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DENGUE FEVER DENGUE FEVER and and
DENGUE HEMORRHAGIC DENGUE HEMORRHAGIC FEVERFEVER
DENGUE FEVERDENGUE FEVER the most common and most the most common and most
important mosquito-borne viral important mosquito-borne viral disease in the worlddisease in the world
found in both tropical and found in both tropical and subtropical regionssubtropical regions
transmitted by aedes aegyptitransmitted by aedes aegypti
Aedes AegyptiAedes Aegypti
primarily a daytime primarily a daytime feederfeeder
lays eggs and produces lays eggs and produces larvae preferentially in larvae preferentially in artificial containersartificial containers
highly urbanizedhighly urbanized
DENGUE VIRUSDENGUE VIRUS
An arbovirus. Dengue is transmitted An arbovirus. Dengue is transmitted though mosquito bitesthough mosquito bites
Causes dengue fever and dengue Causes dengue fever and dengue hemorrhagic feverhemorrhagic fever
Has four serotypes (den 1, den 2, Has four serotypes (den 1, den 2, den3, den4)den3, den4)
All serotypes can cause severe and All serotypes can cause severe and fatal disease fatal disease
All serotypes are immunologically All serotypes are immunologically related but do not provide cross-related but do not provide cross-protective immunity against each otherprotective immunity against each other
Dengue in the PhilippinesDengue in the Philippines
Quick Facts:Quick Facts:•Affects all regions in the Philippines, especially those which are highly populated•Region X (Mindanao) NCR, Region VII (Cebu) with the highest number of cases•28% increase in Dengue cases during the period of Jan to Sep ’05 vs Jan to Sep ’04•Ages of people with Dengue range from 1 to 95 yrs old with a median of 10 years old; 43% belong to 1-9 yr age group and 52% of dengue cases are males•26 – 81% of Dengue cases are unreported
SOURCES: www.doh.gov.ph/nec/dengue/dusept2005.pdf www.bayanihan.org/html/article.php/20060926152921347
REPLICATION AND TRANSMISSIONREPLICATION AND TRANSMISSION OF DENGUE VIRUSOF DENGUE VIRUS
Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
REPLICATION AND TRANSMISSIONREPLICATION AND TRANSMISSIONOF DENGUE VIRUSOF DENGUE VIRUS
Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
CLINICAL CHARACTERISTICSCLINICAL CHARACTERISTICS of DENGUE FEVERof DENGUE FEVER
FeverFever HeadacheHeadache Muscle and joint painMuscle and joint pain Nausea and vomitingNausea and vomiting RashRash Hemorrhagic manifestationHemorrhagic manifestation
PETECHIAEPETECHIAE
Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
DIAGNOSISDIAGNOSIS
Clinical evaluation in Dengue FeverClinical evaluation in Dengue Fever- blood pressure- blood pressure- evidence of bleeding in skin - evidence of bleeding in skin or or other sitesother sites- hydration status- hydration status- evidence of increase vascular - evidence of increase vascular permeability (effusions, permeability (effusions, ascites)ascites)- (+) torniquet test- (+) torniquet test
POSITIVE TORNIQUET TESTPOSITIVE TORNIQUET TEST
Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
CLINICAL CASE DEFINITION CLINICAL CASE DEFINITION DENGUE HEMORRHAGIC FEVERDENGUE HEMORRHAGIC FEVER
4 necessary criteria4 necessary criteria Fever or recent history of acute Fever or recent history of acute
feverfever Hemorrhagic manifestationHemorrhagic manifestation Low platelet count - 100,000/mmLow platelet count - 100,000/mm3 3
or lessor less Objective evidence of leaky Objective evidence of leaky
capillaries capillaries
Pleural EffusionPleural Effusion
Centers for Disease Control and PreventionCenters for Disease Control and Prevention
Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
HEMORRHAGIC MANIFESTATIONSHEMORRHAGIC MANIFESTATIONS
OF DENGUEOF DENGUE HEMORRHGIC FEVERHEMORRHGIC FEVER Skin hemorrhages Skin hemorrhages
- purpura, petechia, ecchymoses- purpura, petechia, ecchymoses Gingival bleedingGingival bleeding Nasal bleedingNasal bleeding Gastrointestinal bleedingGastrointestinal bleeding - hematemesis, melena, - hematemesis, melena,
hematocheziahematochezia HematuriaHematuria Increase menstrual flowIncrease menstrual flow
DANGER SIGNS OF DHFDANGER SIGNS OF DHF
Abdominal pain – intense & sustainedAbdominal pain – intense & sustained Persistent vomitingPersistent vomiting Abrupt change from fever to Abrupt change from fever to
hypothermia with sweating & hypothermia with sweating & prostrationprostration
Restless or somnolenceRestless or somnolence
4 GRADES OF DHF4 GRADES OF DHF
Grade 1Grade 1- - fever & non specific constitutional s fever & non specific constitutional s
& & sx sx - positive torniquet test - positive torniquet test
Grade 2Grade 2- grade 1 + spontaneous bleeding- grade 1 + spontaneous bleeding
Grade 3Grade 3- signs of circulatory failure- signs of circulatory failure
Grade 4Grade 4- profound shock- profound shock
LABORATORY TESTLABORATORY TEST Clinical laboratory testsClinical laboratory tests
- CBC - CBC - liver function tests- liver function tests- Chest X-ray - Chest X-ray - Urinalysis - Urinalysis
VIRUS ISOLATIONVIRUS ISOLATION CELL CULTURECELL CULTURE
Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division Division of Vector-Borne Infectious Diseasesof Vector-Borne Infectious Diseases
VIRUS ISOLATIONVIRUS ISOLATION CELL CULTURECELL CULTURE
Centers for Disease Control and PreventionCenters for Disease Control and PreventionDivision of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases
VIRUS-ISOLATIONVIRUS-ISOLATIONMOSQUITO-INOCULATIONMOSQUITO-INOCULATION
Centers for Disease Control and PreventionCenters for Disease Control and PreventionDivision of Vector-Borne Infectious DiseaseDivision of Vector-Borne Infectious Disease
TreatmentTreatment FluidsFluids RestRest Antipyretics – avoid Antipyretics – avoid
aspirin/NSAIDaspirin/NSAID Monitor blood pressure, hct, Monitor blood pressure, hct,
platelet count, PT, PTT and level platelet count, PT, PTT and level of consciousnessof consciousness
May need transfusion May need transfusion
Undifferentiated fever
Classical DengueFever
DengueHemorrhagicFever
Dengue
N A T I O N A L E P I D E M I O L O G Y C E N T E R
N A T I O N A L E P I D E M I O L O G Y C E N T E R
N A T I O N A L E P I D E M I O L O G Y C E N T E R
4S1)Search and Destroy, mosquito breeding places2)Self protection measures3)Seek early treatment4)Say “NO” to fogging
They Hide, We Seek
N A T I O N A L E P I D E M I O L O G Y C E N T E R
Thou Shalt Protect
N A T I O N A L E P I D E M I O L O G Y C E N T E R
Mistakes to Avoid
N A T I O N A L E P I D E M I O L O G Y C E N T E R