Dengue: Difference between revisions
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==Background== | ==Background== | ||
*Aedes mosquito in urban area, especially during rainy seasons in tropical/subtropic regions (Asia, Africa, Central America, Caribbean) | *Aedes mosquito in urban area, especially during rainy seasons in tropical/subtropic regions (Asia, Africa, Central America, Caribbean) | ||
*Dengue shock syndrome and | *Dengue shock syndrome and hemorrhagic fever rare in travelers | ||
**Caused by second infection of different Dengue serotype | **Caused by second infection of different Dengue serotype | ||
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*Incubation 3-7 days | *Incubation 3-7 days | ||
*Febrile phase: | *Febrile phase: | ||
**High | **High [[fever]] + 'Breakbone' + GI symptoms + [[rash]] + possible exposure | ||
**+/- [[Faget sign]] | |||
**Lasts 3-7 days, majority recover | **Lasts 3-7 days, majority recover | ||
*Critical Phase<ref>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.</ref>: | *Critical Phase<ref>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.</ref>: | ||
**Minority of patients, | **Minority of patients, generally peds and elderly | ||
**Around time of defervescence | **Around time of defervescence | ||
**Vascular leak, hypoproteinemia, hemoconcentration, pleural effusion, ascites | **Vascular leak, hypoproteinemia, hemoconcentration, [[pleural effusion]], [[ascites]] | ||
**Narrowed pulse pressure, persistent vomiting, RUQ tenderness, lethargy and restlessness are signs of impending collapse | **Narrowed pulse pressure, persistent [[vomiting]], RUQ tenderness, lethargy and restlessness are signs of impending collapse | ||
**Mucosal and skin bleeding | **Mucosal and skin bleeding | ||
*"Severe Dengue," any of the following: | *"Severe Dengue," any of the following: | ||
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===Work-up=== | ===Work-up=== | ||
*Labs: | *Labs: | ||
**CBC: Leukopenia, [[thrombocytopenia]], and hemoconcentration | **CBC: [[Leukopenia]], [[thrombocytopenia]], and hemoconcentration | ||
**CMP: LFTs elevated | **CMP: LFTs elevated | ||
**[[DIC]] labs should be sent | **[[DIC]] labs should be sent | ||
**Diagnose by 4x increase in acute/ | **Diagnose by 4x increase in acute/ convalescent titres - unlikely to be resulted in ED | ||
*Tourniquet Test - Tests capillary fragility | *Tourniquet Test - Tests capillary fragility | ||
**Inflate cuff to pressure between SBP & DBP, and leave for 5 min | **Inflate cuff to pressure between SBP & DBP, and leave for 5 min | ||
Revision as of 23:00, 10 September 2016
Background
- 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
Clinical Features
- 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 peds 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
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
Evaluation
Work-up
- 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
- Inflate cuff to pressure between SBP & DBP, and leave for 5 min
- (+) Test = 10-20 petechiae 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 patients (ie pregnant, elderly, children, chronic disease)
- ICU - patients with shock and end-organ damage
See Also
References
- ↑ 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.