dengue fever

1. Dengue phases, clinical
manifestation and Investigation.
Rehan Zahir Raza
Bms17091424

2. Phases
Febrile phase
(2-7 days)
Critical phase
(3-5 days)
Recovery
phase(2-3 days)

3. Febrile phase
• High fever 40 °C (104 °F)
• headache
• generalized arthralgia
• myalgia
• petechiae
• bleeding from mucus membrane.
• A rash occurs in 50–80%

4. Critical phase
• Leukopenia
• thrombocytopenia.
• Increase capillary permeability leading to plasma leakage that lead
to metabolic acidosis.
• In children febrile phase is common carries nausea, vomiting,
thrombocytopenia.
• AST will be 2-3 times higher than ALT.
• Prolong APTT.

5. Recovery phase
• Stabilize hemodynamic status
• increase urine output
• overall clinical improvement.
• Increase in fluid overload can cause cerebral edema.

7. SIGN & SYMPTOMS
• Fever
• Headache
• Muscle, joint pain
• skin rash ( appear 4-5 days after fever )
• Pain behind eyes
• Nausea
• Vomiting
• Mild bleeding

8. WARNING SIGNS
• Severe abdominal pain
• Persistent vomiting
• Vomit with blood
• Drowsiness or irritability
• Dyspnoea
• Swollen lymph node
• diarrhoea

10. Investigation
• Tourniquet test useful in early stage(febrile phase).
Positive if more or equal to 20 petechiae in 2.5cm2.
• Full blood count-leucopenia, neutropenia, thrombocytopenia and Hct
• Dengue lgM test.
• elevated alanine aminotransferase (ALT) or aspartate
aminotransferase (AST)
• serology or detection of dengue viral material in blood by RT-PCR.
• NS1 antigen (3-5days)

12. References
• Clinical medicine ,Kumar and clark’s.
• clinical practice guidelines (CPG),dengue fever.2015
• https://www.cdc.gov/dengue/training/cme/ccm/page47488.html
• https://www.google.com/search?q=ns1+antigen+useful&hl=en&sour
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