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 hemorrhagic fever rare in travelers | ||
**Caused by second infection of different Dengue serotype | |||
== | ==Clinical Features== | ||
* | *Incubation 3-7 days | ||
** | *Febrile phase: | ||
*Labs: CBC: Leukopenia and | **High [[fever]] + 'Breakbone' + GI symptoms + [[rash]] + possible exposure | ||
**+/- [[Faget sign]] | |||
**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>: | |||
**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 | |||
==Differential Diagnosis== | |||
{{Template:Fever in Traveler DDX}} | |||
==Evaluation== | |||
===Work-up=== | |||
*Labs: | |||
**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/ convalescent titres - unlikely to be resulted in ED | ||
*Tourniquet Test - Tests capillary fragility | *Tourniquet Test - Tests capillary fragility | ||
**Inflate cuff to pressure | **Sensitivity of 52% and specificity of 82.4% | ||
**(+) Test = 10-20 | **A positive tourniquet test combined with lekuopenia increases sensitivity to 94%<ref>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. </ref> | ||
**Inflate cuff to pressure between SBP & DBP, and leave for 5 min | |||
**(+) Test = 10-20 petechiae per square inch | |||
[[File:Tourniquettest.gif|thumbnail|Example of positive tourniquet test on the right]] | |||
===Evaluation=== | |||
*Clinical diagnosis | |||
== | ==Management== | ||
*Supportive Care | *Supportive Care | ||
**APAP | **[[APAP]] for pain/fever | ||
***DO NOT use ASA due to | ***DO NOT use [[ASA]] due to hemorrhagic nature | ||
* | *[[IVFs]] | ||
*Blood | *Blood [[Transfusion]] - consider in hemorrhagic shock | ||
== | ==Disposition== | ||
*Home - Well hydrated and non-toxic appearing | *Home - Well hydrated and non-toxic appearing | ||
*Admit - High-risk | *Admit - High-risk patients (ie pregnant, elderly, children, chronic disease) | ||
**ICU - | **ICU - patients with shock and end-organ damage | ||
==See Also== | ==See Also== | ||
[[Travel Medicine]] | *[[Travel Medicine]] | ||
*[[Neglected Tropical Diseases]] | |||
==References== | |||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Tropical Medicine]] | ||
Revision as of 02:48, 30 October 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 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
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
- 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
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.
- ↑ 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.