#BeAwareStayHealthy
HOW TO RECOGNIZE DENGUE FEVER/DENGUE
HAEMORRHAGIC FEVER
Dengue Fever (DF) is an acute febrile illness of 2-7 days
duration (sometimes with two peaks) with two or more of
the following manifestations:
· Headache
· Retro-orbital
pain (Sudden onset of pain, generally around or behind the eye)
· Myalgia (or muscle pain) /arthralgia (joint pain)
· Rash
· Haemorrhagic (general term for a severe illness, sometimes associated with bleeding) manifestation (petechiae and positive tourniquest test) and
· Leucopenia (a decrease in the number of white blood cells)
In children, DF is usually mild. In some adults, DF may be the
classic incapacitating disease with severe
bone pain and recovery may be associated with prolonged fatigue and depression.
Dengue Haemorrhagic Fever (DHF) is a probable case
of dengue and haemorrhagic tendency evidenced
by one or more of the following:
· Positive
tourniquet test
· Petechiae,
ecchymosis or purpura
· Bleeding
from mucosa (mostly epistaxis or bleeding from gums), injection sites or other
sties
· Haematemesis
or melena
· Thrombocytopaemia
(platelets 100,000/cu.mm or less) and
· Evidence of plasma
leakage due to increased capillary permeability manifested by one or more of
the following:
o A > 20% rise in haemotocrit for age and
sex
o A > 20% drop in haemotocrit following
treatment with fluids as compared to baseline
o Signs of plasma leakage (pleural effusion,
ascites or hypoproteinaemia)
Dengue Shock Syndrome (DSS) All
the above criteria of DHF plus signs of circulatory failure manifested by rapid and
weak pulse, narrow pulse pressure (< or equal to 20 mm Hg); hypotension for age, cold and clammy skin and restlessness.
The above descriptions of DF/DHF/DSS are
adequate for guiding doctors to treat the disease. However, for reporting
of the disease, cases should be classified as suspected DF/DHF/DSS on the basis
of above the criteria. Added serological evidence would categorize them into
probable and confirmed cases.
DO'S AND DON'TS FOR DOCTORS
WHAT TO DO:
· Cases
of Dengue fever/Dengue Haemorrhagic Fever (DF/DHF) should be observed every
hour.
· Serial
platelet and haematocrit determinations, drop in platelets and rise in
haematocrits are essential for early diagnosis of DHF.
· Timely intravenous
therapy - isotonic crystalloid solution can prevent shock and/or lessen its severity.
· If
the patient's condition becomes worse despite giving 20ml/kg/hr for one hour,
replace crystalloid solution with colloid solution such as
Dextran or plasma. As soon as improvement occurs, replace with
crystalloid.
· If
improvement occurs, reduce the speed from 20 ml to 10 ml, then to 6 ml, and
finally to 3 ml/kg.
· If
haematocrit falls, give blood transfusion 10 ml/kg and then give crystalloid IV
fluids at the rate of 10ml/kg/hr.
· In case of severe
bleeding, give fresh blood transfusion about 20 ml/kg for two hours. Then give crystalloid at 10 ml/kg/hr for a short time (30-60
minutes) and later reduce the speed.
· In
case of shock, give oxygen.
· For
correction of acidosis (sign: deep breathing), use sodium bicarbonate.
WHAT NOT TO DO:
· Do
not give Aspirin or Brufen for treatment of fever.
· Avoid
giving intravenous therapy before there is evidence of haemorrhage and
bleeding.
· Avoid
giving blood transfusion unless indicated, reduction in haematocrit or severe
bleeding. · Avoid
giving steroids. They do not show any benefit.
· Do
not use antibiotics.
· Do not change the speed
of fluid rapidly, i.e., avoid rapidly increasing or rapidly slowing the
speed of fluids.
· Insertion of nasogastric
tube to determine concealed bleeding or to stop bleeding (by cold
lavage) is not recommended since it is
hazardous.
SIGNS OF RECOVERY:
· Stable
pulse, blood pressure and breathing rate
· Normal
temperature
· No
evidence of external or internal bleeding
· Return
of appetite
· No
vomiting
· Good
urine output
· Stable
haematocrit
· Convalescent
confluent petechiae rash
CRITERIA FOR DISCHARGING PATIENTS:
· Absence
of fever for at least 24 hours without the use of anti-fever therapy
· Return
of appetite
· Visible
clinical improvement
· Good
urine output
· Minimum
of three days after recovery from shock
· No
respiratory distress from pleural effusion and no ascites
· Platelet
count of more than 50,000/mm3
DO'S AND DON'TS FOR PATIENTS
If you or any family member is suffering from suspected dengue
fever, it is important to carefully watch yourself or relative for the next few
days, since this disease can rapidly become very serious and lead to a medical emergency.
The complications associated with Dengue
Fever/Dengue Haemorrhagic Fever usually appear between the third and
fifth day of illness. You should therefore watch the patient for two days even after fever disappears.
WHAT TO DO:
· Keep body
temperature below 39oC. Give the patient paracetamol (not more than four times in 24
hours) as per the dose prescribed below:
Age Dose
(tablet 250 mg) Mg/dose
<1 nbsp="" span="" year=""> ¼
tablet 60
1-4 years ½
tablet 60-120
5 and above 1
tablet 240
· Give large amounts of fluids (water,
soup, milk, juice) along with the patient's normal diet.
· The patient should
take complete rest.
· Immediately consult a doctor if any of
the following manifestations appear:
o Red spots or points on the
skin;
o bleeding from the nose or
gums;
o frequent vomiting;
o vomiting with blood;
o black stools;
o sleepiness;
o constant crying;
o abdominal pain;
o excessive thirst (dry
mouth);
o pale, cold or clammy skin;
o difficulty in breathing.
WHAT NOT TO DO:
· Do not wait in
case the above symptoms appear. Immediately consult a doctor. It is crucial to quickly get treatment in case of these
complications.
· Do not take Aspirin or Brufen or Ibubrufen.
