DENGUE FEVER

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DENGUE FEVER

• Niranjana.J

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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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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

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Clinical Picture

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

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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

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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

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Pathology

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

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Dengue cases reported from various states in
India
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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 4Grade 2 profound shock are together
  called as Dengue Shock Syndrome

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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

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

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• Criteria 3 4
• Thrombocytopenia (lt100,000 platelets per mm³ )
• Evidence of plasma leakage (hematocrit more than
  20 higher than expected, or drop in haematocrit
  of 20 or more from baseline)

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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

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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

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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

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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

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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

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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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