Management of Dengue Infection in Adults

A set of vocabulary-style flashcards covering the epidemiology, clinical phases, diagnostic markers, and management protocols for adult dengue infection based on the 2015 Malaysian Clinical Practice Guidelines.

Aedes aegypti and Aedes albopictus

The two primary mosquito vectors responsible for the transmission of the dengue virus ($DENV-1$, $2$, $3$, and $4$).

Antibody-dependent enhancement

A phenomenon where a secondary infection with a heterologous serotype increases the risk of severe dengue due to cross-reacting antibodies.

$4-7$ days

The typical incubation period for dengue infection, with a range of $3-14$ days.

Febrile Phase

The initial stage of illness lasting $2-7$ days, characterized by sudden high-grade fever, facial flushing, rash, and generalized body aches.

Critical Phase

A period lasting $24-48$ hours, typically occurring after the third day of fever or at defervescence, where plasma leakage and organ dysfunction may manifest.

Recovery Phase

The stage following the critical phase characterized by the cessation of plasma leakage, reabsorption of extravascular fluid, stabilized hemodynamics, and the potential appearance of an 'isles of white in the sea of red' rash.

Warning Signs

Clinical indicators suggesting a high risk for severe dengue, including abdominal pain, persistent vomiting ($>3$ episodes/day), mucosal bleeding, lethargy, and a rising $HCT$ with a rapid drop in platelet count.

$$< 0.2\%$$

The national target case fatality rate for dengue infection in Malaysia.

NS1 Antigen

A highly conserved glycoprotein essential for virus viability that is a marker for acute dengue infection, detectable typically up to day $5$ of illness.

Rapid Combo Test (RCT)

A point-of-care diagnostic assay used to detect $NS1$ antigen and dengue $IgM/IgG$ antibodies simultaneously.

Compensated Shock

A state where the systolic blood pressure is maintained but signs of reduced perfusion exist, such as a narrowed pulse pressure ($< 20\,mmHg$), prolonged capillary refill time ($> 2\,seconds$), and cool extremities.

Decompensated Shock

A medical emergency characterized by hypotension ($SBP < 90\,mmHg$ or $MAP < 60\,mmHg$), unrecordable blood pressure, or metabolic acidosis.

Crystalloids ($0.9\%$ saline)

The fluid of choice for initial resuscitation in both non-shock patients and those in dengue shock syndrome.

Colloids

Intravenous fluids that may be preferred for the third cycle of resuscitation in patients with intractable shock who do not respond to crystalloids.

Adjusted Body Weight (ABW)

The weight value used to calculate fluid maintenance and bolus requirements for obese patients ($BMI > 27.5\,kg/m^2$).

Caval Index

An ultrasound measure of inferior vena cava collapsibility used as an indirect indicator of intravascular fluid adequacy; a value $> 40\%$ suggests fluid responsiveness.

Dengue Hepatitis

A complication characterized by hepatomegaly and elevated transaminases, where $AST$ levels are typically higher than $ALT$ levels.

Haemophagocytic Syndrome (HPS)

A potentially fatal syndrome of extreme immune activation and cytokine storm, sometimes complicating dengue, presenting with persistent fever, cytopenias, and high ferritin ($> 10,000\,ng/mL$).

Vertical Transmission

The passage of the dengue virus from an infected symptomatic mother to the fetus in utero or during delivery.

Discharge Criteria

Standard clinical requirements for leaving the hospital, including being afebrile for $24-48$ hours, a rising white cell count followed by platelet count, and stable haematocrit.