This document discusses the Dengue Syndrome and summarizes key information about Dengue Fever and Dengue Hemorrhagic Fever. It notes that over 2.5 billion people worldwide live in areas where dengue viruses can be transmitted. The document describes the symptoms, diagnosis, and grading of severity for Dengue Fever and Dengue Hemorrhagic Fever. It also provides information on treatment, control measures, and discusses another similar disease, Chikungunya Fever.

1. The Dengue Syndrome
Dr Raghuram V

2. PROBLEM STATEMENT
2.5-3 billion people live in areas where
dengue viruses can be transmitted
In the most recent pandemic in 1998 1.2
million cases of DF and DHF were reported
from 56 countries.
Over the past 10-15 years DF has become the
leading cause of hospitalization and deaths
following diarrhoea and ARI in SEA region.
As on 31/08/06 there were 1235 cases and
10 deaths from dengue in India

3. Manifestations of dengue
syndrome
A symptomatic
Symptomatic-undifferentiated
-Dengue fever with/without haemorrhage
Dengue haemorrhagic fever-no shock
-DSS

4. CLASSICAL DENGUE FEVER
Acute viral infection caused by 4 serotypes
1,2,3,4 of dengue virus
Can occur in endemic and epidemic form.
Epidemics common during rainy season
Mosquitoes kept at 26 degree fail to transmit
the virus.
Reservoir of infection-man and mosquito
Aedes aegypti-main vector

5. Contd…
Other vectors-Aedes albopictus,Aedes
polynesiensis,Aedes scutellaris
Trans ovarian transmission of dengue virus
has been demonstrated in the laboratory.
High fever, chills, intense headache, retro-
orbital pain,photophobia.
Fever shows a biphasic curve pattern
Appearance of diffuse flushing ,mottling or
pin-point eruptions on the face ,neck and
chest during febrile period

6. Contd..
Appearance of maculopapular or
scarlatiniform rash on 3rd or 4th day
Low case fatality
Immunity is type specific

7. DHF
Severe form caused by infection with more
than one serotype of virus
First infection sensitizes, the second causes
an immunological catastrophe
Transmitted by Aedes aegypti
High fever, flushing , headache,
maculopapular rash of rubelliform type
Plasma leakage and abnormal hemostatsis
manifested by rising hematocrit and
moderate to marked thrombocytopenia

8. Criteria for diagnosis of DHF
Fever-acute onset, high, continuous,
lasting for 2-7 days
Haemorrhagic manifestations including
at least a positive tourniquet test
Enlargement of liver

9. Grading of severity of DHF
GRADE I-fever, + tourniquet test
Grade II-grade I with spontaneous
bleeding
Grade III-circulatory failure
Grade IV-profound shock.

10. TREATMENT
Symptomatic and supportive
Parenteral fluid therapy in DHF
Prompt and vigorous volume
replacement in DSS
Replacement of plasma loss

11. Control measures
Mosquito control
Vaccines
Isolation under bed nets
Individual protection against
mosquitoes.

12. CHIKUNGUNYA FEVER
Dengue like disease caused by group A virus
(chikungunya virus) transmitted by
Aedes,Culex, and Mansonia mosquitoes.
“Doubling up”
First outbreak in India occurred in 1963-64 in
Kolkata, 1965 –Chennai
Recent outbreak in 2006 in about 8 states
and UTs

13. Contd..
A&N islands,AP, Delhi, Maharashtra ,Gujarat,
Karnataka,Kerala, MP and TN
More than 1.25 million cases reported-752254
cases from Karnataka
Incubation period 4-7 days
Fever, chills, cephalalgia, lumbago,
conjunctivitis,arthropathy
Morbiliform rash with purpura,vomiting,
epistaxis

14. Diagnosis
Virus isolation from the blood of
patients by the intra cerebral
inoculation in suckling mice or VERO
cells.
Serology –Haemagglutination
inhibition,serum neutralization,
ELISA –to detect IgM
RT-PCR

15. CONTROL MEASURES
VECTOR CONTROL
-ABATE –organophosporous insecticide
used as a larvicide
-ULV quantities of malathion and
sumithion
-Community involvement