DENGUE
- an overview
Epidemiology:
● Global Prevalence: Dengue is a significant global health concern, with
outbreaks reported in more than 100 countries.
● Annual Cases: Estimated annual cases range from 50 to 100 million
worldwide.
● Endemic Regions: Dengue is endemic in tropical and subtropical regions,
including parts of Southeast Asia, the Americas, and the Western Pacific.
Etiology:
● Pathogen: Dengue is caused by the Dengue virus.
● Virus Family: It belongs to the Flaviviridae family.
● Transmission: The virus is primarily transmitted to humans through the bite
of infected Aedes mosquitoes, especially Aedes aegypti and Aedes
albopictus.
● Serotypes: There are four serotypes of the Dengue virus (DEN-1, DEN-2,
DEN-3, DEN-4), all capable of causing the disease.
● Infection: Dengue infection occurs when an Aedes mosquito carrying one of
these serotypes bites a person, introducing the virus into their bloodstream.
● Multiplication: The virus multiplies in the human body, leading to the onset
of dengue fever and potential severe complications
TRANSMISSION
• Mosquito takes blood from a person.
• Extrinsic infection occurs in mosquito midgut and travels
to salivary gland in 8-10 days.
• Once mosquito bites humans intrinsic incubation occurs
in human with onset of symptoms in 4-7 days.
PATHOPHYSIOLOGY
.
3 phases of infection
Febrile Phase (Phase 1):
● Symptoms: This phase usually begins 4-10 days after the mosquito bite
and is often marked by a sudden onset of high grade fever, which can
reach up to 104°F (40°C). Other common symptoms during this phase
include headache, fatigue, nausea, vomiting, diarrhea, abdominal pain,
retro-orbital pain, joint pain, myalgia, maculopapular rash.
● Hepatomegaly and lymphadenopathy are also seen in some patients.
● Key lab finding: Thrombocytopenia
● Duration: The febrile phase typically lasts for 2-7 days.
.
Critical Phase (Phase 2):
● Symptoms: After the febrile phase, some individuals with dengue fever may enter a critical phase,
which can be life-threatening. During this phase, the fever generally subsides, but warning signs of the
critical phase include persistent vomiting, severe abdominal pain, bleeding from the nose or gums, and
the development of small red or purple spots on the skin (petechiae).
● Signs of fluid accumulation, such as pleural effusion or ascites.
● Signs of circulatory shock, including low blood pressure and altered mental status.
● Duration: The critical phase usually lasts for about 24-48 hours, but it can vary from person to person.
Recovery Phase (Phase 3):
● Symptoms: If the patient survives the critical phase, they will gradually enter the recovery phase.
During this phase, the fever subsides, and most symptoms improve. However, individuals may still
experience fatigue, weakness, and a lack of appetite for several weeks.
● Duration: The recovery phase can last for several weeks, and it varies from person to person.
COMPLICATIONS
I. FEBRILE PHASE
• Dehydration
II. CRITICAL PHASE
• Shock
• Hemorrhage
• Organ impairment
III. RECOVERY PHASE
• Fluid overload
.
.
.
DIAGNOSTIC TESTS
•Cbc test - Leukopenia, thrombocytopenia, elevated hematocrit (Hct).
•REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION for rapid identification and serotyping of
DENV in acute phase serum.
• Immunoassay for the detection of non-structural protein I (NS1) antigens - For screening and diagnosis as
early as I day post-onset of symptoms.
• Best used during the first 5 days of illness
SEROLOGICAL METHODS:
•ENZYME LINKED IMMUNOSORBENT ASSAYS(ELISA):
-IgM antibody: usually detected after day 5 of illness (for acute infection)
-IgG antibody: detects past dengue infection
.
TREATMENT
● Treatment is based on symptoms and medical support
-UNCOMPLICATED DENGUE FEVER:
•Bed rest,oral rehydration, antipyretic and analgesic
-SEVERE DENGUE FEVER:
•IVF to maintain effective circulation.
•Monitoring of hematocrit,platelet count,PR,BP and UO
-DENGUE SHOCK SYNDROME:
•Fluid therapy with colloids and extensive monitoring for any complications
CONTROL
• Vector Control
• Eliminating container habitats
• Use of insecticides (larvae and adults)
•Individual and household protection
• Clothing that minimizes skin exposure during daylight hours
• Use of repellents
• Insecticide-treated mosquito nets
• household insecticide aerosol products
• Household fixtures such as window anf door screens.
THANK YOU..
