DENGUE FEVER

RNA Virus

Part of the Family of Flaviviridae

Specifically the Genus Flavivirus

DENGUE

Can also be spread through blood

transfusions of infected patients and Organ
Transplants

INCUBATION PERIOD
The period taken by the multiplying
organism to reach a threshold necessary to
produce symptoms in host.
Ranges from 3-14 Days

But most often from 4-7

TRANSMISSIBILITY PERIOD

Time frame a patient can spread the

pathogen

The mosquito can only become a vector

when it takes blood from an infected
person during the viremia Period
(when the patient has the highest levels of
the dengue virus in the blood)

SIGNS AND SYMPTOMS OF DENGUE FEVER

High Fever, up to 105 F (40.6 C)

Sever Headache, Backache or Pain behind the eyes.
Sever Joint and Muscle Pain (Breakbone Fever)
Nausea and Vomiting
A rash over most of the body, which can subside over
a few days and then reappear
Signs and Symptoms usually begin about four to
seven days after being bitten by the Aedes Mosquito
Mild Dengue Fever Rarely Causes Death and is
usually self limiting

CLINICAL MANIFESTATIONS OF DENGUE

AND DENGUE HEMORRHAGIC FEVER
Undifferentiated fever
Classic dengue fever
Dengue hemorrhagic fever
Dengue shock syndrome

Manifestations of Dengue Virus Infection

Dengue Virus Infection

With Symptoms

Without Symptoms

No Different from
other fever

Without
Hemorrhage

Dengue Fever (DF)

Syndrome

With Unusual
Hemorrhage

No Shock

Dengue Hemorrhage
Fever (DHF)

Dengue Shock
Syndrome

DOES EVERYBODY BLEED WITH DENGUE?

Hemorrhaging (Dengue Hemorrhagic

Fever) &
Shock (Dengue Shock Syndrome)
Happen in less than 5% of those with
Dengue.

DENGUE VIRUS EXISTS AS 4 STRAINS

(SEROTYPES)

DENV-1
DENV-2
DENV-3
DENV-4

DENGUE COMPLICATION RISKS

While each serotype can cause the full

spectrum of disease, virus strain is a risk
factor. Infection with one serotype is
thought to produce lifelong immunity to
that type, but only short term protection
against the other three.

DENGUE COMPLICATIONS RISKS

The risk of severe disease from

secondary infection increases if someone
previously exposed to serotype DENV-1
contracts serotype DENV-2 or DENV-3, or
if someone previously exposed to DENV-3
acquires DENV-2

RISK FACTORS REPORTED FOR DHF

Virus strain :DHF risk is greatest for DEN-2,

followed by DEN-3, DEN-4 and DEN-1

Pre-existing anti-dengue antibody

previous

infection
maternal antibodies in infants

Age(<12)

SIGNS AND SYMPTOMS OF

DENGUE HEMORRHAGIC FEVER (DHF)
A more sever form of Dengue Fever that begins
the same way as Dengue Fever but becomes
worse after several days.
Significant damage to the blood vessels and
lymph vessels.
A decrease in number of clotting platelets
Bleeding from the nose and mouth, Bleeding
under the skin which gives the appearance of
Bruising Death
Increased Menstrual flow

SIGNS AND SYMPTOMS OF

DENGUE SHOCK SYNDROME (DSS)

The most sever form of Dengue

It may start with the signs and symptoms of mild
Dengue plus sever abdominal pain.
Frequent vomiting
Disorientation
Fluid (plasma) leakage
from blood vessels
Heavy Bleeding
Sudden Drop in Blood
Pressure (shock)
Death

Manifestations of Dengue Virus Infection

Dengue Virus Infection

With Symptoms

Without Symptoms

No Different from
other fever

Without
Hemorrhage

Dengue Fever (DF)

Syndrome

With Unusual
Hemorrhage

No Shock

Dengue Hemorrhage
Fever (DHF)

Dengue Shock
Syndrome

CLINICAL CASE DEFINITION FOR

DENGUE HEMORRHAGIC FEVER

4 Necessary Criteria:
Fever, or recent history of acute fever
Hemorrhagic manifestations
Low platelet count (100,000/mm3 or
less)
Objective evidence of leaky
capillaries:

elevated hematocrit (20% or more over

baseline)
low albumin

FOUR GRADES OF DHF

Grade 1

Grade 2

Grade 1 manifestations + spontaneous bleeding

Grade 3

Fever and nonspecific constitutional symptoms

Positive tourniquet test is only hemorrhagic
manifestation

Signs of circulatory failure (rapid/weak pulse, narrow

pulse pressure, hypotension, cold/clammy skin)

Grade 4

Profound shock (undetectable pulse and BP)

DANGER SIGNS IN
DENGUE HEMORRHAGIC FEVER

Abdominal pain - intense and

sustained
Persistent vomiting
Abrupt change from fever to
hypothermia, with sweating and
prostration
Restlessness or somnolence

CLINICAL CASE DEFINITION FOR DENGUE SHOCK

SYNDROME

criteria for DHF

Evidence of circulatory failure manifested

indirectly by all of the following:
Rapid and weak pulse
Narrow pulse pressure ( 20 mm Hg) OR
hypotension for age
Cold, clammy skin and altered mental status
Frank shock is direct evidence of circulatory
failure

LAB TESTS

LABORATORY TESTS
IN DENGUE FEVER

Clinical laboratory tests

CBC--WBC,

platelets, hematocrit

Albumin
Liver

function tests
Urine--check for microscopic hematuria

Dengue-specific tests
Virus

isolation
Serology

LABORATORY METHODS FOR DENGUE

DIAGNOSISVirus isolation to determine
serotype of the infecting virus
IgM ELISA test for serologic
diagnosis

(detection of a past Dengue infection)

OTHER TESTS

OTHER TESTS

Xray for Pleural Effusions

PHARMACOLOGICAL MANAGEMENT
Acetaminophen for Fever Control
Narcotics for pain control as needed.
AVOID ASPRIN OR ANTIGOAGULANT
PROPERTIES.
CHILDREN SHOULD AVOID ASPRIN
WHEN A VIRAL INFECTION IS
SUSPECTED

NON PHARMACOLOGICAL MANAGEMENT

Bed Rest and Hydration
Therapy
Hydration Therapy
Basic Fever Control

Fan
AC
Tepid

shower

Monitoring signs and symptoms for warning

signs of DHF and DSS
Hospitalization should symptoms worsen

MANAGEMENT OF DENGUE FEVER

OUTPATIENT TRIAGE
No hemorrhagic manifestations and
patient is well-hydrated: home treatment
Hemorrhagic manifestations or hydration
borderline: outpatient observation center
or hospitalization
Warning signs
(even without profound
shock) or DSS: hospitalize

Warning Signs for Dengue

Shock
Four Criteria for DHF:
Fever
Hemorrhagic manifestations
Excessive capillary
permeability
100,000/mm3 platelets
Initial Warning
Signals:
Disappearance of
fever
Drop in platelets
Increase in
hematocrit

Alarm Signals:
Severe abdominal pain
Prolonged vomiting
Abrupt change from
fever
to hypothermia
Change in level of
consciousness
(irritability
or somnolence)
When Patients Develop
DSS:
3 to 6 days after onset of
symptoms

PREVENTION IS BETTER THAN CURE

THANK YOU