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Andrea Montelibano Isabelle Escobillo

Andrea Montelibano Isabelle Escobillo. The Virus . Flavivirus Single strand RNA 4 serotypes DENV-1 DENV-2 DENV-3 DENV-4 Infection with one serotype confers lifelong immunity to that serotype but not for the other Secondary infection leads to severe form. The Virus. Vectors

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Andrea Montelibano Isabelle Escobillo

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  1. Andrea Montelibano Isabelle Escobillo

  2. The Virus • Flavivirus • Single strand RNA • 4 serotypes • DENV-1 • DENV-2 • DENV-3 • DENV-4 • Infection with one serotype confers lifelong immunity to that serotype but not for the other • Secondary infection leads to severe form

  3. The Virus • Vectors • Aedesaegypti • Aediesalpobtica

  4. Transmission • Female mosquito infects human during the viremic phase • Virus replicates in the epithelial cell lining of the midgut hemocele  salivary glands • Usually occurs during the rainy season • High vector population is also found in man-made storage containers

  5. Clinical Features • Incubation: 4-6 days (range 3-14) • Constitutional symptoms • Sharp rise in temperature • Flushing, headache, chills, retro-orbital pain, photophobia, joint pains, anorexia, constipations, colicky pain, abdominal tenderness

  6. Clinical Features • Fever • Usually between 39C and 40C, biphasic, lasting 5-7 days • Rash • Day 1-3: Diffuse flushing or fleeting eruptions on the face neck and chest • Day 3-4: Maculopapular or rubelliform • Convalescence: confluent petechiae surround scattered pale areas or normal skin

  7. Clinical Features • Hemorrhagic manifestations • Positive tourniquet test • Massive epistaxis, hypermenorrhea, GI bleeding

  8. Laboratory Features • Leukopenia: WBC =< 5000 cells/mm3 • Mild thrombocytopenia (100,000 to 150,000 cells/mm3) • Mild hematocrit rise (=10%) • Elevated liver enzymes

  9. Classification

  10. Dengue without Warning Signs Lives in or travels to dengue-endemic area, with fever, plus any 2 of the following: • Headache, body malaise, myalgia, arthralgia, retro-orbital pain, anorexia, nausea, vomiting, diarrhea, flushed skin, rash, positive Tourniquet test • CBC with leukopenia, with or without thrombocytopenia and/or dengue NS1 antigen test or dengue IGM antibody test

  11. Dengue with Warning Signs • Lives in or travels to dengue-endemic area, with fever of 2-7 days, plus any of the following: • Abdominal pain or tenderness, persistent vomiting, clinical signs of fluid accumulation, mucosal bleeding, lethargy or restlessness, liver enlargement, decreased or no urine output within 6 hours • Increase in hematocrit and/or decreasing platelet

  12. Severe Dengue • Lives in or travels to dengue-endemic area, with fever of 2-7 days and any of the manifestations of dengue with/without warning signs, plus any of the following • Severe plasma leakage: shock, fluid accumulation with respiratory distress • Severe bleeding • Severe organ impairment • Liver: AST or ALT >= 1000 • CNS: Seizures, impaired consciousness • Heart: Myocarditis • Kidneys: Renal failsure

  13. Laboratory Diagnosis • Dengue NS1 • Detectable on Day 1 to 5 • Dengue IgM/ IgG • Day 3-5 onwards

  14. Clinical Course

  15. Management

  16. Management

  17. Management • When sending home a patient, patient and family advice should be given:

  18. Management • Follow-up: • Daily follow-up is recommended for all patients except those who have resumed normal activities or are normal when the temperature subsides

  19. Fluid Management

  20. Fluid management for patients who are not admitted Calculation of Oral Rehydration Fluids Using Weight (Ludan Method)

  21. Fluid management for patients who are admitted without shock • Isotonic solutions: D5 LRS, D5 NSS, D5 0.9 NaCl, PLR, 0.9 NaCl • Infants <6 months: Dr 0.45 NaCl Calculation of Maintenance IV Fluid Infusions (Holliday and Segar Method)

  22. Fluid management for patients who are admitted without shock • Signs of mild dehydration • TFR = Maintenance IVF + Fluids for Mild Dehydration • Infant (age =< 12 months): 50 ml/kg • Older Child or Adult (age > 12 months): 30 ml/kg • Clinical parameters should be monitored and correlated with hematocrit • Use Ideal body weight for overweight patients

  23. Fluid Management for Patients with Compensated Shock

  24. Hemodynamic Assessment: Continuum of Hemodynamic Changes

  25. Fluid Management for Patients with Hypotensive Shock

  26. Prevention • Success is dependent on • Effectiveness of the initiatives to control the breeding sites of the vector • Improving public and household environmental sanitation and water supply, • Sustained modification of human behaviour

  27. Prevention • Community Participation • active voluntary engagement of individuals and groups to change problematic conditions and influence policies and programmes that affect the quality of their lives or the lives of others • households which do follow the recommended actions for prevention may still harbour Ae. aegyptior other mosquitoes

  28. Prevention • Surveillance • Vector Control • (Future) Vaccination

  29. Thank You!!

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