Dengue: guidelines for diagnosis, treatment, prevention and control .. Since the second edition of Dengue haemorrhagic fever: diagnosis. In recent years dengue fever (DF) has become a major international health problem complication of dengue, called dengue haemorrhagic fever (DHF) has . Dengue Hemorrhagic Fever. Information for Health Care Practitioners. Dengue is a mosquito-borne disease caused by any one of four closely related dengue.
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PDF | Dengue fever, also known as breakbone fever, is a mosquito-borne infectious tropical disease caused by the dengue virus. Symptoms include fever. Dengue viral infections are one of the most important mosquito borne diseases in the world. They may be asymptomatic or may give rise to undifferentiated fever. period (92). Three factors have been implicated as responsi- ble for increased dengue virus transmission in the Americas: the failure to control the Aedes aegypti.
However, cases of severe dengue do occur in the setting of infection by only a single serotype. Worsening microvascular permeability often transpires even as viral titers fall. During the febrile phase, a sudden high-grade fever of approximately 40 C occurs that usually lasts two to seven days. Associated symptoms include facial flushing, skin erythema, myalgias, arthralgias, headache, sore throat, conjunctival injection, anorexia, nausea, and vomiting.
For skin erythema, a general blanchable macular rash occurs in the first one to two days of fever and the last day of fever.
Or, within 24 hours, a secondary maculopapular rash can develop. It can progress to shock, organ dysfunction, disseminated intravascular coagulation, or hemorrhage. The recovery phase entails the gradual reabsorption of extravascular fluid in two to three days. The patient will display bradycardia at this time. The virus antigen can be detected by ELISA, polymerase chain reaction, or isolation of the virus from body fluids. It is vital to assess pregnant patients with dengue as the symptoms may be very similar to preeclampsia.
Supportive management includes giving the patient fluids, acetaminophen for fever, and a blood transfusion for hemorrhage. Confirmed diagnosis is established by culture, antigen detection, polymerase chain reaction, or serologic testing. Avoid giving aspirin and nonsteroidal anti-inflammatory drugs and other anticoagulants. No antiviral medications are recommended. Patients with thrombocytopenia or bleeding may require platelets and fresh frozen plasma. The clinical diagnosis of dengue can be challenging as many other illnesses can present similarly early in the disease course.
Other considerations should include malaria, influenza, Zika, chikungunya, measles, and yellow fever. Obtain a detailed history of immunizations, travel, and exposures. Rapid laboratory identification of dengue fever includes NS1 antigen detection and serologic tests. Serologic tests are only useful after several days of infection and may be associated with false positives due to other flavivirus infections, such as yellow fever or Zika virus.
Patients should be encouraged to consume ample liquids. The return of a patient's appetite is a sign that the infection is subsiding. Consulting an infectious disease specialist is recommended because most clinicians have little experience managing this infection.
The Centers for Disease Control and Prevention has a hotline which also offers advice on treatment. The only way to avoid contracting dengue is to prevent mosquito bites and not travel to its endemic areas. Other preventative measures include the use of DEET insecticide, wearing protective clothing, sleeping under a mosquito net, and eliminating stagnant water around the home.
The diagnosis and management of dengue is complex and this best managed by a multidisciplinary team that includes an infectious disease expert, CDC consultant, emergency department physician and an internist. The care is supportive with fluid, acetaminophen for fever, and a blood transfusion for hemorrhage.
No laboratory tests can predict the progression to severe disease. The role of the primary care provider and nurse practitioner is to educate the traveler on the prevention of mosquito bites. This means covering exposed skin, and use bed nets, particularly during daytime siestas, using mosquito repellents and indoor insecticides. One should also eradicate mosquito breeding grounds like standing water.
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Search term. Dengue Fever Timothy J. Author Information Authors Timothy J. Introduction Dengue is a mosquito-transmitted virus and the leading cause of arthropod-borne viral disease in the world. Epidemiology It is the fastest spreading mosquito-borne viral disease in the world, affecting greater than million humans annually. Pathophysiology Part of the Flavivirus family, the dengue virus is a 50 nm virion with three structural and seven nonstructural proteins, a lipid envelope, and a Probable dengue: The patient lives in or has traveled to a dengue-endemic area.
Symptoms include fever and two of the following: Warning Signs of Dengue: Abdominal pain, persistent vomiting, clinical fluid accumulation such as ascites or pleural effusion, mucosal bleeding, lethargy, liver enlargement greater than 2 cm, increase in hematocrit, and thrombocytopenia.
Severe Dengue: Dengue fever with severe plasma leakage, hemorrhage, organ dysfunction including transaminitis greater than international units per liter, impaired consciousness, myocardial dysfunction, and pulmonary dysfunction. Dengue shock syndrome clinical warnings: Symptoms include rapidly rising hematocrit, intense abdominal pain, persistent vomiting, and narrowed or absent blood pressure. Differential Diagnosis The clinical diagnosis of dengue can be challenging as many other illnesses can present similarly early in the disease course.
Complications Liver injury. Postoperative and Rehabilitation Care Patients should be encouraged to consume ample liquids. Consultations Consulting an infectious disease specialist is recommended because most clinicians have little experience managing this infection. Deterrence and Patient Education The only way to avoid contracting dengue is to prevent mosquito bites and not travel to its endemic areas.
Enhancing Healthcare Team Outcomes The diagnosis and management of dengue is complex and this best managed by a multidisciplinary team that includes an infectious disease expert, CDC consultant, emergency department physician and an internist. Questions To access free multiple choice questions on this topic, click here.
References 1. Entomological and virological surveillance for dengue virus in churches in Merida, Mexico. Sao Paulo. PMC ] [ PubMed: Cost of illness and program of dengue: A systematic review.
Origin and expansion of the mosquito Aedes aegypti in Madeira Island Portugal. Figure 3. The change in distribution of dengue serotypes The figure shows the distribution in a and b.
Figure 4. Dengue virus, antigen and antibody responses used in diagnosis Ig, immunoglobulin; NS, non-structural. Laboratory diagnosis of dengue infection Laboratory confirmation of dengue infection is crucial as the broad spectrum of clinical presentations, ranging from mild febrile illness to several severe syndromes, can make accurate diagnosis difficult.
Box 1 Laboratory diagnosis of a dengue virus infection. Serological testing Serological assays are most commonly used for diagnosis of dengue infection as they are relatively inexpensive and easy to perform compared with culture or nucleic acid-based methods. Neutralization assays The plaque reduction neutralization technique PRNT and the micro-neutralization assay are used to define the infecting serotypes following a primary infection.
Nucleic acid amplification tests Many nucleic acid amplification tests NAATs have been developed for the diagnosis of dengue infection. Antigen detection Dengue antigens can be detected in tissues such as liver, spleen and lymph nodes as well as tissues from fatal cases slides from paraffin-embedded, fresh or frozen tissues using an enzyme and a colorimetric substrate with antibodies that target dengue-specific antigens — NS1 antigen and antibody detection NS1 is a glycoprotein produced by all flaviviruses and is essential for viral replication and viability.
Dengue control and prevention strategies A global strategy for dengue prevention and control was promulgated more than 10 years ago and comprises five major elements BOX 2. Box 2 The global strategy for dengue prevention and control.
Box 3 Tools and resources for dengue control and prevention. Vector control To reduce or prevent dengue virus transmission there is currently no alternative to vector control. Vaccine development As a result of the failure of vector control, the continuing spread and increasing intensity of dengue has renewed interest and investment in dengue vaccine development, making a safe, effective and affordable tetravalent dengue vaccine a global public health priority Table 1 Selected dengue vaccine candidates.
Conclusions Dengue is now a global threat and is endemic or epidemic in almost every country located in the tropics. References 1. WHO; Geneva, Switzerland: Scientific Working Group Report on Dengue.
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