Dengue is caused by one of four viral serotypes closely related viruses, designated den1, den2, den3, and den4. A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as. Increased vascular permeability, together with myocardial dysfunction. Rapid and weak pulse narrow pulse pressure of severe dengue. Agespecific hypotension and cold, clammy skin and restlessness. May 03, 2019 the first dengue hemorrhagic fever epidemic in the americas occurred in cuba in 1981 and involved serotype 2 dengue denv2, with hundreds of thousands of cases of dengue in both children and adults, 24,000 cases of dengue hemorrhagic fever, 10,000 cases of dengue shock syndrome, and 158 reported deaths. Annually, 100 million cases of dengue fever and half a million cases of dhf occur worldwide.
Dengue fever is a disease spread by the aedes aegypti mosquito and caused by one of four dengue viruses that are closely related. Dengue virus infection has been counted among emerging and reemerging diseases because of 1 the increasing number of patients, 2 the expansion of epidemic areas, and 3 the appearance of severe clinical manifestation of dengue hemorrhagic fever dhf dengue shock syndrome dss, which is often fatal if not properly treated. Studies on the pathophysiology of dengue haemorrhagic fever and dengue shock syndrome. Dengue, dengue haemorrhagic fever and dengue shock. An unusual case of dengue shock syndrome complicated by. In the past 30 years, dengue transmission and the frequency of dengue epidemics have increased greatly in most tropical countries in the american region. Dengue fever the clinical features of df frequently depend on the age of the. Antibodydependent enhancement of disease and severe dengue.
Dengue shock syndrome if the person is aware of the signs and symptoms of dengue than the patient can survive by taking proper medical treatment. Infection may be asymptomatic, or may result in a variety of clinical syndromes ranging from dengue fever df, a non. Dengue fever is typically a selflimited disease with a mortality rate of less than 1% when detected early and with access to proper medical care. In addition, some patients with severe illness requiring. Jul 15, 2009 shock syndrome is a dangerous complication of dengue infection and is associated with high mortality. Dengue shock syndrome dss is defined as hypotension, narrow pulse pressure. Dengue shock syndrome andor bleeding complications may occur in both mothers and infants. Impact of dengue virus infection and its control pathogens. As the disease spreads to new geographical areas, the frequency of the outbreaks is increasing along with a changing disease epidemiology. Current and historical conditions indexed list of current and historical nationally notifiable conditions.
Dengue shock syndrome is the fourth clinical syndrome of dengue fever a sever form of dengue hemorrhagic fever 4 criteria for dhf evidence of circulatory failure manifested indirectly by all of the following. Aetiology,pathophysiology and diagnosis of dengue infection. Infected local cells then migrate from site of infection to lymph nodes, where monocytes and macrophages are recruited, which become targets of infection. Among these, there are 200,000 to 500,000 cases of potential lifethreatening dengue hemorrhagic fever dhf dengue shock syndrome dss, characterized by thrombocytopenia and increased vascular permeability. Nov 14, 2006 the severity of dhf varies from mild world health organization grades i and ii, with minimal and transient change in vital signs, to severe world health organization grades iii and iv, with threatened shock e. Focusing on the serious form of dengue, the forms with overt bleeding dengue hemorrhagic fever and shock dengue shock syndrome are classified as dengue with high severity. Dengue pathogenesis, clinical manifestation, lab diagnosis and treatment pathogenesis of dengue. Dengue fever is a mosquitoborne viral illness found throughout the tropics. Dengue viral infections postgraduate medical journal. Dengue shock syndrome is associated with very high mortality. Pathogenesis of dengue haemorrhagic fever and its impact. Dengue is a febrile illness caused by a flavivirus transmitted by aedes aegypti or aedes albopictus mosquitoes while taking a blood meal.
Dengue hemorrhagic fever and dengue shock syndrome some patients with dengue fever go on to develop dengue hemorrhagic fever dhf, a severe and sometimes fatal form of the. Other articles where dengue shock syndrome is discussed. Crystalloid fluid resuscitation and standard dic treatment are critical to the childs survival. These serotypes are members of the flavivirus genus, which also contains the viruses that cause yellow fever, and can occur in any country where. Viral virulence, infection enhancing antibodies, cytokines and chemical mediators in the setting of intense immune activation are the key players implicated in the pathogenesis of dhf. Dengue pathogenesis, clinical manifestation, lab diagnosis. Based on a clinical diagnosis of dengue shock syndrome dss plus. The first dengue hemorrhagic fever epidemic in the americas occurred in cuba in 1981 and involved serotype 2 dengue denv2, with hundreds of thousands of cases of dengue in both children and adults, 24,000 cases of dengue hemorrhagic fever, 10,000 cases of dengue shock syndrome, and 158 reported deaths. Dengue hemorrhagic fever and dengue shock syndrome. The manifestations of which are similar and overlapping in nature grouped into dengue syndromes. Has all the criteria of dhf plus circulatory failure as evidenced by.
Dss is one of the severe situations of dengue which can lead the patient to get hospitalized, in case the following symptoms are found. Studies on the pathophysiology of dengue haemorrhagic fever. Dengue viral infections are one of the most important mosquito borne diseases in the world. Show full abstract was called hemorrhagic dengue fever and dengue shock syndrome hdfdss. May 03, 2019 a child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as this severely ill picu patient did. Age and sex both are affected since dengue is a universal infection season aedes aegypti is more commonly found in tropical and subtropical countries. Vitamin d serostatus and dengue fever progression to dengue. Sep 17, 2010 dengue shock syndrome who 1997 all the above 4 criteria for dhf, plus evidence of circulatory failure. Dengue hemorrhagic fever, dengue shock syndrome, severe dengue, vitamin d, vitamin d binding protein. Clearly, the syndrome of increased vascular permeability, the pathophysiology of which is described above, is the prime reason for shock.
Management of dengue haemorrhagic feverldengue shock syndrome. Pathophysiology and management of dengue hemorrhagic fever. It is the fastest spreading vectorborne viral disease and is now endemic in over 100 countries, resulting in 40% of the worlds population living in an area at risk for dengue. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flulike symptoms. Lcs lum department of paediatrics, faculty of medicine, university of malaya, kuala lumpur introduction the major pathophysiology in dengue haemorrhagic fever dhf and dengue shock syndrome dss is an acute increase in vascular. Its severe forms hemorrhagic fever and shock syndrome may lead to. Its severe forms hemorrhagic fever and shock syndrome may lead to multisystem involvement and death. Dengue is a mosquitoborne flavivirus found in tropical and subtropical regions of the world, mostly in urban and semiurban settings. Management of unusual complications, such as dengue encephalopathy or fulminant hepatitis is not addressed as it is similar to the standard management.
Dengue virus after entering in the body invades the local macrophages and multiply there. Known also as dengue hemorrhagic fever dhf, it starts abruptly with high continuous fever and headache plus respiratory and intestinal symptoms with sore throat. It is noteworthy that patients who are in threatened shock or shock stage, also known as dengue shock syndrome, usually remain conscious. Learn more dengue clinical case management elearning pathophysiology of severe dengue. Dengue fever is a mosquitoborne tropical disease caused by the dengue virus. Clinical and serologic study of cuban children with dengue hemorrhagic feverdengue shock syndrome dhfdss. Ninety percent of dhf subjects are children less than 15 years of age. Rapid and weak pulse narrow pulse pressure clinical manifestation, lab diagnosis and treatment pathogenesis of dengue. Many patients infected with dengue virus remain asymptomatic. A syndrome due to the dengue virus that tends to affect children under 10, causing abdominal pain, hemorrhage bleeding and circulatory collapse shock. There are four serotypes of the disease, which is accepted as the most common arthropodborne disease in the world. Dengue fever is a selflimiting, nonspecific illness characterized by fever, headache, myalgia, and constitutional symptoms. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Dengue shock syndrome an overview sciencedirect topics.
Dengue shock syndrome is severe, and can lead to excessive bleeding and even death. Acute dengue in a neonate secondary to perinatal transmission. They may range from subclinical infection to dengue fever, dengue hemorrhagic fever dhf, and eventually dengue shock syndrome dss. So the primary and secondary infection can be classified by. Pdf pathogenesis and pathophysiology of dengue hemorrhagic. Pathogenesis of dengue haemorrhagic fever and its impact on. Alternate hypothesis on the pathogenesis of dengue. The viruses that cause dengue fever are related to those that. Known also as dengue hemorrhagic fever dhf, it starts abruptly with high continuous fever and headache plus respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Dengue haemorrhagic fever dhf is a potentially deadly complication with symptoms similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. Plasma leakage and intrinsic coagulopathy are the pathological hall marks in dengue haemorrhagic fever dhf. A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as this severely ill pediatric icu patient did. Chapter 2 clinical diagnosis dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever df or dengue haemorrhagic fever dhf with plasma leakage that may lead to hypovolaemic shock dengue shock syndrome, dss figure 2.
However, management of perinatal dengue virus infection deserves special attention35. According to the who criteria, dengue fever df, dengue hemorrhagic fever dhf, and dengue shock syndrome dss were observed in 30. Clinical presentation of antenatal and postpartum dengue is similar to other dengue infections and management is more or less similar to that of adult dengue. Clinical spectrum among symptomatic infection ranges from undifferentiated fever viral syndrome, dengue fever df, and dengue haemorrhagic fever dhf to. Dengue hemorrhagic fever and dengue shock syndrome can be safely treated with just normal saline. Dengue shock syndrome and acute respiratory distress. Underlying pathophysiology of thrombotic events is multifactorial and the management is challenging due to associated thrombocytopenia and bleeding tendency. As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of dengue, there is a. Pathogenesis and pathophysiology of dengue hemorrhagic fever. Summary much remains to be learned about the pathogenesis of the different manifestations of dengue virus denv infections in humans. Ninety percent of dhf subjects are children less than 15. Dec 08, 2017 dengue pathogenesis, clinical manifestation, lab diagnosis and treatment pathogenesis of dengue.
Nov 06, 2017 dengue complications the symptoms of dengue hemorrhagic fever can trigger dengue shock syndrome. Patients admitted with established dss should be cared for in an intensive care or high dependency unit. Others, after an incubation period of 47 range 314 days, develop a febrile illness. Medcram medical lectures explained clearly recommended for you 11. Severe dengue occurs as a result of secondary infection with a different virus serotype. There are four dengue virus denv types denv1, denv2, denv3, and denv4, all of which are capable of inducing severe disease dengue hemorrhagic fever dhfdengue shock syndrome dss. They may be asymptomatic or may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever dhf, or dengue shock syndrome. Dengue fever,dengue shock syndrome linkedin slideshare. Jan 15, 2001 dengue hemorrhagic fever is an important cause of morbidity among asian children, and the more severe dengue shock syndrome dss causes a significant number of childhood deaths.
Dengue haemorrhagic fever dhf and shock syndrome dss. Volume replacement in dengue shock syndrome dengue bulletin vol 25, 2001 51 introduction infection with dengue virus is one of the leading causes of illness and hospital admission of children in southeast asia1,2. Symptoms typically begin three to fourteen days after infection. We report a case of dengue shock syndrome with severe. Globally, it is estimated that approximate 50 to 100 million new dengue virus infections occur annually. National guideline for clinical management of dengue syndrome. Dengue fever is a mosquitoborne infection that causes severe flulike symptoms and can be fatal. Pdf autoimmune pathogenesis in dengue virus infection.
Colloids should be immediately given to children presenting with a pulse pressure at or below 10 mmhg. Failure to refer or transfer potentially critical or critical patients to better facility in time. A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as this severely ill picu patient did. Classically, an increase in systemic vascular resistance as a result of extravasation of plasma occurs, with a resultant reduction in preload.
Management of dengue haemorrhagic feverldengue shock. Department of health and human services centers for. Dss is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia. Rapid and weak pulse and narrow pulse pressure, or. This syndrome is termed severe dengue also known as dengue hemorrhagic fever and dengue shock syndrome.
The seminar addresses unusual manifestations of dengue infection, such as dengue fever with severe haemorrhage, hepatic damage, pulmonary effusion, congestive cardiac failure, and. As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of. Pathophysiology of dengue syndrome clinical manifestation of dengue. National center for emerging and zoonotic infectious diseases. Jun 09, 2016 dengue shock syndrome is the fourth clinical syndrome of dengue fever a sever form of dengue hemorrhagic fever 4 criteria for dhf evidence of circulatory failure manifested indirectly by all of the following. As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of dengue, there is a critical need for adequate tropism assays, animal models, and human autopsy data.
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