Dengue fever

Dengue fever : 

Dengue fever Dr. Shivaprakash Sosale Chandrashekar Asst. Professor in Pediatrics, Sapthagiri Institute of Medical Sciences, Bengaluru . shivaprakashsosale@gmail.com

Introduction: : 

Introduction: Viral illness transmitted by mosquito aedes aegypti Fever -> Bleeding -> shock -> death 4 types of virus –DEN 1,DEN2,DEN 3,DEN 4 Mainly urban areas

History: : 

History: 1st case of dengue in india 1950 1st epidemic in kolkatta with chikungunya in 1963

Factors associated with dengue transmission: : 

Factors associated with dengue transmission: Breeding grounds –Anything that holds water can be a mosquito-breeding site Clean stored water rain, Haphazard construction Water accumulated in discarded tyres ,coconut shells , Poor drainage system , Tropical climate .

Host factors: : 

Host factors: Genetic and race: Caucasians -> black/asian Sex- a) Incidence - Male: Female (2:1), b) Severity – Female>Male Age -16-60 years ,case fatality highest in children IP-around 5days Nutrition –Well nourished > Malnourished

Characteristics of theAedes Mosquito : 

Characteristics of theAedes Mosquito Physical feature – black and white stripes on its body and legs. Bites during the day. Lays its eggs in clean, stagnant water.

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Life cycle of the Aedes Mosquito

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How Do Aedes Mosquitoes Transmit Diseases... Mosquito bites and sucks blood containing the virus from an infected person. Virus is carried in its body. And passes the virus to healthy people when it bites them. Pathogenesis and pathophysiology:

Signs and Symptoms of Dengue Fever : 

Signs and Symptoms of Dengue Fever Abrupt onset of high fever Severe frontal headache Pain behind the eyes which worsens with eye movement Muscle and joint pains Loss of sense of taste and appetite Measles-like rash over chest and upper limbs Nausea and vomiting

Signs and Symptoms of Dengue Hemorrhagic Fever : 

Signs and Symptoms of Dengue Hemorrhagic Fever Symptoms similar to dengue fever plus: Frequent vomiting with or without blood Internal bleeding which can lead to shock Difficulty in breathing. This fever can be difficult to treat, and in some cases even with the best medical care people die. Do not wait, see a doctor immediately. It is crucial to quickly treat anyone with these complications

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If Hemoconcentration (Hct.>20% of original value )+ Capillary leaks Manage as severe dengue Additional features: 1) Deranged liver enzymes 2) Low serum albumin 3) Neutropenia Tourniquet test(18%): Inflate BP cuff midway B/W systolic and diastolic blood pressures for 5 minutes Positive when ≥10 petecheiae per 1 inch area

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Symptoms of Dengue Fever

Laboratory interpretation: : 

Laboratory interpretation:

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Suspect Dengue Suspect Malaria Suspect Leptospira

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Without hemorrhage Febrile phase: 1.Rest .oral fluids 2.Antipyratic –only paracetamol (aspirin ,ibuprofin C/I) 3. Nutritional support 4.adv.about warning signs and symptoms of shock 5.F/U everyday till afebrile for 24 hrs. Dengue hemorragic fever DHF-(Without shock ) WHO Ac.onset of high grade fever for 2-7 days Hemorrhagic manifestation + tortniquet test Platelet count 1lac/cmm Hemoconcentration /evidence of plasma leakage (ascites ,pleural effusion) DSS-(DHF+ signs of failure) Rapid and weak pulse Narrow pulse pressure ( < 20 mm Hg) or hypotension for age Prolonged capillary refill, cold and clammy skin and restlessness Management

Management : 

Management Symptomatic treatment Management of plasma leak and hypotension Management of hemorrhage Indication for fluid resuscitation : Prolonged capillary refill time Narrow pulse pressure Decreased urine output Raise in hematocrit >20% of baseline Hypotension (late sign)

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DSS : Admit in PICU Volume replacement in DSS RL/NS 10-20 ml/kg/hr fast as possible Shock persists Colloidal plasma solution /plasma expander (10-20 ml/kg/hr) No improvement –suggestive of significant internal bleeding Fresh whole blood Improvement No improvement 5ml/kg/hr 6ml 10ml /kg/hr 3ml/kg/hr Improvement 15ml/kg/hr Continue for 24-48 hr unstable vitals Stop IVF when vitals stabilize inotropes ,ventilation Treatment of complications : Blood and platelet transfusions BT indicated if- Significant blood loss >10% Hemolysis Concealed internal bleeding Platelet trans.indicated if- Sig.bleeding + thrombocytopenia Platelet count < 10000/cmm Other complications to be taken care of : Electrolyte imbalance Fluid overload Pleural effusion, ascites

Thanks : 

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