7130948 dengue hemorrhagic fever
TRANSCRIPT
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Dengue hemorrhagic feverDiagnosis, Treatment,Prevention and ControlDengue hemorrhagic feverDiagnosis, Treatment,Prevention and Control
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Why DengueEmerging Health Problem
Almost 1/3rd of the world in endemicareas mostly SEAR countries (52%
Increase in Incidence and Frequency ofepidemics
Among 10 leading causes of pediatrichospitalization & death in SEAR
Economic Burden both DirectIndirect cost
Sporadic cases in Non-Endemicpopulation poses diagnostic difficulty
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South-East Asia South-East Asia
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Indian Perspective
Presently a category B country
Endemic Transmission of all 4serotypes leading on to heterotypicityand hence DHF
Spreading of Geographic distributionof endemicity
Absence of a concrete NationalProgram both Epidemic control aswell as Endemic Surveillance
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KI DENGA PEPO
Acute Febrile Arthopod-borneArboviral illness
Humans are the main amplifying hostDengue virus belongs to Flaviviridaewith 4 serotypes (DEN-1 DEN-4)
Aedes aegypti, a day biting urbanthriving mosquito is the primary vectorAffects mainly tropical and sub-tropical
areas
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Clinical Features
High fever with maculo-papular rash Severe headache/retro-orbital pain
Arthralgia/myalgiaNausea/vomitingPetechiae/purpuraeHemorrhagic phenomenon
Epistaxis, gum bleeds, G I bleeding,hematuria, menorrhagia, ICH
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Dengue hemorrhagic fever
High feverHemorrhagic
phenomenonHepatomegalyHypovolemic
shock
1/3rd cases ofDHF progressto shock
Clinical
indicatorsLaboratoryindicators
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complications
Shock Internal bleeding
Pleural effusion/ascitesEncephalopathyLiver failureIatrogenic
Sepsis Pneumonia Overhydration
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Laboratory findings
Thrombocytopenia Hemoconcentration
LeukopeniaHypoproteinemiaHyponatremiaIncreased SGOTCoagulation defectsHeaptomegaly/pleural effusion/ascites
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Laboratory Diagnosis
Sample collection time
Acute sera (S1)
Convalescent sera (S2) Late Convalescent sera (S3)Sampling methods Tubes/Vials, Filter-paperApproaches Virus Antigen Antibody Genomic sequence
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Approaches
Viral culture
In-situ hybridization
Immuno-cytochemistry
Reverse Transcriptase PCRamplification assay
Serological methods
Cross-reactivity Original Antigenic Sin
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Serological methods
MAC-ELISA Neutralization test
Heme-agglutination inhibition testComplement fixation testDot-Blot immunoassay
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Case definition-Dengue fever
Acute febrile illness with 2 or more of
Headache/retro-orbital pain Arthralgia/myalgia Rash Hemorrhagic manifestation LeukopeniaEither of Supportive serology/positive IgM Occurrence at the same location andtime as other confirmed cases of DF
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1.2.3.4.1.2.
3.4.Dengue Hemorrhagic Fever
Fever or H/O acute fever lasting 2-7 daysHemorrhagic tendencies evidenced by at-least one of
Positive tourniquet testPetechiea / Ecchymosis
Bleeding from mucosa /GIT/ injection sitesor other locationsThrombocytopeniaEvidence of plasma leakage
Rise in hematocritDrop in hematocrit after hydrationPleural effusion, ascites &
hypoproteinemia
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Dengue shock syndrome
All 4 criteria for DHF must be present Evidence of circulatory failuremanifested by
Rapid weak pulse Narrow pulse pressure (
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WHO Grading of DHF
Grade I fever accompanied by nonspecificconstitutional symptoms with apositive tourniquet test and/or easy
bruising
Grade II acute febrile illness withspontaneous bleeding
Grade III Circulatory failure indicatedby rapid weak pulse & hypotension ornarrowing of pulse pressure
Grade IV profound shock withundetected blood pressure or pulse
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Treatment
Anti-pyreticsFluid loss correction
10ml per kg x % body weight lossFluid maintanenceFor shock 10-20 ml/kg bolus upto 20-30ml/kg Plasma/plasma substitute/5% albumin Fresh whole blood Correction of electrolyte and acid-baseimbalance
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Prevention and Control
Vector surveillance and control Fever surveillance
Viral surveillanceCase notificationControl of outbreaksVaccination tetravalent live
attenuated dengue vaccine
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Vector Surveillance
Objectives and Uses
Geographical distribution & density
Evaluate Control ProgramsSampling methods Larval study, Collection on humans/of restingmosquitoes, Ovitrap, Tyre larvitrap &insecticide susceptibilityIndices
House, Container, Breteau landing rate, Indoor resting density
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Vector Control
Environmental management
Improvement of water supply & storage
Solid waste management Reduce, Reuse, Recycle Modification of man-made larval habitatsChemical control Against Lavae, pupae & ovum Against adult mosquitoesBiological control
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Chemical Control
Larvicide application
1% temephos sand granules
methoprenePerifocal treatment malathion, fenthion, fenitrothionSpace spraying Thermal fog ULV Mist
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Confinement of an Outbreak
At the individual level
Repellants, nets, coils & dressesAt the family level Empty/cover/drain/apply larvicideAt the community level Chemical control, communityparticipation, supervision of housesPubic info through medialegislation
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References
www.denguenet.com
www.whosea.org
Pubmed
W H O publication 1997
Nelson text book of paediatrics
Harrisons text book of internalmedicine
Parks text book of S P M
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