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Dengue Fever
Dengue Fever
Dengue Fever
2.
Aedes albopictus, the
secondary vector
believed to be responsible
in maintaining the virus
in the environment
Biting:
generally daybiters with 2 peaks of biting time:
a) at dawn, just before sunrise
b) at dusk, just before sunset
Resting habit:
Aedes aegypti prefers to rest in cool, dark corners of the house.
Commonly, found in closets( where clothes are hung)., under beds, tables
and chairs.
Aedes albopictus adults usually rest outdoors in clearing vegetations;
also
noted indoors.
Flying habits:
average light range is 50 meters; farthest distance is only within
200- 400 meter radius from breeding places.
Pathophysiology:
Dengue Fever
New classification
Dengue without warning signs
Dengue with warning signs
Severe dengue
Dengue Fever
Febrile phase
Usually lasts 2-7 days
Monitoring for warning signs is crucial
to recognize its progression to critical
phase
The earliest abnormality in full blood
count is progressive decrease in total
white cell count.
Critical Phase
Severe dengue
Plasma leakage that may lead to
shock and/or fluid accumulation, with
or without respiratory distress
Severe bleeding
Severe organ impairment
Recovery Phase
Gradual reabsorption of extravasate
fluid
from
intravascular
to
extravascular space by way of
lymphatics will take place in the next
48-72 hrs.
Classical rash of isles of white in the
sea of red
WBC starts to rise soon after
defervescence but normalization of
platelet count is later than that of
Assessment
History
Date of onset
Quantity of oral
intake
Assess for warning
signs
Diarrhea
Seizures
Impaired
consciousness
Behavioural
changes
Urine utput
Family members
or neighbors with
dengue
Assessment
Physical examination
Assessment
Investigation
Wbc
Dengue diagnostic tests: viral culture
isolation r PCR
Management
Group A may be sent home
Group B may be referred for inhospital management
Group C require emergency
treatment and urgent referral
Group A
Treatment plan
Group B
Warning signs
Co-existing conditions that may make
management more complicated like
pregnancy, infancy and old age,
obesity, diabetes mellitus, renal
failure,chronic hemolytic diseases
Social circumstances such as living
alone, or living far from health facility
or without reliable means of transport.
Treatment plan
A. Dengue without warning signs
Encourage oral fluids
If not tolerated, start IV fluid therapy
0.9% NaCl (saline) or Ringers lactate
with or without dextrose at
maintenance rate
Patients may be able to take oral
fluids after a few hours of IV fluid
therapy
Reassess
Give
GROUP C
Treatment Plan
A. Management for patients admitted to
the hospital with Compensated Shock
Start IV fluid resuscitation with isotonic
crystalloid solutions at 5-10ml/kg/hr
over 1 hour, then reassess the
patients
condition
and
decide
depending on the situation:
If
If
If
If
Treatment Plan
Give
Consider
Although
Discharge Criteria
ALL of the following conditions must be
present:
1. No fever for 48 hours
2. Improvement
in clinical status
(general
well-being,
appetite,
hemodynamic status, urine output, no
respiratory distress)
3. Increasing trend of platelet count
4. Stable hematocrit without IV fluids