Education. About denguee

1. CASE PRESENTATION
 DR.MUHAMMAD NOOR
 FCPS PGT, PEDIATRICS
 @ GMMMCH SUKKUR

2. 5 years old female baby wt,15 kg
admitted via ER with the complain of
Fever for 1 week
Rashes for 6 days
Bleeding from nose for 1 day
2

3. • Fever was acute in onset, high grade, undocumented, continuous,
associated with chills relieved by antipyretics…
• Rashes appeared 1 day after fever,1st on face, gradually spread to trunk &
lower limbs, red to purple in color, painless, not itching, not
bleeding/discharging…
• bleeding from nose was spontaneous, profuse fresh red in color, about 2-
3 teaspoons quantity, 2 episodes…
• no hx of bleeding from any other orifice
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4. GENERAL
• Decreased appetite, disturbed sleep pattern
• No hx of weight loss
ALIMENTARY
• No hx of abdominal pain, jaundice
• hematemesis, melena
LOCOMOTER
• No hx of joint or bone pain ,
• swelling
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5. NERVOUS SYSTEM
• No hx of altered consciousness/fits except for
moderate headache
URINARY SYSTEM
• No hx of hematuria / burning micturition
RESPIRATORY SYSTEM
• No hx of cough/breathlessness/hemoptysis
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6. PERSONAL HISTORY
No any addiction
Not school going
Vaccination complete
Normal bowel & bladder habits
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No hx of excessive bleeding from umbilicus @ birth or any
blood transfusion history
There was no past medical & surgical hx

8. FAMILY HISTORY
product of consanguineous marriage
She had 1 brother & 2 sisters all are
healthy & alive
No history of any bleeding disorder in
family
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9. SOCIOECONOMIC HISTORY
Belongs to a
non-affluent
family
Living in a
village
Father laborer
& only source
of income
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10. GENERAL PHYSICAL
EXAMINATION
• Sick looking, irritable, pale child, lying on bed, cannulated on right
hand, with following vitals…
• R/R = 32 br/min
• Pulse = 108 bpm
• Temp = 101’F
• BP = 90/60 mmhg
• SUBVITALS...
• A+,J-,CY-,LN-,E-,K-,CL-
• Multiple petechial rashes on face, trunk & lower limbs, well-
demarcated, non-palpable, red to purple in color, 2 to 3 mm in size,
non-blanching, not bleeding/discharging

11. SYSTEMIC EXAMINATION
• GIT…orodental hygiene was poor.
• On inspection abdomen normal shape.no visible veins or scar except
for few petechial rashes.
• On palpation no tenderness, no mass/viscera palpable.
• Percussion note resonant all over.
• On auscultation bowel sounds audible 4-6/min.
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12. CNS…higher mental functions normal, speech
normal, cranial nerves intact, motor &
sensory system intact, signs of meningeal
irritation absent.
CHEST…b/L clear, normal vesicular breathing,
no added sounds
CVS…S1+S2+0 (no murmur audible)
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13. CASE SUMMARY
• 5 year old female child wt.15 kg admitted in Paeds ward with
complain of fever for 1 week, Rashes for 6 days, Bleeding from nose
for 1 day. Fever acute in onset, high grade, continuous associated
with chills relieved by antipyretics. Rash appeared on face, then
spread to trunk red in to purple painless not itching not discharging.
Bleeding from nose spontaneous 2episodes fresh red in color 2-3
teaspoons Systemic inquiry was normal.
• GPE/ Sick looking irritable pale child with RR-32 HR-108 TEMP-101’F
BP-90/60 and multiple petechial rash on face, trunk and lower limbs,
well demarcated non palpable red to purple in color 2 to 3 mm non
blanching, on discharging systemic examination poor oral hygiene and
rest of examination unremarkable
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14. DIFFERENTIAL
DIAGNOSIS ?
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15. DIFFERENTIAL DIAGNOSIS ?
DENGUE FEVER
MALARIA
MENINGOCOCCEMIA
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16. CBC PROFILE
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Haemoglobin 8.2gm/dl
Hematocrit 40%
RBC 3.83 10^6/L
MCV 71.8 FL
MCH 25.3 PG
MCHC 35.3 g/dL
WBC 14.09 10^3 UL
Neutrophils 20.8%
Lymphocytes 68.2%
Monocytes 9.5%
Eosinophils 0.4%
Basophils 1.1%
Platelet count 63,000
ESR 10mm/1 hr

17. • Retic count........0.8%
• PT……………test=13.6 sec, control=11.5 sec
• APTT………test=34.2 sec, control=30 sec
• Anti-dengue serum IgM & IgG……..
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18. FINAL DIGNOSIS
•DENGUE FEVER
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19. MANAGMENT
• SUPPORTIVE;
• IV line maintained.
• IV fluids given.
• IV antibiotics was started (broad spectrum).
• Inj transamine given.
• Plateletes were arranged and transfused at 10ml per kg.
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20. DENGUE FEVER
• A benign syndrome caused by several
arthropod-borne virus and is characterized by
• biphasic fever
• (a single illness with two distinct periods also
called camel back pattern eg: yellow fever, tick
fever , rat-bite fever),
• myalgia or arthralgia,
• Rash(maculopapular ,macular rash over face,
thorax and flexor surface)
• leucopenia and lymphadenopathy.
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21. DENGUE FEVER
• Most common arbovirus infection of humans.
• Mosquito transmitted by flaviviridea.
• Single stranded RNA.
• 4 serotypes: DENV 1,2,3,4.
• Long life serotype specific immunity.
• Self limited acute febrile viral illness.
• Plagued the tropical region of the world for centuries
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23. EPIDEMIOLOGY
• The mortality is 1-5% without treatment
• Less then 1% with adequate treatment
• However severe disease carries a mortality of 26%
• Seasonal outbreaks since warm and wet conductions favor
development of mosquito.
• Dengue is endemic in more than 110 countries
• It infects 50 to 100 million peoples worldwide a year, leading to half a
million hospitalization, and approximately 12,500 -25000 deaths.
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24. EPIDEMIOLOGY
Dengue viruses are transmitted by mosquito of stegomyia
family.
• AEDES AEGYPTI a day time biting mosquito is the principle vector and
all four virus types have been recovered from it,
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25. VECTORS AND GEOGRAPHICS
DISTRIBUTATION OF DENGUE LIKE DISEASE
GENUS VIRUS AND DISEASE VECTOR GEOGRAPHIC
DISTIBUTION
togavirus chikungunya Aedes aegypti
Aedes africans
Africa , india,
flavivirus West nile fever Culex molestus
Culex univittatus
Europe , africa
Middle east india
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26. CLINICAL MENIFESTATIONS
• Incubation period is 1 to 7 days
• In infants and young children have a non specific febrile illness with ,
pharyngeal inflammation rhinitis and mild cough.
• Older children have symptoms of high grade fever 103,F-106’F, frontal
or retro orbital pain, severe back pain
• Generalized macular rash then morbiliform maculopapular rash that
spares palms and soles
• Nausea vomiting lymphadenopathy
• Biphasic fever
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27. CLASSIFICATION OF DENGUE
Dengue classified into three types:
1) DENGUE FEVER
2) DENGUE HEMORRHAGIC FEVER.
3) DENGUE SHOCK SYNDROME
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28. CLASSIFICATION
D F
D H F D.Fever
2- 7 days fever after bite.
Headache , pain in muscle, itching
Dengue hemorrhage fever/severe
dengue.
3- 7 days after D,fever.
Minor bleeding from nose, gums,
skin
PLASMA LEAKAGE hallmark of DHF
DSS Dengue shock syndrome.
2- 3 days after DHF
Temp; fluctuate.
Vomiting along with bleed
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29. DENGUE HEMORRHAGIC FEVER
GRADE 1:
Fever with nonspecific symptoms and tourniquet test positive.
GRADE 2:
Spontaneous bleed in grade 1 patient usually skin .
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30. DENGUE HEMORRHAGIC FEVER
GRADE 3:
Circulatory failure with rapid and weak pulse , narrow of pulse
pressure, hypotension, cold skin
GRADE 4:
Shock with undetectable blood pressure and pulse.
Grades 3 and 4 also included in or called DEGNUE SHOCK SYNDROME
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31. • Fever (2-7 days in duration may be biphasic)
• Minor or major hemorrhagic manifestations
• Thrombocytopenia (< 100000/Ul)
• Objective evidence of increased capillary
permeability (HCT >20%), pleural effusion or ascites,
or hypoalbuminemia
• Dengue hemorrhagic fever
• Hypotension
• Tachycardia
• Narrow pulse pressure
• Signs of poor perfusion
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WHO CRITERIA
DENGUE HEMORRHAGIC FEVER DENGUE SHOCK SYNDROME

32. WARNING SIGNS IN DENGUE FEVER
• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation
• Lethargy restlessness
• Liver enlargement
• Increase in Hct with concurrent rapid decrease in platelet count
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33. DIAGNOSIS • Clinical diagnosis of dengue fever depends on high index of
suspicion in an area where dengue fever is common.
• Confirmed by isolation of virus, viral antigen, or genome by PCR
analysis.
• Detection of IgM Dengue antibodies as well as four fold or greater
increase in antibody titer
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34. Increase of >20% in HCT
Thrombocytopenia
Prolonged BT
Moderately decreased PT (<40% of control)
Fibrinogen levels may be subnormal
Radiograph of chest reveal pleural effusions in nearly
all pt’s with dengue shock syndrome

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Prevention
 Antimosquito measures
 Avoid open stagnant water in and around home
 Bed nets
 Long sleeved clothing
 In house spraying
 repellants

41. Thank you
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