1. 9 years old girl with High Grade Fever and Rash
9 years old girl presented with complaint of fever for 5 days duration. There are no
symptoms of URTI, UTI, AGE, ear discharge, altered mental status and fitting.
Image Courtesy of Dr Dr Muna Athirah, Duchess of Kent Hospital
On examination, patient is alert and conscious. Questions
1) Describe your finding in the picture
Pulse: rate is 110, weak and volume is poor. 2) What is your complete provisional
Capillary refilling time: more than two seconds diagnosis?
Peripheral examination: cold periphery 3) How do you diagnose dengue fever?
BP: 90/40 4) Describe grading of dengue fever
Temperature: 38 degree celcius,
5) Explain regarding phases of dengue
Lung, Cardiovascular and Abdominal
fever
examination is unremarkable.
6) How do you manage this patient
FBC was taken and the result are shown below: 7) What is the complication of dengue
WBC:2.9 fever
Hb:14
HCT:42
Plt:60

2. Answer
1) Petichae with characteristic of “Islands 6) Grading of dengue fever
of white in a sea of red”
** Usually during recovery phase..
2) Dengue Hemorrhagic fever in critical
phase with compensated shock
** Physician must able to identify
provisional diagnosis of dengue, phase of
illness, hydration and haemodynamic status
(shock or not) and whether require
admission
? Critical phase: Temperature starts to
normalize, 3rd to 7th day of illness,
7) Management for this patient
thrombocytopenia, hemoconcentration,
leucopenia - Admit patient to the wards
- Insert two large bore IV line, CBD
? Compensated shock: Clear consciousness, - fluid resuscitation 10-20 ml/ kg
capillary refilling >2s, cool extremities, crystalloid blus
weak and thready peripheral pulse, - QID FBC to monitor HCT and
tachycardia
platelet
- Put patient on IV maintanence
3) Antibody detection (Dengue Serology
- Repeat the bolus if no
Test like Haemagglutination
improvement. May repeat up to 3
Inhibition Test, Dengue IgM test,
bolus (third one with colloids)
Indirect IgG ELISA test, Dengue
- 15-30 minutes vital sign
Rapid tests), virus isolation, detection
monitoring until stable, and then
of virus genetic materials (polymerase
1-2 hourly
chain reaction -PCR) and detection of
- twice a day monitoring for
dengue virus protein (NS1 antigen).
warning sign, general well being
(appetite/oral intake), bleeding
4) WHO Classification for Dengue Fever
symptoms, neurological/ mental
a) Dengue fever
state
b) Dengue Hemorrhagic fever
- Hourly urine output monitoring
mild (grade I and II)
- Daily BUSE/Creat, LFT, RBS,
Dengue shock syndromes (grade III
Coagulation profile, Acid base
and IV)
imbalance
- Admit patient to Intensive care
5) Complication
unit if condition worsen. Consider
- Acute abdomen
blood product transfusion,
- Hepatitis and liver failure
inotropes.
- Encephalitis or encephalopathy
- Dengue notification form (24H)
- Hypovolumic shock, DIC