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Management of Dengue Fever

Management of Dengue Fever

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Management of Dengue Fever

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  1. Management of Dengue Fever Dr David Tran 16/09/09

  2. Classic clinical dengue fever • Incubation period 3 to 14 days (usually 4 to 7 days) • Sudden onset of fever with severe headache • Retro-orbital pain, fatigue • Often associated with myalgia and arthralgia • Duration of fever usually 5 to 7 days • Sometime maculopapular rash(50% to 66% of cases) • Other non specific signs as inflamed pharynx, gastro-intestinal symptoms

  3. Classic definition of dengue fever(WHO 1997)

  4. Hemorrhagic manifestations / biologic abnormalities • Petechiae, purpura • Gum bleeding, epistaxis, menorrhagia, gastro-intestinal bleedings (rare) • Thrombocytopenia, leukopenia with lymphopenia • Mild elevation of hepatic transaminases & LDH

  5. Definition of dengue hemorrhagic fever (WHO 1997)

  6. Dengue hemorrhagic fever & Dengue shock syndrome • Physiopathology: capillary leakage & hemorrhagic manifestations. • 4 to 7 days after the onset (at approximately the date of defervescence) • Abdominal pain, vomiting, consciousness troubles, hypothermia • Marked decrease in platelet count. • Mortality: up to 10 or 20%

  7. Definition of dengue shock syndrome (WHO 1997)

  8. Diagnosis of dengue hemorrhagic fever (triad of symptoms) • Hemorrhagic manifestations • Platelet count < 100.000 (often >3rd day of illness) • Evidence of plasma leakage (Hematocrite  pleural effusion, ascites, hypoproteinemia)

  9. Lowest platelet count by day of illness in adult dengue hemorrhagic patients

  10. Dengue shock syndrome • Rapid weak pulse & low blood pressure (BP < 90mmHg) • The duration of this shock is short after appropriate volume replacement therapy (Colloid or Cristalloid infusions) • Mortality rate is up to 40%

  11. Different clinical presentation of dengue fever

  12. Serodiagnosis of dengue fever • Serology (IgM capture ELISA) • Problem: negativity of the test early in the course of the disease > should be performed only 4 to 5 days after the onset of fever. • IgM: remain positive for 3 to 6 month • IgG: remain positive for life

  13. Dengue NS1 antigen testing • Early detection of Ag NS1 in blood sample of infected patients > confirm early acute infection • Detection of all 4 types of dengue serotypes • Result available in 15 min. (BioRad® chromatographic strip test) • High specificity (100%) and positive predictive value

  14. Although in some reports, the same efficiency of detection for virus of the 4 serotypes has been described for the Dengue Early ELISA and Strip tests (Dussart et al., 2008), A recent analysis of the performance of these tests in Vietnam suggests a lower sensitivity for DENV-2 compared with DENV-1 and DENV-3.

  15. Problem of sensibility of NS1 detection tests(Ramirez, diagnostic microbiology & infectious disease, Sept 2009) These tests in Vietnam suggests a lower sensitivity for DENV-2 compared with DENV-1 and DENV-3. Also, a decreased sensitivity for DENV-4 with the Dengue Early ELISA has been reported in studies from South America (Bessoff et al., 2008; Dussart et al., 2008). A lower sensitivity for DENV-2 has been described in samples from Vietnam (Hang et al., 2009) tested by the PLATELIA™systems (ELISA and Strip) and belonging to the Asian genotype 1 (according to the classification of Twiddy et al., 2002).

  16. Sensitivity of NS1 Ag detection tests according to the day of illness(Mc Bride, Diagnostic Microbiology & Infectious Diseases, 64 – 2009 – 31,36)

  17. Management of dengue virus infected patient • Most of cases can be managed on an outpatient basis (antipyretic like paracetamol, bed rest, oral hydratation) • Platelet counts and hematocrite determination should be repeated at least every 24 hours • Patient with platelet count < 100.000 should be hospitalized (high risk for dengue hemorrhagic & dengue shock syndrome)