Dengue Treatment- Cause, Symptoms, Signs, Investigations, Prevention.

Dengue

Dengue cause:-

Dengue virus is Flavivirus, mosquito born acute febrile illness, human to human transmission by the bite of Aedes mosquito. and four serotypes, can cause infection.

one serotype does not confer immunity to other, so Dengue can infect 4 times.

needlestick or mucocutaneous exposure & vertical transmission rarely.

bone marrow & solid organ transplant is known to transmit.

Clinical Findings:-

Symptoms and Signs:-

Incubation period is 7–10 days.

Most patients are asymptomatic.

Only 20% develop symptoms- like

mild disease (dengue fever) to
severe hemorrhagic fever (plasma leakage, organ involvement, hemorrhage) to
fatal shock (dengue shock syndrome).

Sudden onset of high fever (40C/104F), chills, severe headache, behind eye pain, facial flushing, malaise, arthralgia, generalized body & muscle pain, nausea, vomiting.

Some have maculopapular rash, conjunctival injection, sore throat.

Mild hemorrhagic manifestations may seen.

Most will recover, & fever cleared by day 8.

Type 2 diabetes mellitus not controlled, may progress to severe dengue- plasma leakage, hemorrhage, or organ involvement.

Hematocrit level increase more than 20%- sign of hemoconcentration & precedes shock.

Pleural effusion and ascites- detected by lateral decubitus chest X-Ray or USG before clinical detection.

Plasma leakage- indicated by persistent vomiting, Increasing liver size, and severe abdominal pain.

Signs of hemorrhage- gastrointestinal bleeding, ecchymoses, and epistaxis appear.

Severe organ involvement- encephalitis, hepatitis, and myocarditis.

Shock developed by critical volume of plasma lost through leakage.

Decrease in consciousness level, hypoperfusion, hypothermia- resulting in progressive organ impairment, metabolic acidosis, DIC- severe hemorrhage think for shock.

Acute kidney injury in shock syndrome shows high mortality.

Laboratory Findings:-

Leukopenia often lymphopenia, elevated transaminases frequently seen.

Hemorrhagic form- Thrombocytopenia, low platelet (normal platelet count is 1.5 – 4.5 Lakh/mcL)),

hemoconcentration, fibrinolysis occur.

Anemia is common.

ESR normal in most cases.

IgM and IgG ELISAs for diagnosis after the febrile phase.

Virus recovered from PCR (in blood). specific viral protein detection- NS1 by ELISA (during first few days of infection).

For antigen detection- Immunohistochemistry (from tissue samples & dried blood spots).

In remote settings-Thrombocytopenia and blood vessel fragility – with a tourniquet cuff test useful.

Chikungunya is more likely to develop a chronic arthritis.

Rhinitis and malaise in influenza & Cyclicity of fevers & splenomegaly in malaria help to differentiate from dengue. Renal function test abnormal may be seen in Leptospirosis. Liver function test abnormal may be seen in Scrub typhus.

Complications:-

pneumonia, bone marrow failure, iritis, retinal hemorrhages, hepatitis, maculopathy, orchitis, and oophoritis.

Neurologic- encephalitis, Guillain-Barré syndrome, subdural hematoma, phrenic neuropathy, cerebral vasculitis, and transverse myelitis.

Acute disseminated encephalomyelitis.

Bacterial superinfection.

Oral- acute gingivitis, palatal bleeding.

Near term maternal infection- risk of hemorrhage in both mother & infant.

Severe dengue- a risk factor for obstetric complications, fetal distress, cesarean delivery, and maternal morbidity.

Dengue Treatment:-

Tablet Paracetamol 500mg sos for fever and arthralgia.

Symptomatic & supportive care. No specific antiviral medicine available. Early detection of disease and close monitoring of symptoms, signs, pulse, BP, platelet, hematocrit is important.

Aspirin & NSAIDs must be avoided if abnormality in liver function, gastritis, or clotting factors, thrombocytopenia, seen in Dengue virus may cause hemorrhage.

volume replacement, blood products, & vasopressors.

Platelet counts generally not predict clinically significant bleeding.

Platelet transfusions considered in severe thrombocytopenia (less than 10,000/mcL) or evidence of bleeding.

benefit in absence of bleeding not observed, but harm may be caused by delay in platelet count recovery.

Monitoring of vital signs, CBC and bleeding manifestations to reduce complications of dengue hemorrhagic fever & shock syndrome.

Keep platelet ready for transfusionin if falling platelet count seen.

Prognosis:-

mortality (2.5% of severe cases).

Causes of death include hemorrhagic fever (seen with recurrent disease) and occasionally fulminant hepatitis.

Thrombocytopenia and acute hepatitis- predictors of higher mortality.

Acute kidney injury (in dengue shock syndrome)- poor prognosis.

Comorbidities- cardiovascular disease, diabetes, kidney disease, stroke, pulmonary disease, and older age are with more severe dengue.

Vaccine is available for prevention of disease.

Most effective way is environmental control of mosquitoes by screening and insect repellents (long-lasting insecticides) & treatment or removal of areas where water is stagnant or builds up.

Advice From- DR RAKESH UKEY MBBS, MD MEDICINE.:-

Please consult in clinic, then start medicine according to diagnosis.

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