What is Dengue Fever its syndrome and when to Admit Patient to Hospital

Dengue  fever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses.

Dengue hemorrhagic fever and dengue shock syndrome.

  • Less than 5% of Dengue patients develop D.H.F. or D.S.S. and if warning signals are known to public all deaths from dengue can be prevented.
  • Early symptoms of D H F are similar to those of dengue fever but after several days patient becomes irritable, restless and sweaty.
  • Bleeding appears as tiny sports on skin.
  • There can be bleeding from nose, G I tract and sometimes brain also.

In some patients disease progresses to a critical phase as fever resolves. During this phase there is leakage of plasma from small blood vessels, typically lasting 1-2 days. This may result in fluid accumulation in chest and abdominal cavity. This results in depletion of fluid from circulation and decreased blood supply to vital organs. This combined with bleeding results in steep and dangerous fall in blood pressure, this is called Dengue Shock Syndrome & this can be fatal.

Decreased level of consciousness occurs in 2-4% of severe cases which is due to either inflammation of brain by virus or indirectly as a result of impairment of vital organs like liver.

Physical examination of patient may reveal

  • Enlarged liver
  • Decreased Blood Pressure
  • Rashes over body
  • Red eyes
  • Swollen gland
  • Weak & rapid Pulse

 

Management

  • Because dengue HF is caused by virus for which there is no cure or vaccine, the only treatment is to treat symptoms and prevent its complications.
  • Patient needs IV fluids to prevent dehydration.
  • Fluid has to be replaced according to requirement
  • If pt. is bleeding and platelet count is low, platelet transfusion has to be given. Usually pt. does not need more than 1-2 transfusion. Normally platelet transfusion is not required as long as the platelet count is above 10000.
  • If the patient is already on aspirin because of associated medical problems like diabetes or heart trouble, he may need platelet transfusion at a cell count of

40- 50,000.

  • In excessive blood loss, blood transfusion may also be required.
  • Oxygen may be needed, when O2 concentration is low.

In critically ill patients with multiorgan failure, one might need the help of ventilator in a critical care unit.

When to admit the patient

  • Severe abdominal pain.
  • Persistent vomiting and restlessness.
  • Abrupt change of temperature from fever to hypothermia.
  • Bleeding or pallor.
  • Cold clammy extremities.
  • Liver enlargement on physical examination
  • Abnormal mental status.

 

Warning

  • Dengue fever or suspected dengue fever patients should not be given aspirin, nimuslide and brufen containing formulation because they tend to aggravate bleeding. Only paracetamol should be given to such patients.

 

Prognosis

  • With early and aggressive treatment most of the patients recover from dengue hemorrhagic fever.
  • However many untreated patients who go into shock carry poor prognosis.