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Presenting this set of slides with name Fever Cough And Chest Pain As Symptoms Of COVID 19 Medical Ppt Powerpoint Presentation Styles Ideas. The topics discussed in these slides are Prevention, Avoid Contact, Medical Mask. This is a completely editable PowerPoint presentation and is available for immediate download. Download now and impress your audience.

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This coloured powerpoint icon is a thermometer gun, perfect for visualising temperature readings. It is a simple, easy to use graphic that is sure to make your presentations stand out. Ideal for any project related to temperature readings.

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This coloured PowerPoint icon depicts a person with a sore throat. It is ideal for presentations and educational materials related to medical conditions, health and wellness, and general health awareness.

This monotone PowerPoint icon is perfect for presentations about sore throat. It features a person with a hand to their throat, indicating discomfort. The icon is simple yet effective, and can be used to effectively communicate the topic to your audience.

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approach to fever - PowerPoint PPT Presentation

approach to fever

Fever dx ,ddx ,rx – powerpoint ppt presentation.

• Dr.Bilal Natiq Nuaman
• Lecturer at Ibn-Sina Medical College
• C.A.B.M. ,F.I.B.M.S. ,D.I.M. ,M.B.Ch.B.
• Because Temperature affects how the enzymes work in your body , People should maintain a normal body temperature of about 37C despite wide variations in both their metabolic activity and the temperature of their environment. Enzymes are proteins that catalyze chemical reactions in living cells.
• Almost all enzymes have an "optimal" temperature. For example, most human derived enzymes will function best at around 37 C .If it gets too hot or cold the enzymes might denature and lose the shape of their active site, which means the substrate may no longer fit and this decreases the rate of the chemical reactions.
• HOMEOSTASIS
• The body keeps its core temperature constant at about 37 C by physiological adjustments controlled by the hypothalamus (Thermostat Center) where there are neurons sensitive to changes in skin and blood temperatures. The temperature-regulating centers are found in the Preoptic Area (the anterior portion of the hypothalamus). This area receives input from temperature receptors in the skin and mucous membranes (Peripheral Thermoreceptors) and from internal structures (Central Thermoreceptors), which include the hypothalamus itself.
• 1-the mean oral temperature is 36.8 0.4C
• 2-The normal diurnal variation is typically 0.5C
• (6 A.M. readings lt 6 P.M. readings by 0.5 C)
• definition-
• Fever is an elevation of body temperature that exceeds the normal daily range and occurs in conjunction with an increase in the hypothalamic set pointfor example, from 37 C to 39 C .
• an A.M. temperature of gt37.2 C
• (98.9F ) or a P.M. temperature of gt37.7 C (99.9F)
• (1) Exogenous pyrogens (micro-organism , toxin ) induce host cells, such as blood leukocytes and tissue macrophages, to produce fever-producing mediators called Endogenous pyrogens (e.g., interleukin-1).
• (2) resetting of hypothalamus thermostatic set point to a higher level through the action of prostaglandin E2.(prodrome)
• (3) generation of hypothalamic mediated responses that raise body temperature (chill)
• (4) development of fever with elevation of body to new thermostatic set point
• (5) production of temperature lowering responses (defervescence-sweating) and return of body temperature to a lower level.
• Exogenous pyrogens induce host cells, such as blood leukocytes and tissue macrophages, to produce fever-producing mediators called endogenous pyrogens (e.g., interleukin-1).
• The endogenous pyrogens mediate a number of other responses. For example, interleukin-1 is an inflammatory mediator that produces other signs of inflammation, such as leukocytosis, anorexia, and malaise.
• The phagocytosis of bacteria and breakdown products of bacteria that are present in the blood lead to the release of endogenous pyrogens into the circulation.
• The endogenous pyrogens are increase the set point of the hypothalamic thermoregulatory center through the action of prostaglandin E2.
• In response to the sudden increase in set point, the hypothalamus initiates heat production behaviors (shivering and vasoconstriction) that increase the core body temperature to the new set point, and fever is established.
• This shift of the set point from normothermic to febrile levels very much resembles the resetting of the home
• thermostat to a higher level in order to
• raise the ambient temperature in a room.
• 1-It enhance immune function
• Increases motility and activity of the white blood cells (T cells and B cells ).
• Stimulates the interferon production .
• Increase phagocytic activity
• 2-Inhibits growth of some microbial agents
• Many of the microbial agents that cause infection grow best at normal body temperatures, and their growth is inhibited by temperatures in the fever range
• Dehydration occurs because of sweating.
• Metabolic effects
• Increased need for oxygen (13 for every 1 C increase in body temp.).
• Increases the heart rate (10 /min. for every 1 C increase in body temp.).
• Increases the respiration rate (4/min. for every 1 C increase in body temp.).
• Increased use of body proteins as an energy source (catabolism)
• With prolonged fever, there is increased breakdown of endogenous fat stores .(metabolic acidosis)
• Precipitates febrile convulsions
• Some Features of Fever
• Relative bradycardia(rising of HR lt5 /min. for each 1C rise )
• Causes Typhoid,Brucellosis,Leptospirosis,and Factitious fever
• Relative tachycardia (rising of HR gt15/min. for each 1C rise )
• Causes Myocarditis, rheumatic fever
• Reversed diurnal pattern (AM Temp. gtPM Temp.)
• Causes Typhoid , disseminated TB
• Failure to have fever
• Cause Elderly,CRF,Corticosteroid
• 1-Onset of fever (warming chill phase )
• Sudden rise pneumonia,malaria,meningitis (associated with oral herpes simplex).
• Gradual rise typhoid fever (step-ladder) .
• 2-Main (pattern-plateau phase)
• Continuous fever does not fluctuate more than 1C during 24hrs, but at no time touches the normal.e.g.pneumonia, typhoid fever, urinary tract infection, brucellosis
• Remitent daily fluctuations exceed 2C but at no time touches the normal.
• It is associated with viral upper respiratory tract, legionella, and mycoplasma infections
• Intermittent fever reaches normal level
• Quotidian wn. Paroxysms of fever occur daily(P.Falciparum)
• Tertian wn. Paroxysms of fever on alternate days(P.Vivax ,Ovale)
• Quartan every 72 hrs (P.Malaiae)
• 3-End of fever
• Crisis (sudden reduction )associated with sweating
• e.g. pneumonia
• Lysis ( gradual reduction)
• e.g. Typhoid
• 1- History taking
• 1)Onset (sudden vs. gradual)2) grade (High vs. low grade)
• Low grade temp.lt38.5 , not associated with rigor (but chills ) , relieved by antipyretics or sponging , not interfere with usual activity .
• High grade temp.gt38.5 , associated with rigor and sweating , not relieved by antipyretics or sponging , interfere with usual activity.
• profound chills accompanied by chattering of the teeth and severe shivering, implies a rapid rise in body temperature. Can be produced by
• 1) brucellosis , malaria , pyelonephritis , Pneumonia
• 2) abscess ,cholangitis , septic arthritis
• 3) lymphoma
• 3)Duration of the fever
• 4)Fever pattern (Remittent fever, Intermittent, continuous fever)
• 5)Timing (through out the day, at night, day time)
• 6)Severityinterfere with sleep , interfere with usual activity
• 7)Relieving and aggravating factors
• 8)Treatment received or/and outcome
• 9)Associated symptoms
• Complete review of systems a) Upper respiratory tract infection (sore throat, coryza)b) Lower respiratory tract infection (cough, chest pain, shortness of breath)c) GIT symptoms (diarrhea watery or mucous, abdominal pain, constipation)d) GUT (Pain on micturation, hesitancy, urgency)e) Skin lesion (rash, infection), night sweat.
• f) Musculoskeletal pain,
• Excessive sweating.
• Night sweats are characteristic of tuberculosis, brucellosis , endocarditis ,lymphoma
• Drug and allergy History
• Drug fever is a disorder characterized by a febrile response coinciding temporally with the administration of a drug in the absence of underlying conditions that can be responsible for the fever. A key feature that differentiates drug fever from fever of other causes is that it disappears once the offending drug is discontinued. Drug fever tends to be a diagnosis of exclusion, often suspected in patients with otherwise unexplained fevers. causes
• antibiotics (penicillin) ,anticonvulsants(phe nytoin) , and some cardiac drugs
• Blood transfusion.
• Immunization and vaccinations .
• Smoking history - amount, duration type
• Alcohol history - amount, duration type
• Occupation, social education background, family social support financial situation, Social class.
• Home conditions-Water supply, Sanitation status in his home surrounding, Geographic area of living, fresh-water swimming.
• Animals / birds in his/her house- exposure to birds (psittacosis) or animals (,avian flu , toxoplasmosis, brucellosis, rabies.)
• Consumption of unpasteurized milk or milk products (tuberculosis, brucellosis and Q fever).
• Sexual History- Unprotected exposure to sexual partner with STD, HIV,syphilis
• Illicit drug usage- injections and sharing of needles (HIV, hepatitis B C, infective endocarditis), site of injection (e.g Femoral vein-septic arthritis, ilio-psoas abscess)
• Travel History
• Travel to an area known to be endemic for certain disease
• Name of the area, duration of stay
• Onset of illness- (incubation period)
• If the patient has been in an endemic area
• The most common diagnoses
• Malaria, Typhoid fever, Viral hepatitis .
• DAY1 Chicken pox
• DAY2 Scarlet fever
• DAY3 Rubella
• DAY4 Measles
• DAY5 Typhus
• DAY6 Typhoid
• (rose spot)
• Koplik's spots in measles
• Forchheimer spots in rubella
• FEVER AND LYMPHADENOPATHY
• Brucellosis
•  Cytomegalovirus
• Epstein-Barr virus
• Human immunodeficiency virus(AIDS)
• Syphilis (secondary) 
• Toxoplasmosis
•     Fever and Jaundice
• Cholangitis ,  Hepatic abscesses,  Malaria ,  Viral hepatitis  , Yellow fever
• Fever and pulmonary involvement
• Severe acute respiratory syndrome (SARS)
• 1-DÖhle bodeis , toxic granulation , band form bacterial inf.
• 2-neutropenia viral inf.,SLE ,typhoid , brucellosis , and b.marrow infiltration(lymphoma,T B,leukemia
• 3-lymphocytosis typhoid , brucellosis , TB ,viral inf.
• 4-Atypical lymphocyte viral inf.
• 5-monocytosis typhoid , brucellosis , TB ,lymphoma
• 6-eosinophilia drug reactions ,hodgkin s dis.,adrenal insufficiency
• 7-thich and thin bld film for malaria
• B-Biochemical
• urea and electrolytes, liver function tests (LFTs), blood glucose , GUE, GSE,
• Sputum for routine microscopy and culture, and microscopy and culture for mycobacteria ,
• Culture of blood , urine .
• inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
• autoantibodies, including antinuclear antibodies (ANA)
• C- Radiology
• CXR, Abdominal US , Echocardiogram , CT/MRI of thorax and abdomen
• Fever must be reduced in some groups of patients
• 1- Patients with preexisting cardiac disease (IHD)
• 2- Patients with cerebrovascular disease
• 3- patient with preexisting pulmonary disease
• 4-Children with a history of seizure
• 5-Pregnants
• 7-Temp.gt39
• Oral aspirin and NSAIDS (paracetamol, ibuprufen ) effectively reduces fever.
• Also reduce systemic symptoms of headache, myalgias, arthralgias due to reduction of PGE2 production.
• It is better to avoid aspirin in children to prevent Reye syndrome.
• Hyperthermia is characterized by an unchanged (normothermic) setting of the thermoregulatory center in conjunction with an uncontrolled increase in body temperature that exceeds the bodys ability to lose heat.
• Causes of Hyperthermia Syndromes
• HEAT STROKE
• Exercise in higher-than-normal heat and/or humidity
• DRUG-INDUCED HYPERTHERMIA
• Anticholinergics, including antihistamines antiparkinsonian drugs diuretics antipsychotics , anesthetics
• ENDOCRINOPATHY
• Thyrotoxicosis, pheochromocytoma
• 1-Daily temperature swings do not occur in patients with hyperthermia
• 2-hyperthermia can be rapidly fatal
• 3-characteristically does not respond to antipyretics
• 4-Hyperthermia is characterized by an unchanged setting of the thermoregulatory center
• 5-Hyperthermia is often diagnosed on the basis of the events immediately preceding the elevation of core temperaturee.g ., heat exposure or treatment with drugs
• that interfere with thermoregulation.
• 6-In patients with heat stroke syndromes and in those taking drugs that block sweating , the skin is hot but dry.
• Physical cooling with sponging, fans, cooling blankets, and even ice baths should be initiated immediately in conjunction with the administration of intravenous fluids and appropriate pharmacologic agents ,if insufficient cooling is achieved by external means , internal cooling can be achieved by gastric or peritoneal lavage with iced saline. .
• In extreme circumstances, hemodialysis or even cardiopulmonary bypass with cooling of blood be performed.
• PUO (FUO) is defined as a temperature persistently above 38.0 C for more than 3 weeks, without diagnosis despite initial investigation during 3 days of inpatient care or after 3 outpatient visits or more . (rule of 3 )
• Three major Infectous causes
• Abscess .. especially occult ..
• Intracellular organisms. (salmonella mycobacterium, brucella)
• Intravascular Endocarditis
• Tuberculosis
• The single most common infection in most PUO series
• Tuberculosis (TB) is an infection, primarily in the lungs (a pneumonia), caused by bacteria called
• tuberculosis. Mycobacterium
• It is spread usually from person to person by breathing infected air during close contact.
• TB can become active and cause infection in the lungs or other parts of the body (Caseating Granuloma).
• The most common symptoms and signs of TB are fatigue, fever, weight loss, coughing, and night sweats.
• The diagnosis of TB involves
• PPD (Skin Tuberculin Test),
• sputum analysis (smear for AFB and culture),
• Chest-X-ray (Apical cavitation , pleural effusion )
• PCR(polemerase chain reaction) tests to detect the genetic material of the causative bacteria.
• Diagnosis sometimes requires Biopsy of Lymph nodes , Bone marrow, Liver .
• Active TB is treated W multiple AntiTB Drugs for 6 months
• An abscess is a collection of pus (neutrophils) that has accumulated within a tissue because of an inflammatory process in response to an infectious process (usually caused by bacteria)
• Usually located in abdomen or pelvis.
• Secondary to appendicitis or diverticulitis.
• Pyogenic liver abscess usually follow biliary tract dis./abd. Suppuration.
• Splenic abscess is usually secondary to hematogenous seeding.
• Perinephric or renal abscess is usually secondary to UTI.
• Intracranial abscess, lung abscess
• Bacterial Endocarditis
• Endocarditis is an inflammation of the valves of the heart caused by the growth of bacteria on one of the heart valves, leading to a mass known as a vegetation.
• Symptoms can be nonspecific and include fever, shortness of breath, and weakness , and it carries a high complications and mortality rates .
• People with existing diseases of the heart valves are at an increased risk of developing endocarditis.
• Diagnosis of Endocarditis depend on Duke Criteria ( ve blood cultures and presence of vegetation on Echo )
• Cancer is the uncontrolled growth of abnormal cells anywhere in a body. The abnormal cells are termed cancer cells, malignant cells, or tumor cells. a mass of cancer cells develop
• Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colon cancer).
• Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle.
• This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastatic disease.
• Malignant causes of fever
• Renal cell carcinoma
• Hepatocellular carcinoma
• Hepatic metastases from any primary
• Fever is a well-recognized manifestation in Lymphoma .
• A Pel-Ebstein phenomenon is one type of Intermittent Fever
• noted in patients with Hodgkin's lymphoma in which the patient experiences fevers which cyclicly increase then decrease over an average period of one or two weeks.(2weeks fever then 2weeks normal)
• Family History
• Search for possible infectious or hereditary disorders
• Periodic Fever (Familial Mediterranean fever-FMF)
• An inherited disorder featuring short recurring crises of severe abdominal pain and bouts of fever. Other symptoms include arthritis, chest pain from inflammation of the lung cavity, and skin rashes. Between attacks, the patient seems healthy.
• Amyloidosis (the abnormal deposition of a particular protein, called amyloid, in various tissues of the body) is a potentially serious complication
• Treatment W Colchicin
• 1-Aspiration of fluid for analysis (pleural , ascitic, joint, CSF)
• 2- Lymph node Biopsy
• When there is LAP( lymphadenopathy) to diagnose Lymphoma , TB , Malignancy
• 3-bone marrow biopsy
• A biopsy is most useful in revealing haematological malignancy, and tuberculosis. It may also lead to a diagnosis of brucellosis, enteric fever or visceral leishmaniasis.
• 4-Liver biopsy
• The procedure may be required to diagnose tuberculosis,
• It is unlikely to be helpful in patients with normal LFTs and normal liver parenchyma on imaging.
• 5-Temporal artery biopsy
• Temporal artery biopsy should be considered in patients over the age of 50 to diagnose giant cell arteritis
• Questions??

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• Guy Kawasaki

Remember: Less is more.

A strong presentation is so much more than information pasted onto a series of slides with fancy backgrounds. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others. Here are some unique elements that make a presentation stand out.

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• Pictures: Pictures can communicate complex ideas quickly and memorably but choosing the right images is key. Images or pictures should be big (perhaps 20-25% of the page), bold, and have a clear purpose that complements the slide’s text.
• Layout: Don’t overcrowd your slides with too much information. When in doubt, adhere to the principle of simplicity, and aim for a clean and uncluttered layout with plenty of white space around text and images. Think phrases and bullets, not sentences.

As an intern or early career professional, chances are that you’ll be tasked with making or giving a presentation in the near future. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others.

• Guy Kawasaki is the chief evangelist at Canva and was the former chief evangelist at Apple. Guy is the author of 16 books including Think Remarkable : 9 Paths to Transform Your Life and Make a Difference.

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Dengue Fever

Aug 22, 2014

1.44k likes | 3.22k Views

Dengue Fever. Dengue Fever. Dengue virus Most prevalent vector-borne viral illness in the world Main mosquito vector is Aedes aegypti, Year round transmission. Dengue Fever.

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• differential diagnoses
• clinical characteristicsof dengue fever
• yellow fever
• increased air travel

Presentation Transcript

Dengue Fever • Dengue virus • Most prevalent vector-borne viral illness in the world • Main mosquito vector is Aedes aegypti, • Year round transmission

Dengue Fever • WHO says some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. • epidemic in more than 100 countries

Dengue fever • genus Flavivirus, • family Flaviviridae • also known as breakbone fever.(bonecrusher disease) -Dandy Fever • Aedes aegypti - rarely the Aedes albopictusmosquito,

Distribution • Endemic in more than 100 tropical and subtropical countries • Pandemic began in Southeast Asia after WW II with subsequent global spread • Several epidemics since 1980s • Distribution is comparable to malaria

ASYMPTOMATIC Undifferentiated Fever Without haemorrhagic SYMPTOMATIC Dengue Fever With unusual haemorrhagic No shock Dengue Haemorrhagic Fever DSS Manifestations of dengue virus infection:

Virology • Flavivirus family • Small enveloped viruses containing single stranded positive RNA • Four distinct viral serotypes (Den-1, Den-2, Den-3, Den-4)

DengueViruses • Four closely related single-stranded RNA Dengue viruses (DEN-1, DEN-2, DEN-3 and DEN-4) • Each serotype provides specific lifetime immunity, and short-term cross-immunity (A person can be infected as many as four times, once with each serotype) • All serotypes can cause severe and fatal disease

Pathophysiology • Transmitted by the bite of Aedes mosquito (Aedes aegypti) • Incubation 3-14 days • Acute illness and viremia 3-7 days • Recovery or progression to leakage phase

Dengue Mosquito • Aedes aegypti is the most important dengue mosquito • It breeds in collections of water close to dwellings • Common breeding sites are; - Domestic water storage containers - tanks, jars, drums, flower vases with water - Roof gutters /sun shades - Used tyres, discarded tins, cans, pots, yogurt cups, polythene bags, tree axils & - Many more places where rain watercollects

The most common epidemic vector of dengue in the world is theAedes aegyptimosquito. It can be identified by the white bands or scale patternson its legs and thorax.

Disease Factors • Dengue-2 serotype most virulent • Increased severity with secondary infections • Increased risk in children <15 years and elderly. • Greatest risk of DHF in infants. • More severe in females • Increased mortality with comorbid conditions • Less common in malnourished children

1 1. Virus transmitted to human in mosquito saliva 2 2. Virus replicateers in target organs local Lymph nodes,liver 4 3 3. Virus infects white blood cells and lymphatic tissues 4. Virus released and circulates in blood Replication and Transmissionof Dengue Virus (Part 1)

6 5. Second mosquito ingests virus with blood 6. Virus replicates in mosquito midgut and other organs, infects salivary glands 7 5 7. Virus replicates in salivary glands Replication and Transmissionof Dengue Virus (Part 2)

Dengue Clinical Syndromes • Undifferentiated fever • Classic dengue fever • Dengue hemorrhagic fever • Dengue shock syndrome

Undifferentiated Fever • May be the most common manifestation of dengue • Prospective study found that 87% of students infected were either asymptomatic or only mildly symptomatic • Other prospective studies including all age- groups also demonstrate silent transmission

Clinical Characteristicsof Dengue Fever • Fever • Headache • Muscle and joint pain • Nausea/vomiting • Rash • Hemorrhagic manifestations • Retro orbital pain

Hemorrhagic Manifestationsof Dengue • Skin hemorrhages: petechiae, purpura, ecchymoses • Gingival bleeding • Nasal bleeding • Gastro-intestinal bleeding: hematemesis, melena, • Hematuria • Increased menstrual flow

Clinical Case Definition forDengue Hemorrhagic Fever • Fever, or recent history of acute fever • Hemorrhagic manifestations • Low platelet count (100,000/mm3 or less) • Objective evidence of “leaky capillaries:” • elevated hematocrit (20% or more over baseline) • low albumin • pleural or other effusions 4 Necessary Criteria:

Clinical Case Definition for Dengue Shock Syndrome • 4 criteria for DHF • Evidence of circulatory failure manifested indirectly by all of the following: • Rapid and weak pulse • Narrow pulse pressure ( 20 mm Hg) OR hypotension for age • Cold, clammy skin and altered mental status • Frank shock is direct evidence of circulatory failure

Four Grades of DHF • Grade 1 • Fever and nonspecific constitutional symptoms • Positive tourniquet test is only hemorrhagic manifestation • Grade 2 • Grade 1 manifestations + spontaneous bleeding • Grade 3 • Signs of circulatory failure (rapid/weak pulse, narrow pulse pressure, hypotension, cold/clammy skin) • Grade 4 • Profound shock (undetectable pulse and BP)

Danger Signs inDengue Hemorrhagic Fever • Abdominal pain - intense and sustained • Persistent vomiting • Abrupt change from fever to hypothermia, with sweating and prostration • Restlessness or somnolence

Unusual Presentationsof Severe Dengue Fever • Encephalopathy • Hepatic damage • Cardiomyopathy • Severe gastrointestinal hemorrhage

Signs and Symptoms ofEncephalitis/EncephalopathyAssociated with Acute Dengue Infection • Decreased level of consciousness: lethargy, confusion, coma • Seizures • Nuchal rigidity • Paresis

Physical Exam • Nonspecific findings • Conjunctival injection, pharyngeal erythema, lymphadenopathy, hepatomegaly (20-50%) • Macular or maculopapular rash (50%)

Laboratory Findings • Leukopenia • Thrombocytopenia (<100,000) • Modest liver enzyme elevation (2-5x nml) • Serology: • Acute phase serum IgM (+6-90 days) ELISA • Acute and convalescent IgG (99% sens, 96% spec) • Hemagglutination inhibition assay (HI) is gold standard. Paired acute and convalescent HI assay, positive if >4 fold titer rise

tourniquet test • The tourniquet test is performed by inflating a blood pressure cuff to a point mid-way between the systolic and • diastolic pressures for five minutes. A test is considered positive when 10 or more petechiae per 2.5 cm2 (1 inch) • are observed. In DHF, the test usually gives a definite positive result (i.e. >20 petechiae). The test may be • negative or mildly positive during the phase of profound shock.

Dengue is currently classified as an emerging or re-emerging infectious disease • Overcrowded population. • Unplanned & uncontrolled urbanization. • Lack of effective mosquito control. • Increased air travel. • Decay of public health measures.

Treatment • No specific therapy • Supportive measures: adequate hydration acetaminophen (if no liver dysfunction) avoid NSAIDs • DHF or DHF w/ shock: IV fluid resuscitation and hospitalization blood or platelet transfusion as needed

Treatment • Treatment with corticosteroids shown not to reduce mortality with severe dengue shock • 2 studies of 63 and 92 pediatric DHF shock pts treated w/ hydrocortisone 50mg/kg x1 or methylprednisolone 30mg/kg x1 dose vs placebo. • Study of 95 pediatric DHF shock pts treated with carbazochrome sodium sulfate (AC-17) vs B vitamins for 3 days • Ribavirin very weak in vitro and in vivo activity against flaviviruses

Traditional and emerging treatments • Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication. • Brazilian traditional medicine,-cat's claw herb • Malaysia,-natural medicine. MasAmirtha and Semalu • Philippines -tawa-tawa herbs and sweet potato tops juice

Vaccination • No current dengue vaccine • Estimated availability in 5-10 years • Vaccine development is problematic as the vaccine must provide immunity to all 4 serotypes • Lack of dengue animal model • Live attenuated tetravalent vaccines under phase 2 trials • New approaches include infectious clone DNA and naked DNA vaccines

Mortality/Morbidity • Treated DHF/DSS is associated with a 3% mortality rate. • Untreated DHF/DSS is associated with a 50% mortality rate.

Differential Diagnoses • Hepatitis • Tick-Borne Diseases, Rocky Mountain Spotted Fever • Malaria • Yellow Fever • Meningitis • Pediatrics, Bacteremia and Sepsis • Pediatrics, Meningitis and Encephalitis

Prevention Biological: • Target larval stage of Aedes in large water storage containers • Larvivorous fish (Gambusia), endotoxin producing bacteria (Bacillus), copepod crustaceans (mesocyclops) Chemical: • Insecticide treatment of water containers • Space spraying (thermal fogs)

Public Health • Major and escalating global public health problem • Global demographic changes: urbanization and population growth with substandard housing, water, and waster management systems • Deteriorating public health infrastructure with limited resources resulting in “crisis management” not prevention • Increased travel • Lack of effective mosquito control

Mosquito control: Options available

Common Misconceptions aboutDengue Hemorrhagic Fever • Dengue + bleeding = DHF • Need 4 WHO criteria & capillary permeability • DHF kills only by hemorrhage • Patient dies as a result of shock • Poor management turns dengue into DHF • Poorly managed dengue can be more severe, but DHF is a distinct condition, which even well-treated patients may develop • DHF is a pediatric disease • All age groups are involved • DHF is a problem of low income families • All socioeconomic groups are affected

Important Instructions for Treatment of DHF Ø Cases of DHF should be observed every hour. Ø Serial platelet and haematocrit determinations, drop in plaelets and rise in haematocrits are essential for early diagnosis of DHF. Ø Timely intravenous therapy – isotonic crystalloid solution – can prevent shock and/or lessen its severity. Ø If the patient’s condition becomes worse despite giving 20ml/kg/hr for one hour, replace crystalloid solution with colloid solution such as Dextran or plasma. As soon as improvement occurs replace with crystalloid.

Important Instructions for Treatment of DHF • Ø In case of shock, give oxygen. • Ø For correction of acidosis (sign: deep breathing), use sodium bicarbonate.

What not to do • Ø Do not give Aspirin or Brufen for treatment of fever. • Ø Avoid giving intravenous therapy before there is evidence of • haemorrhage and bleeding. • Ø Avoid giving blood transfusion unless indicated, reduction in • haematocrit or severe bleeding. • Ø Avoid giving steroids. They do not show any benefit. • Ø Do not use antibiotics • Ø Do not change the speed of fluid rapidly, i.e. avoid rapidly • increasing or rapidly slowing the speed of fluids. • Ø Insertion of nasogastric tube to determine concealed • bleeding or to stop bleeding (by cold lavage) is not • recommended since it is hazardous.

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