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DENGUE FEVER

DENGUE FEVER. Niranjana.J. DENGUE FEVER. Syn: Break-bone Fever / Dandy Fever Acute febrile illness characterized by sudden onset of high fever severe pain in the bones and joints, lymphadenopathy relative bradycardia and a characteristic maculopapular reddish rash.

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DENGUE FEVER

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  1. DENGUE FEVER Niranjana.J

  2. DENGUE FEVER • Syn: Break-bone Fever / Dandy Fever Acute febrile illness characterized by • sudden onset of high fever • severe pain in the bones and joints, lymphadenopathy • relative bradycardia and a characteristic maculopapular reddish rash.

  3. The Virology of Dengue Virus Group: Group IV Family: Flaviviridae Genus: Flavivirus Species: Dengue virus Man is the usual reservoir of infection Transmitted by female Aedes aegypti

  4. Clinical Picture • Classic dengue fever -5 to 8 days. • Clinical picture – • High fever (biphasic pattern) • Myalgia • Arthralgia • Rash syndrome

  5. Rash in Dengue Fever • The dengue rash-characteristically bright red petechiae • Appears first on the lower limbs and the chest,in some, spreads to cover most of the body. • It usually appears on the 3rd to 5th day. • It disappears as the temperature falls

  6. Symptoms of Dengue • fever (saddle back fever) • chills and rigor • constant headaches • bleeding from nose, mouth or gums • orbital pain with painful movements of eyeballs • vomiting and diarrhoea

  7. Pathology • Endothelial swelling of small blood vessels • Perivascular edema • Mononuclear cell infiltration • Second attack of dengue leads to a fulminant hemorrhagic disorder

  8. Dengue cases reported from various states in India

  9. Dengue Hemorrhagic Fever • Grade 1: Fever, constitutional symptoms • Grade 2: Grade 1 + spontaneous bleeding from gums, skin and GIT • Grade 3: Grade 2 + circulatory failure • Grade 4:Grade 2 + profound shock are together called as Dengue Shock Syndrome

  10. WHO Definition of D.H.F • The WHO definition of DHF has been in use since 1975; all the four criteria must be fulfilled Criteria 1:- • Fever • bladder problems • constant headaches • severe dizziness and loss of appetite. • myalgia and arthralgia are absent unlike classical dengue

  11. Criteria 2:- • Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, petechiae on forehead and extremities)

  12. Criteria 3 & 4 • Thrombocytopenia (<100,000 platelets per mm³ ) • Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline)

  13. Dengue Shock Syndrome • Dengue shock syndrome is defined as dengue hemorrhagic fever plus: • Weak rapid pulse • Narrow pulse pressure (less than 20 mm Hg) • Cold, clammy skin and restlessness • Severe abdominal pain, protracted vomiting, marked change in temperature or change in mental status

  14. Complications • Convulsions and respiratory failure • Death can occur on the 4th or 5th day due to gastrointestinal hemorrhage with hematemesis and melena • Circulatory failure • Non fatal cases recover rapidly

  15. Laboratory Findings • Thrombocytopenia with relative leukopenia • Serologicals test -hemagglutination inhibition and complement fixing antibodies demonstrated 7-14 days after the onset • ELISA test (for IgM antibodies) • PCR available to confirm the diagnosis

  16. Treatment • Supportive therapy • Increased oral fluid intake • Platelet transfusion- if the platelet count drops below 20,000 (rare cases) • Aspirin and NSAIDS must be avoided • Emerging evidence suggests that ribavirin inhibit dengue replication.In vivo studies,have not been done yet

  17. Preventive Measures • Old tyres -dispose/cover • Water storage-cover /add temphos • Small container-clean up/bury/cover • Every week have “Dry Day” • Cleanup, drain, empty, or change all standing water

  18. Personal Prevention: • Mosquito repellant - during daytime. • Flywire / screening on doors and windows. • Mosquito coils or vapor mats. • Mosquito nets for children/ elderly • Use combination of the above measures

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