PEDIATRICS, DENGUE , DENGUE IN CHILDREN , NELSON ,PALS ,

1. DENGUE IN
CHILDREN
-Dr.Apoorva.E
PG,DCMS

2. EPIDEMIOLOGY
• Dengue is the most rapidly spreading
mosquito-borne viral disease in the world
• Increase in incidence by over 30-fold in
the last 50 years
• Currently endemic in all continents except
Europe

3. ETIOLOGY
THE VIRUS
• DEN- family flaviviridae
genus flavivirus
• Has four distinct serotypes (DEN1 – 4)
• DEN-2 and DEN-3 cause severe disease
• Cleaved by host and viral proteases into 3
structural proteins and 7 nonstructural
proteins(NS)

4. THE VECTOR
• Transmitted by infected Aedes
mosquitoes
• Highly urbanized,
fresh water,
day feeding mosquito

5. THE HOST
• Humans are the primary host of the virus
• Severity depends upon factors like
gender,secondary infection,age and
chronic diseases (sickle cell anemia,
asthma , DM)
• Vertical transmission and through infected
blood products +

6. PATHOGENESIS

7. Capillary damage
Fluid leaks into extravascular spaces
Hemoconcentration
Hypovolemia
Increased cardiac work
Tissue hypoxia,metabolic acidosis

8. THROMBOCYTOPENIA
+
LIVER DAMAGE
+
DIC
DENGUE HAEMORRHAGIC FEVER

9. A
N
T
I
B
O
D
Y
D
E
P
E
N
D
E
N
T
E
N
H
A
N
C
E
M
E
N
T

10. • Specific antibodies start appearing
around day 5 of illness.
• Infection with one serotype gives lifelong
immunity to that type, but only short term
protection against the other three.
• Secondary infection with DEN-2, DEN-3
is associated with dengue haemorrhagic
fever.

11. CLINICAL MANIFESTATIONS
• Multisystem disease with a wide clinical
spectrum
• Incubation period – 4 to 10 days
• Illness begins abruptly following the
IP,divided into three phases
FEBRILE CRITICAL RECOVERY

12. FEBRILE PHASE
• High grade fever lasting for 2-7 days
• Accompanied by facial
flushing,rash,myalgia,arthralgia,headache,
nausea,vomiting,anorexia,sore
throat,injected pharynx and conjunctiva.
• Petechiae,epistaxis,gum bleed may be
seen.

13. CRITICAL PHASE
• Usually occurs on days 3-6 of the illness
• Lasts for 24-48 hours
• Progressive leukopenia,increasing
hematocrit levels,decrease in platelet
count precede plasma leakage
Ascites Pleural effusion Shock

14. • Prolonged shock leads to DIC which
leads to severe haemorrhage
-Decrease in hematocrit
-GI bleeding usually
• Organ hypoperfusion can lead to
hepatitis,myocarditis,encephalitis

15. RECOVERY PHASE
• Reabsorption of the fluid from
extravascular compartment occurs
• General well-being improves,appetite
returns,hemodynamic status
stabilizes,urine output becomes normal,GI
symptoms abate
• Generalized pruritus,bradycardia ++

17. CLINICAL PROBLEMS
ENCOUNTERED DURING
DIFFERENT PHASES

18. DENGUE CASE
PROBABLE DENGUE
(live in/travel to endemic area+fever+any of the following
two criteria :
rash,nausea/vomiting,aches,positive tourniquet
test,leukopenia,any warning sign)
WARNING SIGNS
NEGATIVE POSITIVE
DENGUE WITH SEVERE
WARNING SIGNS DENGUE
DENGUE
WITHOUT
WARNING
SIGNS

19. WARNING SIGNS

20. SEVERE DENGUE
FEVER OF 2-7 DAYS PLUS ANY OF THE
FOLLOWING FEATURES :
1.EVIDENCE OF PLASMA LEAKAGE
2.SIGNIFICANT BLEEDING
3.ALTERED LEVEL OF CONSCIOUSNESS
4.SEVERE GI INVOLVEMENT
5.SEVERE ORGAN INVOLVEMENT

21. DENGUE SHOCK SYNDROME
COMPENSATED DECOMPENSATED
SHOCK SHOCK
(pulse pressure<20mmHg,
cold clammy extremities,
feeble rapid pulse)

22. DENGUE HAEMORRHAGIC FEVER

23. GRADING OF DENGUE FEVER

24. MANAGEMENT
• HISTORY – Time of fever
onset,associated symptoms,warning
signs,urine output,family or
neighbourhood dengue
• PHYSICAL EXAMINATION – Assess
hydration,hemodynamic status,tender
abdomen,ascites,hepatomegaly,pleural
efffusion,bleeding manifestations,mental
state,tourniquet test

25. • INVESTIGATIONS – CBP with HCT,other
organ function tests as
indicated(USG,CXR,LFT,RFT,PT APTT
INR,BLOOD GLUCOSE,SERUM
ELECTROLYTES,ABG)
• SPECIFIC DIAGNOSTIC TESTS –
NS1 Ag detection
IgM IgG detection
Viral isolation
PCR to detect viral genome

27. DENGUE WITHOUT WARNING SIGNS - TREATMENT

28. DENGUE WITH WARNING SIGNS -
TREATMENT

29. SEVERE DENGUE(COMPENSATED SHOCK) - TREATMENT

31. HYPOTENSIVE SHOCK - TREATMENT

33. DISCHARGE CRITERIA
• No fever for 48hours
• Improvement in general well-
being,appetite,U/O,hemodynamic status
• Increasing platelet count
• Stable HCT without IVF

34. D/D
• CONDITIONS THAT MIMIC FEBRILE PHASE :
Influenza,
measles,
chikungunya,
scarlet fever,
meningococcal infection,
drug reactions,
G.E

35. • CONDITIONS THAT MIMIC CRITICAL PHASE :
Acute GE,
malaria,
viral hepatitis,
acute abdomen,
DKA,
lactic acidosis,
acute leukemia,
platelet disorders,
leptospirosis

37. THANK YOU !