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Infectious disease > Dengue fever > Flashcards

Dengue fever Flashcards

1
Q

What causes dengue fever

A

Arboviral illness spread by culicine mosquitos - aedes aegypti and aedes albopictus esp

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2
Q

Where is dengue endemic to

A

South east asia and south america

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3
Q

What is severe dengue

A

Severe bleeding
Organ impairment
Plasma leakage

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4
Q

Where is denue endemic

A

South east asia
South and central america

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5
Q

Types of dengue

A

Without warning signs
With warning signs
Severe

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6
Q

Probable dengue criteria

A

Live in/travel to dengue endemic area
Fever +
-Nausea, vomit
-Rash
-Aches and pains
- + tourniquet test
-Leukopenia
-Any warning sign

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7
Q

Warning signs dengue criteria

A

Abdo pain or tenderness
Persistnet vomitting
Clinical fluid accumulation
Mucosal bleed
Lethargy, restlessness
Liver enlargement >2cm
Haematocrit increase w rapid decrease and rapid decrease in platelets

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8
Q

What bloods suggest dengue with warning signs

A

Rapid increase haematocrit, rapid decrease in platelets - extravasation of plasma

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9
Q

Crtieria for severe dengue

A

Severe plasma leakage - shock - DSS, fluid acc -> resp distress
Severe bleeding
Sev organ involvement
Liver AST or ALT >1000
CNS - impaired consciousness
Heart and other involvement

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10
Q

Phases of dengue

A

Febrile
Critical
Recovery

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11
Q

6 factors determining phase of dengue

A

Temperature
Oral intake
Urine output
WBC
platelet
HCT

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12
Q

Febrile phase features

A

4 days - high temp, normal bloods

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13
Q

Critical phase length

A

day 4-6
WCC and platelte drop
Haematocrit increase - concentrated

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14
Q

Recovery phase dengue featires

A

Reabsorption of fluid
Recovery of platelet, neutrophil and haematocrit count

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15
Q

WHy important to not overload fluid in recvoery phase

A

Reabsorption of plasma that was extravasated

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16
Q

What viral test use in febrile phase of dengue

A

PCR - high viraemia at this phase

17
Q

When do IgG tests for dengue become positive

A

At end of febrile phase and start of critical phase

18
Q

What is fluid loss from in febrile vs critical phases degnue

A

Febrile - poor oral intake
Insensible
Vomit and diraahoea

Critical - leaking nad bleeding + all of above

19
Q

What diagnostic tests can use <5 days post fever onset

A

Viral RNA - RT- PCR
Virus antigen test - NS1
ELISA

20
Q

Diagnositc tests>5 days post fever onset

A

IgM antibodies

21
Q

What combination of diagnostic tests use in real life and why

A

RT-PCR + IgM
OR NS1 + IgM
Extend detection actue dengue to 10 days post fever onset

22
Q

Principle of management of denfue

A

Correct dehydration in febrile nad critical phases
Prevent fluid overload in recovery phase

23
Q

Initial presentation of dengue fever

A

Intermittent high pyrexias - break bone fever 3-7 dyas
Arhtralgia
Rash - blanching maculopapular erythematous rash (measles similar) may -> petechiae
Bleeding, gums, epistaxis, GI bleeds
Headache
Nausea & vomiting
Lymphadenopathy
Generalised myalgia
Backache
Ocular manifestations:
Retro-orbital pain
Conjunctival injection
Conjunctivitis

24
Q

Symptoms of severe dengue

A

Pulmonary and facial oedema
Ascites
Pleural effusions
Meningism including photophobia
Worsening or more profuse haemorrhage

25
Q

Bloods in dengue

A

Prolongation of APTT and PT
Deranged U&E’s
Elevated LFTs especially AST

26
Q

Tourniquet test postive sign

A

1/3 positive
BP cugff - halfway between systolic and diastolic for 5 mins
+ 20+ petechiae in 2.5cm square on forearm

27
Q

What meds avoid in dengue

A

Aspirin - increased haemorrhage risk and reyes syndrome in children

28
Q

Complications of dengue

A

50% mortality if untreated
severe multi-organ involvement, haemorrhage and shock.
Hepatic failure
Encephalopathy
Myocarditis
Disseminated intravascular coagulation
Septicaemia

29
Q

Incubation period dengue

A

4-10 dyas

30
Q

What subtypes ass w severe disease

A

DEN 2 and 3
Secondary infection (different serotype) - antibody dependent enhacement

Infectious disease (37 decks)

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