dengue

Warning signs

Abdominal pain/ tenderness

Persistent vomiting

Clinical fluid accumulation

MUCOSAL BLEEDING

LIVER ENLARGEMENT >2cm

lethargy, restlessness

Lab results: INCREASE HCT + rapid decrease in PLATELET COUNT

Severe dengue

1. Severe plasma leakage - leading to:

   • SHOCK

   • Fluid accumulation w/ respiratory distress

2. Severe bleeding - by clinician

3. Severe organ involvement

• Liver: AST/ALT >= 1000

• CNS: impaired consciousness

• Heart & other organs

Important lab tests

Baseline HCT!!!

Platelet count

FBC

WCC

Probable dengue

FEVER + any 2 of the following:

• Nausea , vomiting

• Rash

• Aches & pain

• Tourniquet test positive (petechiae on skin)

• Leukopenia

• Any warning sign

Diagnostic tests

1. Blood for PCR (blood in FBC tube)

2. Serum for POCT (Dengue Duo)

3. Serum for Dengue antibody testing

What is considered SHOCK (dengue shock syndrome)

Pulse pressure < 20mmH (Systolic - diastolic)

OR

POOR capillary perfusion

Clinical phases

• Febrile

• Critical (may lead to Severe Dengue)

• Recovery

Febrile phase

• Fever 2-7days

• Facial flushing, generalized body ache, myalgia

• Nausea, vomiting

• +ve tourniquet test

• FBC - drop in WCC

• Critical phase

• Increasing capillary permeability + increasing HCT = beginning

• progressive leukopenia + rapid decrease in platelets

If management delayed → severe dengue

Recovery phase

If the patient survives the 24–48 hour critical phase, a gradual reabsorption of extravascular compartment fluid takes place in the following 48–72 hours.

• General well-being improves, appetite returns, gastrointestinal symptoms abate, haemodynamic status stabilizes and diuresis ensues.

• Some patients may have a rash of “isles of white in the sea of red”. Some may experience generalized pruritus.

• The haematocrit stabilises or may be lower due to the dilutional effect of reabsorbed fluid.

• White blood cell count (WBC) usually starts to rise soon after defervescence.

• Platelet count typically recovers later than that of WBC.