Dengue: Difference between revisions
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**Caused by second infection of different Dengue serotype | **Caused by second infection of different Dengue serotype | ||
== | ==Clinical Features== | ||
*'''Clinical Diagnosis''' - High Fever + 'Breakbone' + GI sxs + Rash + possible exposure | *'''Clinical Diagnosis''' - High Fever + 'Breakbone' + GI sxs + Rash + possible exposure | ||
**Incubate for 4- 7d, influenza like prodrome, fvr, HA, myalgia, LN, rash | **Incubate for 4- 7d, influenza like prodrome, fvr, HA, myalgia, LN, rash | ||
**"Saddle back" fever | **"Saddle back" fever | ||
***high for several days, resolves for several days, then comes back for several days | ***high for several days, resolves for several days, then comes back for several days | ||
==Differential Diagnosis== | |||
{{Template:Fever in Traveler DDX}} | |||
==Diagnosis== | |||
*Labs: | *Labs: | ||
** CBC: Leukopenia, thrombocytopenia, and hemoconcentration | ** CBC: Leukopenia, thrombocytopenia, and hemoconcentration | ||
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**Inflate cuff to pressure b/w SBP & DBP, and leave for 5 min | **Inflate cuff to pressure b/w SBP & DBP, and leave for 5 min | ||
**(+) Test = 10-20 patechiae per square inch | **(+) Test = 10-20 patechiae per square inch | ||
==Treatment== | ==Treatment== | ||
*Supportive Care | *Supportive Care | ||
**APAP for pain/fever | **[[APAP]] for pain/fever | ||
***DO NOT use ASA due to | ***DO NOT use [[ASA]] due to hemorrhagic nature | ||
*[[IVFs]] | *[[IVFs]] | ||
*Blood Component [[Transfusion]] - consider in hemorrhagic shock | *Blood Component [[Transfusion]] - consider in hemorrhagic shock | ||
Revision as of 02:30, 10 June 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
- Clinical Diagnosis - High Fever + 'Breakbone' + GI sxs + Rash + possible exposure
- Incubate for 4- 7d, influenza like prodrome, fvr, HA, myalgia, LN, 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
- 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
Treatment
- Supportive Care
- IVFs
- Blood Component 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