigastric
discomfort, tenderness at the right costal
margin and generalized abdominal pain.
Rash less common during first few days
which resembles classical dengue fever.
May appear late in illness.
2/21/2014
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18. 

Temperature 104-105°F, febrile
convulsion in infants.
Plasma leakage, abnormal hemostasis;
manifested by increased hematocrit
value and moderate to marked
thrombocytopenia.
2/21/2014
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19. Clinical diagnosis:


Fever-acute onset, high,
continuous, lasting for 2-7 days.
Hemorrhagic manifestationspositive tourniquet test (more than
20 petechiae per 2.5 cm²
(Petechiae, purpura, echymosis,
epistaxis, gum bleeding,
haematemesis and/or malaena)
2/21/2014
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20. Grading of severity of DHF:


Grade I: Fever accompanied by non
specific constitutional symptoms. Only
hemorrhagic manifestation is a positive
tourniquet test.
Grade II: Spontaneous bleeding in the
form of skin and/or other hemorrhages+
manifestations of grade 1.
2/21/2014
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21. 

Grade III: Circulatory failure manifested
by rapid and weak pulse, narrowing of
pulse pressure (20 mmHg/ less) or
hypotension with the presence of cold,
clammy skin and restlessness.
Grade IV: Profound shock with
undetectable BP and pulse.
2/21/2014
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22. Laboratory diagnosis:


Thrombocytopenia (100,000/mm³ or
less)
Hemoconcentration; hematocrit is
increased by 20% or more of baseline
value.
2/21/2014
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23. 
Dengue Shock Syndrome: All above
criteria plus shock manifested by rapid
and weak pulse with narrowing of pulse
pressure or hypotension with the
presence of cold, clammy skin and
restlessness.
2/21/2014
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24. Treatment:

Management is symptomatic and
supportive. Bed rest in acute febrile
phase. Antipyretic and sponging. Aspirin
should be avoided particularly in areas
where DHF is endemic, since it may
cause gastritis, bleeding and acidosis.
Oral fluid and electrolyte therapy in
excessive sweating, vomiting and
diarrhoea.
2/21/2014
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25. 
Management of DHF- during febrile
phase similar to DF. Increased
hematocrit indicates significant plasma
loss and need for parenteral fluid
therapy. In grade I and II, volume
replacement can be given in 12-24
hours. Patient with signs of bleeding and
persistently increased hematocrit should
be admitted to hospital.
2/21/2014
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26. 



Volume and type of fluid similar to
diarrhoea with moderate isotonic
dehydration.
Hct determination at every 4-6 hours and
recording of vital signs.
Fluid used- 5% Dextrose in Ringers lactate
solution.
Management of shock
2/21/2014
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27. Control measures
for Dengue
Control or eradication of the
mosquitoes carrying the virus that
causes dengue.
•
2/21/2014
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28. To prevent mosquito bites, wear longsleeved shirts, long pants, socks and
shoes when outdoors.

29. Install mosquito screens on
windows

30. For personal protection, use mosquito
repellant sprays that contain DEET when
visiting places where dengue is endemic.

31. They bite during early morning hours,
before day break and in the late afternoon
before dark.

32. Cover overhead tank to prevent
access

33. Eliminate stagnant water at home,
workplaces and their vicinity.

34. Eliminate breeding sources (unused
plastic pools, old tires, or buckets
and clearing clogged gutters)

35. Use citronella oil-based creams and
sprays or other mosquito repellents

36. Replace water in flower vases once
a week