Today is our topic of discussion Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)
Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)
Clinical feature:
- Initial stages of disease resemble symptoms of classic dengue fever.
- Fever subsidies in 2 to 7 days followed by S/S of restlessness along with features of shock.
- Hemorrhagic manifestations (due to thrombocytopenia) –
a. Skin hemorrhages may be in the form of small blotches of redness or diffuse red patches.
b. Bleeding from nose
c. Bleeding from gums, mucosal surface of mouth and injection site
d. Haematemesis &/or melaena
DSS (if untreated):
Shock and death; warning signs
a. Rapid and weak pulse Don
b. Severe abdominal pain
c. Vomiting
d. Mental irritability
Investigation :
- Total platelet count (thrombocytopenia)
- Tourniquet test (see below)
- Other investigations (as necessary
‘Tourniquet test’ for diagnosis of DHF:
Application of a tourniquet or inflatable cuff to the arm. Inflating the cuff midway between systolic and diastolic blood pressure and holding it for five minutes produces red patches in the forearm or arm. This test is called tourniquet test.
Treatment:
Adequate supportive care can control its morbidity –
Analgesics & Anti-pyretics:
Paracetamol (Aspirin & other I/M injections are avoided).
Plenty of fluid:
ORS, dab water etc.
DHF & DSS:
Hospitalization (without hospitalization mortality can be 50%).
Supportive treatment for maintaining vital functions –
- IV fluids
- Blood transfusion
- Platelet transfusion (if platelet count <50,000/cmm)
Patients are nursed under mosquito net.
Prevention and control:
Mosquito control:
Combatting the vector mosquitoes by-
- Destroying the breeding sources.
- Application of appropriate insecticides to larval habitat and periodic re-application.
Other measures:
- Isolation under bed nets for first few days
- Individual protection against mosquitoes
Vaccination:
Till to date, no immunization has been invented.
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