Illness in Children: Febrile and Critical Phases

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Questions and Answers

What is the primary purpose of estimating NS1 antigens and IgM and IgG at the time of presentation?

To confirm the presence of dengue virus

To determine the required hospitalization level

To achieve the best sensitivity in clinical practice (correct)

To assess the need for molecular testing

Why are molecular tests not routinely indicated for diagnosing dengue fever?

They are only effective during critical phases.

NS1 antigen estimation typically suffices. (correct)

They require specialized laboratory equipment.

They have lower sensitivity than antibody tests.

What aspect of dengue in children emphasizes the need for continuous monitoring?

The effectiveness of outpatient management

The rapid progression of the disease

Minute-to-minute variation in clinical illness state (correct)

The high rate of hospitalization

Which of the following describes the IgG antibody response during secondary dengue?

It is good and appears early within the first few days. (A) Signup and view all the answers

What classification method can help in determining the further care needed for children with dengue?

Flowchart 1 based on clinical disease classification (C) Signup and view all the answers

What is characteristic of the febrile phase in children suffering from dengue?

It lasts for 2–5 days with persistent fever. (A) Signup and view all the answers

What occurs during the critical phase of dengue in children?

There is a significant risk of hemodynamic issues. (C) Signup and view all the answers

In which phase do children begin to experience clinical improvement after dengue fever?

Convalescent phase (C) Signup and view all the answers

Which diagnostic test is preferred for detecting NS1 antigen in dengue?

ELISA (C) Signup and view all the answers

When do IgM antibodies typically become detectable in dengue patients?

After day 5 of illness (D) Signup and view all the answers

What is the duration of the convalescent phase in children with dengue?

2–3 days (B) Signup and view all the answers

What is the key characteristic of IgG antibodies in primary dengue infection?

They peak and then decline but persist for life. (C) Signup and view all the answers

How long can IgM antibodies remain detectable in patients after dengue infection?

Up to a year. (A) Signup and view all the answers

What is the focus of the National Guideline for Dengue Case Management during the COVID-19 Pandemic?

Guidelines for dengue fever case management specifically during COVID-19 (B) Signup and view all the answers

Which organization published comprehensive guidelines for the prevention and control of dengue?

World Health Organization (B) Signup and view all the answers

What is the primary target audience of the Clinical guidelines for the management of DF/DHF/DSS?

Health care providers and clinicians (A) Signup and view all the answers

Which aspect of dengue management was emphasized in the National Guidelines for Management of Dengue Fever in Adults by Sri Lanka?

Treatment protocols specifically for adults (B) Signup and view all the answers

What is the primary purpose of the resources linked in the provided text?

Offering case management and clinical guidelines for dengue (B) Signup and view all the answers

What occurs during recovery in a patient's white blood cell count?

It rises before platelet count. (C) Signup and view all the answers

What should be assessed after 20 mL/kg crystalloid or colloid resuscitation in pediatric intensive care units for dengue shock?

Hemodynamic status via echocardiography (B) Signup and view all the answers

What is a key indicator of clinical recovery in platelet count?

Rising platelet count (A) Signup and view all the answers

Which monitoring method is suggested for ensuring safe fluid therapy at the bedside?

Lung ultrasonography for B lines (D) Signup and view all the answers

Which statement about C-reactive protein (CRP) is correct during the observed condition?

It is normal or mildly elevated. (A) Signup and view all the answers

In what situation is it preferable to manage a child categorized as having dengue shock?

In pediatric intensive care unit (B) Signup and view all the answers

In severe disease, which of the following is true regarding liver function tests?

Mild elevation of SGOT is common. (D) Signup and view all the answers

What is the potential consequence of aggressive fluid resuscitation in dengue management?

Respiratory worsening (B) Signup and view all the answers

What is a typical finding in ferritin levels during dengue fever?

High ferritin may indicate severe disease. (B) Signup and view all the answers

What is essential when advanced monitoring is not immediately available during fluid resuscitation for dengue?

Continuous clinical monitoring (B) Signup and view all the answers

What renal function test abnormalities are seen in severe diseases?

Proteinuria and hyponatremia. (C) Signup and view all the answers

Which coagulation abnormalities are typical in severe diseases?

Low fibrinogen and raised PT. (A) Signup and view all the answers

What conditions are indicated by elevated lactate levels during shock?

Poor prognostication. (A) Signup and view all the answers

Study Notes

Phases of Dengue Fever in Children

Febrile Phase: Duration of 2–5 days; children remain febrile throughout; possible biphasic temperature.
Critical Phase: Occurs 3–4 days after fever onset; plasma leakage and hemoconcentration may lead to hypotensive shock and organ dysfunction.
Convalescent Phase: Begins after 6–7 days of fever; extracellular fluid returns to circulation, leading to clinical improvement over 2–3 days.

Diagnostic Approach for Dengue Fever

NS1 Antigen: Glycoprotein appearing at symptom onset, declines in subsequent days; ELISA preferred for its high sensitivity.
Dengue IgM: Emerges after day 5; present in 70% by day 10 and 100% by day 14; can be detectable for up to a year, impacting diagnostic sensitivity.
Dengue IgG: Appears in primary infections within 1–2 weeks; persists for life; early and robust response observed in secondary dengue.
Molecular Tests: PCR options available but NS1 and antibody tests are usually sufficient for diagnosis; high sensitivity in early infections.

Management Principles for Dengue Fever

Clinical Classification: Assess severity for appropriate management; continuous monitoring essential during critical illness.
White Blood Cell Count: Typically low; recovery indicated by rise in white cell count preceding platelet increase.
Platelet Count: Rapid decline during critical phase; recovery marked by platelet increase.
Liver Function Tests: Mild elevation of SGOT/SGPT, low albumin, and coagulation abnormalities in severe cases.
Ferritin Levels: Higher in dengue than other febrile illnesses; very high levels associated with severe disease and hemophagocytic lymphohistiocytosis.
Renal Function Tests: Elevated creatinine and proteinuria indicate severe conditions; metabolic acidosis may present in shock.

Additional Monitoring and Care

Advanced monitoring (e.g., lung ultrasonography) can aid in fluid therapy decisions.
Proper management of dengue shock necessary in pediatric intensive care settings; echocardiography may assess hemodynamics after fluid resuscitation.
Continuous clinical monitoring is crucial, particularly when advanced methods are unavailable.

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Description

This quiz focuses on the febrile and critical phases of illness in children. It covers symptoms, duration, and temperature patterns experienced during these phases. Test your knowledge about how illnesses progress in pediatric patients.