Presented by:

Zainodin G. Papandayan
Junior Intern IM FUMC

Dengue is a mosquito-borne viral infection

Severe flu-like illness and sometimes causing
a potentially lethal complication called
severe dengue.
IR increased 30-fold over the last 50 years
Up to 50-100 million infections are now
estimated to occur annually in over 100
endemic countries, putting almost half of the
worlds population at risk.

Severe dengue (previously known as dengue

haemorrhagic fever) was 1st recognized in the
1950s during dengue epidemics in the
philippines and thailand.
Today it affects Asian and Latin American
countries and has become a leading cause of
hospitalization and death among children
and adults in these regions.

Aedes aegypti is the most common vector

that can carry the dengue virus and it has 4
serotypes: DEN-1, DEN-2, DEN3, and DEN-4.
Recovery from infection by one provides
lifelong immunity against that particular
serotype.
However, cross immunity to the other
serotypes after recovery is only partial and
temporary.
Subsequent infections by other serotypes
increase the risk of developing severe
dengue.

The female Aedes aegypti mosquito is the

primary vector of dengue.
The virus is transmitted to humans through
the bites of infected female mosquitoes.
Incubation period lasts for 4-10 days, an
infected mosquito is capable of transmitting
the virus for the rest of its life.

Infected humans are the main carriers and

multipliers of the virus, serving as a source
of the virus for uninfected mosquitoes.
Patients who are already infected with the
dengue virus can transmit the infection (for
4-5 days, maximum 12) via Aedes mosquitoes
after their first symptoms appear.

Aedes aegypti
> Yellow fever mosquito.

Aedes albopictus
> Asian tiger mosquito.

> Has bright silvery lyre-shaped dorsal > Has a single longitudinal silvery
pattern and white banded legs
dorsal stripe and white banded legs.
> Occupies urban areas with or
without vegetation.

> Associated with thickets and

arboreal vegetation.

> Bites, rests, and lay eggs both

indoors and outdoors.

> Mostly and outdoor (garden)

mosquito.

> Sneaky biter.

> Aggressive biter.

> Main dengue vector worldwide

> Main dengue vector in some areas

but is mostly a secondary vector

Aedes aegypti
> High preference for taking blood
meals from humans and to lesser
extent from domestic mammals,
which makes it a very capable vector
of dengue viruses .

Aedes albopictus
> Bites humans but also a variety of
available domestic and wild
vertebrates that do not carry the
dengue viruses, which lowers its
capacity to transmit them

> The major production places are

> Shows preference for treeholes and
human-made containers, treeholes
bamboo internodes with water but
and bamboo internodes holding water can also utilize human-made
containers for its immature
development
> Most containers with water used
for immature development are within
or in close proximity to households

> Utilizes water-filled containers

around or further away from
households

Aedes aegypti

Lives in urban habitats and breeds mostly in man-made

containers.
Is a daytime feeder, its peak biting periods are early in
the morning and in the evening before dusk.

Aedes albopictus

Secondary dengue vector in Asia.

Is highly adaptive and therefore can survive in cooler
temperate regions of Europe.
Its spread is due to its tolerance to temperatures below
freezing, hibernation, and ability to shelter in
microhabitats.

Dengue fever
A severe, flu-like illness that affects infants, young
children and adults, but seldom causes death.
Should be suspected when a high fever
(40 C/104 F) is accompanied by 2 of the ff sx:

severe headache

pain behind the eyes

muscle and joint pains

N/V

swollen glands or rash

(Sx. Usually last for 2-7 days, after and IP of 4-10 days
after the bite)

Severe dengue, is a potentially deadly complication

due to:

plasma leaking,
fluid accumulation,
respi. Distress,
severe bleeding,
or organ impairment.

Warning signs occur 3-7 days after the 1st symptoms

in conjunction with a decrease in temp. (below
38C/100F) and include: severe abd. Pain, persistent
vomiting, rapid breathing, bleeding gums, fatigue,
restlessness, blood in vomit.

1.) Febrile
pts typically develop high grade fever
usually 2-7 days and is often accompanied by
facial flushing, skin erythema, gen. body ache,
injected pharynx and conjunctival injection.
Difficult to distinguish dengue clinically from
non-dengue febrile diseases
A positive tourniquet test in this phase increases
the probability of dengue.

2.) Critical phase

Aroung

the time of defervescence, when the temp drops

to 37.5 38C or less
Usually on days 3-7 of illness, an increase in capillary
permeability in parallel with increasing haematocrit
levels
Progressive leukopenia followed by a rapid decrease in
platelet count usually precedes plasma leakage.
Pleural effusion and ascites may be clinically detectable
depending on the degree of plasma leakage and the
volume of fluid therapy.

2.) Critical phase

Shock

occurs when a critical volume of plasma is

lost through leakage.
With prolonged shock, the consequent organ
hypoperfusion results in progressive organ
impairment, metabolic acidosis and disseminated
intravascular coagulation.
Leads to severe haemorrhage causing the
haematocrit to decrease in severe shock.

3.) Recovery phase

If

the patient survives the 24-48 hour critical

phase, a gradual reabsorption of extravascular
compartment fluid takes in the following 48-72
h.
General well-being improves, appetite returns,
gastrointestinal symptoms abate, haemodynamic
status stabilizes and diuresis ensues.
Some patients may have a rash of isles of white
in the sea of red or Hermans rash.

3.) Recovery phase

Respiratory

distress from massive pleural

effusion and ascites will occur at any time if
excessive intravenous fluids have been
administered.
During the critical and/ or recovery phases,
excessive fluid therapy is associated with
pulmonary edema or congestive heart failure.

Tourniquet test
Patient

should be afebrile
Fever may lead to false positive result
1. Get blood pressure first
2. Then get the sum of systolic and diastolic divided
by 2
3. Ex. 120/80 2 = 100
4. Inflate in 100 mmHg
5. Then wait for 5 min
(+) result reveals the presence of more than 20
petechiae in the antecubital fossa.

There is no specific treatment for dengue

fever.
For severe dengue, medical care by
physicians and nurses experienced with the
effects and progression of the disease can
save lives decreasing mortality rates from
more than 20% to less than 1%. Maintenance
of the patients body fluid volume is critical
to severe dengue care.

There is no vaccine to protect against

dengue.

At present, the only method to control or prevent

the transmission of dengue virus is to combat vector
mosquitoes through:

Preventing mosquitoes from accessing egg-laying

habitats by environmental management and
modification;
disposing of solid waste properly and removing artificial
man-made habitats;
covering, emptying and cleaning of domestic water
storage containers on a weekly basis;
applying appropriate insecticides to water storage
outdoor containers;

using of personal household protection such as

window screens, long-sleeved clothes, insecticide
treated materials, coils and vaporizers;
improving community participation and
mobilization for sustained vector control;
applying insecticides as space spraying during
outbreaks as one of the emergency vector control
measures;
active monitoring and surveillance of vectors should
be carried out to determine effectiveness of control
interventions.

WHO responds to dengue in the following ways:

supports countries in the confirmation of outbreaks

through its collaborating network of laboratories;
provides technical support and guidance to countries for
the effective management of dengue outbreaks;
supports countries to improve their reporting systems
and capture the true burden of the disease;
provides training on clinical management, diagnosis and
vector control at the regional level with some of its
collaborating centres;
formulates evidence-based strategies and policies;

develops new tools, including insecticide products

and application technologies;
gathers official records of dengue and severe
dengue from over 100 Member States;
publishes guidelines and handbooks for case
management, dengue prevention and control for
Member States.

Sources:
http://www.cdc.gov/dengue/resources/30Jan2012/
comparisondenguevectors.pdf
http://www.who.int/mediacentre/factsheets/fs11
7/en/
http://www.who.int/rpc/guidelines/978924154787
1/en/

Thank you for listening