dengue fever is one of the communicable disease caused by the bite of female mosquito (aedes aegypti

1. DENGUE FEVER

2. Dengue is a mosquito – borne infection
found in tropical and subtropical regions
around the world.
Also known as break bone fever.
About 50 – 100 million infections world
wide every year.

3. EPIDEMIOLOGICAL
DETERMINANTS

4. Agent:- dengue virus
Dengue virus belongs the genus
flavivirus.

5. Dengue virus transmitted by the bite of
female aedes mosquito.
In India aedes aegypti is the main vector
in most urban areas.
Population & lifespan depends on –
rainfall , water storage , temperature ,
and humidity.
Survive between 16ºC to 30ºC and a
relative humidity of 60 – 80%.

6. Host :- primates
The dengue virus infects humans and several
species of lower primates.
 Age:- all age group ; mainly <15 yrs of age group
 Sex:- both genders are at risk
 Travel:- dengue endemic areas is a most important
risk factor
 Migration:- patient during viremia to a non –
endemic area may introduce dengue into that
area.

7. ENVIRONMENTAL FACTOR:-
- Urban place
- Uncontrolled population growth without
appropriate water management

8. MODE:-
COMMUNICABALE DISEASE ( VECTOR)
mosquitoe born disease

9. Undifferentiated fever
Classic dengue fever
Dengue hemorrhagic fever
Dengue shock syndrome

10. PROBABLE DENGUE:- live in / travel to dengue
endemic area.
 Fever and 2 of the following criteria
 Nausea , vomiting
 Rash
 Aches and pains
 Tourniquet test positive
 Leucopenia
 Any warning sign

11. WARNING SIGNS:-
Abdominal pain or tenderness
Persistent vomiting
Mucosal bleed
Lethargy / restlessness
Liver enlargement

12. SEVERE DENGUE:-
Severe plasma leakage leading to:
- Shock
- Fluid accumulation with respiratory
distress
Severe bleeding
Severe organ involvement:-
- Liver
- CNS- impaired consciousness
- Heart and other organs

13. The clinical course of illness passes
through 3 phases.
Febrile phase
Critical phase
Convalescent phase

14. FEBRILE PHASE:-
The onset of dengue fever usually with
sudden rise in temperature which may
be lasting 5 – 8 days and commonly
associated with headache , flushing and
rash.
There may be pain in muscles , joint or
bone
Rash usually appear after 3 or 4 day of
fever and commonly seen in face , neck
and other part of the body

15. CRITICAL PHASE:-
Phase starts after 3 to 4 days of onset of
fever.
During this phase plasma leakage and
high hemoconcentration are documented,
also patient may develop hypotension.
Abnormal homeostasis and leakage leads
to shock , bleeding, accumulation of fluid
in pleural and abdominal cavity.
The period of plasma leakage usually
persists for 36 – 48 hrs.

16. CONVALESCENT PHASE( RECOVERY PHASE):-
During recovery phase the extracellular
fluid which is lost due to capillary leakage
returns to the circulatory system and signs
and symptoms improve.
This phase occurs after 6 – 7 days of fever
and last 2 – 3 days.

17.  Blood pressure
 Evidence of bleeding in skin or other sites
 Hydration status
 Evidence of increased vascular permeability-
pleural effusion , ascites
 Tourniquet test:- inflate blood pressure cuff to a
point midway between systolic and diastolic
pressure for 5 minutes.
 Positive test : 20 or more petechiae per 1
inch²(6.25cm²)

18. Virus isolation:-
- Genome detection:-
- Antigen detection:-
Serological diagnosis:-
- ELISA

19. Complete blood count
Serum protein and albumin level
Chest X- ray :- effusion
USG:- ascites

20. Out patient :-
Advise bed rest
Encourage to have plenty of oral fluid
intake
Give paracetamol for high fever if the
patient is uncomfortable
Inform the patient about the warning
signs.

21. Indication of hospitalization:- When
patient develops ;
Giddiness
Cooler extremities
Oliguria with dark urine
Bleeding from any site
Persistent vomiting
Lethargy or irritation
Sever abdominal pain

22. Management priorities:
Replacement of plasma
Recognition & management of
hemorrhage
Prevention & management of fluid
overload
Prevention of iatrogenic infection

23. Stable pulse, BP and breathing rate
Norma temperature
No evidence of external / internal
bleeding
Return of appetite
No vomiting
Good urinary output

24. PREVENTION

25.  vaccine :- CYD-TDV( Dengvaxia) three doses ,
each shot is spaced 6 months apart.
subcutaneous rote at 9 yrs.
 Best preventive measure:- eliminate mosquito
breeding spots by;
- Changing the water on alternate days in the pot
plates.
- Turning over water storage containers
- Clearing blockage and put insecticide in roof
gutters monthly
 Application of mosquito repellents

26. THANK YOU