Dengue Fever

Dr. Bhaskar Shenoy, Dr. Archana M
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Physical Examination
• Diffuse skin flushing of the face, neck and chest develops early in the infection. This evolves into a maculopapular or rubelliform rash of whole body on day 3 or 4 of fever, which is associated with blanching when pressed. (1)
• Hemorrhagic signs-Minor haemorrhage includes petechiae, purpura, positive tourniquet test (BP cuff is inflated to a point midway between systolic and diastolic blood pressures for 5 minutes. The test is positive if >10 petechiae per square inch or per 2.5 square cm appear on forearm) (1), conjunctival haemorrhage.
Major haemorrhage includes epistaxis, gingival bleeding, and hematemesis. malena, metromenorrhagia, bleeding from venepuncture site. These signs can occur either in DF or DHF. (1,5)
• Hepatomegaly
• Plasma leakage-Ascites, postural dizziness or pleural effusion leading to respiratory distress. These are seen in DHF. (1,5)
• Circulatory collapse-cold clammy skin, rapid and weak pulse with narrowing of pulse pressure to <20mm Hg with decreased diastolic pressure, postural drop of blood pressure >20mmHg, capillary refill time greater than 3 seconds, reduced urine output, indicates presence of shock and supports diagnosis of dengue shock syndrome. (1,5)
Of these manifestations bleeding and hepatomegaly are highly correlated with the progression of DF into severe dengue disease (SDD) (6).

• The incubation period is 3-14 days (average 7 days). (1)
• Febrile phase is characterized by a sudden high grade fever and dehydration which lasts for 2-7 days. (1)
• Critical phase is characterized by plasma leakage, bleeding, shock and organ impairment and lasts for 24-48 hours. It starts around the time of defervescence, typically days 3 to 7 of infection. (1)
• Spontaneous recovery phase is characterized by stoppage of plasma leak and plasma returns to circulation. Patient starts passing copious amount of dilute urine, develop bounding pulses, wide pulse pressure and rise in blood pressure. Appetite improves and patient feels better. (1)

• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation
• Mucosal bleed
• Lethargy, restlessness
• Liver enlargement >2cm.
• Laboratory: Increase in hematocrit concurrent with rapid increase in platelet count

1. Severe plasma leakage
• Shock (DSS)
• Fluid accumulation with respiratory distress
2. Severe bleeding
3. Severe organ involvement
• Liver: ALT > 1000 IU/L
• CNS: Impaired consciousness
• Involvement of Heart and other organs

• High grade fever with spikes of 39.4-40.5 degree Celsius. It may be biphasic and last for 5-7 days.
• Aches particularly backaches, myalgia, arthralgia, bone pain, headache, retro-orbital pain in adolescents and older children
• Gastrointestinal symptoms like anorexia, nausea or vomiting, epigastric discomfort or pain.
• Lethargy, restlessness, collapse or dizziness may be present.
• Upper respiratory tract symptoms-sore throat, cough are rare.(1,5)


References
Dengue Fever Dengue Fever 06/28/2016
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