Clinical Manifestations of Dengue Fever/DHF/DSS :Clinical Manifestations of Dengue Fever/DHF/DSS Dr. S. Aswini Kumar. MD Professor of Medicine Govt Medical College Hospital Thiruvananthapuram 1


Dangerous Dengue :Dangerous Dengue Dengue classic Dengue Hemorrhagic Fever Dengue Shock Syndrome Death 2


Dengue is a scare! :Dengue is a scare! 3


Definition :Definition Acute febrile viral illness characterized by Fever Headache Bone pains Muscle pains Nausea & vomiting Maculopapular Rash Leucopenia & thrombocytopenia Hemorrhagic manifestations 4


Dengue Virus – Flaviviridae :Dengue Virus – Flaviviridae DEN 1 DEN 2 DEN 3 DEN 4 Infection with one serotype produces life long immunity But only temporary & partial immunity against other types 50nm 11Kb 4 SEROTYPES 5


Vector - Aedes Egypti Mosquito :Vector - Aedes Egypti Mosquito Otherwise called as Tiger Mosquitoes because of dark lines Once infected mosquito remains infected for life and able to transmit to susceptible individuals 6


How do you get it? :How do you get it? 7


Epidemiology :Epidemiology 250 250 Aedes.Aegypti is a tropical and subtropical species of mosquito 8


Dengue Epidemic – Every 2-3y :Dengue Epidemic – Every 2-3y 9


Cyclical pattern - transmission :Cyclical pattern - transmission Coincides with summer season Cool temperature affects mosquito survival 10


Transmission and Replication :Transmission and Replication 11


First Infection :First Infection 12


Second Infection :Second Infection 13


More serious infection :More serious infection Practically no antibodies are formed to neutralize the DEN 2 viruses 14


Infected monocytes :Infected monocytes  Vasoactive Mediators  increase Vasular Permiability 15


Immunity determination :Immunity determination 16


WHO Case Definition :WHO Case Definition 17


Dengue Clinical Syndromes :Dengue Clinical Syndromes 18


Clinical Spectrum :Clinical Spectrum Children, Travelers, Adults 19


Undifferentiated Fever :Undifferentiated Fever 20


Classical Dengue Infection :Classical Dengue Infection Generalized Maculo-papular Rash Characteristic of Dengue Fever; uncommon in DHF & DSS 21


Hemorrhagic Meanifestations :Hemorrhagic Meanifestations 22


Visible Petechiae in legs :Visible Petechiae in legs A common hemorrhagic manifestation of Dengue Fever 23


Clinical case definition for Dengue Hemorrhagic fever :Clinical case definition for Dengue Hemorrhagic fever 24


Polyserositis Common in DHF :Polyserositis Common in DHF Associated with Plasma Leakage 25


Temperature & Virus Positivity :Temperature & Virus Positivity The relation of fever, virus titer and antibody titer with time Anti Dengue IgM by Fever Day for 55 patients with Dengue IgM only reaches levels positive 2 to 3 days after the fever falls below 38°C. This is about the 6th day of illness 26


Four grades of DHF :Four grades of DHF 27


Dengue Hemorrhagic Fever :Dengue Hemorrhagic Fever 28


Thrombocytopenia in Smear :Thrombocytopenia in Smear Platelets are seen singly and the count is reduced 29


The Tourniquet Test for Dengue :The Tourniquet Test for Dengue May be mildly positive or neative in Severe case of DSS 30


Clinical case definition for Dengue Shock Syndrome :Clinical case definition for Dengue Shock Syndrome 31


Signs and Symptoms of encephalitis/encephalopathy :Signs and Symptoms of encephalitis/encephalopathy 32


Dengue Encephalopathy :Dengue Encephalopathy 33


Warning signs -Dengue Shock :Warning signs -Dengue Shock 34


Other Fevers for Diagnosis :Other Fevers for Diagnosis 35


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