guidelines issued to doctors ON
Dengue Fever

 

What causes this Arbo Virus infection?

Dengue Virus – belongs to flavi virus group, 4 distinct types Type I to IV

Affects adults and children.

Clinical manifestations              

Fever, malaise, myalgia, lymphadenopathy, bleeding, shock, WHO guidelines

r    High grade fever  2 – 7 Days

r    Hemorrhagic  tendencies

r    Thrombocytopenic     < 1  Lakh/mm3

r    Evidence of plasma leakage ( pleural effusion, ascities)

Vector

Aedes Aegypti  breeds in small collection of  fresh water like in coconut shells, tins, empty tyres etc.Virus multiplies in salivary gland and mid gut epithelium of the mosquitoes

Clinical Features

3 overlapping forms

r Classic dengue ( Commonly seen in mid Kerala)

r    Dengue haemorrhagic fever (DHS) -  (Spontaneous hemorrhage)

r    Dengue shock syndrome (DSS)  -  profound  circulatory failure

Classic dengue

Incubation period 2-7 Days.                             Mild rhinopharyngitis

Severe splitting headache                                 Macular rash

Retro –orbital pain, backache, leg pains &        Lymphodenopathy
arthralgias                                                           Hypotension.

True rigors    

Poor prognosis

Encephalitis like picture                                     Intra cranial haemorrhage

Metabolic & electrolyte disturbance                   Hepatic failure

DIC, profound shock (refractory to Rx)

Routine Lab tests

        Mimic Leptospirosis but in lesser degree

        Low ESR, High Hb/PCV (hemoconcentration)may suggest

        Renal involvement less

Confirmations

        IgM ELISA for Dengue

        Rising titre/ High titre

Treatment

No specific Rx, Mainly Symptomatic and supportive. Aggressive treatment of  hypotension, blood component therapy in particular platelet transfusion and management of shock has been very rewarding. Secondary infection in these patients can be controlled with appropriate broad spectrum antibiotics.