Dengue: Difference between revisions

(Created page with "==Background== #aedes mosquito in urban area ==Diagnosis== # incubate for 4- 7d, influenza like prodrome, fvr, ha, myalgia, LN, rash # dengue shock syndrome and hem fvr rare in ...")
 
 
(34 intermediate revisions by 10 users not shown)
Line 1: Line 1:
==Background==
==Background==
#aedes mosquito in urban area
*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


==Diagnosis==
==Clinical Features==
# incubate for 4- 7d, influenza like prodrome, fvr, ha, myalgia, LN, rash
*Incubation 3-7 days
# dengue shock syndrome and hem fvr rare in travelers- usually in pt c prev infc
*Febrile phase:
# leukopenia, thrombocytopenia
**High [[fever]] + 'Breakbone' + GI symptoms + [[rash]] + possible exposure
# dx by 4x increase in acute/ conv titres
**+/- [[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


==Treatment==
==Differential Diagnosis==
{{Template:Fever in Traveler DDX}}


==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%<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]]
===Diagnosis===
*Clinical diagnosis
==Management==
*Supportive Care
**[[Acetaminophen]] for pain/fever
***DO NOT use [[aspirin]] due to hemorrhagic nature
*[[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
==Prevention==
*Vaccine available for the prevention of dengue virus and associated severe sequelae, Dengvaxia.<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>
*Only recommended for individuals 9-45 years old 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 patient has confirmed or likely dengue virus infection and they live and/or work in an endemic area, have them follow up with PCP for vaccination.


==See Also==
==See Also==
[[Travel Medicine]]
*[[Travel Medicine]]
*[[Neglected Tropical Diseases]]
 
==References==
<References/>


[[Category:ID]]
[[Category:ID]]
[[Category:TropMed]]
[[Category:Tropical Medicine]]

Latest revision as of 18:01, 7 September 2022

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

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
Example of positive tourniquet test on the right

Diagnosis

  • Clinical diagnosis

Management

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

Prevention

  • Vaccine available for the prevention of dengue virus and associated severe sequelae, Dengvaxia.[3]
  • Only recommended for individuals 9-45 years old who have been infected once before with the virus[4].
  • If patient has confirmed or likely dengue virus infection and they live and/or work in an endemic area, have them follow up with PCP for vaccination.

See Also

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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
  4. ↑ 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
Retrieved from "https://www.wikem.org/w/index.php?title=Dengue&oldid=366151"