Professional Thesis
PowerPoint Template
DENGUE
WHO Definition Of Dengue:
Acute Febrile illness with 2 or > of the
following:
Headache
Retro-orbital pain
Myalgia
Arthralgia
Rash
Hemorrhagic manifestations
Leukopenia
Hepatomegaly common
1. Virus transmitted
to human via mosquito Dengue Virus Transmission
saliva
2. Virus replicates
in target organs
3. Virus infects WBCs and
lymphatic tissues
4. Virus released and
circulates in blood
5. Second mosquito
ingests virus with blood
6. Virus replicates in mosquito
Aedes aegypti Breeding Sites
Prolonged shock
Liver failure
Encephalopathy
Renal failure
Co-infection
Co-morbidities
Hemorrhagic Manifestations of Dengue
Skin hemorrhages:
petechiae, purpura, ecchymoses
Gingival bleeding
Nasal bleeding
Gastrointestinal bleeding
Hematemesis, melena, hematochezia
Hematuria
Increased menstrual flow
Clinical Case Definition for Dengue Hemorrhagic Fever
4 Necessary Criteria:
1. Fever, or recent history of acute fever
2. Hemorrhagic manifestations
3. Low platelet count (100,000/mm3 or less)
4. Objective evidence of “leaky capillaries:”
• elevated hematocrit (20% or more over baseline)
• low albumin
• pleural or other effusions
Clinical Case Definition for Dengue Shock Syndrome
Four Necesary criteria for DHF
• Rapid and weak pulse
• Narrow pulse pressure (< 20 mm Hg) OR hypotension for age
• Cold, clammy skin and altered mental status
+ Plus
Evidence of circulatory failure manifested by:
DHF
Grade 1
Fever and nonspecific
constitutional symptoms
Positive tourniquet test is only
hemorrhagic manifestation
Difference
DENGUE HEMORRHAGIC FEVER DENGUE FEVER
Febrile Phase Febrile
2 – 7 days Phase
Critical Phase
3-7 days Critical
Lasts only for 24 –
48 hours Phase
Recovery Phase Recovery
5 - 7 days
Difference
DENGUE FEVER DENGUE HEMORRHAGIC FEVER
Headache, muscle/ joint/ bone Key feature is PLASMA LEAK
pain, Plasma leakage:
BLEEDING seen in some (not Rising Hct 20% or More
all) OR even less but towards
Low Hemorrhagic manifestations 20% if on IV fluids
Leucopenia Se Cholesterol <100mg/dl
Plt <100,000 in about 50% of (or drop of 20mg/dl)
patients(may be normal initially) Se Albumin <3.5 g/dl
No plasma leakage
(or drop of 0.5g/dl)
Thrombocyt Organ
openia
Bleeding Involvement
•Low production due to temporary bone •Thrombocytopenia •Direct involvement - infection
marrow suppression •Activation of the coagulation
•Increased consumption (activation of
of hepatocytes or brain with
system due to endothelial
coagulation system) the dengue virus
dysfunction, cytokines
•Direct infection of platelets with the •Circulatory failure - poor
•Poor perfusion of GIT: can lead to
virus: kills platelets
•Increased destruction of platelets by mucosal bleeding organ perfusion
activated macrophages •Drugs: Steroids, NSAIDS •Drugs – Paracetamol
PULSE PRESSURE! WARNING if 20 or less
BP 120/6 Pulse Pressure =60
BP 80/60 Pulse Pressure= 20
Dengue Dengue Shock
Hemorrhagic Syndrome-
Fever < 5%- leak BIG LEAK
Decompens Compensa
Profound ated Shock ted Shock
Shock (feeble
pulse, pulse
(pulse
(No BP, pressure
pressure
No Pulse) 20-30)
<20)
FLUID TYPES IN MANAGEMENT
s RL
S v
N
Crystalloids Colloids
0.9% Normal Saline – Adults
Dextran 40 in saline
5% Dextrose 0.9% Saline –
Children
6% Starch
5% Dextrose ½ Saline –
<6months
Clinical Scenario
If Afebrile Pt.
Restless
Irritable Decision
Pulse rate
CRFT>2 sec
Skin cold
Pulse pressure <20
HCT
Urine output <0.5 ml/kg IV Fluid Bolus
Clinical Scenario
Afebrile
Restless
Confused
Decision
Skin pale
CRFT>2 sec
Urine output < 0.5ml/kg/hr
PR
BP
PP Blood
HCt Transfusion
Clinical Scenario
Afebrile patient Vital Signs
Skin colour normal
Puffy eyelids
Temp. normal
Distended Abdomen Pulse pressure wide
Tachypnea Urine output > 1ml/kg/hr
Dyspnoea CRFT< 2 sec
PR rising
orthopnea
BP rising
Respiratory HCt low
distress
Patient Profile
•Generalized Aches and
Gender weakness
•Fever 102
•Dizziness
Com
• Female •Blood vomit – 2 Episodes
with Trace
Married •Abdominal Pain &
• 6 months ago plai Heartburn
•Loss of Appetite
•Low Urine Output
Age:
• 29
nt: •Pulse rate:105
•Irritability
•Dry Mouth
•Nausea
Weight •Retro-orbital Pain – Headache
•Dehydration
• 68kg
BP:
Medical History
• 95/60
• Jaundice 1.5 months back
• Acne
Comborbidities
• No UTI
•
•
•
No Cardiovascular History
No Pulmonary issue
Constipation
Lifestyle Habits
• Diet – Fast Food
Family History • Weekly hoteling
• No fruit intake
• Hypertension
• Rheumatoid Arthritis
• Coffee + Tea twice a day each
Immediate Self Medication History
Chest: Clear
• Ranitidine – 2 days for stomach
• Naproxen 550mg – 2 tablets for headache
• Isotretinoin 10mg Daily for past 1 month
• Bromazepam 3mg routine
Parameter Reference Range Day 1 Day 2 Day 3
RBC 4 – 5.5 m/C 3.8 3.8 4.0
Hgb 11 – 16 g/dL 9 9 9.5
HCT 36 – 46 % 30 31 38
Platelets 150 – 450 x 78 88 130
10 /uL
WBC 5.2 – 12 x 10/uL 3.3 3.5 4.8
MCV 76 - 96 70 73 75
MCHC 33 – 37 g/dL 35 35 35
Neutrophils 40 – 74 % 82 89 78
Lymphocytes 19 – 48 % 50 62 63
Blood Coagulation Profile
Parameter Reference Range Day 1 Day 3
Prothrombin Time 10 – 13 sec 17 12
INR 0.9 – 1.2 1.4 1.2
Liver Enzymes
Parameter Reference Range Day 1 Day 3
Albumin 3.8 – 5.1 g/Dl 3.8 4.3
Total Bilirubin 0.2 – 1.2 mg/dL 0.4 0.7
ALT 5 – 55 u/L 128 68
ALP 5– 40 u/L 202 108
Inj Inf
Teph
Btro Inj Dext Inj
Medic
40m l inj Bofal
rose
ation gan in Ons
on g 500 100m 5%
Admis BiD mg l NS x w/v et
sion
4 OD IV BD 1000 BiD
Days ml
Disch Tab Tab Tab
Calpol Tab Tab Syp
arge 500mg 2
Nuberol
Meclop Onset
Risek
Hepamer
Forte 20mg
Medic Tablets TDS TDS 4mg BD TDS z
TDS
ation
Tablet Folic Duplicatio
Risek vs n of
Duplication of
Sachet as Acid Calpol &
Metoclopramid
e and the patient Regime Nuberol
Ondansetron Forte
for NV had n More than
abdominal
complaint Missing Daily dose
Follow up for Ultrasound for
abdominal
liver profile tenderness not
missing performed
Patient not screened
for Hepatitis neither
in past medical
Avoid Spicy
Stop intake of isotretinoin
and bromazepam and Oily
foods
Educate the effect
Take Risek sachet/Tab
half an hour before food of Naproxen on
stomach
Take soft Use
Avoid light food Take Use full
self initially mosquito sleeves
followed by Plenty repellent
medicat taking green shirts
ion with leafy of oral and
and long
vegetables avoid
pain once the liquid build up length
killers condition
settles. s of water pants
