Podcast
Questions and Answers
What is the usual time period during which patients with plasma leakage become worse?
What is the usual time period during which patients with plasma leakage become worse?
What is a likely consequence of profound and/or prolonged shock?
What is a likely consequence of profound and/or prolonged shock?
What is an early sign of plasma leakage?
What is an early sign of plasma leakage?
What is the usual duration of the period of clinically significant plasma leakage?
What is the usual duration of the period of clinically significant plasma leakage?
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What is a common haemorrhagic manifestation of plasma leakage?
What is a common haemorrhagic manifestation of plasma leakage?
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What can precede clinical detection of pleural effusion and ascites?
What can precede clinical detection of pleural effusion and ascites?
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What can reduce the degree of haemoconcentration?
What can reduce the degree of haemoconcentration?
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What is a consequence of severe shock?
What is a consequence of severe shock?
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What is the purpose of adopting the distinction between dengue and severe dengue?
What is the purpose of adopting the distinction between dengue and severe dengue?
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What is a common feature of influenza not typically seen in dengue?
What is a common feature of influenza not typically seen in dengue?
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What is the characteristic of diseases that mimic dengue and severe dengue?
What is the characteristic of diseases that mimic dengue and severe dengue?
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Which of the following is a characteristic of chikungunya that distinguishes it from dengue?
Which of the following is a characteristic of chikungunya that distinguishes it from dengue?
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What is the purpose of clinical manifestations associated with fever and epidemiological information in diagnosing dengue?
What is the purpose of clinical manifestations associated with fever and epidemiological information in diagnosing dengue?
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What is a laboratory feature that is highly predictive of dengue diagnosis?
What is a laboratory feature that is highly predictive of dengue diagnosis?
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What is the benefit of using virological tests in diagnosing dengue?
What is the benefit of using virological tests in diagnosing dengue?
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Which of the following is a symptom that can be misdiagnosed as infectious hepatitis?
Which of the following is a symptom that can be misdiagnosed as infectious hepatitis?
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Which of the following diseases can mimic the febrile phase of dengue?
Which of the following diseases can mimic the febrile phase of dengue?
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What is a common feature of primary infection with HIV that can mimic dengue?
What is a common feature of primary infection with HIV that can mimic dengue?
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What is the purpose of the WHO dengue classification and case definitions?
What is the purpose of the WHO dengue classification and case definitions?
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Which of the following is a characteristic of SARS that can make diagnosis difficult?
Which of the following is a characteristic of SARS that can make diagnosis difficult?
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Which of the following is a reference for the classification and case definitions of dengue?
Which of the following is a reference for the classification and case definitions of dengue?
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What is a characteristic of adenovirus infection?
What is a characteristic of adenovirus infection?
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Why is it necessary for clinicians to be familiar with the epidemiological characteristics of febrile diseases in the locality?
Why is it necessary for clinicians to be familiar with the epidemiological characteristics of febrile diseases in the locality?
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What is a characteristic of dengue that distinguishes it from other diseases?
What is a characteristic of dengue that distinguishes it from other diseases?
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What is the title of the journal in which the article by Alvarez M et al. was published?
What is the title of the journal in which the article by Alvarez M et al. was published?
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What is the purpose of the stepwise approach to the management of dengue as suggested in Table 6?
What is the purpose of the stepwise approach to the management of dengue as suggested in Table 6?
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What is the method used by Prado I et al. to detect dengue virus?
What is the method used by Prado I et al. to detect dengue virus?
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In which year was the article by Guzman MG et al. published?
In which year was the article by Guzman MG et al. published?
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What is the organ where dengue virus RNA was not detected by Rosen L et al.?
What is the organ where dengue virus RNA was not detected by Rosen L et al.?
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What is the technique used by Hall WC et al. to demonstrate yellow fever and dengue antigens?
What is the technique used by Hall WC et al. to demonstrate yellow fever and dengue antigens?
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What is the title of the book edited by Gubler DJ and Kuno G?
What is the title of the book edited by Gubler DJ and Kuno G?
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What is the study by Limonta D et al. about?
What is the study by Limonta D et al. about?
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What is a characteristic of patients who are able to tolerate adequate volumes of oral fluids?
What is a characteristic of patients who are able to tolerate adequate volumes of oral fluids?
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Which of the following is a co-existing condition that may affect the patient's condition?
Which of the following is a co-existing condition that may affect the patient's condition?
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What is an indication for laboratory tests such as full blood count (FBC) and haematocrit (Hct)?
What is an indication for laboratory tests such as full blood count (FBC) and haematocrit (Hct)?
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What is a common finding in patients with severe shock?
What is a common finding in patients with severe shock?
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What is a social circumstance that may affect the patient's condition?
What is a social circumstance that may affect the patient's condition?
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What is an indication for starting I.V. fluid therapy?
What is an indication for starting I.V. fluid therapy?
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What is a laboratory test that may be indicated in patients with severe shock?
What is a laboratory test that may be indicated in patients with severe shock?
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What is a characteristic of patients with severe bleeding?
What is a characteristic of patients with severe bleeding?
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Study Notes
Dengue Fever
- Patients with increased capillary permeability may exhibit warning signs, mainly due to plasma leakage, marking the beginning of the critical phase.
Critical Phase
- The critical phase usually occurs around the time of defervescence, when the temperature drops to 37.5-38°C or less and remains below this level, typically on days 3-8 of illness.
- Progressive leukopenia followed by a rapid decrease in platelet count usually precedes plasma leakage.
- An increasing hematocrit above the baseline may be one of the earliest additional signs.
- The period of clinically significant plasma leakage usually lasts 24-48 hours.
- The degree of plasma leakage varies, and a rising hematocrit precedes changes in blood pressure (BP) and pulse volume.
Haemoconcentration and Fluid Therapy
- The degree of haemoconcentration above the baseline hematocrit reflects the severity of plasma leakage.
- However, this may be reduced by early intravenous fluid therapy.
- Frequent hematocrit determinations are essential because they signal the need for possible adjustments to intravenous fluid therapy.
Pleural Effusion and Ascites
- Pleural effusion and ascites are usually only clinically detectable after intravenous fluid therapy, unless plasma leakage is significant.
- A right lateral decubitus chest radiograph, ultrasound detection of free fluid in the chest or abdomen, or gallbladder wall edema may precede clinical detection.
Haemorrhagic Manifestations
- Haemorrhagic manifestations such as easy bruising and bleeding at venepuncture sites occur frequently.
- If shock occurs when a critical volume of plasma is lost through leakage, it is often preceded by warning signs.
Consequences of Shock
- With profound and/or prolonged shock, hypoperfusion results in metabolic acidosis, progressive organ impairment, and disseminated intravascular coagulation.
- This can lead to severe haemorrhage causing the hematocrit to decrease in severe shock.
Differential Diagnoses of Dengue
- A number of infectious and non-infectious diseases mimic dengue and severe dengue.
- Clinical manifestations associated with fever, epidemiological information, and virological tests (if available) are particularly useful in patients with acute undifferentiated fever.
- Conditions that present with an influenza-like syndrome, such as influenza itself, measles, chikungunya, infectious mononucleosis, and human immunodeficiency virus (HIV) seroconversion illness, may mimic the febrile phase of dengue.
Clinical Management
- Health-care workers at the first levels of care should apply a stepwise approach to the management of dengue.
- Laboratory tests, such as full blood count (FBC) and hematocrit (Hct), are essential for monitoring and treatment.
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Description
Learn about the critical phase of dengue fever, including warning signs, plasma leakage, and changes in leukopenia and platelet count. Understand the timeline of disease progression.