1. AETIOLOGY,PATHOPHYSIOLOGY AND DIAGNOSIS OF DENGUE INFECTION DR LEE OI WAH PEG. PERUBATAN UD54

5. Serotype Surveilan Di Ng Perak 2002 - 2007 Year No of Samples Type 1 Type 2 Type 3 Type 4 2002 113 0 1 1 2 2003 22 0 0 0 0 2004 8 0 1 0 0 2005 250 4 1 3 2 2006 160 4 0 4 1 2007 243 9 19 7 0 Total 796 17 22 15 5

6. DENGUE VECTORS Aedes aegypti Aedes albopictus

7. Larva Pupa 1 - 2 Days 1 - 3 Days 6 - 8 Days 2 - 3 Days Water LIFE CYCLE OF THE AEDES Adult Eggs Hatch 1- 48 hrs Complete cycle 9 – 10 days

8. DENGUE TRANSMISSION Infected Person Susceptible Person Mosquito Bite Infected Mosquito Infected Mosquito Bites next person Becomes Sick Mosquito Bite Infected Mosquito 3 – 14 days later Remains viremic 2 to 10 Days 8 – 12 DAYS

9. Manifestations of the dengue syndrome Asymptomatic Undifferentiated fever No h'rage Unusual hemorrhage Dengue Fever DHF I & II DSS Dengue Hemorrhagic Fever ( plasma leakage) Symptomatic Dengue virus Infection

11. Dengue Shock Syndrome (WHO 1997) All the above 4 criteria for DHF, plus evidence of circulatory failure: rapid and weak pulse narrow pulse pressure less than 20mmHg or hypotension for age cold clammy skin and restlessness

12. WHO grading of DHF/DSS (WHO 1997 ) Grade 1 In the presence of haemoconcentration, fever and symptoms, a positive TT Grade 2 spontaneous bleeding in addition to the manifestation from Grade 2 Grade 3* circulatory failure, pulse pressure less than 20 mmHg but systolic pressure normal Grade 4* profound shock, hypotension or unrecordable blood pressure. Simplification: Grade 1 & 2: Non-shock DHF Grade 3: COMPENSATED shock Grade 4: DECOMPENSATED shock #

13. Dengue Case Classification Dengue Perak 5/2010

21. Deferversence 24-48 hours

30. Thrombocytopenia

33. 120 110 100 90 80 70 60 Blood pressure, pulse pressure, heart rate in hypovolemic shock Time LCS Lum Compensated shock Decompensated shock First sign of shock is tachycardia Followed by increasing diastolic BP Drop is systolic BP is relatively late event PR