Dengue fever by Dr. Basil Tumaini

Dengue fever by Dr. Basil Tumaini at Kilema hospital in Moshi District Council

1. Dengue Fever Dr. Basil Tumaini, MD

2. Outline of this presentation on Dengue Introduction Transmission cycle Clinical features and diagnosis Principles of management Prevention and control 20 May 2014 2 Dr. Basil/Kilema hospital/2014/3

3. INTRODUCTION Dengue is a spectrum of a viral disease 1 caused by the dengue virus 2 that is transmitted from an infected person to another person via the bite of a female Aedes mosquito 3 . The virus causes a spectrum from a flue-like illness to a life threatening haemorrhagic disease and shock 20 May 2014 3 Dr. Basil/Kilema hospital/2014/3

4. Dengue is the most rapidly spreading mosquito-borne viral disease in the world. Incidence is rapidly increasing The disease is spreading to new countries and from urban to rural areas Synonyms : break bone fever , dandy fever , dengue fever 20 May 2014 Dr. Basil/Kilema hospital/2014/3 4

5. EPIDEMIOLOGY > 40% of the world population is at risk for dengue infection (>2.5 billion people) Between 50 and 100 million new infections worldwide every year. 500,000 develop severe dengue requiring hospitalization, mostly children ~ 2.5 % of those affected die 20 May 2014 5 Dr. Basil/Kilema hospital/2014/3

6. DENGUE IN TANZANIA First recorded in Dar es Salaam in 2010 40 people diagnosed with the disease July 2013: another outbreak 172 people found with the disease The current outbreak can be traced to January 2014 Currently:˃ 400 diagnosed, ≥ 3 deaths . (by April 2014) 20 May 2014 6 Dr. Basil/Kilema hospital/2014/3

7. DENGUE IN TANZANIA Already reported in Kilimanjaro Two confirmed Dengue f ever patients ( Mwika and Kyaseni ) by May 2014 Treated and discharged 20 May 2014 7 Dr. Basil/Kilema hospital/2014/3

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9. EFFORTS IN REGIONS Rukwa Regional Commissioner (RC), Engineer Stella Manyanya has called upon residents in her region to seek medical advice once they suspect to be having symptoms of Dengue fever. 20 May 2014 9 Dr. Basil/Kilema hospital/2014/3

10. TRANSMISSION CYCLE INTERACTION HUMANS DENGUE VIRUS AEDES MOSQUITO 20 May 2014 10 Dr. Basil/Kilema hospital/2014/3

11. 20 May 2014 Dr. Basil/Kilema hospital/2014/3 11 TRANSMISSION CYCLE

12. TRANSMISSION CYCLE: SUMMARY A dengue epidemic requires the presence of: The vector mosquito (usually Aedes aegypti). The dengue virus. A large number of susceptible human hosts. 20 May 2014 Dr. Basil/Kilema hospital/2014/3 12

13. Dengue viruses seen in electron micrographs of tissues 20 May 2014 Dr. Basil/Kilema hospital/2014/3 13

14. DENGUE VIRUS An arbovirus ( ar thropod- bo rne virus) Genus: Flavivirus Family: Flaviviridae Single-stranded RNA virus 4 serotypes: DEN-1 to 4 20 May 2014 14 Dr. Basil/Kilema hospital/2014/3

15. AEDES MOSQUITO The mosquito is black with white strips 20 May 2014 15 Dr. Basil/Kilema hospital/2014/3

16. AEDES MOSQUITO Dengue virus is transmitted by Aedes mosquitoes, especially Aedes aegypti Breeds in clean water: empty vessels, coconut shells, plastic containers, flower pots, discarded tires, wet shower floors, uncovered barrels, buckets, toilet tanks Bites during the day , particularly in the early morning and in the evening 20 May 2014 16 Dr. Basil/Kilema hospital/2014/3

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19. Diseases spread by Aedes mosquitoes Dengue fever Yellow fever Chikungunya Other diseases NB: Aedes mosquitoes breed all year round 20 May 2014 Dr. Basil/Kilema hospital/2014/3 19

20. Increasing Incidence of Dengue Uncontrolled urbanization Poor water, sewer and waste management Lack of effective mosquito control Global travel (for work and vacation) Lack of public health infrastructure in many countries 20 May 2014 Dr. Basil/Kilema hospital/2014/3 20

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22. CLINICAL FEATURES Incubation period : 3 – 14 days Duration of symptoms : 7 – 10 days Symptoms : mostly asymptomatic, fever, headache, rash, muscle and joint pains Complications : bleeding, organ damage, shock Case fatality rate : ˂ 1% with treatment, 1-5% without Rx; 25% in severe cases 20 May 2014 Dr. Basil/Kilema hospital/2014/3 22

23. 3 CLINICAL PRESENTATIONS Dengue Febrille Illness (DF) Dengue Haemorrhagic Fever (DHF) Dengue Shock syndrome (DSS) 20 May 2014 Dr. Basil/Kilema hospital/2014/3 23

24. DENGUE FEBRILE ILLNESS (DF) Acute febrile illness of 2 – 7 days plus two(2) or more of the following: Retro-orbital or ocular pain Headache Rash Myalgia Arthralgia Leukopenia Haemorrhagic manifestations But not meeting the case definition of DHF Other constitutional symptoms may/may not occur 20 May 2014 Dr. Basil/Kilema hospital/2014/3 24

25. CHARACTERISTIC DENGUE RASH SIMILAR TO MEASLES 20 May 2014 Dr. Basil/Kilema hospital/2014/3 25

26. Haemorrhagic manifestations Petechiae Purpura / ecchymosis Epistaxis Gum bleeding Blood in vomitus , urine, or stool Vaginal bleeding Positive tourniquet test 20 May 2014 Dr. Basil/Kilema hospital/2014/3 26

27. DENGUE HAEMORRHAGIC FEVER (DHF) ALL OF THE FOLLOWING : Acute febrile illness of 2 – 7 days plus Haemorrhagic manifestation or positive tourniquet test plus Thrombocytopenia (˂ 100, 000 cells/mm 3 )+ Evidence of plasma leakage 20 May 2014 Dr. Basil/Kilema hospital/2014/3 27

28. Haemorrhagic manifestations in DHF 20 May 2014 Dr. Basil/Kilema hospital/2014/3 28

29. Evidence of plasma leakage Haemoconcentration : increase in Hct ˃ 20 % above average for age or decrease in Hct ˃ 20 % of baseline following fluid replacement therapy, OR Pleural effusion or ascites , OR Hypoproteinemea 20 May 2014 Dr. Basil/Kilema hospital/2014/3 29

30. DENGUE SHOCK SYNDROME (DSS) All criteria of DHF plus circulatory failure Evidence of circulatory failure include: Rapid and weak pulse and narrow pulse pressure Age-specific hypotension Cold, clammy skin and Restlessness 20 May 2014 Dr. Basil/Kilema hospital/2014/3 30

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32. Diagnosis Medical history Physical examination Laboratory tests Radiological test 20 May 2014 Dr. Basil/Kilema hospital/2014/3 32

33. Diagnosis: History fever headache muscle pain joint pain eye pains Bleeding etc 20 May 2014 Dr. Basil/Kilema hospital/2014/3 33

34. Physical examination fever rash haemorrhagic manifestations tourniquet test hypotension evidence of circulatory failure etc 20 May 2014 Dr. Basil/Kilema hospital/2014/3 34

35. Physical examination EVALUATE : HR, capillary refill, skin colour, temperature, BP, PP LOOK FOR : evidence of bleeding on the skin and other sites LOOK FOR : evidence of increased vascular permeability MEASURE and ask about urine output 20 May 2014 Dr. Basil/Kilema hospital/2014/3 35

36. Laboratory tests FBP ( Leukopenia , thrombocytopenia, Hct changes); low serum protein; clotting time Serodiagnosis : dengue IgM & IgG Rapid Strip test (serial/paired) Detection of virus 20 May 2014 Dr. Basil/Kilema hospital/2014/3 36

37. Special Test (ELISA) ELISA Plate IgM-capture ELISA 20 May 2014 37 Dr. Basil/Kilema hospital/2014/3

38. Radiology CXR: pleural effusion USS: ascites 20 May 2014 Dr. Basil/Kilema hospital/2014/3 38

39. MANAGEMENT No specific treatment, cure or currently effective vaccine Mainly supportive treatment No antibiotics are of proven value Relieve pain, control fever, avoid NSAIMs, more fluids, monitor . 20 May 2014 Dr. Basil/Kilema hospital/2014/3 39

40. Principles of management Tell patients to drink plenty of fluids and get plenty of rest . Tell patients to take antipyretics (PCM) to control their temperature. Children with dengue are at risk for febrile seizures during the febrile phase of illness 20 May 2014 Dr. Basil/Kilema hospital/2014/3 40

41. Principles of management ... ctd 3. Warn patients to avoid aspirin and other NSAIMs because they increase the risk of hemorrhage 4. Monitor your patients’ hydration status during the febrile phase of illness. Educate patients and parents about the signs of dehydration and have them monitor their urine output 20 May 2014 Dr. Basil/Kilema hospital/2014/3 41

42. Principles of management ... ctd 5. If patients cannot tolerate fluids orally, they may need IV fluids. Assess hemodynamic status frequently by checking the patient’s heart rate, capillary refill, pulse pressure, blood pressure, and urine output. Perform hemodynamic assessments,baseline hematocrit testing, and platelet counts 20 May 2014 Dr. Basil/Kilema hospital/2014/3 42

43. Principles of management ... ctd Continue to monitor your patients closely during and after defervescence . The critical phase of dengue begins with defervescence and lasts 24–48 hours. 20 May 2014 Dr. Basil/Kilema hospital/2014/3 43

44. Child with severe form of Dengue Oxygen IV Fluids Special Care See the tubes every where 20 May 2014 44 Dr. Basil/Kilema hospital/2014/3

45. PREVENTION 20 May 2014 Dr. Basil/Kilema hospital/2014/3 45

46. Mosquito Control Do not allow empty vessels, coconut shells, plastic containers, flower pots, tires etc to collect rain water in them Frequently (once in 2-3 days) empty all water storage containers Cover your over tanks to prevent mosquitoes breeding in fresh water 20 May 2014 46 Dr. Basil/Kilema hospital/2014/3

47. How to prevent mosquito bites Screen your homes with wire mesh Wear full clothing – long sleeves Apply mosquito repellents Keep Dengue fever patient under mosquito net True community participation is key Integrated vector management         20 May 2014 47 Dr. Basil/Kilema hospital/2014/3

48. Dispersing standing water and to decrease mosquito populations 20 May 2014 Dr. Basil/Kilema hospital/2014/3 48

49. Each person is a Book ! Each Day is a Learning Opportunity!! Learning has More Relevance today than ever !!! We need to learn 20 May 2014 49 Dr. Basil/Kilema hospital/2014/3

50. THANKS 20 May 2014 Dr. Basil/ Kilema hospital/2014/3 50 Prepared by Dr. Basil Tumaini, MD