Dengue Fever Treatment ,Symptoms, Diagnosis,
Intro
Dengue Virus Vector (Aedes Aegypti Mosquito) infection caused by Dengue virus Dengue virus is an RNA virus of genus flowery virus and it is transmitted by the mosquito it is egypti mosquito it is egypti mosquito has characteristic white and black stripes over it
Clinical Presentation now coming to the clinical presentation of dengue fever Dengue fever is usually divided into four different categories
Dengue without warning signs Dengue with warning signs severe Dengue previously called as Dengue hemorrhagic fever and
Dengue shocks and Rome now not all patients go into all these phases majority of the patients develop Dengue without warning signs and they are better after a week but few patients who are not managed properly or the patients who are immunocompromised and the immune system is weak they can progress from Dengue without warning signs to being a shock syndrome
We divide patient into these categories based on the symptoms as well as we will treat these patients according to these categories now coming to the first one
Dengue without Warning Signs Symptoms Dengue without warning science in which the majority of patients present in Dengue without warning sign this phase lasts for the first seven days after the onset of symptoms whenever a patient gets bite from 80s egypti mosquito there is really an incubation period of 4 to 10 days in which patient is not having symptoms and after that four to ten days patient and starts to develop symptoms and those symptoms last for seven daysthat is Dengue without warning signs patient will be complaining of high grade fever high grade fever up to 40 degree centigrade and if the patient has two of these things severe headache and retro orbital pain patient would be complaining the doctor whenever I look on the sides I get severe pain at the back of my eyes and patients will be having myalgias arthralgias so where muscle pain joint pain which is called as brake bone fever remember all these viral infections they have classical myalgia's associated with this these viral infections have severe muscle pain associated with them and other than that patient will also be having typical joint pain associated with it other than that patient can also develop a maculopepular rash a measles like xantham with the generalized lymphadenopathy so the patient will be having a high grade fever and with high grade fewer patient will be having two or more of these things that is Dengue without warning signs this is a picture showing measles like maculopapular rash which appears in
Dengue not all patients have this type of rash but few patients can develop a measles like xantham and remember the rash that appears in ding URS is a blanching rash now if you see if you place hand on the rash the area will blanch that is a blanching rash of dengue now most of the patients of dengue virus develop Dengue without warning signs and they recover from it without developing any complications of shock and hemorrhage so when the patients are recovering they usually develop a different type of regime which you will be able to appreciate white spots and their skin will be red that is called as island of white in the sea of red that type of rash usually begins to appear when the patient is recovering from Dengue virus and it is also associated with pruritus patient will be having severe itching with it another thing that you would
Capillary Fragility Test appreciate in a patient with Dengue virus is positive capillary fragility test what is positive capillary fertility test and how do you test it what you do is that you apply a PP cuff around the patient's arm you apply the BP cuff and you you first check the blood pressure if the blood pressure is from 120 to 80 then you take the midpoint in between 120 and 80 is 100 mm of Ng then you inflate the BP cuff up to 100 mm of HG and you keep it inflated for five minutes you wait for five minutes and after five minutes when you take the BP cuff off what you will see is that you will see these particular these particular hemorrhages within one inch square area if you see 10 or more petite it is indicative of a positive fragility test positive capillary fragility test means that the capillaries because when you have applied pressure on the arm with BP cuff a pressure of 100 mm of a Jeep the patient will have damage of the capillaries when the capillaries are damaged platelets adhere to the capillaries and they stop the bleeding but usually these Dengue patients are having thrombocytopenia when they are having thrombocytopenia their capillaries will be leaking their capillaries will be leaking blood and that will appear as particular on the place where you inflated the cuff for five minutes so that is a positive capillary fragility test= you inflate it to the point between diastolic and systolic pressure you in keep it inflated for five minutes and after five minutes when you take it off you will be able to appreciate 10 or= more petite Ki that is a positive capillary fragility test and it shows thrombocytopenia so this was all about Dengue without warning
signs now coming to Dengue with Dengue with Warning Signs warning signs majority of the patients develop Dengue without warning signs they develop fever they develop retro orbital pain they develop headache myelgias but after four to seven days there are fewer subsides and they are totally but some patients as soon as their fewer subsides they develop warning signs what are those warning signs we are going to discuss that but when the fever subsides they develop warning signs so this is a critical period as soon as the fewer subsides critical period starts because within that critical period patient starts to develop warning signs and we should observe the patient in that you should tell the patient that when you are going home and when the viewer subsides if there is any change in your health status if you are facing any abdominal pain any problem you should immediately report to the hospital because that is a period
where the warning signs appear that is a critical period warning signs appear after the fewer subsides and occurs three to seven days after September monster when the patient is recovering from fever the critical periods start and in that critical period patient starts to develop the warning signs at risk population include patients with severe comorbidities infants less than one year of age any patient with a history of previous
Monitoring High-Risk Dengue Patients for Warning Signs
Dengue infection necessitates vigilant monitoring of individuals at high risk. Swift observation is crucial as their fever subsides, ensuring their condition is closely tracked. This is especially important for patients susceptible to developing warning signs during the critical phase. These warning signs encompass persistent abdominal pain, continuous vomiting, emergence of new issues post-fever, hepatomegaly (liver enlargement exceeding two centimeters), third space fluid accumulation, and the onset of pleural effusion.
Noteworthy indicators of a worsening condition include coughing, breathing difficulties, and ascites accompanied by abdominal pain. Notably, hematocrit levels may rise while platelet counts decrease. The elevation in hematocrit is attributed to fluid leakage into the third space, where plasma escapes from blood vessels, leading to pleural effusions and ascites. Consequently, an apparent increase in red blood cell concentration within vessels occurs due to fluid leakage, highlighting the importance of careful observation and early intervention.
hematocrit t shows that the fluid is leaking out in the third space the patient will develop thrombocytopenia gingival bleed petite epistaxis these warning signs so this was Dengue with warning
Severe Dengue (Dengue Hemorrhagic Shock)
Signs now coming to sovereign occurs in the patient who are already infected with Dengue virus who are already patients of dengue virus and now they got a second bite from 80s egypti and this time the 80s Edge of Time mosquito was containing a different zero type of dengue virus now the patient is infected with two different zero types of dengue virus that patient is highly prone to develop Dengue hemorrhagic fever
Dengue patients to use mosquito repellents Nets to avoid second bite because second bite can be fatal for these patients occurs when the patient is reinfected with different zero type and it occurs after the fewer subsides patients can develop a second fever Spike because there is a bite from a different zero type of dengue virus patient can develop severe hemorrhagic manifestations therefore it is called as Dengue hemorrhagic pure because this time the hemorrhagic manifestations will be severe but tki echymosis thrombocytopenia with platelets going down below one lakh Pattients can develop severe organ involvement hepatomegalia liver failure change in the mental status this time it's severe because this time
Exploring Different Dengue Virus Strains and Associated Complications
Within the realm of Dengue infection, distinct strains of the virus can infiltrate a patient's system. This occurrence may trigger plasma leakage, leading to severe consequences. Notably, patients might experience heightened respiratory distress due to pleural effusion, coupled with abdominal pain arising from ascites. Concurrently, a decrease in hematocrit levels becomes evident during this phase. This decline can be attributed to profound hemorrhaging, which results in the loss of red blood cells. Therefore, a notable correlation emerges: plasma leakage into the third space corresponds to an increase in hematocrit, while excessive bleeding corresponds to a decrease.
This particular phase, recognized as Dengue Shock Syndrome, manifests with its own distinct characteristics. In cases of Dengue Shock Syndrome, patients grapple with severe hemorrhagic Dengue, culminating in shock. As a consequence, blood pressure drops significantly, with vital signs exhibiting a negative trend. The circulatory collapse and shock that arise from the amalgamation of severe hemorrhagic Dengue represent a critical condition known as Dengue Shock Syndrome. The management of this syndrome is imperative, as it carries a high fatality risk when not properly addressed
Diagnosis(Serology,NS1
Diagnosis(Serology,NS1) now coming to the diagnosis of dengue virus there are few basic tests that you can perform in Daily virus detection but it's the timing of these tests that's more important you can perform serologic tests Eliza to detect IGM antibodies IGM antibodies against the virus are detected but remember whenever there is infection it always takes some time for the immune system to produce antibodies so patient in the initial three four days the antibodies will be negative and the patient will be having infection you can also detect while RNA through net tests now coming to an important test ns1 antigen test ns1 antigen test is basically an antigen a known structural protein present on the Dengue virus and you detect that antigen now in the time period where the antibodies have not yet appeared against this antigen
when the antibody tests are negative in the very start you can detect this antigen so in the very initial stage in the first seven days of the symptom onset you can use ns1 antigens to detect the presence obtaining after three four days the antibodies will also appear against this antigen and the antibodies will be positive IGM antibodies will be positive so ns1 antigen test is a good test in the initial phase,