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Enveloped virus
3 major proteins
SS positive sense RNA
3
Dr. S Guanasena
Viral Serotypes
DV1
DV2
DV3
DV4
Subgroups and clades
One or more virus types in
circulation during an epidemic
4
Spectrum of Disease
Clinical course of
Dengue
Dengue Infection
DLF
SHOCK
A complex clinical syndrome
of decreased blood flow
to body tissues
resulting in
cellular dysfunction and
eventual
organ failure
Plasma leaks -
Pathophysiology
Host response
Subsequent infection
Previous IgG
Neutralizing (protective)
non neutralizing (replication enhancing)
Viral response
Pathophysiology of DHF
Increased capillary permeability
Protein rich fluid exudes into the interstitial space - Pleural effusion ,
Ascites etc.
Loss of volume
Reduces pulse pressure
during the critical phase – when the fluid is oozing out - would result
in
They die
Either due to shock and 20 organ failure
Approximate outcomes
Single organ failure - mortality = 40%
1. Febrile Phase
2. Critical Phase
3. Recovery Phase
Clinical course of
DHF
Febrile Phase
High fever
Some petechial hemorrhages
With generalized aches & pains and
headache;
this usually lasts two to seven days
Critical Phase
Starts with the resolution of fever
Occurs in a few people
Lasts for just 24-48 hours or so
Is associated with plasma leak – volume depletion
& shock
Warning signs
Low pulse pressure <20 mm
Tender hepatomegaly
Signs of impending DHF
Low cholesterol
Haemoconcentration
HCT 20% rise from baseline or rise
approaching 20% if patient already
on IV fluids
Biochemistry
o Serum albumin < 3.5 g/dl or 0.5
gm/dl fall during illness
Non fasting serum cholesterol < 100
mg/dl or 20mg/dl fall during illness
Oedematous gall bladder wall on U/S
25
Rate of Fluid loss and
intake (Critical Phase)
Clinical course of
DHF
Recovery Phase
First 5 days
NS 1
PCR
>5 days
IgM
IgG
Update on vaccine
Chimera vaccine Attenuated vaccine
Yellow fever & 6-8 cycles in DKC
dengue (Dog kidney cells)
Launched 2016
Partial immunity
Risk of secondary
infection
HAVE WE DONE
ENOUGH?
Decrease prevalence by
10% per year
What are our Goals?????
Keep DHF mortality below
1%
Current situation in
Punjab
Lahore 2011 Rawalpindi 2015
03 deaths