DENGUE FEVER

Dr.N.C.Nanda

Jt.Director, HOD- Paediatrics

IGH,Rourkela

Aedes Mosquito

Burden of Dengue Illness• Predilection for Paed- age group& high mortality

• One disease entity with wide spectrum of Clinical

Presentation

• Unpredictable clinical evolution & outcome

• WHO System for classifying DEN. Syndromes to 5

grades

• Three arbitrary phases (DHF/DSS)

(Febrile Leaky Congestive)

World Distribution of Dengue Fever and the Principal Epidemic

Vector, Aedes aegypti

Average Annual No. Of DF & DHF Cases

Reported to WHO & Countries Reporting Dengue

Dengue Case Classification & Levels of Severity

Non Severe Dengue

Course of Dengue Illness

Febrile Phase

Defervescence

Phase

Defervescence

Phase

Critical Phase

Recovery Phase Recovery

Critical Phase

Normal Death

Recovery Phase

Normal Death

WHO System for Classifying Dengue Syndromes

The Course of Dengue Illness

Clinical Observation

• Febrile Phase - Fever,Hepatomegaly

Bleeding Sites

• Leaky Phase - Restlessness,Serous effusion,

(Around defervescence) Oligaria,Hypotension,Shock,

DIVC,MOI

• Congestive Phase - 12-24 Hrs

• Convalescence - Bradycardia

Confluent Rash

• Unusual Manifestation- Hepatic and Cardiac failure

CNS involvement

Diagnosis• Clinical

• Haematological - TLC,Platelet count, HCT,

Se.protein,Enzymes,

Coag.profile,E/O DIC

• Virological

Virus isolation - Mosquito

Antigen detection - NS1 DV ag (ELISA)

Molecular Method - PCR

Serology - HAI, CF,NT,EIA, MAC-ELISA,

IF,Immunoblot.

• Others : ECG – Bradycardia

CXR – PL.Effusion

Frequently Observed

Clinical Sign

• Fever

• Flushing

• Hepatomegaly

• Vomiting

• Ascitis & Pl.Effusion

• Pain Abd.

• Bleeding SIGNS

• Encephalitis

• Bradycardia

• ARDS

Lab Findings

• HCT, Thrombocytopenia

• SGPT & SGOT

• Hypoalbuminimia

• Hyponatrimia

• Hyperkalimia

• Hypernatrimia

• Hyperkalimia

• + ve CRP

Differential Diagnosis of Dengue Fever

Warning Signs

Admission Criteria

Haemodynamic assessment: Continuum of Haemodynamic Changes

Management• Entirely symptomatic and supportive but early

• Careful monitoring of physical signs and Lab result

• Early recognition and active intervention of ominous signs

OPD SETTINGS : Limited drugs

Counsel parents

HOSPITAL MANAGEMENT :IV line and CVP line

Lab sample

IV fluid therapy

Clinical monitoring

Transfusion of platelet/blood

Use of vasopressor and steroids

Monitor and intervene in cong.ph

Algorithm For Fluid Management In Hypotensive Shock

Algorithm For Fluid Management in Compensated Shock

Good Clinical Practice & Bad Clinical Practice

Prognosis Favourable

• High index of suspicion

• Early recognition of plasma leak

• Close monitoring Thrombocyte count and

HCT

• Early transfusion of platelet when needed

REASONS OF MORTALITY

DHF/DSS

FAILURE TO RECOGNISE:

Shock

Concealed haemorrhage

Congestive failure

MESSAGE

• A complex disease, has a set clinical pattern

and fixed time bound course of events.

• Management relatively simple, inexpensive &

very effective in saving lives - so long as high

index of suspicion, early recognition understanding

different phases, correct timely monitoring leading

to rational supportive management leads to good

clinical outcome

Breeding Sites of Dengue Vectors

PREVENTION• Dengue is preventable.

• Information, Education and Communication

• Key MessagesPrevent Mosquito breeding

(Proper water storage, Dry water storage containers, Remove disposables, Fill up ditches, Cover water with oil, Larvivorous fish)

Prevent Mosquito biting (Proper clothing, Wiring doors and windows, ITB)

• Local Health Department Involvement.

Observe One dry Day Every Week

THANK YOU