DENGUE FEVER
Contents:
- Introduction
- Clinical presentation
- Diagnosis
- Treatment
- Diet
Introduction:
- Dengue fever is a viral infection caused by dengue virus.
- Dengue virus is an RNA virus of genus flavi virus.
- —There are four serotypes dengue virus that is DENV-1, DENV-2, DENV-3, DENV-4
-
—Dengue virus
transmitted by Aedes aegypti mosquito
 |
| Aedes aegypti mosquito |
Aedes aegypti mosquito known to transmit Dengue virus, Yellow fever virus, Chikungunya virus, and Zika virus and it also suggest as a potential vector of Venezuelan Equine Encephalitis virus and studies shown it is capable to transmit West Nile virus as well.
Clinical Presentation:
Divides into 4 categories :
- Dengue without warning sign
- Dengue with warning sign
- Severe dengue / dengue hemorrhagic fever
- Dengue shock syndrome
Remember Note:
- Not all patient goes in all these phases.—
- Majority of patient develops dengue without warning sign and they cure self or general treatment.
- But few patients who are not manage properly or the patient who are immunocompromised and who have weak immune system, they can progress from dengue without warning sign to dengue shock syndrome.
- Incubation period 4-10 days (2-14 days)
- —High grade fever 40˚C (104˚f)
Following any of two are
present
- Severe headache
- Retro orbital pain
- Myalgia, arthralgia (break bone fever)
- Maculopapular widespread rashes.
- Generalised lymphadenopathy.
Dengue with warning sign
Critical
period begins -
—
3-7 days after
symptoms onset
Warning signs appear
after fever subsides
Population
who are at risk –
- —Pt. with severe comorbidities
- —Infants less than 1 year of age
- —History of previous or recurrent dengue infection.
Warning Signs Include:
- Abdominal pain with or without tenderness.
- Persistent vomiting (>3 times in 24 hours)
- —Bleeding from nose or gums.
- —Blood in vomiting or blood in stool or blood in urine.
- —Lethargy, restlessness, irritable.
- —Enlarge liver > 2 cm
Severe Dengue / Dengue haemorrhagic fever
Re-infected with different serotype
This phase begins after fever subside
—Temperature (hypothermia to second fever spike)
—Plasma leak resulting in pleural effusion, ascites, haematocrit drops
—Hemorrhagic manifestations such as gingival bleed, epistaxis, petechiae, ecchymosis, purpura, thrombocytopenia,
—Severe organ involvement like hepatomegaly, liver failure
—Changes in mental status - confusion
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| Petechiae and Purpura |
 | ||||||||||||||||
| Ecchymosis |
 |
| Gingival Bleeding |
Dengue Shock Syndrome
Severe hemorrhagic dengue
+
Shock (circulatory collapse)
—Severe hemorrhagic
fever with circulatory collapse is called dengue shock syndrome
—It is fatal if not
manage properly
Diagnosis
Serologic test to
detect IgM (Initial 3-4 days
the antibodies will be negative but patient having infection.
—NAAT to detect viral
RNA
—NS-1 antigen to
detect dengue non structural protein 1 (NS 1 antigen can be detected directly
after onset of symptoms, before even IgM production begins)
—Positive capillary
fragility test.
 |
| When test become positive |
TOURNIQUET
FRAGILITY TEST –
Tourniquet applied to arm. Inflated to a point b/w systolic and diastolic pressure for 5 minutes.
Positive test : If 10 or more petechiae appear per square inch on forearm.
Tourniquet applied to arm. Inflated to a point b/w systolic and diastolic pressure for 5 minutes.
Positive test : If 10 or more petechiae appear per square inch on forearm.
Treatment Approache
Don’t do this
—Don’t use
corticosteroids due to increase risk of GI bleeding, hyperglycemia.
—Do not give platelet
transfusion for low platelet count b/c it leads to fluid overload.
—Do not assume that IV
fluid are necessary, use minimum amount of IV fluid to keep patient profused.
—Do not give ½ NS b/c
it leads to ascites, pleural effusion etc.
You can do this
—Do recognize the
clinical period
—Monitor fluid intake
output, vital sign HCT level etc.
—Do administer
colloids such as albumin for refractory shock who do not responds 2-3 boluses
of isotonic saline.
—Do give PRBCs or
whole blood for significant bleeding.
Dengue without warning sign Treatment approach
—Paracetamol, cold
sponging for fever (don’t give aspirin,
ibuprofen)
—Prevent dehydration
(oral fluid – ORS)
Dengue with warning sign treatment approache
—Admit in hospital
—Check hematocrit value
—If oral fluid intake
inadequate give isotonic crystalloid (normal saline, RL)
—Stepwise manner,
5-7ml/kg/hour for 1-2 hours followed by 3-5ml/kg/hour for 2-4 hours (increase
rate if vital signs worsening.
—Control fever with paracetamol and cold sponging.
—Continue monitor –
Haematocrit, fluid intake urine output, vital signs
Severe Dengue / Dengue haemorrhagic fever
—Admit patient for
emergency management.
—Monitor fluid
intake/output
—Give controlled fluid
5-7ml/kg/hr for 1-2 hours, 3-5ml/kg/hr for next 2-4 hours, 2-3ml/kg for next
2-4 hours.
Check haematocrit level
DECREASING
—Transfusion 5-10ml/kg
PRBCs.
Or
—10-20ml/kg whole
blood immediately
INCREASING
—Give controlled
crystalloid (NS, RL) 10-20 ml/kg bolous over 1 hour
Dengue Shock Syndrome
—If patient have hypotensive shock: Give isotonic
crystalloid or colloid bolus 20ml/kg within 15 min.
—If condition improve than continue crystalloid
and colloid and slowly taper.
—If condition not
improve than check haematocrit.
—If hematocrit decrease than
transfuse 5-10ml/ kg PRBCs or 10-20ml/kg whole blood.
If hematocrit increase than give
colloid 10-20ml/kg bolus over 30 min – 1 hour What can we do at home
—Cold sponging to
control fever.
—ORS to maintain
hydration.
—Papaya leaf
juice/papaya to maintain or increase platelet count. Papaya leaf extract is
good for digestion which contain papain and chympapain.
—Avoid heavy work or
routine work.
—Increase fruits
(specially citrus fruits) in diet.
What should eat
—Vitamin-C : It has antiviral
and anti-oxidative properties and it boost immunity and it help to absorb
another helpful nutrients such iron from intestine. Sources – Orange, lemon,
papaya, pineaple etc.
—
—Vitamin-K : Sprouts, broccoli,
and green leafy vegetables.
—
—High-calorie
foods:
Milk, rice, potato etc.
—
Water What should avoid to eat
—Red
or brown colored : Drink
or food like chocolate, violet colored juices b/c it misleads the disease
progression.
—
—Caffeine : Energy drinks,
coffee, tea b/c these act as diuretics which make difficult to maintain
hydration.
—
—Spicy
foods :
Avoid spicy foods b/c it stimulates the stomach for more acid production which
may cause stomach or intestinal bleeding.
—
—Fatty
foods :
Cheese, cuts, butter, deep fried food and avocado etc. Dengue fever reduces the capacity of digestion and which
make difficult to digest for the stomach.
