Day of Illness Figure 4. Laboratory Diagnostic Options in a Patient with Suspected Dengue Infection. Detection of viral nucleic acid, nonstructural protein 1 (NS1), or IgM sero- conversion is a confirmatory finding in patients in whom dengue is a possi- ble diagnosis. Day 0 is the first day when the patient noted any symptom during this illness. ELISA denotes enzyme-linked immunosorbent assay, and RT-PCR reverse-transcriptase polymerase chain reaction.T. Mudwal’s Hypersensitivity Type Ill Theory Virus in Monotocyte Ability and it of Mocrophegeeel V4 a Complement Activation Complex immune» DHF oa Symptoms rus + Antibody Destruction by Spread to the whole body healthy | +t Virus in Macrophage Cell macrophage celland Immune complex in Autoreactive Thrombocyte macrophage tissue Thrombocyte ———* Lymphocyt —* | Antibody call and new (THelpar) (Positive) macrophage cell from bone marrow T Suppressor failureCRITICAL PHASE (TOXIC HEMORRHAGIC STAGE) * Days 4-7 of illness * Time of defervescence * Temperature drops to 37.5 - 38 °C + Increase in capillary permeability, increasing haematocrit levels + Plasma leakage (24-48 hours) > Progressive leukopenia > rapid decrease in platelet count (Suggested Dengue Classification and Level of Severity Figure 1.4 Suggested dengue case classification and levels of serverity DENGUE + WARNING SIGNS SEVERE DENGUE SPD Ee eld SL EL Pe eat De CRITERIA FOR DENGUE + WARNING SIGNS CRITERIA FOR SEVERE DENGUE. Probable dengue Warning signs* Severe plasma leakage leading to : tive in travel to dengue endemic area. « Abominal pein or tenderness «Shock (DSS) Feverand 2 ofthetolowing criteria: persistent vornting pause, voitng « Orica! uid sooumultion severe bleed + Aches and pons - Muto ed as sted Hen «= Tomniquet test positive + Lethargy, restlessness = Leukopenia « Liver enlargment > 2em ‘Severe organ involvement + Any waming sign + Labortony:nerease n HET coneurent Liver: AST arALT >= 1000 Laboratory-confirmed dengue ——-‘W#h rapid deerease in platelet count CONS : impaired consciousness (Gmporert when me sign of plasma leakage) + (requiring strict cbosrvation and medical itrvention) Heart and other organs: «+ Fd accuruiation with respiratory distress Source: World Health Organization. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control - New Edition 2009. WHO: Geneva; 2009eee Lina 2 mainuenarae Rds 5% omitrone 6 norm wine CL aa licen ot amma” Sreutse sss ot Nota ionyPhases of infections resulting in Dengue Hemorrhagic Fever Febrile * Deforvescenee + Thrombocytopenia gree ometrer + Increasing hervatoctt Critical (plasma leak) + Loukopenta (v0 ear Hallmark features: Potential complications: + Debytration due to decreused uid intake, cemesis, and increased metabolic state + Convulsions die to high fever + Rarely, severe hemorthoge, Hallmark features: mal or subnarmal temperatures, of plasma Weak into itanasl spaces. frying dagroes of homorthage, * Risk of developing shock and death Potential complications: + Unrecognized severe plasms leakage Convalescence (Reabsorption), Hallrnark features: + Resolution of plasma leakage and amorrha Statist ot vital ig + Improved appetite and sense of wellbeing. Potential complications: + Intravascular abd averload due to continual angressive volume resuscitation luring convalescence phase.YZ Dengue Case Definitions ? US.AIR FORCE Denque Fever Dengue Hemorrhagic Fever + Probable: * Fever (acute presentation) Acute Febrile Illness, and/or 2-7 days, +/- biphasic, +1: suggestive serology, + 2: + +Tourniquet Test + HA « Petechiae, ecchymoses, + Myalgia/arthralgia purpura + Rash + Bleeding from mucosa, Gl, + Retro-orbital pain injection sites, other + Hemorrhage + Hematemesis or melena + Leukopenia * Thrombocytopenia + Confirmed (sp. Labs) + Plasma leakage « Reportable (both of the above) WHO. Dengue Hemorrhagic Fever, 2" Ed. 1997First four days The client may experience fever as the invasive stage abruptly happens. The common manifestations include: High fever accompanied with abdominal pain and headache which could be sometimes regarded as symptoms of common conditions. Sometimes, symptoms of flushing, vomiting, conjunctival infection and epistaxis occur but due to changes in viral infectivity, onset of these symptoms may vary. ( During 4" to 7" days a) | Itis already called as toxic or hemorrhagic stage; fever may subside but the risks for bleeding | tendencies for the client may however, take place. Clinical manifestations may include: Severe abdominal pain, hematemesis, melena, unstable blood pressure with narrowing pulse pressure and at times shock. Dengue may be fatal at this point. 7th te 10th days itis called as convalescent or recovery stage when generalized body status is regained and vital signs especially the blood pressure of the client is already stable.