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Dengue
This document discusses dengue fever, caused by the Aedes mosquito. It notes that dengue illness predominantly affects pediatric populations and can have a high mortality rate. Clinical presentation can vary widely, from fever to bleeding to shock. The disease progresses through febrile, leaky, and congestive phases. Diagnosis involves clinical observation, hematological tests, and virological methods. Management is supportive through monitoring and intervening early if warning signs appear. Prognosis is favorable with early recognition and treatment of plasma leakage and thrombocytopenia. Prevention focuses on eliminating mosquito breeding sites and preventing bites.
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Dengue
- 1. DENGUE FEVER Dr.N.C.Nanda Jt.Director, HOD- Paediatrics IGH,Rourkela
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- 3. Burden of DengueIllness • Predilection for Paed- age group& high mortality • One disease entity with wide spectrum of Clinical Presentation • Unpredictable clinical evolution & outcome • WHO System for classifying DEN. Syndromes to 5 grades • Three arbitrary phases (DHF/DSS) (Febrile Leaky Congestive)
- 4. World Distribution ofDengue Fever and the Principal Epidemic Vector, Aedes aegypti
- 5. Average Annual No.Of DF & DHF Cases Reported to WHO & Countries Reporting Dengue
- 6. Dengue Case Classification& Levels of Severity Non Severe Dengue
- 7. Course of DengueIllness Febrile Phase Defervescence Defervescence Phase Phase Critical Phase Critical Phase Recovery Phase Recovery Phase Recovery Normal Death Normal Death
- 8. WHO System forClassifying Dengue Syndromes
- 9. The Course ofDengue Illness
- 10. Clinical Observation • FebrilePhase - Fever,Hepatomegaly Bleeding Sites • Leaky Phase - Restlessness,Serous effusion, (Around defervescence) Oligaria,Hypotension,Shock, DIVC,MOI • Congestive Phase - 12-24 Hrs • Convalescence - Bradycardia Confluent Rash • Unusual Manifestation- Hepatic and Cardiac failure CNS involvement
- 11. Diagnosis • Clinical • Haematological - TLC,Platelet count, HCT, Se.protein,Enzymes, Coag.profile,E/O DIC • Virological Virus isolation - Mosquito Antigen detection - NS1 DV ag (ELISA) Molecular Method - PCR Serology - HAI, CF,NT,EIA, MAC-ELISA, IF,Immunoblot. • Others : ECG – Bradycardia CXR – PL.Effusion
- 12. Frequently Observed Clinical Sign Lab Findings • Fever • HCT, Thrombocytopenia • Flushing • SGPT & SGOT • Hepatomegaly • Hypoalbuminimia • Vomiting • Ascitis & Pl.Effusion • Hyponatrimia • Pain Abd. • Hyperkalimia • Bleeding SIGNS • Hypernatrimia • Encephalitis • Hyperkalimia • Bradycardia • + ve CRP • ARDS
- 13. Differential Diagnosis ofDengue Fever
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- 16. Haemodynamic assessment: Continuumof Haemodynamic Changes
- 17. Management • Entirely symptomaticand supportive but early • Careful monitoring of physical signs and Lab result • Early recognition and active intervention of ominous signs OPD SETTINGS : Limited drugs Counsel parents HOSPITAL MANAGEMENT :IV line and CVP line Lab sample IV fluid therapy Clinical monitoring Transfusion of platelet/blood Use of vasopressor and steroids Monitor and intervene in cong.ph
- 18. Algorithm For FluidManagement In Hypotensive Shock
- 19. Algorithm For FluidManagement in Compensated Shock
- 20. Good Clinical Practice& Bad Clinical Practice
- 21. Prognosis Favourable • Highindex of suspicion • Early recognition of plasma leak • Close monitoring Thrombocyte count and HCT • Early transfusion of platelet when needed
- 22. REASONS OF MORTALITY DHF/DSS FAILURE TO RECOGNISE: Shock Concealed haemorrhage Congestive failure
- 23. MESSAGE • A complex disease, has a set clinical pattern and fixed time bound course of events. • Management relatively simple, inexpensive & very effective in saving lives - so long as high index of suspicion, early recognition understanding different phases, correct timely monitoring leading to rational supportive management leads to good clinical outcome
- 24. Breeding Sites ofDengue Vectors
- 25. PREVENTION • Dengue ispreventable. • Information, Education and Communication • Key Messages Prevent Mosquito breeding (Proper water storage, Dry water storage containers, Remove disposables, Fill up ditches, Cover water with oil, Larvivorous fish) Prevent Mosquito biting (Proper clothing, Wiring doors and windows, ITB) • Local Health Department Involvement. Observe One dry Day Every Week
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