Dengue, DSS, DHF, prevention and its homeopathic management

1. TOPIC NAME – DENGUE
-HEM SHAH
(INTERNEE)

2. OVERVIEW
• What is dengue
• Abstract
• Introduction
• Definition
• General facts about dengue
• Epidemiology
• Causative agent of dengue
• Transmission
• Mechanism
• Signs and symptoms
• Dengue hemorrhagic fever
• Dengue shock syndrome
• Differential diagnosis
• Diagnostic test
• Complications
• Management
• Prevention
• Aim of treatment
• Homeopathic Management
• Prognosis
• Conclusion
• Reference

3. WHAT IS DENGUE?
• Dengue is a viral disease.
• It is transmitted by the infective bite of aedes aegypti mosquito.
• Man develops disease after 5-6 days of bitten by an infective
mosquito.
• It occurs in two forms:
-Dengue fever
-Dengue Hemorrhagic fever (DHF)
• Dengue fever is a severe, flu-like illness.
• Dengue haemorrhagic fever (DHF) is more severe form of disease,
which may cause death.

4. ABSTRACT
Dengue is the most prevalent arthropod-borne virus
affecting humans today. The virus group consists of 4
serotypes that manifest with similar symptoms.
Dengue causes a spectrum of disease, ranging from a
mild febrile illness to a life-threatening dengue
hemorrhagic fever.

5. INTRODUCTION
• Dengue fever is also known as breakbone fever.
• It is a arthopod-brone (arboviral) illness in human
it is caused by infection with 1 of the 4 serotypes of dengue
virus (denv 1, 2, 3, 4), which is flavivirus.
• Dengue is transmitted by the infective bite of aedes egypti
mosquito.

6. DEFINATION
• Dengue is the
mosquito-borne
infection found in
tropical and sub-
tropical regions
around the world.

7. GENERAL FACTS ABOUT DENGUE
• It is nicknamed break-bone fever.
• About 50-100 million infections world wide every year.
• Dengue fever is passed by infected female ADES AEGYPTI
mosquitoes.
• Dengue is caused by flaviviruses.

8. EPIDEMIOLOGY
• The mortality is 1-5% without
treatment.
• Less then 1% with adequate
treatment.
• Dengue is endemic in more than
110 countries
• It infects 50 to 100 million people
worldwide a year, leading half of
million hospitalizations, and
approximately 12,500 – 25,000
deaths.

9. CAUSATIVE AGENT OF DENGUE
• Dengue is cause by a RNA virus
• This virus is member of the viral family Flaviviridae
• Having 4 serotypes DENV-1, DENV-2, DENV-3 and DENV-4.
• All four serotypes can cause the full spectrum of diseases.
• Transmitted by aedes mosquitoes.
• Infection with one serotype is believed to produce lifelong immunity
to that serotype but only short term protection against the others.

10. DENGUE VIRES
INFECTION
ASYMPTOMATIC SYMPTOMATIC
UNDIFFERENCIATED
FEVER
(VIRAL FEVER)
DENGUE FEVER
(DF)
WITHOUT
HAEMORRAGE
WITH UNUSAL
HAEMORRAGE
DHF
( WITH PLASMA
LECKEGE)
DHF NON SHOCK
DHF WITH SHOCK
(DSS)
EXPANDED DENGUE
SYNDROME
(UNUSAL
MANIFESTATION)

11. TRANSMISSION

12. TRANSMISSION
• Dengue is transmitted by several species of mosquito within the genus
Ades, principally A. aegypti.
• Humans are the primary host of the virus, but it circulates in non-
human primates.
• An infection can be acquired via single bite.
• A female mosquito that takes a blood meal from a person infected with
dengue fever becomes itself infected with the virus in the cells lining in
the gut.
• About 8-10 days later, the virus spreads to other tissues including the
mosquito ‘s salivary gland and is subsequently released in to the saliva.

13. MECHANISM
• When a mosquito carrying dengue virus bites a person,
the virus enters the skin together with the mosquito’s saliva.
• It binds to and enters white blood cells and reproduces inside the
cells while they move throughout the body.

14. • In severe infection, the virus production inside the body is greatly
increased, and many more organs (such as the liver and the bone
marrow) can be affected, and the fluid from the blood stream leaks
through the wall of small blood vessels into body cavities.
• As a result, less blood circulates in the blood vessels, and the blood
pressure becomes so low that it cannot supply sufficient blood to
vital organs.
• Furthermore, dysfunction of the bone marrow leads to reduced
numbers of platelets, which are necessary for effective blood
clotting; this increases the risk of bleeding, the other major
complication of dengue fever.

15. SIGN AND SYMPTOMS
• Asymptomatic or mild such as an uncomplicated fever(80%)
• More severe illness (5%)
• In a small proportion it is life threatening
• The incubation period (time between exposure and onset of
symptoms) ranges from 3-14 days, but most often it is 4-7 days

16. • The characteristic symptoms of dengue are :-
1. onset fever
2. Headache (typically located behind the eyes)
3. Muscles and joint pain and a rash
4. The alternative name for dengue, “break-bone fever”
(comes from the associated muscle and joint pains)

17. • Symptoms include fever,
headache, muscles and joint pains
and a characteristic skin rash that
is similar to measles.
• In a small proportion of cases the
disease develops into the life-
threatening dengue hemorrhagic
fever.
• Resulting in bleeding, low levels
of blood platelets and blood
plasma leakage, or into dengue
shock syndrome, where
dangerously low blood pressure
occurs.

18. WARNING SIGNS
• Abdominal Pain
• Ongoing Vomiting
• Liver enlargement
• Mucosal bleeding
• High hematocrit with low platelets
• Lethargy
• Vomiting with blood
• Swollen lymph nodes

19. The course of infection is divided into three
phases :-
1. Febrile phase
2. Critical phase
3. Recovery phase

20. FEBRILE PHASE ( 1 to 7 days)
• High fever, often over 104°F stays for 1 or 2
days
• Generalized pain
• Headache, usually lasts two to seven days.
• Rash occurs in the first or second day of
symptoms as flushed skin.
• Later in the course of illness (days 4-7) as a
measles like rash
• Small petechiae (small red spots that do not
disappear when the skin is pressed , which
are caused by the broken capillaries ) can
appear at this point as may some mild
bleeding from the mucous membranes of
the mouth and nose.

21. CRITICAL PHASE (last for 1 to 2 days)
• A critical phase, which follows the resolution of the high fever and
typically lasts for one to two days.
• During this phase there may be significant fluid accumulation in the
chest and abdominal cavity due to increased capillary permeability
and leakage.
• This leads to depletion of fluid from circulation and decreased blood
supply to vital organs.
• Organs dysfunction and severe bleeding, typically from the GIT.
• Shock (DHS) and hemorrhage (DHF) occurs in less than 5% of all cases
of dengue.
• However those who have previously been infected with other
serotypes of dengue virus are at an increased risk.

22. RECOVERY PHASE (last for 2 - 3 days)
• Resorption of leaked fluid into the blood stream.
• This is usually last two or three days
• Severe itching and a slow heart rate
• During this stage, a fluid overload state may occurs; if affects the
brain, it may cause a reduced level of consciousness or seizures.

23. Dengue Hemorrhagic Fever (DHF)
It is a severe case of dengue
with hemorrhagic tendency
evidence by :-
• Positive tourniquet test
• Petechiae, ecchymosis or
purpura
• Bleeding from mucosa
(epistaxis or bleeding from
gums), injection sites or
other sites

24. DENGUE SHOCK SYNDROME
All the above criteria of DHF plus signs
failure manifested by the following:
• Rapid and weak pulse
• Narrow pulse pressure (</= to
20mm Hg)
• Hypotension for age
• Cold and clammy skin
• Restlessness
• Decreased or absent urine

25. Associated problems with Dengue
• Dengue can occasionally affect several other body systems
• A decreased level of consciousness
• Infection of the brain by the virus or indirectly as a result of
impairment of vital organs, for example – Liver
• Other neurological disorders such as transverse myelitis and
Guillain-Barre Syndrome
• Infection of the heart and acute liver failure are among the are
complications

26. DIFFERNTAIL DIAGNOSIS
1. Chikungunya
2. Malaria
3. Leptospirosis
4. Typhoid fever

27. DIAGNOSTIC
TEST

28. WHO-PROPOSED CLINICAL DEFINATION OF
DENGUE
PROBABLE DENGUE
• Exposure in a endemic area
• Fever
Two of :-
• Nausea/Vomiting
• Rash
• Aches/pains
• Positive tourniquet test
• Leucopenia
• Any warning sign in someone who
lives in endemic area.
WARNING SIGNS
• If there is any warning sign
immediately go for the treatment,
usually warning signs occurs before
the onset of severe dengue

29. Diagnosis is typically made clinically, in the basis
of
• Reported symptoms and physical examination
• Dengue rapid test
• Earliest change detectable on Laboratory
investigations:-
1) Low white blood cell count.
2) Increase plasma leakage results in
hemoconcentration(as indicated by a rising
hematocrit)
3) Hypoalbuminemia.
4) Pleural effusion or ascites can be detected
by physical examination when large.
5) Demonstration of fluid on USG may assist in
the early identification of dengue shock
syndrome.

30. Tourniquet Test :-
The tourniquet test is the part of the
new WHO case definition for
dengue.
The test is a marker of capillary
fragility and it can be used as a
triage tool to differentiate patients
with acute gastroenteritis, for
example, from those with dengue.
Even if a tourniquet test was
previously done , it should be
repeated if:-
• It was previously negative.
• There is no bleeding
manifestation.

31. HOW TO DO A TOURNIQUET TEST
1. Take the patient’s blood pressure
and record it, for example
100/70.
2. Inflate the cuff to a point
midway between SBP and DBP
and maintain for 5 minutes
[100+70]/2=85mmHg
3. Reduce and wait 2 minutes.
4. Count petechiae below
antecubital fossa.
5. A positive test is 10 or more
petechiae per 1 square inch

32. Complications
• Hyperpyrexia
• Severe hemorrhage
• Dengue Shock Syndrome
• Hematemesis
• Tachypnoea
• Bleeding gums

33. MANAGMENT
• Oral rehydration therapy
• Intravenous fluids
• Blood transfusion - PCV or
Whole blood recommended

34. Preventions
• There are approved vaccines for the dengue virus.
• Prevention thus depends on control of and protection from the bites
of the mosquito that transmits it.
• Aedes mosquitoes usually bite during the day.
Therefore, special precaution should be taken early morning hours
before day break and in the late afternoon before dark
• Conduct Dengue awareness programs in you areas
• Advice people showing symptoms of dengue to immediately go for
check-up is to find and eliminate their breeding sites.`

35. Protection against mosquitoes
 Mosquito Net
 Screening - Screening of buildings with copper or bronze gauze
 Repellents
 Smell - Avoid wearing heavily scented soaps and perfumes
 Stagnant water – The Aedes mosquito prefers to breed in clean, stagnant
water. It is important to frequently check and remove stagnant water in
your home.
 Turn buckets and watering cans over – store them in shelter so water
cannot accumulate in them.
 Remove the water from plant pot plates- to remove mosquito eggs, clean
and scrub them thoroughly

36. AIM OF TREATMENT
• Relieving symptoms of pain.
• Controlling fever.
• Telling patients to avoid aspirin and other nonsteroidal, anti-
inflammatory medications
• Drink more fluids, especially when they have a high fever.

37. HOMEOPATHIC
REMEDIES

38. 1. Eupatorium Perfoliatum for dengue fever with bone breaking
pains (preventive remedy)
• This medicine is called “Bone Set”, since it relieves the terrible deep
bone pains with the Dengue fever.
• Excruciating Pains in the muscles with high grade fever.
• Throbbing headache in the occiput and the vertex.
• Soreness in the eyes or the eyeballs.
• Chill preceded by intense thirst, severe soreness and aching in bones
• Sweating provides relief except headache

39. 2. Bryonia Alba– Homeopathic remedy for dengue fever with
intense thirst
• Stitching and tearing pains in the whole body with high grade fever.
• The two distinguishing features of this medicine are increased thirst and
that the pains and all sorts of sufferings of the patient are aggravated by
motion.
• Dryness of the mouth, tongue and other mucous membranes ,patient is
thirsty for large quantities of water at one go.
• Severity of symptoms like intense headache at the temples , head
brusting sensation, eye pain.
• Bitter taste in mouth.

40. 3. Phosphorus – Homeopathic medicine for hemorrhagic dengue fever
• There is burning and numbness of the hands, arms and feet.
• Intense thirst with fever, the patient wants to have cold water or even
chilled water.
• Hemorrhage from any and every part or orifice of the body may be
seen.
• The patient may feel unusually hungry.

41. 4. Rhus Tox – Homeopathic remedy for pains relieved by motion
• It is indicated by the muscular soreness and pains in the body which are
relieved only while in motion.
• The patient cannot rest as it is the worst position for him.
• The tongue gets coated white while the tip of the tongue remains red
and forms a red triangle at the tip.
• Severe aching of limbs and bones which is worse during rest and better
while moving around
• Extreme restlessness

42. 5. Carica Papaya- Homeopathic remedy for improving platelet count
• Carica Papaya is a homeopathic remedy made from papaya fruit.
• It has been seen that it improves the platelet counts in patients whose
platelets are falling.
• Best for digestive system
• It is one of the best remedy metabolism of the body
• It increases the appetite
• Undigested stool
• Enlarged Liver and Spleen

43. 6. Gelsemium- Homeopathic medicine for Dengue Fever with
weakness and prostration
• A state of dullness, dizziness and drowsiness is the perfect description
to select Gelsemium.
• The patients seem lethargic and have a desire to lie down in perfect
silence without any disturbance.
• The patient experiences chill during fever in the back and travels up
and down the back.
• Occipital Headache travelling to forehead and eyes.
• There is also an absence of thirst in majority of cases.

44. PROGNOSIS
• Usually with regular treatment and ample rest and
fluids the prognosis is good
• But in some cases Dengue can turn Hemorrhagic
due to low platelet count which can be life
threatening
• Regular monitoring of patient is important

45. CONCLUSION
• Though Dengue fever has various clinical manifestations
none were specific to the disease.
• Fever was the only clinical feature which was maximally
associated.
• Total leucocyte count may determine the outcome
• More prospective study and more number of cases are to be
analyzed to know the exact clinical manifestation which may
determine the outcome.
• Homeopathy plays a great role in managing DENGUE

46. REFRENCE
• Textbook of Golwalla medicine for student
• Boericke’s new manual of homeopathic Materia medica
• Practice of medicine by Dr. V.K Chauhan
• Preventive and social medicine by Dr. K. Park
• Images from google

47. THANK YOU