Dengue: Difference between revisions

Revision as of 22:06, 15 August 2022

Aedes mosquito in urban area, especially during rainy seasons in tropical/subtropic regions (Asia, Africa, Central America, Caribbean)
Dengue shock syndrome and hemorrhagic fever rare in travelers
- Caused by second infection of different Dengue serotype

Incubation 3-7 days
Febrile phase:
- High fever + 'Breakbone' + GI symptoms + rash + possible exposure
- +/- Faget sign
- Lasts 3-7 days, majority recover
Critical Phase^[1]:
- Minority of patients, generally pediatric and elderly
- Around time of defervescence
- Vascular leak, hypoproteinemia, hemoconcentration, pleural effusion, ascites
- Narrowed pulse pressure, persistent vomiting, RUQ tenderness, lethargy and restlessness are signs of impending collapse
- Mucosal and skin bleeding
"Severe Dengue," any of the following:
- Shock from plasma leakage
- Hemorrhage
- Respiratory distress

Labs:
- CBC: Leukopenia, thrombocytopenia, and hemoconcentration
- CMP: LFTs elevated
- DIC labs should be sent
- Diagnose by 4x increase in acute/ convalescent titres - unlikely to be resulted in ED
Tourniquet Test - Tests capillary fragility
- Sensitivity of 52% and specificity of 82.4%
- A positive tourniquet test combined with lekuopenia increases sensitivity to 94%^[2]
- Inflate cuff to pressure between SBP & DBP, and leave for 5 min
- (+) Test = 10-20 petechiae per square inch

Example of positive tourniquet test on the right

Supportive Care
- APAP for pain/fever
  - DO NOT use ASA due to hemorrhagic nature
IVFs
Blood Transfusion - consider in hemorrhagic shock

Home - Well hydrated and non-toxic appearing
Admit - High-risk patients (ie pregnant, elderly, children, chronic disease)
- ICU - patients with shock and end-organ damage

Note for vaccination: There is now a vaccine available for the prevention of dengue virus and associated severe sequelae, Dengvaxia. Importantly, this vaccine is only recommended in individuals 9-45 who have been infected once before with the virus^[3]. If you see a patient who has confirmed or likely dengue virus infection and they live and/or work in an endemic area (likely to include more of the US as global warming changes viable regions for Aedes aegypti to live), inform them of the recommendation and ask them to follow up with their PCP to secure the vaccine.

↑ Simmons, C.P., Farrar, J.J., van Vinh Chau, N. and Wills, B. (2012) ‘Dengue’, New England Journal of Medicine, 366(15), pp. 1423–1432.
↑ Gregory CJ, Lorenzi OD, Colón L, García AS, Santiago LM, Rivera RC, Bermúdez LJ, Báez FO, Aponte DV, Tomashek KM, Gutierrez J, Alvarado L. Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room. PLoS Negl Trop Dis. 2011 Dec;5(12):e1400.
↑ Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1

Authors:

@@ Line 52: / Line 52: @@
 *Admit - High-risk patients (ie pregnant, elderly, children, chronic disease)
 **ICU - patients with shock and end-organ damage
+*'''Note for vaccination:''' There is now a vaccine available for the prevention of dengue virus and associated severe sequelae, Dengvaxia. Importantly, this vaccine is only recommended in individuals 9-45 who have been infected once before with the virus<ref>Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1</ref>. If you see a patient who has confirmed or likely dengue virus infection and they live and/or work in an endemic area (likely to include more of the US as global warming changes viable regions for ''Aedes aegypti'' to live), inform them of the recommendation and ask them to follow up with their PCP to secure the vaccine.
 ==See Also==