Download MBBS Dengue Fever Lecture PPT

Dengue fever is an acute illness
characterised by fever,myalgia,arthralgia
& rash
Severe dengue infcn ? abnormalities in
hemostasis,marked leakage of plasma

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from the capillaries,shock
Caused by any 4 serotypes of dengue
virus(arbovirus)
Vector-aedes aegypti

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Dengue virus transmitted to humans
through bite of female aedes mosquitoes
They acquire the virus while feeding the
blood of infected person.
After an IP of 8-10 days they are capable

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of transmitting virus.
Humans are the main amplifying host.
The virus circulates in the blood of
infected host for 2-7 days.

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PATHOLOGY

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Presence of virus in tissue mainly leads to
hemodynamic alteration with generalised
vascular congestion and mast cell
recruitment in lungs
Variable hepatic involvement has been

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reported-diffuse hepatitis with midzonal
necrosis & steatosis,focal areas of
necrosis

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CLINICAL MANIFESTATIONS
Incubation period-4-10 days

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Infants & young children present with an
undifferentiated febrile illness
Classical presentation seen in older
children ,adolescents & adult
It can be described under 3 phases -

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Febrile phase, Critical phase & Recovery
phase

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FEBRILE PHASE
Sudden onset of high grade fever (may
last for 2-7 days)

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Facial flushing ,skin erythema
Myalgia,arthralgia,headache
Anorexia,nausea,vomiting
Child may have sore throat,conjunctival
injection

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positive tourniquet test may be seen

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Minor hemorrhagic manifestation-
petechiae & mucosal bleed
Liver ?enlarged and tender from 2-5 days
Progressive decrease in WBC & platelet

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count

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CRITICAL PHASE
b/w 3-7 days of onset of fever
Bleeding and shock
Fall in platelet count

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Increased PCV
Organ dysfunctions-severe
hepatitis,encephalitis,myocarditis,severe
bleeding

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RECOVERY PHASE

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After 24-48 hrs in critical phase
General wellbeing improves
Appetite returns
Hemodynamic status stabilizes
May have rash of isles of white in the sea of red

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Generalised pruritis
PCV stabilizes,WBC start to rise
Recovery of platelet count take longer duration

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LAB INVESTIGATION
Low platelet count

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Rise in PCV
Fall in WBC count
Serum chemistry
? decrease in total protein&albumin
? Increased levels of SGOT ,SGPT

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X-ray of chest-may show varying degree of
pleural effusion- right side/bilateral

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USG abdomen ?ascites ,enlarged
gallbladder
Others

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? Virus isolation
? PCR
? NS1 antigen detection
? IgM & IgG detection

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MANAGEMENT

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Patients with dengue infection can be
1. Undifferentiated fever
2. Dengue without warning
signs
3. Dengue with warning signs

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4. Severe dengue infection

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Undifferentiated fever
Dengue without warning
signs
Fever

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Non specific
,bodyache,rashes
symptoms
Paracetamol for fever
Paracetamol for fever

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& bodyache
Regular monitoring for
Minor bleeding
development of
treated

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complication
symptomatically
Drink plenty of water
Monitor the patient

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Dengue with warning signs

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Children with suspected dengue infection
who have any of the following needs
hospitalization
? Abdominal pain/tenderness
? Persistent vomiting

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? Clinical fluid accumulation
? Mucosal bleed ,lethargy
? Liver enlargement>2 cm

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Severe dengue infection.....
CRITICAL CRITERIA

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? a/c onset of high grade fever
? Hemorrhagic manifestation
? Tender hepatomegaly
? Effusion in body cavity/shock
LABORATORY CRITERIA

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? Thrombocytopenia -1lakh cell/cu.mm
or 1-2 platelet per oil immersion

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MANAGEMENT OF BLEEDING
PETECHIAL SPOT /MILD MUCOSAL
SEVERE BLEED&

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BLEED HEMODYNAMICALLY
STABLE
HEMODYNAMIC INSTABILITY
Bed rest
Blood transfusion &

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monitoring
Maintenence of
hydration
If bleeding cannot be
managed ?fresh frozen

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Avoid IM injection &
any procedure
plasma ,platelet rich
predispose to
plasma may be

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mucosal trauma.
considered

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SUPPORTIVE CARE
Organ dysfunction should be managed
Broad spectrum antibiotics ? superadded

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infection
Blood transfusion 20ml/kg for shock
Monitoring of heart rate ,BP, respiratory
rate, pulse pressure

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