DENGUE

Definition of PROBABLE DENGUE

PROBABLE DENGUE

Lives or travels to dengue- endemic area, with

fever and two of the following criteria:

-Nausea/vomting

-rash

-aches and pains

-tourniquet test positive,

-Leucopenia

-any warning sign

Warning signs of dengue

FEHLAMP

Fluid accumulation

Enlargement of liver >2cm

Hct increase

Lethargy

Abd pain

Mucosal bleed

Persistent vomiting

Criteria for SEVERE DENGUE

1) severe plasma leakage

-shock and fluid accumulation

2) severe bleeding

3) severe organ involvement

-Liver: AST or ALT >1,000

-CNS: impaired consciousness

-Heart and other organs

Phase of Dengue which begins at defervescence and lasts 24-48hrs

CRITICAL PHASE

Pathophysiology of critical phase

Plasma leakage

Viremia causes increase in cytokines/chemokines and increasing vascular permeability then resulting to capillary leakage

Phase of dengue where in plasma leakage subsides and begins to reabsorb extravasated IV fluids and effusions

Convalescent phase

What happens in Hct and Plt levels during convalescent phase?

Hematocrit stabilizes or falls (dilutional)

Plt ct rise

Detects antigen on days 1-4 after onset of symptoms (F e b r i l e p h a s e )

NS1Ag

how many days prior appearance of IgM and IgG

5 days - IgM

14 days - IgG: 4x increase in titer for SECONDARY dengue

Define Group A, B and C dengue

A - ASYMPTOMATIC

B - with warning signs OR WITHOUT BUT WITH:

comorbids (dengue, old, renal…),

social circumstances

C - HYPOVOLEMIC SHOCK

How do you manage Group A, B, C

GROUP A

- ASYMTPOMATIC

-Tx: send patient home, inc fluid intake

GROUP B

-Symptomatic or Asymptomatic but 1) comorbids 2) social

-Tx: Inpatient

GROUP C

-SHOCK

-Tx: ICU, fluid resuscitation, glycemic control

Most serious manifestation of dengue hemorrhagic fever

Characterized by a marked increase in vascular

permeability

DENGUE SHOCK SYNDROME

Initial choice of resuscitation fluids in DSS

Crystalloids 0.9% NSS or LR

DOH ENHANCED 4S STRATEGY

Search and Destroy

Self protection

Seek early consultation

Say no to indiscriminate fogging