Dengue

Question 1

What are the 3 phases of dengue?

Answer 1

Febrile Phase
Critical Phase
Recovery Phase

Question 2

Dengue Warning Signs

Answer 2

• Abdominal pain
• Persistent vomiting (≥ 3 times/day)
• Persistent diarrhoea (≥ 3 times/day)
• Clinical fluid accumulation
• Mucosal bleed
• Lethargy, confusion, restlessness
• Tender liver
• Lab findings: ↑ HCT + rapid ↓ platelet count
  — HCT make ≤ 60 years old - 46
  — HCT male > 60 years old - 42
  — HCT female (all age group) - 40

Question 3

Dengue Non-Warning Signs

Question 4

Dengue

Answer 4

Acute pharyngitis, measles and others

Question 5

WHO Classificaiton A patient should be suspected to have dengue infection if one has fever + which 2 other criterias?

Answer 5

• Nausea, vomiting
• Rash
• Aches and pains
• Leucopenia
• Any warning signs

Question 6

Primary Care Management

Answer 6

• Symtomatic and supporive
• Daily and frequent monitoring until afebrile for at least 24-48H (clinical & serial FBC/HCT)
• Advise to return to hospital as soon as the warning signs/sever dengue arise

Question 7

Haemodynamic Assesstment (CCTVR)
5-in-1 maneuver
(30 seconds)

Answer 7

• Colour
• CRT
• Temperature
• Pulse Volume
• Pulse Rate

Question 8

By assessing hemodynamic status, we have to identify whether there are any pathophysiological changes in the patient.

Is the patient having normal circulation, compensated shock, or decompensated/hypotensive shock?

Answer 8

Question 9

Diagnostic Tests for Dengue

Answer 9

• Rapid Combo Test (RCT): Dengue NS1 Ag/ IgM & IgG Ab
• Non-Structiral Protein 1
• Dengue Serology Tests by ELISA
• Dengue Viral RNA detection

Question 10

Direct Methods vs Indirect Methods

Answer 10

Indirect methods are more accesssible (Serology IgG, IgM)
Direct methods are more sophisticated and better confidence (virus isolation, genome detection, NS1 detection)

Question 11

Dengue Criteria for Hospital Admission

Answer 11

Take note of several high risk groups too:
- presence of comorbidities
- elderly, infant, obesity
- on antiplatelet anticoagulant
- pregnant
- social factor transport
- secondary dengue infection

Question 12

Fluid therapy for patients without warning signs but unable to tolerate orally/evidence of haemoconcentration

Answer 12

Question 13

Fluid regime for patients with warning signs but without shock

Answer 13

Question 14

Fluid regime for patient with compensated and decompensated shock

Answer 14