The document discusses dengue fever, which infects 50 million people annually in dengue endemic countries. It notes that all four dengue virus serotypes are found in India, and infection with one serotype only provides lifelong immunity to that serotype. A secondary infection with a different serotype can cause the more severe dengue hemorrhagic fever or dengue shock syndrome. It outlines the symptoms and stages of primary and secondary dengue infections.

1. Pragadeesh.g

2. 50 million dengue infections occur annually
2.5 billion people live in dengue endemic countries
Dengue is now endemic in all WHO regions except the
WHO European region.
WHO South-east Asia region and Western pacific region
-70% of population at risk
-75% of disease burden

6. All four serotypes
DENV-1
DENV-2
DENV-3
DENV-4 are found INDIA
DENV-1&DENV-2 are widely found

7.  Infection with one serotype confers lifelong immunity to
that serotype only
 Secondary infection with any other serotype which caused
primary infection causes severe form of dengue
DHF/DSS

8. ASYMPTOMATIC
DSS
SYMPTOMATIC
Without haemorrhage
With unusual haemorrhage
No shock
Undifferentiated Fever
Dengue Fever
Dengue
Haemorrhagic
Fever

9. Primary infection with dengue virus
Simple indistinguishable fever from other viral infection
URI & GIT symptoms are common

11. Abrupt onset, rising to 39.5-41.4 C
Accompanied by
frontal or retro-orbital headache
Pain behind the eyes,photophobia
chillness
Last 1-7 days
Biphasic:
defervesce for 1-2 days
recurring with second rash

12. break bone fever is the another name of DF
After onset of fever
May last several weeks
Increase in severity
Most common in legs, joints, and lumbar spine;
With muscular and joint pains.

13.  FIRST RASH: first 1-2 days of
fever, transient, generalized, macular and blanching;
 SECOND RASH
• 3-6 days.
• morbilliforms , maculopapular , rubella type
• Involving the trunk first, spreading to the face and extremities,
sparing palms and soles.
 other rash: petechiae

15.  Skin hemorrhages:
petechiae, purpura, ecchymoses
 Gingival bleeding
 Nasal bleeding
 Gastro-intestinal bleeding:
hematemesis, melena, hematochezia
 Hematuria
 Increased menstrual flow

18. FEBRILE PHASE
CRICTICAL PHASE
RECOVERY PHASE

20. High fever(40-41)
Headache
Anorexia
Vomiting
Abdominal pain
Tenderness at right costal margin
 Rash less common

21. Inflate blood pressure cuff to a
point midway between systolic
and diastolic pressure for 5
minutes
Positive test: 20 or more
petechiae per 1 inch2 (6.25
cm2)

22. Days 3-7
Progressive leukopenia followed by thrombocytopenia
Plasma leakage - pleural effusion /ascites
Warning signs-abdominal tenderness,persistent
vomiting,liver enlargement,lethargy,restlesness ,mucosal
bleeding
Shock
Organ impairment-hepatitis ,encephalitis,myocarditis
DIC and haemorrhage

23. Improvement in general condition
Good apetite
Stable hemodynamics
Isles of white in sea of red
PCV stabilizes , increasing WBC
count and platelet count

24. Shock-due to plasma leakage
pulse pressure <=20 mm Hg
Severe bleeding
Severe organ impairment
due to thrombocytopenia
hypoxia
acidosis

25. stages complication
Febrile phase Dehydration ,neurological
disturbances and seizures in
children
Critical phase Shock ,severe haemorrhage, organ
impairment
Recovery phase Hypervolemia if excess fluids given

26. Initial Warning Signals:
• Disappearance of fever
• Drop in platelets
• Increase in hematocrit
When Patients Develop DSS:
• 3 to 6 days after onset of
symptoms