Dengue Fever History, Biology, Pathology, Clinical Management, and Prevention.
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Transcript of Dengue Fever History, Biology, Pathology, Clinical Management, and Prevention.
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Dengue Fever History, Biology, Pathology, Clinical Management, and
Prevention.
San Estanislao, Paraguay
February, 2008
Blair Thedinger
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Dengue Fever Hits Paraguay By REUTERS
Published: March 4, 2007
ASUNCIÓN, Paraguay, March 2 — A Supreme Court justice, soccer players and a senator have come down with dengue in Paraguay, as the worst outbreak in the country’s history hit the well off as well as its usual victims among the poor.
On Friday, a nurse who worked with the public health service died after being hospitalized for dengue…
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Dengue History
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Wilder-Smith A and Schwartz E. N Engl J Med 2005;353:924-932
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Geographic distribution of Aedes aegypti in the Americas,
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Dengue Worldwide Today
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Epidemia No caracterizada año 1988/1989 (40,000)
IgM +● Año 2000 DEN-1 24,282
(estimaciones 300,000) ● Año 2001 DEN-2 38 ● Año 2002 DEN-1,2,3 130 ● Año 2003 DEN-1,3 137● Año 2004 DEN-3 12● Año 2005 DEN-2 36● Año 2006 DEN-3 1.889● Año 2007 DEN 3 6.313
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Fecha Inicio Síntomas
Cas
os C
onfir
mad
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Curva Epidémica de Dengue según Inicio de Síntomas Paraguay - 2007*
Total de Casos Notificados* = 28.182
592 casos
Pico Máximo de Noticación 20 de febrero - Sem Epid : 8
* Datos parciales hasta el 26 de Octubre - Sem .Epid. 43Fuente: DIVET
519
12/31 2/20 5/27
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Monath T. N Engl J Med 2007;357:2222-2225
Dengue Microbiology
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Vector Biology
Aedes Species
Aedes Species
Cycle in Nature Urban / semi-urban Epidemic cycle
Rural – Urban Cycle
Aedes aegypti
Aedes aegypti
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Symptoms
Fever
Headache
Retro Orbital Pain
Myalgias/Arthralgias
Nausea and Vomiting
Weakness
Rash
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Wilder-Smith A and Schwartz E. N Engl J Med 2005;353:924-932
Dengue Rash with Sparing of Islands of Skin
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Diagnosis
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Wilder-Smith A and Schwartz E. N Engl J Med 2005;353:924-932
Positive Result on a Tourniquet Test
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Laboratory Tests
.gif
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Figure 2 Representation of the temporal appearance of virus ,IgM,and IgG antibodies in persons infected with dengue virus.
Viremia
IgM
IgG(1)
IgG(2)
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Wilder-Smith A and Schwartz E. N Engl J Med 2005;353:924-932
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Suspected Cases of Dengue Clinical and Epidemiologic Criteria
Group A Ambulatory care from homePatient or caretaker instructed regarding warning signs and directed to urgently consult medical attention with one or more warning signs.Follow up within 24 hours
Alarming Signs ***Shock
Bleeding*DehydrationLittle or no oral intakeClinical EdemaComorbidities**
Absent
Group CSuspected cases of moderate DHF/DSS (reversible shock)Hospitalize in specialized units
Grupo DSuspected cases of Severe DHF/DSS (Refractory shock or recurrent treatment with cristaloids or prolonged shock)Hospitalizein the ICU
Group BSuspected cases of complicated Dengue orMild DHF(Hematocrit and Platlets)Hospitalize for observationOral re-hydration or IV if the can not tolerate fluids PO
* Spontaneous or provoked bleeding ** Comorbidities incluye: Cardiovascular disease, Diabetes, Immunosuppresed, Kidney disease, Malnutrition, Anemia, Asthmatics,etc.*** Clinical signs: Moderate to intense abdominal pain, persistent vomiting, sharp drop in temperature, changesin the level of consciousness, Postural Hypotention, pulse pressure <20 mmHg Labratory signs: Progressive rise in hematrocrit, progressive fall in platelets.
One of more Alarming signs
Outpatient
Inpatient
Figure 1
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Wills B et al. N Engl J Med 2005;353:877-889
Kaplan-Meier Curves for Time from Study Entry to Initial (Panel A) and Sustained (Panel B) Cardiovascular Stability among Children in Group 1, According to the Resuscitation Fluid Received
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Prevention and Vector Control
• Vaccine
• Vector Control
• Challenges to Prevention
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Monath T. N Engl J Med 2007;357:2222-2225
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Challenges
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Challenges
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Challenges
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Looking Ahead
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