Dengue Fever Treatment (Dengue Hemorrhagic Fever) Symptoms, Rashes, Diagnosis, Management Lecture

Summary

This video script offers a comprehensive guide on Dengue fever, detailing its clinical presentation, diagnosis, and treatment strategies. It explains the different categories of Dengue, from mild to severe, and emphasizes the importance of recognizing warning signs post-fever subsidence. The script also outlines diagnostic tests, treatment protocols, and crucial 'do's and don'ts' in managing Dengue patients, including fluid management and the use of medications like corticosteroids and platelet transfusions.

Takeaways

• 🦟 Dengue fever is a viral infection caused by the Dengue virus, which is transmitted by the Aedes aegypti mosquito.
• 🏥 Dengue fever is categorized into four presentations: Dengue without warning signs, Dengue with warning signs, Severe Dengue (previously known as Dengue hemorrhagic fever), and Dengue shock syndrome.
• 🌡 The majority of patients experience Dengue without warning signs, characterized by high-grade fever, severe headache, retro-orbital pain, myalgia, and arthralgias.
• 🔴 A maculopapular rash similar to measles and generalized lymphadenopathy may appear in some patients with Dengue fever.
• 📉 Dengue patients often undergo a capillary fragility test to check for thrombocytopenia, indicated by petechiae after a blood pressure cuff is inflated and then released.
• ⚠️ A critical period occurs 3-7 days after fever subsides, during which patients may develop warning signs such as abdominal pain, persistent vomiting, and organ involvement.
• 🩸 Severe Dengue can result from a second infection with a different serotype of the Dengue virus, leading to hemorrhagic manifestations and shock.
• 🧪 Diagnosis of Dengue includes serologic tests for IgM antibodies, NS1 antigen tests, and molecular tests to detect viral RNA.
• ❌ In treating Dengue, avoid corticosteroids, platelet transfusions for low platelet counts unless severe bleeding occurs, and do not assume IV fluids are necessary.
• ✅ Key 'do's' in Dengue treatment include recognizing the critical period, monitoring fluid intake and output, administering colloids for shock, and giving whole blood or packed red blood cells for severe bleeding.
• 📈 Treatment strategies vary based on the type of Dengue, from fever control and hydration in mild cases to controlled fluid administration and monitoring in severe cases and shock syndrome.

Q & A

What is Dengue fever?

Dengue fever is a viral infection caused by the Dengue virus, which is an RNA virus of the genus Flavivirus. It is transmitted by the Aedes aegypti mosquito, characterized by its white and black stripes.

How is Dengue fever typically categorized?

Dengue fever is usually divided into four categories: Dengue without warning signs, Dengue with warning signs, severe Dengue (previously called Dengue hemorrhagic fever), and Dengue shock syndrome.

What are the typical symptoms of Dengue fever without warning signs?

In the category of Dengue without warning signs, patients usually present with high-grade fever, severe headache, retro-orbital pain, myalgias, arthralgias, and a maculopapular rash similar to measles. They may also experience generalized lymphadenopathy.

What is the significance of the 'critical period' in Dengue fever?

The 'critical period' refers to the time immediately after the fever subsides, which is when patients are at risk of developing warning signs. This period is crucial because it is when patients may progress to severe forms of the disease if not properly monitored.

What are some warning signs of Dengue fever that may appear after the critical period?

Warning signs that may appear after the critical period include abdominal pain, persistent vomiting, a large liver, fluid leakage in the third spaces, pleural effusion, ascites, a rise in hematocrit level, and a drop in platelet count.

What is the purpose of the capillary fragility test in Dengue fever?

The capillary fragility test is used to detect the presence of thrombocytopenia in Dengue patients. It involves inflating a blood pressure cuff to a certain pressure for five minutes and observing for petechiae, which indicate capillary leakage.

What are some diagnostic tests used for Dengue virus detection?

Diagnostic tests for Dengue virus include serologic tests to detect IgM antibodies, RT-PCR to detect viral RNA, and the NS1 antigen test, which detects a structural protein present on the Dengue virus.

Why should corticosteroids not be used in the treatment of Dengue fever?

Corticosteroids should not be used in Dengue fever treatment because they increase the risk of GI bleeding, cause hyperglycemia, and lead to immunosuppression, which can worsen the condition.

When should platelet transfusions not be given in Dengue patients?

Platelet transfusions should not be given for thrombocytopenia unless there is severe thrombocytopenia with a platelet count less than 10,000 associated with severe bleeding, as they do not decrease the risk of bleeding and may lead to fluid overload.

How should fluid management be approached in patients with Dengue shock syndrome?

In Dengue shock syndrome, fluid management should be approached with caution. If the patient is in hypotensive shock, isotonic crystalloids or colloids should be given as a bolus, and the response should guide further fluid administration. Monitoring of hematocrit and vital signs is crucial to determine whether the patient is bleeding or experiencing fluid leakage into third spaces.

What are the main treatments for patients with Dengue fever without warning signs?

The main treatments for Dengue fever without warning signs include fever control with paracetamol, cold sponging, preventing dehydration through oral fluids, and ensuring adequate hydration with solutions like oral rehydration solutions or fruit juices.