Questions and Answers
What clinical issue is most commonly associated with the critical stage of dengue?
How long does the febrile phase of dengue typically last?
What is a key laboratory finding during the critical period of dengue?
What generally follows defervescence during the clinical course of dengue?
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What is the primary purpose of the tourniquet test in suspected dengue cases?
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Which parameter rises and indicates severity of plasma leakage during the critical phase?
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How long does the clinically significant plasma leakage typically last during the critical stage?
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In the context of dengue, what does a rising hematocrit level indicate?
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Which of the following symptoms indicates a need for hospital admission in dengue patients?
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What laboratory finding suggests increased risk of mortality in dengue patients?
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Which factor is NOT considered a risk factor associated with mortality in dengue?
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What type of fluid is appropriate for maintenance in dengue patients without shock?
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What symptom is associated with significant bleeding in patients admitted due to dengue?
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Which of the following transfusions may be considered for children exhibiting signs of DIC related to dengue?
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Which of the following laboratory tests is NOT recommended as routine for dengue patients?
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What can be inferred about citronella-based repellents in comparison to DEET-based repellents in dengue prevention?
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What is a common complication associated with the critical stage of dengue?
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During which stage of dengue may the AST or ALT levels reach ≥1000?
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What unique skin manifestation distinguishes the recovery phase of dengue?
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What is the marker of acute dengue infection detectable within the first week?
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What is the most important indicator for starting intravenous fluid therapy in dengue patients?
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What is the primary characteristic of a primary dengue infection?
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Which group of patients should be managed as inpatients due to co-existing conditions?
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Which statement about platelet transfusions in dengue management is correct?
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What happens to pulse pressure during early shock in dengue?
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What type of fluid is contraindicated for maintenance in dengue management?
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At what stage is dengue shock syndrome (DSS) most likely to occur?
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Which of the following is NOT a warning sign of dengue?
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Which parameter is indicative of more severe shock in adults?
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During which phase of dengue do patients typically develop a high-grade fever suddenly?
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Which of the following changes occurs during the critical period of dengue infection?
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What clinical observation should alert a physician to a high probability of dengue at the initial evaluation?
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What does a positive tourniquet test indicate in the context of dengue?
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In which period do most patients experience defervescence, indicating a decrease in fever?
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What is the significant laboratory change related to fluid leakage observed during the critical stage?
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What does the degree of hemoconcentration reflect during the critical phase of dengue?
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How long is the period of clinically significant plasma leakage likely to last during the critical period?
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Which of the following signs and symptoms indicate a need for admission in dengue patients?
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What laboratory finding is indicative of increased mortality risk in dengue patients?
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Which of the following is considered a risk factor associated with mortality in dengue?
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What is the recommended fluid type for maintenance in dengue patients without shock?
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Which symptom is NOT associated with significant bleeding in dengue patients?
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What condition warrants consideration of plasma transfusion in children with dengue?
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Which factor is NOT linked to an increased risk for mortality in patients with dengue?
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Which statement about citronella-based repellents in relation to dengue is accurate?
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What physiological response occurs during the initial stage of shock?
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What is observed in patients during the recovery phase of dengue?
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What indicates the presence of dengue shock syndrome (DSS)?
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Which statement concerning fluid management in dengue is true?
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In which situation is hospitalization for dengue management warranted?
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What is indicated by an AST or ALT level greater than or equal to 1000?
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What distinguishes dengue from chikungunya in clinical manifestations?
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How does the pulse pressure change during early shock in dengue?
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What is the primary characteristic of a secondary dengue infection?
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What condition warrants the use of PRBCs or whole blood in dengue management?
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What is the effect of excessive intravenous fluid therapy during the recovery stage?
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What is the expected outcome of a narrowing pulse pressure during compensated shock?
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What is commonly seen in the early stages of dengue infection?
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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.
