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Prevention of Dengue
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DENGUE FEVER
Dr.N.C.Nanda
Jt.Director, HOD- Paediatrics
IGH,Rourkela
Aedes Mosquito
Burden of Dengue Illness• Predilection for Paed- age group& high mortality
• One disease entity with wide spectrum of Clinical
Presentation
• Unpredictable clinical evolution & outcome
• WHO System for classifying DEN. Syndromes to 5
grades
• Three arbitrary phases (DHF/DSS)
(Febrile Leaky Congestive)
World Distribution of Dengue Fever and the Principal Epidemic
Vector, Aedes aegypti
Average Annual No. Of DF & DHF Cases
Reported to WHO & Countries Reporting Dengue
Dengue Case Classification & Levels of Severity
Non Severe Dengue
Course of Dengue Illness
Febrile Phase
Defervescence
Phase
Defervescence
Phase
Critical Phase
Recovery Phase Recovery
Critical Phase
Normal Death
Recovery Phase
Normal Death
WHO System for Classifying Dengue Syndromes
The Course of Dengue Illness
Clinical Observation
• Febrile Phase - Fever,Hepatomegaly
Bleeding Sites
• Leaky Phase - Restlessness,Serous effusion,
(Around defervescence) Oligaria,Hypotension,Shock,
DIVC,MOI
• Congestive Phase - 12-24 Hrs
• Convalescence - Bradycardia
Confluent Rash
• Unusual Manifestation- Hepatic and Cardiac failure
CNS involvement
Diagnosis• Clinical
• Haematological - TLC,Platelet count, HCT,
Se.protein,Enzymes,
Coag.profile,E/O DIC
• Virological
Virus isolation - Mosquito
Antigen detection - NS1 DV ag (ELISA)
Molecular Method - PCR
Serology - HAI, CF,NT,EIA, MAC-ELISA,
IF,Immunoblot.
• Others : ECG – Bradycardia
CXR – PL.Effusion
Frequently Observed
Clinical Sign
• Fever
• Flushing
• Hepatomegaly
• Vomiting
• Ascitis & Pl.Effusion
• Pain Abd.
• Bleeding SIGNS
• Encephalitis
• Bradycardia
• ARDS
Lab Findings
• HCT, Thrombocytopenia
• SGPT & SGOT
• Hypoalbuminimia
• Hyponatrimia
• Hyperkalimia
• Hypernatrimia
• Hyperkalimia
• + ve CRP
Differential Diagnosis of Dengue Fever
Warning Signs
Admission Criteria
Haemodynamic assessment: Continuum of Haemodynamic Changes
Management• Entirely symptomatic and supportive but early
• Careful monitoring of physical signs and Lab result
• Early recognition and active intervention of ominous signs
OPD SETTINGS : Limited drugs
Counsel parents
HOSPITAL MANAGEMENT :IV line and CVP line
Lab sample
IV fluid therapy
Clinical monitoring
Transfusion of platelet/blood
Use of vasopressor and steroids
Monitor and intervene in cong.ph
Algorithm For Fluid Management In Hypotensive Shock
Algorithm For Fluid Management in Compensated Shock
Good Clinical Practice & Bad Clinical Practice
Prognosis Favourable
• High index of suspicion
• Early recognition of plasma leak
• Close monitoring Thrombocyte count and
HCT
• Early transfusion of platelet when needed
REASONS OF MORTALITY
DHF/DSS
FAILURE TO RECOGNISE:
Shock
Concealed haemorrhage
Congestive failure
MESSAGE
• A complex disease, has a set clinical pattern
and fixed time bound course of events.
• Management relatively simple, inexpensive &
very effective in saving lives - so long as high
index of suspicion, early recognition understanding
different phases, correct timely monitoring leading
to rational supportive management leads to good
clinical outcome
Breeding Sites of Dengue Vectors
PREVENTION• Dengue is preventable.
• Information, Education and Communication
• Key MessagesPrevent Mosquito breeding
(Proper water storage, Dry water storage containers, Remove disposables, Fill up ditches, Cover water with oil, Larvivorous fish)
Prevent Mosquito biting (Proper clothing, Wiring doors and windows, ITB)
• Local Health Department Involvement.
Observe One dry Day Every Week
THANK YOU