dhf presentation for camkaa

8/14/2019 DHF Presentation for CAMKAA

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DENGUE HEMORRHAGIC

FEVER

Prof. CHHOUR Y MENG

MD, MPH

Director National Pediatric Hospital


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The key components arerepresented by 4 Ws:

WHAT ? WHO ?

WHEN ? WHERE ?


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1) WHAT IS DENGUE ?

Dengue is a vector borne disease

Serious public health problem inCambodia

Constitutes as one of the ten leadingcauses of hospitalization and death ofchildhood.


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2) WHO AFFECTED BYTHE DENGUE ?

All people ( Male / Female ), especially:

Children < 15 years old,

The most affected, children 46 y

High mortality, children from 1 4 y.


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3)WHERE DOES THE DENGUE OCCUR ?

Rural: along the river, bamboo,coconut shells, earthen jars

Urban: slum areas,overcrowded places,

containers, water jars, ant-traps, unused-containers


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Larvae Water containers Water containers

Water jars Water jars

Pots of flowers Unused containers

Ant-traps Tires, cans, coconutshellsPlastic bags, broken

earthen jarsBamboos

Adult

mosquito

Clothes Holes in tree

Curtains


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4) WHEN DOES THE DENGUE HAPPEN?

Rainy seasons(MayOctober, November)

- Poor sanitation + lifestyle

- A lot of breeding sites- Increase the mosquito density.

But the transmission is happen all longyear

Epidemic occurs every 2 to 3 years.


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T HE 3 P R E D O M IN A N T D IS E A S E S in

0

50

100

150

200

250

J an F eb M ar A pr M ay J un J ul A ug S ep O c t N o v D ec

D iarrhea A R I D HF


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HOW DOES THE DENGUE TRANSMIT?


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Etiology

4 sertypes of dengue viruses: Serotypes 1, 2, 3, 4

Members of the family Flaviviridae

The infection in human by anyone of theses

serotypes can produce life-long immunity againstreinfection of the same serotype, but only temporary

and partial protection against the others.


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CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS


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INCUBATION PERIODINCUBATION PERIOD

5 8 DAYS5 8 DAYS

CLINICAL


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CLINICALMANIFESTATIONS INMANIFESTATIONS IN

TYPICAL CASE OF DHFTYPICAL CASE OF DHF

1.1. High, continuous feverHigh, continuous fever

2.2. Hemorrhagic manifestationHemorrhagic manifestation

3.3. HepatomegalyHepatomegaly

4.4. Circulatory disturbance / shock.Circulatory disturbance / shock.


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LABORATORY CRITERIALABORATORY CRITERIA

1.1. HaemoconcentrationHaemoconcentration

((

20% increase in HCT level ).20% increase in HCT level ).2.Thrombocytopenia2.Thrombocytopenia

(( 100,000/mm3).100,000/mm3).


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Clinical Manifestations Contd.

Incubation: 1-7 days Acute Febrile Phase (2- 7 days):

Typically, sudden on set of fever,

Temperature: 39.5 41c Facial flushing, skin erythema, headache and

muscle pain

Convulsion may be present in infants

Mild conjunctival injection Injected Pharynx, anorexia, vomiting and

abdominal pain are common


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Acute Febrile Phase (cont.):

Hemorrhagic manifestations: Skin petechia (invariable)

Positive Tourniquet test ( more than 10 per 2.5cm)

Easy bruising

Epistaxis, gum bleeding, gastrointestinal bleedingare less common, but may be severe. Massive

gastrointestinal hemorrhage may be present in

association with prolonged shock. Hematuria is

extremely rare. Soft and tender Hepatomegaly is often found

Generalized lymphadenopathy occurs in

some cases


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Tourniquet test positive


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Critical Phase (24-48 hours) occurs at the

end of febrile phase.

Rapid drop of temperature (subnormal temp.)

Circulatory disturbances

Sweating, restless, cold extremities.

In mild DHF cases, the changes of vital

signs are minimal and transient. Patients

will recover shortly after an appropriatetreatment.


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In more DHF severe cases, the disease

develops rapidly a stage of shock.

DHF/DSS:

Acute onset

Acute abdominal pain

Restless

Subnormal temperature

Cold and clammy skin

Weak and rapid pulses

Narrow blood pressure (20mmHg)

Respiration rapid and labored.


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SEVERITY OF DHFSEVERITY OF DHF


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GRADE IGRADE I

Fever accompanied byFever accompanied bynon-specific symptoms withnon-specific symptoms witha positive tourniquet test.a positive tourniquet test.


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GRADE IIGRADE II

Spontaneous bleeding-skinSpontaneous bleeding-skinand/or other haemorrhageand/or other haemorrhageare in additional to those ofare in additional to those of

Grade IGrade I


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GRADE IIIGRADE III

Circulatory failureCirculatory failure


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GRADE IVGRADE IV

Profound shock withProfound shock withundetectable BP and Pulseundetectable BP and Pulse


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MANAGEMENTMANAGEMENT

Symptomatic and SupportiveSymptomatic and Supportive


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Crystalloid solutions:- 5%D/NSS

- 5%DLR*

- 5%D/AR Colloid solution:

- Dextran 40

- FWB

Type of solutions

Lactate Ringer solutions are contra-indicatedLactate Ringer solutions are contra-indicated

in case of acidosis.in case of acidosis. NSS or Acetate Ringer should be instead of LRNSS or Acetate Ringer should be instead of LR

in case of shockin case of shock


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WARNING SIGNS OF SHOCKWARNING SIGNS OF SHOCK

1.1. Sudden drop of temperature-Sudden drop of temperature-subnormal level.subnormal level.

2.2. Restless.Restless.

3.3. Acute abdominal pain.Acute abdominal pain.

4.4. Cold at extremities.Cold at extremities.5.5. Oliguria.Oliguria.


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Causes of death in DHF

Prolonged shock

Fluid overload

Massive bleeding Unusual manifestations:

Encephalopathy/ Encephalitis

Hepatic failure Dual Infections


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Drowsiness, shock. Platelet count only 1000/mm3


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DHF/DSS + restlessness


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DHF/DSS with profound shock + respiratory

failure


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Shock, very severe dyspnea and massive ascites


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DHF/DSS with respiratory failure + renal failure


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DHF/DSS + very severe respiratory distress +

massive ascites


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PREVENTION AND CONTROLPREVENTION AND CONTROL


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dhf presentation for camkaa

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