dengue shock syndrome management guidelines

DHF and dengue shock syndrome (DSS) manifest generally as plasma leakage leading to shock and can be fatal, and occur more frequently among children and young adults. There is no specific treatment for dengue, and care is largely supportive. Oral rehydration and analgesia are routinely used. Dengue shock syndrome. The management of dengue is symptomatic and supportive. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. #### Summary points Dengue has been reported in almost 70 countries, with about five million cases reported between 2000 and 2007 (figs 1⇓ and 2⇓).1 In 2002, at the peak of the current pandemic, over 1.2 million cases were reported worldwide. Prompt restoration of the volume of circulating plasma is the cornerstone of therapy for dengue shock syndrome. Background Dengue fever is a hemorrhagic fever caused by flaviviruses. There has been no previous summary of existing dengue guidelines to explore their usefulness in the context of IMCI and to identify questions for research. Dengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. 3 4 Dengue haemorrhagic fever and dengue shock syndrome in infants less than 1 year of age accounts for 5% of children hospitalised with dengue disease in this region. Criteria for diagnosing dengue (with or without … While DF is a sim-ple, self-limited febrile illness, DHF is a severe and potentially life-threatening condition. Dengue virus infection has varying clinical manifestation ranging from asymptomatic infection to life-threatening hemorrhagic fever and dengue shock syndrome. Algorithm for Intravenous Fluid Management in Patients with Hypovolemic Shock (Severe Dengue Shock Syndrome) ‒ Group ..... 14 References..... 15 . Abbreviations: DF - Dengue Fever, DHF - Dengue Haemorrhagic Fever, DSS - Dengue Shock Syndrome, ARDS - Acute Respiratory Distress Syndrome, MODS - Multiple Organ Dysfunction Syndrome. Warning signs include severe abdominal pain, persistent vomiting, marked change in … Indian National Guideline has been developed to make uniform criteria to grade the severity for better planning and management of dengue infection in the country. Flow Chart 1-Volume replacement flow chart for a patient with Severe Dengue and a >20% increase in haematocrit. The place of steroids in the management of severe forms of dengue is unclear.1, 2 Studies to assess the effects of steroids have all been done in children and with the steroids given at a late stage of dengue shock syndrome (DSS). Although the first exposed serotype antibody is not neutralizing, it does allow enhanced … Wills BA, Nguyen MD, Ha TL, et al. Management of dengue haemorrhagic feverldengue shock syndrome. Guidelines for Clinical Management of Dengue Infection in Pregnancy Page 3 Early bleeding due to gastric erosions should be anticipated in dengue patients who have taken NSAIDs or steroids. Quezon City, PH: Philippine Pediatric Society Inc; 1998. Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. This new classification classifies dengue into dengue (D), dengue with warning signs … View Article PubMed/NCBI Google Scholar 5. The only recognised treatment is maintaining adequate hydration in dengue fever and fluid replacement therapy in dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). There were no local guidelines available on recording, reporting and management of these co-morbidities. It is crucial to recognise plasma leakage, shock and early or severe organ impairment. Profound shock. Platelet transfusions do not decrease the risk of severe bleeding and may instead lead to fluid overload and prolonged hospitalization. Dengue is a single disease with several different clinical presentations. Bed rest is recommended for patients with symptomatic dengue fever, dengue hemorrhagic fever, or dengue shock syndrome. Permit the patient to gradually resume their previous activities, especially during the long period of convalescence. Hypotension for age 2. Indian J Med Microbiol. The most feared complication is a poorly understood vasculopathy that occurs in only a small minority of symptomatic individuals, especially children and young adults, but can result in potentially fatal dengue shock syndrome (DSS). Warning signs Abdominal … Dr. H.A.P. As most of the studies were focused on its diagnosis and treatment, scanty data is available on associated diseases/co-morbidities in these patients that could have contributed to a higher mortality. What you need to know about dengue shock syndrome. There are a number of rare presentations that were reported in the last outbreak in 2017. The guidelines, published in November 2012, supersede the previous guidelines on Management of Dengue Fever / Dengue Haemorrhagic Fever published by the Epidemiology Unit, Ministry of Health in 2010. The case fatality rate in patients with dengue shock syndrome can be as high as 44%. This case report describes a 7-year-old Thai boy, another 7-year-old Thai boy, and a 9-year-old Thai boy who exhibited signs and symptoms of dengue shock syndrome; all the children had secondary dengue virus infections, documented by serology and reverse transcriptase polymerase chain reaction. Each of the four serotypes is capable of causing the full spectrum of clinical manifestations of dengue. AdHoc Committee on Dengue Infections of the Philippine Pediatric Society. Case Definitions for Reporting. 35. Dengue shock syn- drome most commonly occurs from day 3 to 7 of the febrile illness. Dengue Shock Syndrome Evidence of circulatory failure manifested indirectly by all of the following: Rapid and weak pulse Narrow pulse pressure (< 20 mm Hg) OR hypotension for age Cold, clammy skin and altered mental status Frank shock is direct evidence of circulatory failure 6. Songco RS, Purugganan H, Carandang EH, et al. These are Clinical Practice Guidelines on Management of Dengue Infection in Adults (Revised 2nd Edition) 2010. Case management No specific treatment is available for dengue fever. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. 6. X DON’T give platelet transfusions for a low platelet count. Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate … Dengue is endemic in more than 125 countries in tropical and subtropical regions and causes an estimated 390 million infections annually worldwide, of which 96 million are clinically apparent [ 1 ]. In addition, some patients with severe illness requiring medical intervention do not meet all criteria for … The only recognized treatment is maintaining adequate hydration in dengue fever and fluid replacement therapy in hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Important risk factors influencing who will develop dengue haemorrhagic fever or severe disease during epidemics include the virus strain and serotype, immune status of the host, age, and genetic predisposition. A successful management of dengue fever in pregnancy: report of two cases. These guidelines were developed based on the best available evidence at the time of writing. He had dengue shock syndrome after entering the critical phase on the fifth day of the illness. plasma is the cornerstone of therapy for dengue shock syndrome. Diagnostic serology. There are four serotypes of the virus Den1, Den 2, Den 3 and Den 4. The current WHO classification used since the 70s classifies dengue into dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS). Clin Infect Dis. Kahandaliyanage Director General of Health Services . The dengue virus is an arbovirus belonging to the family of Flaviviraedae. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. Moderate shock, identified by narrowing of the pulse pressure or hypotension for age, is present in grade III DHF, whereas profound shock with no detectable pulse or blood pressure is present in grade IV DHF. Single rapid TaqMan fluorogenic probe based PCR assay that detects all four dengue serotypes. Underlying pathophysiology of thrombotic events is multifactorial and the management is challenging due to associated thrombocytopenia and bleeding tendency. In patients with dengue hemorrhagic fever or dengue shock syndrome, duration of shock is the main risk factor for severe bleeding. WHO management guidelines, first proposed in 1975, recommend replacement of … There are four dengue virus (DENV) types (DENV-1, DENV-2, DENV-3, and DENV-4), all of which are capable of inducing severe disease (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]). Dengue Fever Classical Dengue fever or Break bone fever is an acute febrile viral disease frequently presenting with headaches, bone or joint pain, muscular pains,rash,and leucopenia. The case-fatality rate was approximately 1%. There is no role of prophylactic transfusion with platelets and fresh frozen plasma in dengue patients. The term DHF suggests that hemorrhage is the cardinal manifestation of severe dengue; however, plasma leakage leading to intravascular volume depletion and potentially shock is the most specific feature of severe dengue and the focus of clinical management guidelines and algorithms . 2005; 6: 412–419. 2001;32(2):204–213. The arthropod vectors are members of the genus Aedes … DHF/dengue shock syndrome (DSS). Severe dengue also includes several other clinical entities and endpoint diseases, some linked to the fundamental biology of dengue infections, others of iatrogenic origin, and others of as yet unknown pathogenesis. Source: Guidelines for clinical management of dengue fever, dengue haemorrhagic fever and dengue shock syndrome. DHF and dengue shock syndrome (DSS) manifest generally as plasma leakage leading to shock and can be fatal, and occur more frequently among children and young adults. N Engl J Med. 8.2 Management of Dengue Shock Syndrome 21 8.3 Management of Pleural Effusion 21 8.4 Indications for Blood Products in Dengue Infection 22 8.5 Management of Upper Gastrointestinal Bleeding in Dengue 22 Patients 8.6 Intensive Care in Dengue Infection 23 9. All four children were identified to have invasive aspergillosis by histopathology and three cases were positive on fungal culture for Aspergillus spp. Early clinical findings are nonspecific but require a high index of suspicion because recognizing early signs of shock and promptly initiating intensive supportive therapy can reduce risk of death among patients with severe dengue to <0.5%. See Box 3-01 for information regarding the World Health Organization (WHO) guidelines for classifying dengue. In dengue-endemic regions, the triage of patients with suspected dengue infection should be carried out in … There … guidelines, which are adapted from the 1997 World Health Organization (WHO) guidelines. HEALTHCARE SETTINGS Both outpatient and inpatient settings. The plan of management is:- 1. 2008. There is no specific treatment for dengue, and care is largely supportive. This clinical guideline was developed through series of consultations with national specialists in their relevant fields. Dengue is a notifiable disease. 2 Introduction Dengue is an infectious disease caused by a flavivirus called dengue virus (DENV), which has four known distinct serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). 51. Dengue has a wide clinical presentation ranging from being asymptomatic to uncomplicated fever or dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). (6) Pregnant women … (ar–arthropod, bo–borne). Thus, it was essential to frame the common guidelines on Clinical Management of Dengue for the physicians across the country. of India. Routine within 48 hours for cases in areas not receptive to dengue transmission. Hemorrhagic manifestations are well known to be associated with dengue fever, though the thrombotic events are only seldom reported. Related Papers. National Guidelines for Clinical Management of Dengue Syndrome, First Edition, 2000 ... National Guidelines for Clinical Management of Dengue Syndrome, First Edition, 2000 Disease Control Directorate, Directorate General of Health Services, GOB 3 Introduction hen a disease becomes a public health problem it attracts the attention of national health agencies. This has clearly helped reduce the mortality due to Dengue. Clinical and Laboratory Guidelines for Dengue Fever and Dengue Haemorrhagic Fever/Dengue Shock Syndrome for Health Care Providers Produced by the Caribbean Epidemiology Center (CAREC) Pan American Health Organization World Health Organization General aspects Dengue is an endemic tropical vira l disease in many areas in the World including the Caribbean and the Americas. Pediatr Crit care Med. Until the end of the 1980s South East Asia and the Western Pacific region were the regions most affected by dengue. CPG Dengue Infection PDF Final. In Australia it’s geographical distributi… The Surviving Sepsis Campaign (SSC) guidelines are mainly based on evidence from studies on bacterial sepsis. 7. Since 2004, the HTD has used two formats of an immunoglobulin M (IgM) antigen capture ELISA for the presumptive laboratory diagnosis of dengue in a proportion of clinically suspected cases. These guidelines are widely applicable, but there are also exceptions. Routine within 48 hours for cases in areas not receptive to dengue transmission. Aggressive management of dengue shock syndrome may decrease mortality rate: a suggested protocol. I hope that these guidelines on clinical management of dengue fever and dengue haemorrhagic fever prepared by the Epidemiology Unit in collaboration with the Sri Lanka College of Paediatricians will be a vital tool to all clinical practitioners in order to further strengthen clinical management. J Med Virol. Reassess the clinical status, repeat the HCT and review fluid infusion rates accordingly. Case 2 A 24-yr-old female presented on day 3 of fever with vomiting, headache, chills and rigors. Dengue Clinical Syndromes: 1.Undifferentiated fever; 2.Classic dengue fever; 3.Dengue hemorrhagic fever, or DHF; and 4.Dengue shock syndrome, or DSS. Key words: Dengue, DHF-dengue hemorrhagic fever , DSS-dengue shock syndrome. Dengue is the most common mosquito-borne viral infection in the world. Classification . Criteria for Discharging Patients Hospitalised with Dengue 24 Infection 10. These guidelines however needed to be updated due to new issues that had to be addressed. Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy samples. We report a case of dengue shock syndrome with severe thrombocytopenia complicated by ilio-femoral deep vein thrombosis. It is endemic in parts of Asia and the Americas and has been increasingly reported from many tropical countries in recent years [1–3]. Key Words: Dengue shock syndrome,Guidelines, Mortality Introduction Dengue has emerged as important healthcare issue in Pakistan during last two decades.1,2,3Hyper-immune response and plasma leakage are hallmarks of complicated version of dengue infection which is termed as dengue hemorrhagic fever (DHF).4,5Dengue In 2010 guidelines were developed on the management of Dengue fever and Dengue haemorrhagic fever in Children and Adolescents. In approximately 30% of DSS cases, recurrent episodes of shock occur. Dengue hemorrhagic fever (DHF) and CLINICAL PRACTICE GUIDELINES. By Israr Mohtar. Warrilow D, Northill JA, Pyke A, Smith GA. Fever & Dengue Shock Syndrome (DSS)):(5) Severe Plasma Leakage leading to: o Shock (DSS) o Fluid accumulation with respiratory distress Severe Bleeding as evaluated by clinician Severe organ involvement o Liver: AST or ALT ≥ 1000 o CNS: impaired consciousness o Failure of heart and other organs Mortality rates from severe dengue can be as high as 20% if untreated. 2008 Oct-Dec. 26(4):377-80. . This can be achieved by frequent clinical and laboratory monitoring. The infection is a dynamic disease and management issues vary according to the three phases of the clinical course. Laboratory criteria for the diagnosis of dengue virus may include 1 of the following: Dengue virus isolation. Dengue Case Classification Dengue with warning signs Severe dengue 7. Dengue Shock Syndrome is a presentation of Dengue Syndrome when a case of DHF manifests circulatory failure with one or more of the following features: 1. Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. the difference between the systolic and diastolic pressures) is ≤ 20 mm Hg in children and he/she has signs of poor capillary perfusion (cold extremities, delayed capillary refill, and rapid pulse rate). However, even without NSAIDs or steroids, overt or occult bleeding can occur in dengue, especially in DHF. 9 ... dengue shock syndrome (DSS). Serology: HI and IgM posi- tive. However there are many incidences of symptomatic disease; they can be partitioned into two syndromes: dengue fever (DF) and DHF/dengue shock syndrome (DSS). Summary Public health priority Urgent for cases in dengue-receptive areas, where there is potential for onward local transmission. Severe Dengue includes plasma leakage and dengue shock syndrome, which are less quantitatively defined than DHF and DSS in the 1997 WHO Guidelines. DENGUE fever is an acute, febrile, flu like illness caused by the Dengue virus. Dengue Management DO’s and DON’Ts X DON’T use corticosteroids. We report a case of dengue shock … Dengue haemorrhagic fever and dengue shock syndrome typically occur in children under the age of 15 years, although dengue fever primarily occurs in adults and older children. Also known as dengue hemorrhagic fever (DHF), dengue fever shock syndrome can occur after 2 to 6 days of infection with … aegypti.Ae. Comment: The salient features are an early onset of shock and DIVC. To provide a comprehensive review of dengue, with an emphasis on clinical syndromes, classification, diagnosis, and management, and to outline relevant aspects of epidemiology, immunopathogenesis, and prevention strategies. Guidelines for the diagnosis and treatment of dengue hemorrhagic fever/dengue shock syndrome. Common symptoms in impending shock include abdominal pain, vomiting, and restlessness. 2 Dengue is associated with maternal and fetal morbidity with the stillbirth rate in the range of 6.6–47%. Dengue hemorrhagic fever (Chapter 389) and dengue shock syndrome are forms of dengue reinfection characterized by capillary leakage and hemorrhage. During 2004 and 2005, cases were tested using a … Dengue Shock Sindrome. Despite many years of effort to develop … … … The spread of Dengue virus infection is reaching pandemic proportions. Geneva: World Health Organization; 2009. vi DENGUE IN THE CONTEXT OF THE IMCI Executive summary Dengue is not included in the generic Integrated Management … Platelets as a drug target for Dengue Haemorrhagic Fever2 5 Repaired 4 1. Dengue is the most common mosquito-borne viral infection in the world. This is intended to reach all levels of the health eare services which would lead to reduction in morbidity and prevention of mortality duc to dengue illness. Case fatality rate (DF & … I hope that the guidelines on clinical management of Dengue/ Dengue Haemorrhagic Fever prepared by the Epidemiological Unit with the contribution of experts in this field will prove useful to clinicians for better case management and reduction of mortality due to this disease. Dr. Ravindra Ruberu Secretary Health vii. Thus, it was essential to frame the common guidelines on Clinical Management of Dengue for the physicians across the country. These guidelines on clinical management of DF/DHF/DSS have been developed in consultation with the leading national and international experts in the field of clinical management of DHF. Dengue epidemic in Lahore (2011) resulted in hundreds of deaths and affected thousands. Narrow pulse pressure (<_ 20 mm of Hg) . This has clearly helped reduce the mortality due to Dengue. With each chapter focusing on a different type of EDS, the book covers the definition, concept, prevalence, pathophysiology, management, complications and outcomes of the condition. Oral rehydration and analgesia are routinely used. References 25 i . In 2009, a new classification of dengue proposed by WHO Tropical Disease Research (TDR) was published in the WHO TDR 2009 dengue guidelines. It was previously classified into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Directorate of National Vector Borne Disease Control Programme, DGHS, Ministry of Health and Family Welfare, Govt. Dengue is usually dreaded for causing shock due to capillary leakage. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. A revised WHO case classification was introduced in 2009, replacing the traditional dengue fever and dengue haemorrhagic fever/dengue shock syndrome with dengue with and without warning signs and severe dengue . Comparison of three fluid … The CPG supersede the ... haemorrhagic fever or dengue shock syndrome and other forms of severe dengue. Transmission is via the bite of an infective female mosquito, principally Ae. 4. Around the time the fever begins to subside (usually 3–7 days after symptom onset), the patient may develop warning signs of severe disease. Management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. The third edition, 2013 of the national guideline on dengue syndrome N Engl J Med 2005;353:877-89. Dengue shock syndrome (DSS) - The patient is considered to have shock if the pulse pressure (i.e. diagnosis was dengue shock syndrome with multiorgan failure. By adeel rafi ahmed. Ranjit S, Kissoon N, Jayakumar I. aegypti is a highly domesticated urban mosquito found in the tropics and subtropics. Hemophagocytosis is confirmed by histopathology of autopsied reticuloendothelial organs. The three boys experienced substantial plasma leakage demonstrated by pleural effusion … The book discusses all aspects of expanded dengue syndrome (EDS), an emerging entity of dengue infection, and serves as definitive source of information for health care professionals. v Foreword Since publication of the new edition of Dengue: Guidelines for diagnosis, treatment, prevention and control by the World Health Organization (WHO) in 20091, the need to provide more training to health-care workers in this area has become increasingly evident. Despite the substantial limitations at that time in the laboratory diagnosis of viral diseases and confounding outbreaks of other mosquito-borne illnesses such as chikungunya, the essential features of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) were identified, and the major principles for appropriate management were defined . Based mainly on expert opinion, WHO management guidelines for DSS … Dengue is considered a major and emergent concern. Dengue CDNA National Guidelines for Public Health Units 1. Cold clammy skin, restlessness, rapid weak pulse 3. Previous infection with an alternative serotype allows antibody to the previously encountered serotype to combine with the newly infecting serotype. Although case s … There 2002 Apr. Clin Infect Dis 2001;32:204-13. shock and Dengue Shock Syndrome patients (refer to Algorithm for Fluid Management in Compensated Shock). These are Clinical Case Management Guidelines of Dengue Fever/Dengue Hemorrhagic Fever/Dengue Shock Syndrome (1st Edition) 2011. Some infections result in dengue haemorrhagic fever (DHF), a syndrome that in its most severe form can threaten the patient's life, primarily through increased vascular permeability and shock. Dengue in children ≤2 years of age constituted 2.9% and 7.7% of dengue infections in children as reported from two different hospitals in Thailand. Dengue shock syndrome is a dangerous complication of dengue fever and is associated with high mortality. Conclusion: Increased awareness, better transport facilities and case management according to the WHO guidelines is needed to further reduce mortality and cost burden of dengue cases. I hope that the guidelines on clinical management of Dengue/ Dengue Haemorrhagic Fever prepared by the Epidemiological Unit with the contribution of experts in this field will prove useful to clinicians for better case management and reduction of mortality due to this disease.

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