Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Dengue Fever PowerPoint PPT presentation
characterised by fever,myalgia,arthralgia
& rash
Severe dengue infcn ? abnormalities in
hemostasis,marked leakage of plasma
from the capillaries,shock
Caused by any 4 serotypes of dengue
virus(arbovirus)
Vector-aedes aegypti
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
of transmitting virus.
Humans are the main amplifying host.
The virus circulates in the blood of
infected host for 2-7 days.
PATHOLOGY
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
reported-diffuse hepatitis with midzonal
necrosis & steatosis,focal areas of
necrosis
CLINICAL MANIFESTATIONS
Incubation period-4-10 days
Infants & young children present with an
undifferentiated febrile illness
Classical presentation seen in older
children ,adolescents & adult
It can be described under 3 phases -
Febrile phase, Critical phase & Recovery
phase
FEBRILE PHASE
Sudden onset of high grade fever (may
last for 2-7 days)
Facial flushing ,skin erythema
Myalgia,arthralgia,headache
Anorexia,nausea,vomiting
Child may have sore throat,conjunctival
injection
positive tourniquet test may be seen
Minor hemorrhagic manifestation-
petechiae & mucosal bleed
Liver ?enlarged and tender from 2-5 days
Progressive decrease in WBC & platelet
count
CRITICAL PHASE
b/w 3-7 days of onset of fever
Bleeding and shock
Fall in platelet count
Increased PCV
Organ dysfunctions-severe
hepatitis,encephalitis,myocarditis,severe
bleeding
RECOVERY PHASE
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
Generalised pruritis
PCV stabilizes,WBC start to rise
Recovery of platelet count take longer duration
LAB INVESTIGATION
Low platelet count
Rise in PCV
Fall in WBC count
Serum chemistry
? decrease in total protein&albumin
? Increased levels of SGOT ,SGPT
X-ray of chest-may show varying degree of
pleural effusion- right side/bilateral
USG abdomen ?ascites ,enlarged
gallbladder
Others
? Virus isolation
? PCR
? NS1 antigen detection
? IgM & IgG detection
MANAGEMENT
Patients with dengue infection can be
1. Undifferentiated fever
2. Dengue without warning
signs
3. Dengue with warning signs
4. Severe dengue infection
Undifferentiated fever
Dengue without warning
signs
Fever
Non specific
,bodyache,rashes
symptoms
Paracetamol for fever
Paracetamol for fever
& bodyache
Regular monitoring for
Minor bleeding
development of
treated
complication
symptomatically
Drink plenty of water
Monitor the patient
Dengue with warning signs
Children with suspected dengue infection
who have any of the following needs
hospitalization
? Abdominal pain/tenderness
? Persistent vomiting
? Clinical fluid accumulation
? Mucosal bleed ,lethargy
? Liver enlargement>2 cm
Severe dengue infection.....
CRITICAL CRITERIA
? a/c onset of high grade fever
? Hemorrhagic manifestation
? Tender hepatomegaly
? Effusion in body cavity/shock
LABORATORY CRITERIA
? Thrombocytopenia -1lakh cell/cu.mm
or 1-2 platelet per oil immersion
MANAGEMENT OF BLEEDING
PETECHIAL SPOT /MILD MUCOSAL
SEVERE BLEED&
BLEED HEMODYNAMICALLY
STABLE
HEMODYNAMIC INSTABILITY
Bed rest
Blood transfusion &
monitoring
Maintenence of
hydration
If bleeding cannot be
managed ?fresh frozen
Avoid IM injection &
any procedure
plasma ,platelet rich
predispose to
plasma may be
mucosal trauma.
considered
SUPPORTIVE CARE
Organ dysfunction should be managed
Broad spectrum antibiotics ? superadded
infection
Blood transfusion 20ml/kg for shock
Monitoring of heart rate ,BP, respiratory
rate, pulse pressure
This post was last modified on 12 August 2021