Dengu Fever By Dr Mahipal
-
Upload
mahipal33 -
Category
Health & Medicine
-
view
8.418 -
download
0
description
Transcript of Dengu Fever By Dr Mahipal
![Page 1: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/1.jpg)
![Page 2: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/2.jpg)
Dengue Fever(Pronounced as Dhen Gey)
A comprehensive presentationby
Dr.P MAHIPAL REDDY
![Page 3: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/3.jpg)
Alternative Names
Onyong- Nyang Fever West Nile Fever Break Bone Fever Dengue like Disease
![Page 4: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/4.jpg)
Background
Propagation of viral illnesses Transmission of viral illnesses Various families of Arbor viruses Manifestations of Arborviral illnesses Dengue – A Flavivirus- EM- Cell culture Transmitted by mosquito Aedes aegypti
![Page 5: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/5.jpg)
Viral Illnesses - Propagation
Human Human
HumanZoonotic Accidental
Virus
Arthropod
Rodent
![Page 6: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/6.jpg)
Transmission of Viral Illnesses
Droplet infection as in case of
Measles, Influenza, Coryza etc. Blood to blood transmission- HIV, HBV Feco-oral – Rota, Polio Direct contact – Herpes simplex etc Arthropod borne –Dengue, JE, YF Tick borne – CEE, Colorado TF
![Page 7: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/7.jpg)
Arthropod borne Viral Diseases
Flavivirus – Mosquito borne – YF, DF,JE Flavivirus – Tick Borne –CEE, RSSE, KFD Buniyavirus – Mosquito- CE Plebovirus – Sandfly Fever Arinavirus – LCM virus Colivirus – Colorado Tick fever Vesiculovirus – Vesicular stomatitis Alphavirus – E/W/V equine encephalitides
![Page 8: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/8.jpg)
Manifestations of Arborviral Illnesses
Most Arboviral diseases are rural Arboviral illnesses cause typical
manifestations – Often overlap The following clinical syndromes occur
1. FM – Fever – Myalgia complex
2. AR – Arthritis – Rash complex
3. HF – Haemorrhagic Fever
4. E – Encephalitis
![Page 9: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/9.jpg)
Epidemiology of Dengue
The Dengue Virus The Vector Global distribution of Dengue Transmission cycle – host – vector Propagation of virus – I.P Natural History of Dengue Dengue Hemorrhagic fever –
Endemicity pattern
![Page 10: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/10.jpg)
Epidemiological Triangle
The Host
The Virus The Vector
Interaction
![Page 11: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/11.jpg)
The Agent
Dengue Virus
![Page 12: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/12.jpg)
The Dengue Virus
Flavivirus Positive sense Single stranded RNA virus 40 to 50 nanometers Four sero-sub types Type 1 to 4 Arthropod borne
![Page 13: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/13.jpg)
Dengue Virus
Electron Micrograms
![Page 14: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/14.jpg)
Dengue Virus
Cell Culture
Of Dengue
Virus
![Page 15: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/15.jpg)
The Vector
Aedes aegypti(Infected Female Mosquito)
(rarely Aedes albapticus)
![Page 16: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/16.jpg)
Peculiarities of A.aegypti
It is a day biting mosquito when normally
coils, repellents, nets etc are not used It breads in fresh water around homes Lays eggs preferentially in water jars, discar-
ded containers, coconut shells, old tires etc. Can transmit trans-ovarially the infection Year round breeding 250 N to 250 S Tropics and sub-tropics are its favorite zones. It
is an urban vector
![Page 17: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/17.jpg)
Aedes aegypti
Dengue, YF, CGF
![Page 18: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/18.jpg)
Aedes aegypti
Dengue
Yellow Fever
Chichungunya
Fever
![Page 19: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/19.jpg)
Dengue on the Globe
Highly endemic Recently acquired
![Page 20: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/20.jpg)
Dengue Fever
Caused by an arthropod borne virus It is a zoonotic virus Man is accidentally infected Other vertebrates are the reservoirs Dengue virus has 4 subtypes 1 to 4 Positive sense, single str RNA- 40nm Vector mosquito is Aedes aegypti
![Page 21: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/21.jpg)
Mechanism of Transmission
Vector is infected after ingestion of blood meal from a viremic vertebrate
Virus multiplies in the system of vector
for 2-3 weeks – extrinsic incubation pd. Natural vertebrate partner has only
transient viremia and doesn’t suffer Virus is injected by the A.aegypti into man After 2-7 days of IP, man develops FM,HF
![Page 22: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/22.jpg)
Dengue Transmission Cycle
![Page 23: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/23.jpg)
Dengue Transmission
![Page 24: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/24.jpg)
Dengue Illnesses - Propagation
![Page 25: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/25.jpg)
Natural History of Dengue
Human Inf In apparent
DFM
Primary
DHF/DSS
30%
69%
01%
Re infection
Secondary
DHF/DSS
10%
Recovery100%
Death5%
95%
![Page 26: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/26.jpg)
DHF Endemicity
![Page 27: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/27.jpg)
Pathogenesis of DHF
Immuno-pathogenic
Cascade
![Page 28: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/28.jpg)
Hypotheses on DHF - DSS
Neutralizing Ab are type specific nutralize the homologous sub type
Subsequent infection with heterologous sub type causes immune complexes
These Immune Complexes target the mononuclear lineage foe enhanced viral replication
Infected monocytes release vasoactive mediators causing vascular damage
![Page 29: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/29.jpg)
Initial Immunogenecity
![Page 30: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/30.jpg)
Immune Complexes
![Page 31: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/31.jpg)
Attack on Host Immune Cells
![Page 32: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/32.jpg)
Immunopathogenic Cascade of DHF/DSS
Macrophage – monocyte infection Previous infection with heterologous
Dengue serotype results in production
of non protective antiviral antibodies These Ab bind to the virion’s surface
Fc receptor and focus the Dengue virus
on to the target cells – macro/monocytes T cell - cytokines, interferon, TNF alpha
![Page 33: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/33.jpg)
The Disease
Clinical Features
![Page 34: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/34.jpg)
Dengue Presentations
Undifferentiated fever Dengue Fever (DF) with the Fever-
Myalgia (FM) presentation (classical) Dengue Hemorrhagic Fever (DHF) Dengue Shock Syndrome (DSS)
![Page 35: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/35.jpg)
Hemorrhagic Manifestations
Skin hemorrhages:petechiae, purpura, ecchymoses
Gingival bleeding Nasal bleeding Gastro-intestinal bleeding:
hematemesis, melena, hematochezia Haematuria Increased menstrual flow
![Page 36: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/36.jpg)
Clinical Manifestations- DF
IP of 2 – 7 days - typical patient develops Sudden onset of fever, chills, headache Back pain with severe myalgia, arthralgia Retro-orbital pain – break bone fever Macular rash – in axillary area Adenopathy, palatal vesicles, scleral inj. Maculo-papular rash on trunk –
extremities Epistaxis and scattered petechiae
![Page 37: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/37.jpg)
Other manifestations- DF
Anorexia. Nausea, vomiting In apparent illness-to acute incapacitation Illness is about 2–5 days, biphasic course Pain on eye movements Pain on palpating abdominal muscles Primarily not a respiratory illness Rare - aseptic meningitis Complete recovery is the rule - asthenia
![Page 38: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/38.jpg)
Petechiae
![Page 39: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/39.jpg)
Dengue Haemorrhagic Fever (DHF)
Vascular instability Decreased vascular integrity Assault on macro vasculature Decreased platelet function Increased vascular permeability Vascular disruption and local bleeds Hypotension, hemoconcentration- shock
![Page 40: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/40.jpg)
DHF – Clinical Criteria
![Page 41: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/41.jpg)
Criteria for DHF
Fever, or recent history of acute fever Hemorrhagic manifestations Low platelet count (100,000/mm 3 or
less) Objective evidence of “leaky capillaries:”
Elevated hematocrit -20% or moremore over baseline or
Low albumin, pleural effusion
![Page 42: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/42.jpg)
Criteria for DSS
The four criteria of DHF Evidence of circulatory failure
1. Rapid and weak pulse
2. Narrow pulse pressue (less than 20mm)
3. Hypotension for the age
4. Cold clammy skin
5. Altered mental status
![Page 43: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/43.jpg)
Four Grades of DHF/DSS
Grade 1
Fever, Const. Symptoms, +ve tourniquet test Grade 2
Grade 1 + Spontaneous bleeding Grade 3
Signs of circulatory failure Grade 4
Profound shock - B.P. Pulse not recordable
![Page 44: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/44.jpg)
Ecchymosis – Periorbital Edema
![Page 45: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/45.jpg)
Large Subcutaneous Bleed
![Page 46: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/46.jpg)
Capillary Damage
![Page 47: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/47.jpg)
Tourniquet Test
Inflate blood pressure cuff to a pointmidway between systolic and diastolicpressure for 5 minutes
Positive test: 20 or more petechiaeper 1 inch² (6.25 cm²)
![Page 48: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/48.jpg)
Tourniquet Test
![Page 49: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/49.jpg)
PEI = A / B x 100
Pleural Effusion
![Page 50: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/50.jpg)
Clinical tests for DHF
Petechiae after tourniquet test Overt bleed from previous GI lesions Platelet count less than 100,000/ul Low pulse pressure, cyanosis, effusions Hypotension, Shock
![Page 51: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/51.jpg)
DHF- Poor Prognostic Signs
Girl children under 12 with DHF/DSS Severe hypotension and shock Multifocal bleeding – abdominal pain CNS encepahlopathy, fits, coma Watch for preorbital edema, proteinuria
postural or otherwise hypotension Serotype 2 infection after type 4 Malnutrition is protective
![Page 52: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/52.jpg)
Unusual Presentations of Dengue
Encephalopathy Hepatic damage Cardiomyopathy Severe GI bleeding
![Page 53: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/53.jpg)
Differential Diagnosis
FM complex1. Anicteric leptospirosis
2. Rickettsial fevers
3. Influenza, Measles, Rubella DHF / DSS
1. Other hemorrhagic fevers
2. DIC due to septicemia
3. Complicated Malaria
4. Meningococcemia
![Page 54: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/54.jpg)
Laboratory Diagnosis
Complete Blood Counts Hematocrit Platelet Count Serum GOT, GPT Serum Albumin Proteinuria, hematuria Immunological Tests Chest Skiagram
![Page 55: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/55.jpg)
Laboratory Diagnosis
Leucopenia. Thrombocytopenia Increased SGOT, SGPT Rising Ab titre in paired sera Antigen detection ELISA IgM-capture ELISA within few hours Reverse transcription PCR confirmatory IgG ELISA significant of past infection
![Page 56: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/56.jpg)
Immuno Detection Tests
ELISA Plate IgM-capture ELISA
![Page 57: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/57.jpg)
Treatment of DF
Supportive measures - Vector barrier Avoid Aspirin and if possible NSAIDs Steroids should not be used Fluid replacement to avoid hemoconc. Children below 12 require careful watch
for DHF / DSS No antiviral agents are of proven value
![Page 58: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/58.jpg)
DHF / DSS
Intensive Care
Oxygen
Rehydration
Barrier Nursing
Mosquito Screen
![Page 59: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/59.jpg)
Common Misconceptions- DHF
Dengue + bleeding = DHF DHF is fatal only due to hemorrhage
No Majority of deaths are due to shock Poorly managed DF turns into DHF Positive tourniquet = DHF
it is not specific for DHF,
it indicates capillary fragility of any origin
![Page 60: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/60.jpg)
More Common Misconceptions
DHF is only a pediatric illness –
No, All ages may be involved DHF is a problem of poor families –
No, in fact they may not have
immune complexes to required level Tourists will get DHF –
No, in fact they are at low risk
![Page 61: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/61.jpg)
Management of DHF/DSS
Close monitoring of hypotension/shock Oxygen administration IV. Infusion of crystalloids/colloids Platelet transfusion Clotting factors replacement Case fatality is 5% in good centers
![Page 62: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/62.jpg)
Fluid Balance
Continue monitoring after defervescence Serial hematocrits, BP, Urine output Fluid replacement is twice the requirement 1500 ml + 2 x (weight-20) – for 60 kg wt.
Eg. {1500 + 2 x (60-20)} x 2
= {1500 + (2x 40)} x 2 = (1500 + 800) x 2
= 2300 x 2 = 4600 ml = 10 pints
![Page 63: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/63.jpg)
Immunization
Each serotype produces life long immunity There is not efficacious vaccine available Vaccine needs to be tetravalent Live attenuated vaccines possible Several candidate vaccines are on trials It may be harmful to vaccinate in view
of the pathogenesis of DHF/DSS
![Page 64: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/64.jpg)
Vector Control
Biological1. Largely experimental
2. Use of fish to feed on larvae Environmental
1. Elimination of larval habitat
2. Most likely successful strategy Purpose of control
To reduce female vector density
![Page 65: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/65.jpg)
Vector Control of Dengue
Mosquito control is expensive –impossible Destruction of breeding sites – viable Spraying insecticides for adult control- ? Individual measures to avoid vector contact
1. Mosquito screens, repellents (DEET)
2. Permithrin impregnated clothing Non degradable tires, long life plastics-avoid
![Page 66: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/66.jpg)
Challenge
Achieve active community involvement Solicit input from the earliest program
planning stages Encourage community ownership True community participation is key
![Page 67: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/67.jpg)
Bibliography
World Health Organization Reports Pan American Health Organization Center for Diseases Control, Atlanta National Institute of Communicable
Diseases, New Delhi Bangladesh Center for Dengue Harrison's Principles of Internal
Medicine, 15 ed.
![Page 68: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/68.jpg)
Each Patient is a Book Each Day is a Learning Opportunity CME has More Relevance
Now Than Ever
Together We Learn Better
![Page 69: Dengu Fever By Dr Mahipal](https://reader036.fdocuments.in/reader036/viewer/2022081515/554b33fab4c905da088b51f4/html5/thumbnails/69.jpg)
Thank You !