Dengue Fever From Redbook Online-2012 - Pdf-Passwrd

From: Dengue
American Academy of Pediatrics. Dengue. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 REPORT
OF THE COMMITTEE ON INFECTIOUS DISEASES. American Academy of Pediatrics; 2012; 305-307
Clinical Manifestations
Dengue has a wide range of clinical presentations, from a mild

viral syndrome to classic dengue fever and severe dengue (ie,
dengue hemorrhagic fever or dengue shock syndrome).
Approximately 5% of patients develop severe dengue, which is
more common with second or other subsequent infections. Less
common clinical syndromes include myocarditis, pancreatitis,
hepatitis, and neuroinvasive disease.
Date of download: 10/10/2014
Copyright yyyy American Academy of Pediatrics.

All rights reserved.
From: Dengue
Dengue is a dynamic disease beginning with a nonspecific, acute febrile illness

lasting 2 to 7 days (febrile phase), progressing to severe disease during fever
defervescence (critical phase), and ending in a convalescent phase. Fever may be
biphasic and usually is accompanied by muscle, joint, and/or bone pain, headache,
retro-orbital pain, facial erythema, injected oropharynx, macular or maculopapular
rash, leukopenia, and petechiae or other minor bleeding manifestations. Warning
signs of progression to severe dengue occur in the late febrile phase and include
persistent vomiting, abdominal pain, mucosal bleeding, difficulty breathing, early
signs of shock, and a rapid decline in platelet count with an increase in hematocrit
(hemoconcentration). Patients with nonsevere disease begin to improve during the
critical phase, and people with clinically significant plasma leakage attributable to
increased vascular permeability develop severe disease with pleural effusions
and/or ascites, hypovolemic shock, and hemorrhage.

From: Dengue
Etiology
Four related RNA viruses of the genus Flavivirus, dengue viruses (DENV)-1, -2, -3,
and -4, cause symptomatic (~25%) and asymptomatic (~75%) infections. Infection
with one DENV type produces lifelong immunity against that type and short-term
(2 months) cross-protection against infection with the other 3 types of DENV. A
person has a lifetime risk of up to 4 DENV infections.

From: Dengue
Epidemiology
DENV primarily is transmitted to humans through the bite of infected Aedes aegypti
(and less commonly Ae. albopictus or Ae. polynesiensis) mosquitoes. Humans are
the main amplifying host of DENV and the main source of virus for Aedes
mosquitoes. A sylvatic nonhuman primate DENV transmission cycle exists in parts
of Africa and Southeast Asia but rarely crosses to humans. Because of the
approximately 7 days of viremia, DENV can be transmitted following receipt of blood
products, donor organs or tissue, percutaneous exposure to blood, and exposure in
utero or at parturition.

From: Dengue
Epidemiology: Continued
Dengue is a major public health problem in the tropics and subtropics; an estimated 50
million cases occur annually, and 40% of the world's population lives in areas with
DENV transmission. In the United States, dengue is endemic in Puerto Rico, the Virgin
Islands, and American Samoa. In addition, millions of US travelers, including children,
are at risk, because dengue is the leading cause of febrile illness among travelers
returning from the Caribbean, Latin America, and South Asia. Outbreaks with local
DENV transmission have occurred in Texas, Hawaii, and Florida in the last decade.
However, although 16 states have A aegypti and 35 states have A albopictus
mosquitoes, local dengue transmission is uncommon because of infrequent contact
between people and infected mosquitoes. Dengue occurs in both children and adults
and affects both sexes with no differences in infection rates or disease severity.

From: Dengue
The incubation period for DENV replication in mosquitoes is 8 to 12 days

(extrinsic incubation); mosquitoes remain infectious for life (approximately
1 month). In humans, the incubation period is 3 to 14 days before
symptom onset (intrinsic incubation). Infected people, both symptomatic
and asymptomatic, can transmit to mosquitoes 1 to 2 days before
symptoms develop and throughout the approximately 7-day viremic
period.

Diagnostic Tests
From: Dengue
Red Book, 2012
Laboratory confirmation of a clinical diagnosis of dengue depends on when a serum

sample is obtained during the course of illness and may require detection of anti-DENV
immunoglobulin (Ig) M antibodies by enzyme immunosorbent assay (EIA), detection of
DENV RNA by reverse-transcriptase polymerase chain reaction (RT-PCR) assay, or
detection of DENV antigen by immunoassay. DENV RNA is detectable during the febrile
phase, but anti-DENV IgM antibodies are not detectable until 4 to 5 days after illness
onset. DENV nonstructural protein 1 (NS-1) antigen is detectable for the first 10 days of
illness. Other approaches are fourfold or greater increase in reciprocal IgG anti-DENV
titer or hemagglutination inhibition titer to DENV antigens in acute- and convalescentphase sera or IgM anti-DENV in CSF. Diagnostic testing for DENV is available through
commercial reference laboratories, some state public health laboratories, and the
Dengue Branch of the Centers for Disease Control and Prevention. Anti-DENV IgM
antibody testing is not useful, because it remains elevated for life after DENV infection
and often is falsely positive in people with prior infection with or immunization against
other flaviviruses (eg, West Nile, Japanese encephalitis, or yellow fever viruses).

From: Dengue
Treatment
No specific antiviral therapy exists for dengue. During the febrile
phase, patients should stay well hydrated and avoid use of aspirin
(acetylsalicylic acid), aspirin-containing drugs, and other
nonsteroidal anti-inflammatory drugs (eg, ibuprofen) to minimize the
potential for bleeding. Additional supportive care is required if the
patient becomes dehydrated or develops warning signs for severe
disease at the time of fever defervescence.

Treatment
From: Dengue
Early recognition of shock and intensive supportive therapy can reduce risk of death
from approximately 10% to less than 1% in severe dengue. During the critical phase,
maintenance of fluid volume and hemodynamic status is central to management of
severe cases. Patients should be monitored for early signs of shock, occult bleeding,
and resolution of plasma leak to avoid prolonged shock, end organ damage, and fluid
overload. Patients with refractory shock may require intravenous colloids and/or blood
or blood products after an initial trial of intravenous crystalloids. Reabsorption of
extravascular fluid occurs during the convalescent phase with stabilization of
hemodynamic status and diuresis. It is important to watch for signs of fluid overload,
which may manifest as a decrease in the patient's hematocrit as a result of the
dilutional effect of reabsorbed fluid.

From: Dengue
Isolation of the Hospitalized Patient
Standard precautions are recommended, with attention to the potential for

bloodborne transmission. When indicated, attention should be given to control
of Aedes mosquitoes to prevent secondary transmission of DENV from
patients to others.
Figure Legend:

Control Measures
Vaccines are not available to prevent dengue. A number of candidates are in clinical
trials to evaluate immunogenicity, safety, and efficacy. No chemoprophylaxis or antiviral
medication is available to treat patients with dengue. People traveling to areas with
endemic dengue (see DengueMap: www.healthmap.org/dengue/) are at risk of dengue
and should take precautions to protect themselves from mosquito bites. Travelers should
select accommodations that are air conditioned and/or have screened windows and
doors. Aedes mosquitoes bite during the daytime, so bed nets are indicated for children
sleeping during the day. Travelers should wear clothing that fully covers arms and legs,
especially during early morning and late afternoon. Use of mosquito repellents
containing up to 50% N,N-diethyl-meta-toluamide (DEET) for adults (including pregnant
women) and up to 30% DEET for children older than 2 months of age is recommended
when used accordingly to directions on product.
Dengue, acquired locally in the United States and during travel, became a nationally
notifiable disease in 2010. Suspected cases should be reported to state health
departments.
From: Dengue
Figure Legend:
Cytoarchitectural changes found in a liver tissue specimen extracted from a Dengue hemorrhagic fever patient in Thailand
(hematoxylin-eosin stain, magnification x70). This particular view reveals mid-lobular necrosis, with accompanying acidophilic
degeneration, and moderate hypertrophy of Kupffer cells. Courtesy of Dr. Yves Robin and Dr. Jean Renaudet, Arbovirus Laboratory
at the Pasteur Institute in Dakar, Senegal; World Health Organization

From: Dengue
Figure Legend:
Cytoarchitectural changes found in a liver tissue specimen extracted from a Dengue hemorrhagic fever patient in Thailand
(hematoxylin-eosin stain, magnification x70). This particular view reveals focal necrosis of liver cells without an accompanying
inflammatory infiltrate. It is the peripheral regions that are the sites of uneven, discrete lymphocytic infiltration. Courtesy of Dr. Yves
Robin and Dr. Jean Renaudet, Arbovirus Laboratory at the Pasteur Institute in Dakar, Senegal; World Health Organization

From: Dengue
Figure Legend:
Distribution of dengue, western hemisphere. Courtesy of Centers for Disease Control and Prevention

From: Dengue
Distribution of dengue, eastern hemisphere. Courtesy of Centers for Disease Control and Prevention

American Academy of Pediatrics. Dengue. In: Pickering LK, Baker CJ, Kimberlin DW, Long
SS, eds. Red Book: 2012 REPORT OF THE COMMITTEE ON INFECTIOUS DISEASES.
American Academy of Pediatrics; 2012; 305-307
From: Dengue
Red Book, 2012
Dengue Virus Infection. Number of reported cases, by age group United States, 2011. Courtesy of Morbidity and Mortality Weekly Report

From: Dengue
Dengue virus (DENV) is a member of the family Flaviviridae and a positive-sense RNA virus. Epidemics caused by the 4
DENV serotypes have emerged as major public health problems in tropical and subtropical regions over the past 20 years
(1). DENV is transmitted to humans by the bite of an infected mosquito. Female Aedes aegypti mosquitoes are the main
vector involved in the urban transmission cycle of the virus. A Aegypti is a tropical mosquito that lays its eggs on the
walls of containers commonly found in and around homes (1). Female mosquitoes remain infectious for their entire lives
and have the potential to transmit virus during each human feeding. Mosquitoes and larvae may be infected by vertical
transmission and maintain the virus in nature (2). Spread of the mosquito vector and virus has led to a resurgence of
dengue fever epidemics and the emergence of dengue hemorrhagic fever (3). No dengue vaccine is currently available,
and dengue control relies solely on vector control. For successful epidemiologic investigations, identification and typing
of DENV from field-caught mosquitoes and eggs are needed. Courtesy of Emerging Infectious Diseases


Dengue Fever From Redbook Online-2012 - Pdf-Passwrd

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Dengue Fever From Redbook Online-2012 - Pdf-Passwrd

Diunggah oleh

Hak Cipta:

Format Tersedia

From: Dengue

Dengue has a wide range of clinical presentations, from a mild

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Dengue is a dynamic disease beginning with a nonspecific, acute febrile illness

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

The incubation period for DENV replication in mosquitoes is 8 to 12 days

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Laboratory confirmation of a clinical diagnosis of dengue depends on when a serum

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Isolation of the Hospitalized Patient

Standard precautions are recommended, with attention to the potential for

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Copyright yyyy American Academy of Pediatrics.

Copyright yyyy American Academy of Pediatrics.

Date of download: 10/10/2014

Copyright yyyy American Academy of Pediatrics.

Copyright yyyy American Academy of Pediatrics.

Anda mungkin juga menyukai