Dengue: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *High Fever + 'Breakbone' + GI sxs + Rash + possible exposure | ||
** | **4- 7d incubation period → influenza-like prodrome (Fever, headache, myalgias, lymphadenopathy, rash) | ||
**"Saddle back" fever | **"Saddle back" fever - high for several days, resolves for several days, then comes back for several days | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | |||
*Labs: | *Labs: | ||
** CBC: Leukopenia, thrombocytopenia, and hemoconcentration | ** CBC: Leukopenia, thrombocytopenia, and hemoconcentration | ||
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**(+) Test = 10-20 patechiae per square inch | **(+) Test = 10-20 patechiae per square inch | ||
== | ===Evaluation=== | ||
*Clinical diagnosis | |||
==Management== | |||
*Supportive Care | *Supportive Care | ||
**[[APAP]] for pain/fever | **[[APAP]] for pain/fever | ||
***DO NOT use [[ASA]] due to hemorrhagic nature | ***DO NOT use [[ASA]] due to hemorrhagic nature | ||
*[[IVFs]] | *[[IVFs]] | ||
*Blood | *Blood [[Transfusion]] - consider in hemorrhagic shock | ||
==Disposition== | ==Disposition== | ||
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*[[Travel Medicine]] | *[[Travel Medicine]] | ||
*[[Neglected Tropical Diseases]] | *[[Neglected Tropical Diseases]] | ||
==References== | |||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:TropMed]] | [[Category:TropMed]] | ||
Revision as of 08:28, 18 August 2015
Background
- Aedes mosquito in urban area, especially during rainy seasons in tropical/subtropic regions (Asia, Africa, Central America, Caribbean)
- Most cases occur in SE Asia
- Dengue shock syndrome and hem fever rare in travelers
- Caused by second infection of different Dengue serotype
Clinical Features
- High Fever + 'Breakbone' + GI sxs + Rash + possible exposure
- 4- 7d incubation period → influenza-like prodrome (Fever, headache, myalgias, lymphadenopathy, rash)
- "Saddle back" fever - high for several days, resolves for several days, then comes back for several days
Differential Diagnosis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Diagnosis
Work-up
- Labs:
- CBC: Leukopenia, thrombocytopenia, and hemoconcentration
- CMP: LFTs elevated
- DIC labs should be sent
- Dx by 4x increase in acute/ conv titres - unlikely to be resulted in ED
- Tourniquet Test - Tests capillary fragility
- Inflate cuff to pressure b/w SBP & DBP, and leave for 5 min
- (+) Test = 10-20 patechiae per square inch
Evaluation
- Clinical diagnosis
Management
- Supportive Care
- IVFs
- Blood Transfusion - consider in hemorrhagic shock
Disposition
- Home - Well hydrated and non-toxic appearing
- Admit - High-risk pts (ie pregnant, elderly, children, chronic dz)
- ICU - pts with shock and end-organ damage