DENGUE
By Group R3-R
Table of Contents
1. Epidemiology
2. Etiology
3. Clinical Features
4. Diagnosis
5. Differential Diagnoses
6. Treatment
7. Prevention
1. Epidemiology
2. Etiology
DENV has a single-stranded,
positive-sense RNA genome
that is about 10.7 kb long
Transmission
Aedes aegypti Aedes albopictus
3. Clinical Features
Clinical Features
Dengue guideline 2018 &
WHO classification of dengue fever
[Link] fever (DF)
[Link] haemorrhagic fever (DHF)
- DHF stade I
- DHF stade II
- DHF stade III
- DHF stade IV
3 phases
[Link] phase (3-7 days)
[Link] phase / Afebrile
phase (24-48h)
[Link] phase /
Recovery phase
Febrile Phase 3-7 days
➢ Gastrointestinal symptoms
(anorexia, nausea, vomiting, abdominal pain, and diarrhea)
➢ Respiratory tract symptoms
(cough, sore throat, and nasal congestion)
A positive tourniquet test
indicates the increase capillary
fragility in early febrile stage.
Critical phase/Afebrile phase
(24-48h)
• Systemic vascular leak syndrome
- Plasma leakage: pleural effusion, peritoneal fluid
- Organs impairement
- Hemorrhagic manifestations
- Shock
• Plasma leakage and hemorrhage
resolve.
• Normal temperature
• Stable pulse, BP and respiratory rate
• Good urinary output
• Stable hematocrit, Thrombocytopenia
can last few more days
4. Diagnosis
4. Diagnosis
-Clinical findings: is often made based on clinical signs and symptoms.
-Laboratory Diagnosis:
Virological tests:
RT-PCR (detects viral RNA, best performed between day 0-7 of
onset)
NS1 Antigens test: fast and can detect dengue before antibodies
appear
SerologiCal tests (Antibody detection):
Dengue IgM AB test: useful when NS1 is negative and best
performed on Day 4-5 onwards, peaks at 2 weeks, and
disappears by 2-3 months. (Good for primary infection)
Dengue IgG AB test: useful for past infection detection, and
best performed from day 7 onwards. (it appears earlier in
secondary infection)
IgG & IgM ratio test: used to differentiate between primary
and secondary infection:
primary inf: IgM > IgG
secondary inf: IgG > IgM
It is essentiel to differentiate because the secondary infections have a
higher risk of severe dengue due to antibody-dependent enhancement
(ADE).
Hematological tests:
Complete blood count:
Leukopenia (lower WBC)
Thrombocytopenia (lower platelets <100,000/mm cube)
Hemo-concentration (Hematocrit >20% from baseline)
Liver function tests
elevated ALT/ AST (might seen in severe dengue)
Coagulation profile:
Prolonged PT, APTT, and low fibrinogen can indicates DIC
(may find in severe cases)
Additional tests in severe case:
imaging
Ultrasound
Chest X-ray
Tourniquet test (recommended by WHO guildeline to detect capillary
fragility specially in dengue where there might be vascular
leakage or increase of permeability)
5. Differential Diagnoses
Chikungunya fever Malaria Typhoid Fever
A mosquito-borne tropical A potentially life‑threatening A systemic illness caused by
disease that causes fever and tropical disease caused by Salmonella enterica serotype
polyarthralgia. Onset of Plasmodium parasites. It may Typhi. Manifestations include
symptoms occurs within 2 present with relatively fever, chills, abdominal pain,
weeks of infection. Treatment unspecific symptoms like rose spots on the trunk and
is supportive and patients fever, nausea, and vomiting 1 abdomen, and
usually make a full recovery. to 6 weeks after infection. hepatosplenomegaly.
Clinically suspected cases are
confirmed by direct parasite
detection in a blood smear.
Influenza Zika Virus Infection Oropouche Virus Disease
A highly contagious viral A mosquito-borne infection A midge- and mosquito-borne
infection that typically occurs that is usually asymptomatic tropical disease that causes
during the winter months. It is or causes mild fever, joint chills, myalgias, arthralgias,
caused by influenza A, B, and C pain, rash, and conjunctivitis. abrupt-onset fever, and severe
viruses. Symptomatic patients It can also be transmitted headache. Onset of symptoms
may present with sudden onset sexually and transplacentally. occurs within 3-10 days of
of high fever, headache, The most feared complication being bitten. Treatment is
myalgias, arthralgias, is fetal microcephaly, which supportive and patients
nonproductive cough, and occurs after mothers contract usually make a full recovery
malaise. the virus. within one week.
6. Treatment
Treatment of Dengue Fever
No specific treatment for dengue fever exists.
Goal standard for dengue fever is based on the clinical manifestations and each clinical
manifestation varies among the three phases: febrile, critical, and recovery phase. They
can accompanied by with or without warning:
Warning Signs
Persistent vomiting
Mucosal bleeding
Liver enlargement(hepatomegaly)
Legathy
Laboratory finding:
Leucopenia
Thrombopenia
Increase in ALT and AST→ indication for liver damage due to hepatic cytolysis
Increase in PTT, INR( coagulation factors)
Febrile Phases: fever but no warning signs detected
2~5 days after fever has started
Antipyretic: paracetamol 10mg/kg/H
Avoid using aspirins and ibuprofen (NSAID)
Taking adequate bed rest
Stay hydrated- drink a lot water,Fruit juice water ,coconut water
Vomiting: antiemetic medications (Domperidone 0.3 mg/kg/H (2~3 time per days)
Following Up:
CBC( thrombopenia, leukopenia)
Hematocrit
Vital Signs( body temperature, pulse rate, respiratory signs, and BP)
Critical Phrases:
~Occur in subset of patients
exists in two clinical manifestations( Dengue Hemorrhagic Fever and Dengue Shock Syndrome)
Use IV fluids( NSS and D5%)
Intravenous Vitamin K
Blood Transfusion( Platelet)
Oxygen Support
Following check up
Urine output every 2-3 hrs
Vital Signs
CBC
Hematocrit looking a decrease- indication
Check renal and liver functions
Coagulation factors
Recovery phase:
• The following sign are signs of recovery:
-Normal temperature.
-Stable pulse ,BP and respiratory rate .
-No evidence of any bleeding .
-No vomiting .
-Return of appetite.
-Good urinary output.
-Stable hematocrit.
~Maybe chronic fatigue
7. Prevention
👉 DENGUE FEVER IS AN AIRBORNE VIRAL
INFECTION.
👉 Mosquito bites prevention and controlling
mosquito populations are essential in dengue
fever prevention.
[Link] mosquito bites:
Use insect repellent
Wear protective clothing
Use mosquito nets
Screen windows and doors
[Link] mosquito populations
Eliminate breeding sites: tires, flower pots,
buckets,...
Environmental management: properly dispose
of trash, maintain clean surrounding
environment
Community involvement: population education,
initiate programs (spraying insecticides,
distributing larvicides)
THANK
YOU
