What is dengue shock syndrome? RNA virus belongs to flavivirus genus of the Flaviviridae family. There are four serotypes DEVN1, DEVN 2, DEVN 3 and DEVN 4. Infection with one virus produces lifelong immunity with that virus. It is transmitted by the urban adapted Aedes aegypti and to a certain extent Aedes albopictus. Lives in intimate contact with humans and feeds during the day and lays eggs in stagnating water. It is a form of hypovolemic shock due to severe plasma leakage and continued vascular permeability. It may progress from asymptomatic capillary leakage to compensated shock and hypotensive shock.
- Cold extremities
- Weak pulse and low pulse pressure
- Kussmaul’s breathing and metabolic acidosis
- Altered mental status
- Seizures, lethargy, and ultimately to multi-organ failure.
- It is estimated that 50 million dengue infections per year occur across approximately 100 countries all over the world.
- The first occurrence of dengue fever in India documents back in 1946.
- In India, dengue outbreaks occur during the rainy season and at the end of the monsoon(October and November).
- Paracetamol and cold sponging for fever. (Aspirin and NSAIDs are contraindicated)
- Increase oral fluid intake.
- Adequate fluid replacement based on hematocrit determinations. Over fluid infusion should be avoided. Urine output should be monitored.
- Blood transfusions are given according to the clinical situation(fresh packed red cells have high levels of 2,3 DPG levels to improve oxygen releasing capacity of HB).
- Prophylactic platelet transfusion is not recommended. Can be transfused when the platelet count is 10,000.
- IgM capture ELISA detects dengue specific IgM antibodies (5- 60 days).
- NS1 antigen marker of acute dengue infection (glycoprotein produced by all Flaviviridae and is essential for replication and viability. (day 1- 5).
- Virus isolation RT PCR
- Virus culture
- Chest X-Ray / USG whole Abdomen
- Tourniquet test- 10 or more petechiae per 2.5 cm2
INDICATION FOR HOSPITALISATION
- Abdominal pain, black tarry stool, epistaxis, bleeding from gums or respiratory distress.
- Progressive thrombocytopenia and increasing haematocrit.
- Infects monocytes in blood and macrophages from the skin, liver, spleen and thymus.
- May be found in the central nervous system but does not undergo any replication.
- Doesn’t infect endothelial cells, only minor nonspecific changes in the microvasculature.
Dr Ajay Aggarwal - Director, Internal Medicine, Fortis Hospital Noida says that the incubation period is 4-7 days.
- Dengue fever- Severe headache, myalgia, arthralgia, and rash.
- DHF- seen in patients when they have repeated infection with another strain of dengue virus. It is characterised by acute onset.
- Febrile phase-(3-7 days) Characterised by high fever, headache, retro-orbital pain and a transient macular rash. Anorexia, nausea and vomiting, mild bleeding manifestations like petechiae and ecchymosis, leucopenia, thrombocytopenia and deranged liver enzymes.
- Critical phase- Occurs around the time of defervescence manifests as hemoconcentration and hypoproteinemia. Moderate to severe thrombocytopenia, decreased fibrinogen levels. Due to plasma leakage patient shows tachycardia and narrowing of pulse pressure. May develop shock-warning signs are persistent vomiting, tender hepatomegaly, severe abdominal pain, development of effusions, mucosal bleeding and lethargy. This phase is usually recovered with IV rehydration.
- Recovery phase- Spontaneously reverts to normal afebrile, normotensive, severe fatigue. May develop arrhythmias, myocarditis or encephalopathy.
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