Dengue workshop

How is dengue fever transmitted ?

• Bite of an infected mosquito

• Bite of an infected male Aedes mosquito

• Bite of an infected female Anopheles mosquito

• Bite of an infected female Aedes mosquito

Aedes aegypti is also vector for the following EXCEPT:

• Zika

• Yellow fever

• Chikungunya

• Malaria

Dengue fever incubation period ranges from :

• 1-12 days

• 3-14 days

• 14-28 days

• 28-32 days

45 years old lady, currently diagnosed as dengue fever day 4 of illness in defervescence phase 24 hours complaint to you minimal amount of hematemesis. 

O/E, clinically pink, CRT < 2 sec, good pulse volume, not tacchypnoiec                                           BP 101/ 70 PR 110 SP02 99%  under RA 

Lungs clear  Abdomen tender at epigastrium , PR brownish 

HB 10 / TWC 3.2/ PLT 30/ HCT 46          VBG, Lactate,  Coag -  in process 

What is your next 1st step? 

• Refer surgical for urgent OGDS 

• Platelet transfusion , IV Nexium and refer surgical for OGDS

• Fluid resuscitation as compensated shock protocol 

• IV Nexium infusion

You are the MO in district hospital, reviewing one case in ED. 35 years old female with u/l DM, complaint of fever for 4 days associated with myalgia, joint pain and retroorbital pain. Fever resolved this morning, however complaint of breathlessness

O/E CRT < 2 sec, good pulse volume, pink, RR 24

BP 101/70 PR 100 SP02 92% under RA, 98% under NP023l

Lungs- reduced breath sound with stony dullness bilaterally up to MZ , Abd soft, minimal ascites, no pedal edema

FBC Hb 12/ TWC 2.8/ PLT 50/ HCT 46 Dengue combo IgG - ve , IgM +ve, NS1 ag +ve , RTK ag -ve

CXR bilateral pleural effusion up to midzone

What is your next plan ?

• Start IV lasix 40mg stat and refer tertiary hospital

• Admit ward for observation

• Start IVD 1.2cc/ kg/ hr and admit ward

• Start IVD 5cc/ kg/ hr and refer tertiary hospital

28 years old technician, Male with NKMI complaint of fever, myalgia , joint pain and retroorbital pain for 2 days. He is still able to take orally.

O/E not in distress, CRT< 2 sec, good pulse volume, not tacchypnoiec, pink, hydration good

He lives with his wife and 2 children

Lungs clear, Abdomen soft

FBC Hb 12/ TWC 2.5/ PLT 101/ HCT 44 RTK ag -ve Dengue combo NS1 +ve, IgG and IgM negative

What is your plan ?

• Admit medical ward dengue cubicle

• Allow discharge with ibuprofen for joint pain

• Allow discharge and verbal advise to come stat if developed warning sign

• Discharge with MC and dengue card for blood taking cm , TCA stat if warning sign

Choose the correct statement (s)

• plasma leakage is one of the feature of dengue hemorrhagic fever

• there is no role for endoscopic intervention when patient had persistent UGIB with thrombocytopenia

• we need to do baseline coagulation profile for patient admitted with dengue fever

• Dengue patient who had petechiae and mucosal bleed warrants platelet transfusion if platelet counts less than 50k

What are the risk factor(s) of bleeding complications in dengue fever

• prolong duration of shock

• persistent vomiting

• persistent thrombocytopenia during recovery phase of dengue fever

• chronic use of NSAIDs

I will suspect occult bleeding in dengue fever if patient has..

• refractory shock in severe dengue

• unexplained lactate acidosis

• plasma leakage with significant hemoconcentration

• drop in hematocrit after patient stabilized with fluid resuscitation in plasma leakage

Treatment for dengue carditis :

• Antiviral

• IV immunoglobulin

• IV Methylprednisolone

• Supportive with just sufficient fluids therapy