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IM Infectious Diseases > Dengue > Flashcards

Dengue Flashcards

0
Q

Acute febrile illness with no focus of infection

A

Dengue

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1
Q

Dengue incubation period

A

2-7days

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2
Q

Fever pattern in Dengue

A

Biphasic

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3
Q

No. Sero types of dengue

A

4

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4
Q

Principal vector of dengue

A

Aedes aegypti

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5
Q

Pathogenesis theories (2) of DHF in guazon

A
  1. Macrophage/monocytes infection
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6
Q

Most dangerous serotype more prone to producing DHF

A

Serotype 2

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7
Q

DHF patho genesis

A

Previous infections with heterogous dengue virus serotype produces nonprotective antiviral antibodies resulting to enhanced infection

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8
Q

Risk factors for induction of vascular permeability and shock
(7)

A
  1. Presence of enhancing and nonneutralizing antibodies (trans placental maternal antibody in less than 9 months old, antibody from previous infection
  2. Age: dec susceptibility after 12 years
  3. Females more affected
  4. Whites more than blacks
  5. Malnutrition protective
  6. Infecting serotype 2
  7. Sequence 1 followed by serotype 2
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9
Q

Pathogenesis of dengue shock syndrome

A

Increased vascular permeability

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10
Q

Typical/ Break-bone fever symptoms

A 
Fever
headache
retro-orbital pain
back pain
severe myalgia
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11
Q

Initial symptoms 6

A 
1 maculopapular rash
2 lymphadenopathy
3 anorexia
4 nausea and vomiting
5 palatal vesicles
6 scleral injection
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12
Q

Rash of dengue

A

Maculopapular

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13
Q

CBC FINDINGS

A

Leukopenia
Thrombocytopenia
Elevated hematocrit

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14
Q

Serum transaminases

A

Ast or ALt > 1000 in severe dengue

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15
Q

Chest X-ray

A

Watch out for pleural effusion

16
Q

Serology options recovery and acute phase

A
  1. Recovery- igM Elisa or paired serology

2. Acute- antigen-detection Elisa or RT-PCR

17
Q

Antigen determination of dengue during the first 3-4 days

A

NS-1 antigen

18
Q

+ tourniquet test

BP cuff inflated midway systolic and diastolic for 5 minutes

A

> 20 petechiae in a square inch 1.5 inches fr color aspect of the antecubital fossa

19
Q

WHO Classification of Probable Dengue 7

A 
1. Lives in/traveled to dengue endemic area
2 FEVER plus 2 of the following
- nausea and vomiting
- rashes/body aches
-leukopenia
-positive tourniquet test
-any warning signs
20
Q

Warning signs 7

A 
1 Abdominal tenderness
2 Persistent vomiting 
3 bleeding in mucous membranes
4 fluid collection evaluated clinically
5 lethargy restlessness
6 hepatomegaly > 2 cm
7 increase in HCT with rapid decrease in platelets
21
Q

Severe dengue

3

A 
1 Severe plasma leakage leading to shock, fluid accumulation respiratory distress
2 Severe bleeding
3 Severe organ involvement 
ast/alt >1000
Impaired consciousness
Cvs and others
22
Q

Dengue without warning signs treatment

A
  1. Bed rest
  2. Sufficient fluid intake
  3. Paracetamol as needed
23
Q

Signs of progressing disease

A

1 defervescence
2 improving WBC count
3 warning signs

24
Q

Dengue with warning signs hydration mgmt

A 
1 OFI if tolerated
2 IVF
START: 5-7ml/kg/hour for 1-2 hours 
Then 3-5mL/kg/hr for 2-4hours 
Further reduction to 2-3ml for maintenance
25
Q

At 2-3mL, and not improving mgmt

A
  1. hct rises or same level-continue for 2-3hours

2. Rapid HCT inc and worsening vitals 5-10ml/kg/hr for 1-2 hrs

26
Q

Dengue with warning signs monitoring

A

Baseline HCT then q6-12hours

Serum glucose other organ function tests

27
Q

Severe dengue resuscitation

A

Crystalloids at 5-10 in 1h
Then5-7 in 1-3h
3-5 in 2-4
Maybe maintained over 24-48hours

28
Q

Mgmt of severe dengue with unstable vitals

A

Hct still high >.5 give 2nd bolus at 10-20ml/kg/hr for 1 hour
HCT decrease may indicate bleeding or transfusion

29
Q

Mgmt Hypotensive shock

A

20mL/kg bolus for 15 minutes

Then 10ml/kg/hr IVF for 1 hour reduce based on symptoms

IM Infectious Diseases (2 decks)

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