DENGUE WHO and PIDSP
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Questions and Answers

What clinical issue is most commonly associated with the critical stage of dengue?

  • Fatigue
  • Dehydration
  • Shock/bleeding (correct)
  • Fever resolution

    • How long does the febrile phase of dengue typically last?

  • 1-3 days
  • 7-14 days
  • 5-10 days
  • 2-7 days (correct)

    • What is a key laboratory finding during the critical period of dengue?

  • Increase in white blood cell count
  • Decrease in white blood cell count
  • Increase in platelet count
  • Decrease in platelet count (correct)

    • What generally follows defervescence during the clinical course of dengue?

    <p>The critical phase</p> Signup and view all the answers

    What is the primary purpose of the tourniquet test in suspected dengue cases?

    <p>To detect capillary fragility</p> Signup and view all the answers

    Which parameter rises and indicates severity of plasma leakage during the critical phase?

    <p>Degree of hemoconcentration</p> Signup and view all the answers

    How long does the clinically significant plasma leakage typically last during the critical stage?

    <p>24-48 hours</p> Signup and view all the answers

    In the context of dengue, what does a rising hematocrit level indicate?

    <p>Onset of shock</p> Signup and view all the answers

    Which of the following symptoms indicates a need for hospital admission in dengue patients?

    <p>Elevated hematocrit</p> Signup and view all the answers

    What laboratory finding suggests increased risk of mortality in dengue patients?

    <p>Thrombocytopenia with APC &lt; 50,000/mm3</p> Signup and view all the answers

    Which factor is NOT considered a risk factor associated with mortality in dengue?

    <p>Mild dehydration</p> Signup and view all the answers

    What type of fluid is appropriate for maintenance in dengue patients without shock?

    <p>Isotonic fluid</p> Signup and view all the answers

    What symptom is associated with significant bleeding in patients admitted due to dengue?

    <p>Pleural effusion</p> Signup and view all the answers

    Which of the following transfusions may be considered for children exhibiting signs of DIC related to dengue?

    <p>Plasma transfusion</p> Signup and view all the answers

    Which of the following laboratory tests is NOT recommended as routine for dengue patients?

    <p>Partial prothrombin time (PTT)</p> Signup and view all the answers

    What can be inferred about citronella-based repellents in comparison to DEET-based repellents in dengue prevention?

    <p>Evidence is insufficient to demonstrate superiority of citronella</p> Signup and view all the answers

    What is a common complication associated with the critical stage of dengue?

    <p>Severe hemorrhage</p> Signup and view all the answers

    During which stage of dengue may the AST or ALT levels reach ≥1000?

    <p>Critical stage</p> Signup and view all the answers

    What unique skin manifestation distinguishes the recovery phase of dengue?

    <p>Isles of white in a sea of red</p> Signup and view all the answers

    What is the marker of acute dengue infection detectable within the first week?

    <p>NS1 antigen</p> Signup and view all the answers

    What is the most important indicator for starting intravenous fluid therapy in dengue patients?

    <p>Hematocrit levels</p> Signup and view all the answers

    What is the primary characteristic of a primary dengue infection?

    <p>High levels of IgM</p> Signup and view all the answers

    Which group of patients should be managed as inpatients due to co-existing conditions?

    <p>Diabetic patients</p> Signup and view all the answers

    Which statement about platelet transfusions in dengue management is correct?

    <p>They can lead to fluid overload.</p> Signup and view all the answers

    What happens to pulse pressure during early shock in dengue?

    <p>It narrows significantly.</p> Signup and view all the answers

    What type of fluid is contraindicated for maintenance in dengue management?

    <p>Half normal saline</p> Signup and view all the answers

    At what stage is dengue shock syndrome (DSS) most likely to occur?

    <p>Defervescence stage</p> Signup and view all the answers

    Which of the following is NOT a warning sign of dengue?

    <p>Severe headache</p> Signup and view all the answers

    Which parameter is indicative of more severe shock in adults?

    <p>Pulse pressure ≤ 20 mmHg</p> Signup and view all the answers

    During which phase of dengue do patients typically develop a high-grade fever suddenly?

    <p>Febrile phase</p> Signup and view all the answers

    Which of the following changes occurs during the critical period of dengue infection?

    <p>Progressive decrease in platelet count</p> Signup and view all the answers

    What clinical observation should alert a physician to a high probability of dengue at the initial evaluation?

    <p>Progressive decrease in total white cell count</p> Signup and view all the answers

    What does a positive tourniquet test indicate in the context of dengue?

    <p>≥10 petechiae after BP inflation</p> Signup and view all the answers

    In which period do most patients experience defervescence, indicating a decrease in fever?

    <p>Days 3-8 of illness</p> Signup and view all the answers

    What is the significant laboratory change related to fluid leakage observed during the critical stage?

    <p>Progressive decrease in platelet count</p> Signup and view all the answers

    What does the degree of hemoconcentration reflect during the critical phase of dengue?

    <p>Severity of plasma leakage</p> Signup and view all the answers

    How long is the period of clinically significant plasma leakage likely to last during the critical period?

    <p>24-48 hours</p> Signup and view all the answers

    Which of the following signs and symptoms indicate a need for admission in dengue patients?

    <p>Shortness of breath</p> Signup and view all the answers

    What laboratory finding is indicative of increased mortality risk in dengue patients?

    <p>Hgb decline by &gt; 20%</p> Signup and view all the answers

    Which of the following is considered a risk factor associated with mortality in dengue?

    <p>Narrow pulse pressure on admission</p> Signup and view all the answers

    What is the recommended fluid type for maintenance in dengue patients without shock?

    <p>Isotonic fluid</p> Signup and view all the answers

    Which symptom is NOT associated with significant bleeding in dengue patients?

    <p>Mild fever</p> Signup and view all the answers

    What condition warrants consideration of plasma transfusion in children with dengue?

    <p>Disseminated intravascular coagulopathy (DIC)</p> Signup and view all the answers

    Which factor is NOT linked to an increased risk for mortality in patients with dengue?

    <p>Mild fatigue</p> Signup and view all the answers

    Which statement about citronella-based repellents in relation to dengue is accurate?

    <p>There is no difference in effectiveness compared to DEET-based repellents.</p> Signup and view all the answers

    What physiological response occurs during the initial stage of shock?

    <p>Tachycardia</p> Signup and view all the answers

    What is observed in patients during the recovery phase of dengue?

    <p>Hemodynamic stability</p> Signup and view all the answers

    What indicates the presence of dengue shock syndrome (DSS)?

    <p>Continued vascular permeability</p> Signup and view all the answers

    Which statement concerning fluid management in dengue is true?

    <p>0.9% saline is recommended for Group B management</p> Signup and view all the answers

    In which situation is hospitalization for dengue management warranted?

    <p>Living alone with no transportation means</p> Signup and view all the answers

    What is indicated by an AST or ALT level greater than or equal to 1000?

    <p>Severe liver damage</p> Signup and view all the answers

    What distinguishes dengue from chikungunya in clinical manifestations?

    <p>Symmetric arthritis of small joints</p> Signup and view all the answers

    How does the pulse pressure change during early shock in dengue?

    <p>It narrows towards 20 mmHg</p> Signup and view all the answers

    What is the primary characteristic of a secondary dengue infection?

    <p>Low levels of IgM antibodies</p> Signup and view all the answers

    What condition warrants the use of PRBCs or whole blood in dengue management?

    <p>Severe gastrointestinal bleeding</p> Signup and view all the answers

    What is the effect of excessive intravenous fluid therapy during the recovery stage?

    <p>Hypervolemia and pulmonary edema</p> Signup and view all the answers

    What is the expected outcome of a narrowing pulse pressure during compensated shock?

    <p>Decreased stroke volume</p> Signup and view all the answers

    What is commonly seen in the early stages of dengue infection?

    <p>Fever with viremia</p> Signup and view all the answers

    Study Notes

    Dengue Phases

    • Three phases of dengue: Febrile, Critical, Recovery.
    • Transition from febrile to afebrile phase coincides with onset of critical phase, known as Defervescent Stage.
    • Critical stage is marked by a noticeable decrease in temperature.
    • Potential clinical issues during the critical stage include shock and bleeding.
    • Laboratory changes in the critical period: decrease in platelet count and increase in hematocrit.

    Febrile Phase

    • Patients often develop a sudden high-grade fever during this phase.
    • Duration of acute febrile phase is 2-7 days.
    • The earliest abnormality in full blood count is a progressive decrease in total white cell count, indicating high probability of dengue.

    Critical Stage

    • Progressive decrease in platelet count and increase in hematocrit occur during this period.
    • Defervescence lasts typically from days 3-8 of illness.
    • Clinically significant plasma leakage lasts 24-48 hours, indicated by rising hematocrit preceding changes in blood pressure and pulse volume.
    • Metabolic acidosis and organ impairment may occur due to profound shock.

    Recovery Phase

    • Recovery phase presents with a confluent erythematous or petechial rash, described as "isles of white in the sea of red."
    • Symptoms include general pruritus and stabilization or decrease in hematocrit due to fluid reabsorption.
    • White blood cell count recovers before platelet count.

    Medical Complications

    • Febrile stage complications include dehydration and febrile seizures in young children.
    • Critical stage complications involve shock from plasma leakage, severe hemorrhage, and organ impairment.
    • Recovery stage may see hypervolemia if intravenous fluid therapy is excessive.

    Diagnosis and Laboratory Findings

    • NS1 antigen is a marker of acute dengue infection and is best requested during the febrile phase (day 1 to days 4-5 of fever).
    • Development of IgM antibodies occurs with disappearance of fever and viremia.
    • Primary infections feature high IgM and low IgG levels; secondary infections have low IgM and high IgG levels.
    • Significant laboratory findings indicating risk for mortality include decline in Hb, thrombocytopenia, hemoconcentration, and elevated AST.

    Management and Treatment

    • Corticosteroids are not indicated for dengue management due to associated risks.
    • Platelet transfusions for low platelet counts are not beneficial and may lead to complications.
    • Fluid management for patients includes isotonic solutions; Group B patients should receive 0.9% saline or Ringer's lactate.
    • IV fluids should be initiated based on hematocrit findings, starting with 5-7 ml/kg/hour.
    • Patients with high-risk factors (age, comorbidities) should be monitored closely and may require hospitalization.

    Indicators of Severity

    • Warning signs of dengue include abdominal tenderness, mucosal bleeding, vomiting, enlarged liver, clinical fluid accumulation, lethargy, and increase in hematocrit.
    • Risk factors associated with mortality include hypotension, narrow pulse pressure, severe dengue stages, and significant bleeding.
    • Early signs of shock include tachycardia, narrowed pulse pressure, and delayed capillary refill.

    Miscellaneous

    • Citronella-based repellents have insufficient evidence to prove superior effectiveness over DEET-based repellents in dengue prevention.

    Social Considerations for Admission

    • Certain social circumstances, such as living alone or far from health facilities, may necessitate hospital management.

    Dengue Phases

    • Three phases of dengue: Febrile, Critical, Recovery.
    • Transition from febrile to afebrile phase coincides with onset of critical phase, known as Defervescent Stage.
    • Critical stage is marked by a noticeable decrease in temperature.
    • Potential clinical issues during the critical stage include shock and bleeding.
    • Laboratory changes in the critical period: decrease in platelet count and increase in hematocrit.

    Febrile Phase

    • Patients often develop a sudden high-grade fever during this phase.
    • Duration of acute febrile phase is 2-7 days.
    • The earliest abnormality in full blood count is a progressive decrease in total white cell count, indicating high probability of dengue.

    Critical Stage

    • Progressive decrease in platelet count and increase in hematocrit occur during this period.
    • Defervescence lasts typically from days 3-8 of illness.
    • Clinically significant plasma leakage lasts 24-48 hours, indicated by rising hematocrit preceding changes in blood pressure and pulse volume.
    • Metabolic acidosis and organ impairment may occur due to profound shock.

    Recovery Phase

    • Recovery phase presents with a confluent erythematous or petechial rash, described as "isles of white in the sea of red."
    • Symptoms include general pruritus and stabilization or decrease in hematocrit due to fluid reabsorption.
    • White blood cell count recovers before platelet count.

    Medical Complications

    • Febrile stage complications include dehydration and febrile seizures in young children.
    • Critical stage complications involve shock from plasma leakage, severe hemorrhage, and organ impairment.
    • Recovery stage may see hypervolemia if intravenous fluid therapy is excessive.

    Diagnosis and Laboratory Findings

    • NS1 antigen is a marker of acute dengue infection and is best requested during the febrile phase (day 1 to days 4-5 of fever).
    • Development of IgM antibodies occurs with disappearance of fever and viremia.
    • Primary infections feature high IgM and low IgG levels; secondary infections have low IgM and high IgG levels.
    • Significant laboratory findings indicating risk for mortality include decline in Hb, thrombocytopenia, hemoconcentration, and elevated AST.

    Management and Treatment

    • Corticosteroids are not indicated for dengue management due to associated risks.
    • Platelet transfusions for low platelet counts are not beneficial and may lead to complications.
    • Fluid management for patients includes isotonic solutions; Group B patients should receive 0.9% saline or Ringer's lactate.
    • IV fluids should be initiated based on hematocrit findings, starting with 5-7 ml/kg/hour.
    • Patients with high-risk factors (age, comorbidities) should be monitored closely and may require hospitalization.

    Indicators of Severity

    • Warning signs of dengue include abdominal tenderness, mucosal bleeding, vomiting, enlarged liver, clinical fluid accumulation, lethargy, and increase in hematocrit.
    • Risk factors associated with mortality include hypotension, narrow pulse pressure, severe dengue stages, and significant bleeding.
    • Early signs of shock include tachycardia, narrowed pulse pressure, and delayed capillary refill.

    Miscellaneous

    • Citronella-based repellents have insufficient evidence to prove superior effectiveness over DEET-based repellents in dengue prevention.

    Social Considerations for Admission

    • Certain social circumstances, such as living alone or far from health facilities, may necessitate hospital management.

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    Description

    Test your knowledge on the three phases of dengue fever: febrile, critical, and recovery. This quiz covers pivotal moments in the progression of the disease, including temperature changes and laboratory findings during the critical stage.

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