7130948 Dengue Hemorrhagic Fever

8/8/2019 7130948 Dengue Hemorrhagic Fever

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Dengue hemorrhagic feverDiagnosis, Treatment,Prevention and ControlDengue hemorrhagic feverDiagnosis, Treatment,Prevention and Control


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Why DengueEmerging Health Problem

Almost 1/3rd of the world in endemicareas mostly SEAR countries (52%

Increase in Incidence and Frequency ofepidemics

Among 10 leading causes of pediatrichospitalization & death in SEAR

Economic Burden both DirectIndirect cost

Sporadic cases in Non-Endemicpopulation poses diagnostic difficulty


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South-East Asia South-East Asia


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Indian Perspective

Presently a category B country

Endemic Transmission of all 4serotypes leading on to heterotypicityand hence DHF

Spreading of Geographic distributionof endemicity

Absence of a concrete NationalProgram both Epidemic control aswell as Endemic Surveillance


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KI DENGA PEPO

Acute Febrile Arthopod-borneArboviral illness

Humans are the main amplifying hostDengue virus belongs to Flaviviridaewith 4 serotypes (DEN-1 DEN-4)

Aedes aegypti, a day biting urbanthriving mosquito is the primary vectorAffects mainly tropical and sub-tropical

areas


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Clinical Features

High fever with maculo-papular rash Severe headache/retro-orbital pain

Arthralgia/myalgiaNausea/vomitingPetechiae/purpuraeHemorrhagic phenomenon

Epistaxis, gum bleeds, G I bleeding,hematuria, menorrhagia, ICH


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Dengue hemorrhagic fever

High feverHemorrhagic

phenomenonHepatomegalyHypovolemic

shock

1/3rd cases ofDHF progressto shock

Clinical

indicatorsLaboratoryindicators


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complications

Shock Internal bleeding

Pleural effusion/ascitesEncephalopathyLiver failureIatrogenic

Sepsis Pneumonia Overhydration


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Laboratory findings

Thrombocytopenia Hemoconcentration

LeukopeniaHypoproteinemiaHyponatremiaIncreased SGOTCoagulation defectsHeaptomegaly/pleural effusion/ascites


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Laboratory Diagnosis

Sample collection time

Acute sera (S1)

Convalescent sera (S2) Late Convalescent sera (S3)Sampling methods Tubes/Vials, Filter-paperApproaches Virus Antigen Antibody Genomic sequence


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Approaches

Viral culture

In-situ hybridization

Immuno-cytochemistry

Reverse Transcriptase PCRamplification assay

Serological methods

Cross-reactivity Original Antigenic Sin


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Serological methods

MAC-ELISA Neutralization test

Heme-agglutination inhibition testComplement fixation testDot-Blot immunoassay


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Case definition-Dengue fever

Acute febrile illness with 2 or more of

Headache/retro-orbital pain Arthralgia/myalgia Rash Hemorrhagic manifestation LeukopeniaEither of Supportive serology/positive IgM Occurrence at the same location andtime as other confirmed cases of DF


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1.2.3.4.1.2.

3.4.Dengue Hemorrhagic Fever

Fever or H/O acute fever lasting 2-7 daysHemorrhagic tendencies evidenced by at-least one of

Positive tourniquet testPetechiea / Ecchymosis

Bleeding from mucosa /GIT/ injection sitesor other locationsThrombocytopeniaEvidence of plasma leakage

Rise in hematocritDrop in hematocrit after hydrationPleural effusion, ascites &

hypoproteinemia


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Dengue shock syndrome

All 4 criteria for DHF must be present Evidence of circulatory failuremanifested by

Rapid weak pulse Narrow pulse pressure (


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WHO Grading of DHF

Grade I fever accompanied by nonspecificconstitutional symptoms with apositive tourniquet test and/or easy

bruising

Grade II acute febrile illness withspontaneous bleeding

Grade III Circulatory failure indicatedby rapid weak pulse & hypotension ornarrowing of pulse pressure

Grade IV profound shock withundetected blood pressure or pulse


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Treatment

Anti-pyreticsFluid loss correction

10ml per kg x % body weight lossFluid maintanenceFor shock 10-20 ml/kg bolus upto 20-30ml/kg Plasma/plasma substitute/5% albumin Fresh whole blood Correction of electrolyte and acid-baseimbalance


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Prevention and Control

Vector surveillance and control Fever surveillance

Viral surveillanceCase notificationControl of outbreaksVaccination tetravalent live

attenuated dengue vaccine


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Vector Surveillance

Objectives and Uses

Geographical distribution & density

Evaluate Control ProgramsSampling methods Larval study, Collection on humans/of restingmosquitoes, Ovitrap, Tyre larvitrap &insecticide susceptibilityIndices

House, Container, Breteau landing rate, Indoor resting density


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Vector Control

Environmental management

Improvement of water supply & storage

Solid waste management Reduce, Reuse, Recycle Modification of man-made larval habitatsChemical control Against Lavae, pupae & ovum Against adult mosquitoesBiological control


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Chemical Control

Larvicide application

1% temephos sand granules

methoprenePerifocal treatment malathion, fenthion, fenitrothionSpace spraying Thermal fog ULV Mist


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Confinement of an Outbreak

At the individual level

Repellants, nets, coils & dressesAt the family level Empty/cover/drain/apply larvicideAt the community level Chemical control, communityparticipation, supervision of housesPubic info through medialegislation


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References

www.denguenet.com

www.whosea.org

Pubmed

W H O publication 1997

Nelson text book of paediatrics

Harrisons text book of internalmedicine

Parks text book of S P M


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7130948 Dengue Hemorrhagic Fever

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