An acute fibrile illness syndrome caused by arboviruses that characterized by biphasic fever, myalgia, arthralgia, leukopenia, rash & lymphadenopathy.A.k.a dengue / breakbone fever
Only 1/3 of DHF patient develop shock and circulatory failure ( outpatient Tx is enough , bring back when there are alarming signs) .Early plasma, fluid & electrolyte replacement proved to have favourable outcome( maintain circulation). In DHF/DSS case, great care taken to reduce invasive procedures while managing shock
5. AETIOLOGY
Caused by 4 distinct but related viruses, DEN-
1/2/3/4- classified under Flaviviridae family
ssRNA viruses, enveloped and spherical (50 nm)
Infection by one type confer lifelong immunity
towards that type, but only partial towards other
type.
Evidence increase risk for DHF if there is sequential
infection
6. Vector : Aedes aegypti (main), Aedes albopictus &
Culex quinquefasciatus
A.aegypti (day-time bitting mosquito)
-must be infective female
-prefer feeds on human (abundant around
human.
-breeds in clear water
-bitting activity reduced in low temperature
14ºC(transmission less in winter)
9. Clinical Manifestation
Dengue Fever
- 1◦ Infection with DEN-2 and DEN-4 are thought to be
inapparent, regardless of age
- 1◦ infection with DEN-1 & DEN-3 in adult produces
biphasic fever and rash.
- Manifestation varies,
in infant & young child –asymptomatic to 1-5 days
fever, rhinitis, mild cough, pharyngeal inflammation
In classic dengue fever
- after incubation 2-7 d, rapid & sudden onset of fever
10. Accompanied by frontal or retro-orbital headache
Back pain (precedes fever,occassionally)
Macular rash (transient, generalized,in first 2 days of
fever)
Pulse rate is slow ( in proportion to fever)
Myalgia ( increase in severity)
Nausea & vomiting (on 2-6 D of fever)
Generalized Lymphadenopathy , followed by of period of
Defervescence.
Generalized mobiliform, maculopapular rash(palm &
soles spare)- disappear in 1-5 D (Biphasic ◦C curve)
11. At any stage, petechiae,epistaxis & purpuric lesion occur
(not common)
After febrile stage, prolonged asthenia, bradycardia &
extrasystole note( common in adult)
12. Dengue Hemorrhagic Fever( DHF).
~Other suggestive signs: hepatomegaly, circulatory
disturbance, hematocrite fall after fluid replacement
13. Clinical Manifestation
Dengue Hemorrhagic Fever (DHF/ DSS)
An acute vascular permeability syndrome followed with
abnormal in hemostasis.
Progression of illness is characteristics (in children).
In mild 1st phase: abrupt onset of fever, malaise,
cough, vomiting, headache & anorexia ( after 2-5 Days of
rapid deteroriation & physical collapse)
In 2nd phase: has clammy hand, cold, warm trunk.
Flush face & diaphoresis.
Restlessness, irritated, complained of mid-epigastric
pain.
Peripheral cyanosis may occur.
14. Scattered petechiae on forehead, extremities, spontenous
ecchymoses, easy bruising and bleeding at site of
venupuncture( common findings).
Respiration is rapid & often laboured.
The pulse pressure is usually narrow (≤20 mmHg),
systole & diastolic pressure may be low or unobtainable.
Liver become tender ( 2-3 fingerbeadth below costal
margin, firm & nontender)
Bilateral or unilateral pleural effusion (radiograph)
After 2-3 Days of crisis, convalescence is rapid in
children who recovered.
Temperature may return to normal during or before
shock.
24. Prognosis
Only 1/3 of DHF patient develop shock and
circulatory failure ( outpatient Tx is enough , bring
back when there are alarming signs) .
Early plasma, fluid & electrolyte replacement proved
to have favourable outcome( maintain circulation).
In DHF/DSS case, great care taken to reduce
invasive procedures while managing shock.
In children,
-in shock with unobtainable BP,
Has poor
-in shock but delayed admission,
prognosis
-in shock with GIT bleeding