dengue syndrome...

1. Dengue syndrome

2. Presented by :
Sanghana P. Narwade (intern)
SDDCH, parbhani
 Guided by :
Dr. Apurv soni sir

3.  Content:
 Introduction
 Problem statment
 Epidermiological determinamts
 Transmission of disease
 Criteria for clinical diagnosis
 Laboratory diagnosis
 Clinical managment
 Control mrasures
 Global stratergy for dengue preservation and control 2012-2020
 The goals

4. Dengue syndrome
 Dengu viruses are arbovirus capable of infecting humans and causing
disease.
This infecting may be asymptomatic or may lead t0
1.Classical dengue fever
2.Dengue haemorragic fever without shock
3.Dengue harmorragic fever with shock

6. Problem statement
- dengue fever (DF) and it’s sever forms: dengue hamorragic fever (DHF) and
dengue shock syndrome (DSS) have become major international public health
- some 2.5 billion people I.e two fifth of the world’s population in topical and subtopical
contries are at risk of the disease.
- an estimated 50 million dengue infections occur worldwide annually
- about 5,00,000 people with DHF require hospitalization each year
- approximately 90% of them are children aged less than 5year and about 2.5% of these
affected die
- dengue and DHF is endemic in more than 100 countries in the WHO
Region of Africa, the America, eastern Mediterranean, south, east Asia and western pacific
- the South –East Asia and western Pacific regions are most seriously affected.

7. India
-in India, the risk of dengue has increased in recent year due to rapid has
increases in recent year due to rapid urbanization, life style changes and
deficient water management.
- dengue is endemic in 35 states
- during 2014 about 40,425 cases werereported with 137 deaths
- the highest number of cases were reported from Maharashtra, followed
by odisha, west Bengal, karnataka, tamil nadu, keralaband Gujarat.

8.  Epidermological determinants
A) agent
- a dengue virus form a distinct complex within the genus flavivirus based
on the antigenic and biological characteristics
- there are four serotype
1) DENV -1
2) DENV-2
3) DENV-3
4) DENV-4
-all four serotype have been associated with epidemics of dengue fever
with verying degree of severity.

9.  B) vector
 Aedes Aegypti and aedes albopictus are two most important vectors of
dengue virus
Transmission of disease:
- dengue viruses are spread to peoplethrough the bites of infected
species mosquitoes
- incubation period :8-10 days

11.  DF/DHF syndrome :
- DF/DHF IS Characterized by “ice-berg” pyramid phenomenon.
- most of the cases are symptomless followed by DF, DHF and DSS
Clinical manifestation :
Dengue virus infection may be symptomatic or may cause undifferentiated
febrile illness or dengue harmorrhagic fever including dengue shock
syndrome.

12. 1) Undifferentiated fever
- infants, children and adults who have been infected with dengue virus, especially for the first time. May developed simple fever
-maculopapular rashes may accompany the fever or may appear during defervencase.
-upper respiratory and gastro intestinal symptoms are common.
2) Classic dengue fever
1.all ages both sexes are suscept to dengue fever
2) children usually affect more than adult
3) incubation period 3-10 days
4) the onset is sudden, with chills and high fever, intense headache, muscle and joint pain
5) within 24 hr restore –orbital pain particularly on eye movement or eye pressure and photophobia developa

14. 6) other common symptoms, include extrememe weakness, anorexia,
constipation, altered taste sensation, colicky pain, abdominal tenderness,
dragging pain in inguinal region, sore throat and general depression
7) fever is between 39°c to 40°c
3) Dengue haemorragic fever :
- dengue haemorragic fever(DHF) is a serve form of dengue fever
- the course of dengue illness can be divided into three phases :febrile
phase, critical phase and recovery phase

15. 1) Febrile phase :
- incubation period :4-6 days
1. Illness commonly begins abruptlt with high fever, accompanied by facial
flushing and headache
2.anorexia, vomiting, epigastric discomfort tenderness at the right costal
margin and generalized abdominal pain are common.
3.occasionally temperature may be 40°c to41°c
4.febrile convvulsion may occur particularly in infa
2.critical phase :
1.around the time of defervescence when the temperature drops to 37.5 -
38°c Or less and remain below this level, usually on day 3-7 of illness

17. 2.Increase in capillary permeability in parallel with increasing haematocrit levels
may occur, this marks the begining of the critical phase.
3.The period of clinically significantplasma leakage usually lasts 24-48hr.
4.Progressive leukopenia followed by a rapid decrease in platlet count usually
decrease in platelet count usually proceded plasmaleakage.
3.recovery phase :
1.if the patient survives the 24-48 hrs critical phase, a gradual
reacobsorption of extra vascular compartment fluid takes place in the following
48-72 hrs
2.general well being improves, appetite returns, gastrointestinal symptoms
abable hemodynamic status stabillizes and diuresis ensues

18. 3.patient may have a rash of “isles of white in the sea of red” Some may
experience generalized pruritus.
4.Bradycardia and electocardiographic changes are common during this
stage.
-- severe dengue :
Severe dengue is defined by one or more of the following :
1.Plasma leakage that may lead to shock (dengue shock) and fluid
accumulation with or without respiratory distress.
2.Serve bleeding
3.Serve organization impairment

20. Criteria for clinical diagnosis
1.Dengue fever:
Acute febrile ilness with Two Or more of the following:
1.Headache
2.resto-orbital pain
3.Myalgia
4.arthralgia/bone pain
5.Rash
6.Haemorrhagic manifestations
7.leucipenia(wbc <5000 cells/mm)
8.Thrombocytopenia (platelet count<1, 50,000 cells/mm)
9.Rising haematocrit(5-10%)

21. And at least one of the following:
- Supportive serology on single serum sample:titre>1280 with
haemagglutination inhibition test. Comparable IgG titre with enzyme-linked
immunosorbent assay or testing positive in IgM antibody test.
Occurance at the same location and time as confirmed cases of dengue fever
2.dengue haemorragic fever:
- Acute onset of fever of two to seven day duration.
- Haemorragic manifestations
- Platelate count <1, 00,000 cells/mm
- Objective evidence of plasma leakage

22. 3.Dengue shock syndrome:
- tachycardiya, cool extremities, delayed capillary refill, weak pulse, lethary Or
which may be a sign of reduced brain perfusion
- Pulse pressure <20 mmHg with increased daistolic pressure, I. E 100/80 mm Hg
- Hypotensiin by age <5yr: 80 mmHg
Older children and adult : 80-90 mmHg
Laboratory diagnosis :
The the following laboratory tests available to diagnose dengue fever and DHF:
1.Virus isolation (speciman is taken during the first six days)
2.Viral nucleic acid detection (CRT-PCR) assay and real time (RT-PCR assay)
3.Immunological response and serological tests –
1.haemagglutinatin – inhibition assay(HIA)
2.cimplement fixation (cf)

23. 3.IGM capture enzyme – linked immunosorbent assay (MAC-ELISA)
4.Iindirect IgG-ELISA
5.IgM/IgG ratio
4.Viral antigen detection –ELISA and dot bilot assay
5.Rapid diagnostic test
6.Analysis of haematological parameters.
Managment of DHF dengue fever:
1.Encorage intake of oral rehydration
2.Give paracetamol for high fever if patient is uncomfortable
3. The interval of paracetamol dosing should not be less than 6hrs
4.Tepid sponge if the patient still has high fever

25. -criteria for discharge of patients :
1.absence of fever for at least 24 hr. Without ise of anti- pyretic drugs.
2.return to appetite
3.visible clinical improvement
4.good orine out put
5.minimum of 2-3 days after recovaryfeom shock
6.no respiratory distress from pleural effusion or ascites
7.Platelet count >50, 000/cu mm
- control measure :
1.Mosquito control
2.vaccines(CYD- TDV is a prohylatc tetravalent, live attenuated viral vaccine)

26. Global stratergy for dengue prevention and control 2012-2020 :
Dengue is a global threat that requires a global response involving all
possible partners.
- The global stratergy promots co-ordination and collaboration among multi
sectoral partners on integrated vector managment approach and sustained
control measures at all levels
- The goals are :
1.To reduce dengue mortaliry by at least 50% by 2020
2.To reduse dengue morbidity by at least 25% by 2020
3.To estimate the true burded of the disease by 2015

28. Thank you..!