Dengue Shock Syndrome

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Dengue Hemorrhagic Fever Management

Dengue Hemorrhagic Fever ManagementTable 2 from Diagnosis and management of dengue fever in children ...Full text] Current perspectives on the spread of dengue in India | IDRFluid Management in DHF Patients - ppt download

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Challenges in DSS  early detection vital  Rapid replacement of fluid/blood  Prolonged shock → metabolic acidosis organ ...

 

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Dengue shock syndrome

This condition is characterized by petechia (bright red, itchy and small rash appearing on extremities that spread over entire body except for the face) and ecchymoses (larger blood patches under the skin). Even minor injuries cause bleeding. Some recognizing symptoms of dengue shock syndrome are as follows:

  • Weak and rapid pulse
  • Narrow pulse (less than 20 mm Hg)
  • Cold, clammy skin
  • Restlessness.

If a proper diagnosis and treatment are not available to the patient, it may lead to the death of the individual within 48 hours.

Dengue Rashes

 

Dengue hemorrhagic fever

What are the symptoms of dengue? Is there any dengue cure in particular? These are the questions that arise in any normal individual. Dengue hemorrhagic fever is characterized by the increase in the vascular permeability, abnormal clotting mechanism, and hypovolemia. It is a deadly complication. The symptoms are more similar to the dengue fever, but in a few days, these symptoms are followed by restlessness, irritability, and sweating. The fever continues for 2 to 7 days. The temperature may reach upto 41-degree Celsius and convulsions, and other complications may occur. A few recognizing sign and symptoms of dengue hemorrhagic fever are as follows

  • Continuous and severe pain in abdomen
  • Bleeding from gums, nose, and mouth
  • Skin bruises
  • Frequent vomiting with or without blood
  • Black stools
  • Excessive thirst
  • Dry mouth
  • Pale, cold skin
  • Restlessness
  • In some cases, patients may be sleepy.

Dengue fever prevention

The factors that increase the chance of developing dengue hemorrhagic fever are as follows:

  • Presence of antibodies against dengue virus from a previous infection
  • Age below 12 years
  • Being female
  • Weak immune system

If dengue hemorrhagic fever is mild, the fever subsides and the symptoms abate, but in severe cases, after a few days of the illness, the condition of the patient starts deteriorating. Temperature drops and signs of circulatory failure follows. The patient may also go into the shock, and the condition is termed as dengue shock syndrome.

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Dengue fever ,Dengue shock syndrome

 

 

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Dengue fever ,Dengue shock syndrome

 

Dengue fever ,Dengue shock syndrome

 

Dengue fever

 

Frsh

Aedes aegyptii-daytime,urban,collections of water. Dengue like disease-chikungunya, o’nyong- nyong, westnile fever. IP-1 t...

Multiple types of dengue virus. Dengue 3 virus- severe clinical syndrome.. Relatively mild 1st phase with rapid clinical d...

GRADE 1- Fever + positive tourniquet test. GRADE 2- Spontaneous bleeding. GRADE 3-Circulatory failure. GRADE 4- Profound s...

DF. Bed rest, supportive treatment, Aspirin C/I.  DHF. 1. IVF NS>RL. 2. If pulse pressure <10mm Hg/elevn of hematocrit pe...

 

Criteria High fever/ recent history of acute fever A (+)ve tourniquet test Thrombocytopaenia <100,000 cells/mm3 Object...

Dengue haemorrhagic fever is a dynamic disease 1. Febrile phase 2. Critical phase 3. Convalescent phase

Management as out patients Oral fluid (maintainance) Eg:-oral rehydration fluid, king coconut juice, fruit juices….etc  ...

Paracetamol 10-15mg/kg/dose (max 60mg/kg/day) Anti-emetics and H2 RB. NO NSAIDs or any STEROID Review with FBC , 1st a...

When to admit the patient ? Clinical judgment All patients with plt  100,000/mm3 All patients with warning signs

Following patients with probable dx of DF should admit.  Infants Obese Major co-morbidities Adverse social circumstan...

In DF & DHF ; lasts for 2-7 days Total WBC count initially high or normal drops < 5000/mm3

Adequate fluid intake Total fluid requirement  degree of dehydration (oral + IV) Maintenance volume Infants <6 months – ...

Adequate physical rest Paracetamol 10-15mg/kg/dose (max 60mg/kg/day) NO all NAIDSs & STEROIDS Monitoring - ( Annexure ...

Seen only in DHF late febrile phase; 3rd day to 7th day of illness up. Rapid drop in temperature Lasts for 24 – 48 hour...

Leak starts slowly, increases gradually, peak around 24 hours, slows down and ceases around 48 hours. 0 5 10 15 20 25 30 ...

 

Dengue fever

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WHAT IS DENGUE FEVER? <ul><li>An acute ,self-limited, febrile disease . </li></ul><ul><li>Dengue virus are maintained in a...

Dengue Fever(2),09

Dengue Fever(2),09

 

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WHAT IS DENGUE FEVER? <ul><li>An acute ,self-limited, febrile disease . </li></ul><ul><li>Dengue virus are maintained in a...

 

Clinical manifestations <ul><li>DF: fever, headache, myalgias, bone pain.Lymphadenopathy, skin rash. </li></ul><ul><li>L...

Why should we learn it ? <ul><li>2500 million at risk from dengue per year. </li></ul><ul><li>Epidemic in more than 100...

Etiology <ul><li>Dengue virus: enveloped RNA virus </li></ul><ul><li>Classified : family of Flaviviridae. </li></ul><ul>...

 

How DF transmitted? <ul><li>Sources of infection: patients and </li></ul><ul><li>anyone who with Covert infection </li><...

 

<ul><li>How dengue virus cause the disease ? </li></ul><ul><li>(pathogenesis and clinical presentations) </li></ul>

Dengue virus Blood stream Mononuclear-phagocyte system second viremia Antigen antibody complexes complement system incuba...

 

risk factors for DHF <ul><li>Important risk factors for DHF include </li></ul><ul><li>Virus factors: </li></ul><ul><ul><l...

 

Enchancing antibody <ul><li>heterotypic antibodies </li></ul><ul><ul><li>enhancement of virus replication in macrophages ...

 

Neutralizing antibody to Dengue 1 virus Dengue 1 virus Homologous Antibodies( 同型抗体 ) Form Non-infectious Complexes Non-n...

pathophysiological changes occur in DHF/DSS: <ul><li>Increased vascular permeability </li></ul><ul><li>haemoconcentration(...

CLINICAL PRESENTATIONS <ul><li>Incubation: 5-8 days </li></ul><ul><li>Clinical features depend on the age of the patient:...

Manifestation Of Dengue Virus Infections ASYMPTOMATIC DSS SYMPTOMATIC Without haemorrhage With unusual haemorrhage No shoc...

 

Undifferentiated Fever <ul><li>the most common manifestation of dengue </li></ul><ul><li>87% of students infected were eit...

<ul><li>Dengue fever (DF) </li></ul>1. fever <ul><li>Abrupt onset, rising to 39.5-41.4 C </li></ul><ul><li>Accompanied by </li></ul><ul><li>frontal or retro-...

2. Bone pains <ul><li>break bone fever is the another name of DF </li></ul><ul><li>After onset of fever </li></ul><ul><li>...

3. Rash <ul><li>first rash: first 1-2 days of fever, transient, generalized, macular and blanching; </li></ul><ul><li>Seco...

4. Hemorrhage <ul><li>Skin he morrhages: petechiae, purpura </li></ul><ul><li>Gin gi val bleeding </li></ul><ul><li...

 

Physical exams(1) <ul><li>Fever </li></ul><ul><li>Conjunct i val injection, pharyngeal eryth e ma </li></ul><ul><li>Rash: ...

Physical exams(2) : Tourniquet Test <ul><li>Method: </li></ul><ul><ul><li>Inflate blood pressure cuff </li></ul></ul><ul...Clinical forms of DF(china) <ul><li>Mild type </li></ul><ul><li>Typical type </li></ul><ul><li>Severe type: </li></ul><ul>...

 

Presentations of DHF/DSS(1) <ul><li>high fever : remains >39 for 2-7days </li></ul><ul><li>hepatomegaly : varies in size ...DSS(2)=DHF+SHOCK <ul><li>at the end of the febrile phase </li></ul><ul><li>signs of circulatory disturbance </li></ul><ul... finding DF DHF <ul><li>(+1-25%,++26-50%,+++51-75%,++++76-100%) </li></ul><ul><li>Fever ++++ ++++ </li></ul><ul><li>P...finding DF DHF <ul><li>Maculopapular rash ++ + </li></ul><ul><li>Myalgia/arthralgia +++ + </li></ul><ul><li>Leukopen...

Lab tests(1) <ul><li>Clinical laboratory tests </li></ul><ul><ul><li>CBC-- Leukopenia is typical; </li></ul></ul><ul><ul>...

Lab tests(2) : Dengue-specific tests <ul><li>serologic tests: Antibody assay </li></ul><ul><li>useful for documenting: </...

Diagnosis of DF <ul><li>Epidemiological evidences </li></ul><ul><li>Clinical presentations </li></ul><ul><li>Lab tests: </...four criteria for DHF <ul><li>Fever , last for 2-7days </li></ul><ul><li>at least one of Hemorrhage evidences </li></ul><u...

Diagnosis criteria for DSS <ul><li>four criteria for DHF </li></ul><ul><li>Evidence of shock </li></ul><ul><ul><li>sweat,...

Differencial diagnosis <ul><li>Include a wide spectrum of </li></ul><ul><li>viral </li></ul><ul><li>bacterial </li></ul>...

prognosis <ul><li>Self-limit disease </li></ul><ul><li>Convalescence may be prolonged </li></ul><ul><ul><li>with weakness ...

Treatment of DF <ul><li>complicated, no specific trx </li></ul><ul><li>Fluid replacement: adequate hydration </li></ul><u...

 

Continuous Monitoring of <ul><li>VS </li></ul><ul><li>Diuresis,mental status </li></ul><ul><li>Evidence of bleeding </li><...

Management for DHF <ul><li>Prevent and Treatment of shock: </li></ul><ul><li>mild to moderate isotonic dehydration (5%-8%...

prevention <ul><li>Three operations </li></ul><ul><li>must be conducted </li></ul><ul><li>isolation of patients. </li></u...

vaccine <ul><li>no vaccine currently available </li></ul><ul><li>research is underway for the development of a vaccine. ...

Personal protection <ul><li>remain in well-screened or completely enclosed, air-conditioned areas; </li></ul><ul><li>wear...

 

Dengue Hemorrhagic Fever Management

Athogenesis of dengue haemorrhagic fever and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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