DENGUE HEMORRHAGIC FEVER

- LITERATURE REVIEW-

NAME :NUR HAFIZA BT BAHAROM

STUDENT ID : 6003789
SUPERVISOR : PROF DR NADIA
MONTASSER

ELECTIVE POSTING

14/7/14 8/8/14 ( 3 WEEKS ) : OBSTETRICS &

GYNAECOLOGY
SUPERVISED by : DR AQMAR SURAYA
11/8/14 29/8/14 (3 WEEKS) : INTERNAL MEDICINE
SUPERVISED by : DR NURULANISSA BINTI ABD KADIR

CONTENTS
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL DISEASE
DIAGNOSIS
MANAGEMENT
PREVENTION & CONTROL

INTRODUCTION
Viral hemorhagic fever is a general term

for severe illness, associated with severe

bleeding that is caused by a number of
viruses.
Dengue hemorrhagic fever is an
infection associated with an increase in
microvascular permeability, a
decrease in plasma volume and in
severe forms of hypotension and shock.

DENGUE FACTS
oCausative
2.5 billionAgent
of people
are currently at risk
:

Host : Human

Dengue
virus infections.
from
dengue
o Each year, around 50-100 million dengue
infections has been reported.
o Endemic-epidemic disease
o Fatality rate may be as high as 12-44%
Mode of Transmission
Vector
:
o Mosttransmission
: Mosquito
bite
,
of
the
cases
are coming
from
South
Aedes mosquito
Blood &
donation.
East Asia, American, African
Pasific

CLINICAL DISEASE

CASE DEFINITION
According to WHO , the following symptoms ALL must
be present :
1) Fever, or history of acute fever : lasting 2-7
days.
2) Hemorrhagic tendencies :
- positive tourniquet test
- petechiae
- hematemesis or melena
- ecchymoses or purpura
- bleeding from the mucosa
3) Evidence of thrombocytopenia (< 100,000
cells per mm3).
4) Evidence of plasma leakage ; manifested by at
least one of the following :
- a rise in hematocrit >20% above average for
age, sex & population.
- a drop in the hematocrit following volumereplacement treatment >20% of baseline.

LABORATORY DIAGNOSIS
1. Complete Blood Picture

1. Thrombocytopenia
( <100 000 cells per
mm3)
2. Haemoconcentration
; hematocrit
increase >20%
from baseline or
population of the
same age)
3. Total WBC is usually
normal at the onset
of fever ; then
leucopenia develops
as the disease
progress

2. Direct Laboratory Test (DIAGNOSTIC)

I.
-.
-.
-.

II.
III.
-.
-.
IV.
-.

Isolation of virus
Most definitive test for dengue
infection.
Useful only at the early phase of illness
The monoclonal antibody
immunofluorescence test is the
method of choice for identification of
dengue virus.
Viral nucleic acid detection
Dengue viral genome ; ribonucleic acid
(RNA), can be detected by RT-PCR
Viral antigen detection
Non sturctural protein 1(NS1)
glycoprotein is produced by all
flaviviruses
Commercial kits for detection of NS1
antigen are now available
Serology test
The IgM capture enzyme-linked

MANAGEMENT of DHF
Isotonic crystalloid solution should be

used throughout the critical period.

Duration of IV fluid therapy
- shock : not exceed 24-48 hours
- without shock : not exceed 60-72 hours
Dextran-40 may be used instead for those
who does not respond to crystalloid.

BLEEDING
Packed red blood cells
Fresh frozen plasma
Platelet concentrate : 0.2 to 0.4 unit/kg
FLUID OVERLOAD
In early stage :
Switch from crystalloid to colloid solutions as
bolus fluids ( Dextran-40)
In late stage :
Furosemide ( stable vital signs)
- 10 ml/kg/h of colloid (Dextran) : shock with
fluid overload.
SUPPORTIVE
CARE
Renal replacement therapy
Vasopressor and Inotropic

PREVENTION and CONTROL

Global strategy for dengue preventive
measures
Aim : to reduce the burden of dengue
Dengue mortality
Implement early case detection
c.
Vector
a.
Appropriateb.
management
Community
control
Susceptible
Dengue morbidity :
measures
protection

Chemical
Implement improved outbreak prediction and
and health
Government
methods
detection
education
Health
Biological
Epidemic measures
for facing epidemic
officials
methods
Involves early warning of epidemic transmission
NGOs
Physical
A contigency plan
for local outbreak : active case
methods
detection, protocols

CONCLUSION

Early recognition and careful

monitoring are essential

Community participants play an

important role in controlling the

spread of the disease.