Dengue

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epidemiology

• 70-500 mil. infections per year
• 2.1 mil. severe dengue per year
• 21,000 deaths per year
• significant impact on both health systems and individuals
  • no reliable way to predict who truely needs hospitalization

clinical course

severe dengue

• definition WHO
  • warning sign
    • abd pain/tenderness
    • persitent vomiting
    • clinical fluid accumulation
    • mucosal bleeding
    • lethargy
  • severe dengue
    • severe plasma leakage leading to:
    • severe bleeding
    • severe organ involvement
• dehydration - shock/bleeding - reasbsorption/fluid overload
• secondary organ impairment may be idiosyncratic

• risk factors of severe dengue
  • young age
  • female gender
  • previous flavivurs/dengue infection
  • genotype of dengue virus
  • co-morbidity

• organ impairment is due to both of direct cell destruction by virus and secondary inflammatory process like plasma leakage
  • some patients present virus encephalitis, the others encephalopathy without virus in CSF

treatment

• RCTs of antivirals and steroid have shown no effect so far

algorithm of fluid management