Dengue Guideline 2022 PDF

Pocket Guideline for Dengue Clinical Case Management 2022 (Revised) National Malaria Elimination & Aedes Transmitted Diseases Control Program Disease Control Division Directorate General of Health Services Mohakhali, Dhaka-1212 Pocket Guidel...

Pocket Guideline for Dengue Clinical Case Management 2022 (Revised) National Malaria Elimination & Aedes Transmitted Diseases Control Program Disease Control Division Directorate General of Health Services Mohakhali, Dhaka-1212 Pocket Guideline for Dengue Clinical Case Management 2022 (Revised) Editorial Board Advisor : Prof. Dr. Abul Bashar Mohammad Khurshid Alam, Director General, DGHS Chief Patron : Prof. Dr. Md. Nazmul Islam, Director, Disease Control & Line Director, CDC, DGHS Editor in Chief : Prof. Quazi Tarikul Islam Editors : Prof. Ahmedul Kabir Prof. HAM Nazmul Ahasan Prof. Md. Billal Alam Prof. Md Titu Miah Prof. Dr. Md. Robed Amin Prof. Md. Jahangir Alam Prof. Rubina Yasmin Dr. Hafez Md. Nazmul Ahsan Dr. Mohammad Rafiqul Islam Managing Editor : Dr. Md. Ekramul Haque National Malaria Elimination & Aedes Transmitted Diseases Control Program Disease Control Division, DGHS Mohakhali, Dhaka-1212  New revised WHO Dengue case classification by severity A) Dengue without warning signs: Group A (Send home). B) Dengue with warning signs: Group B (Referred for in-hospital care). C) Severe dengue: Group C (Require emergency management).   Dengue case classification by severity Dengue ± warning signs Severe dengue with 1. Severe plasma leakage Without warning signs 2. Severe haemorrage 3. Severe organ impairment  Criteria for dengue ±warning signs Criteria for severe dengue Probable Dengue Warning Signs* 1. Severe Plasma Leakage Live in/travel to dengue Seveere abdominal pain or leading to : endemic area. Fever and 2 tenderness Shock (DSS) of the following criteria Persistent vomiting >3 times/ day Fluid accumulation with Nausea, vomiting Persistent diarrhoea >3 times/ day respiratory distress Rash Clinical fluid accumulation 2. Severe Bleeding Aches and pains Mucosal bleed as evaluated by clinician Tourniquet test positive Lethargy, restlessness Leucopenia Liver enlargement >2cm 3. Severe Organ Involvement Laboratory : Increase in Hct. Liver: AST or ALT>=1000 Any Warning singn concurrent with rapid decrease CNS: Impaired consciousness Laboratory Confirmed dengue Heart and other organs in platelet count (important when no sign of 4. Metabolic & electrolytes plasma leakage) Requiring strict observation and medical intervention abnormalities  Clinical Management Dengue case classification Dengue Viral Infection Symptomatic Asymptomatic Mild DF : Group -A Moderate DF : Group - B Servere DF: Group -C DF with high risk / DF with warning signs & symptoms co-morbid conditions with / without minor bleeding  A. Undifferentiated DF Infants A. DF with warning sign A. DF with significant B. Fever without complication Old age and symptoms Haemorrhage like bleeding, hypotension Diabetes Recurrent vomiting B. (i) DHF with significant and organ involvement Hypertension Abdominal pain/tenderness haemorrhage with or without C. Without evidence of Pregnancy General weakness/lethargy/ shock capillary leakage Coronary Artery Disease restless (ii) DHF III & IV (DSS) with Haemoglobinopathies Minor bleeding shock with or without Immunocompromized Mild pleural effusion/ascites significant haemorrhage Home Management patient Hepatomegaly C. Severe organ involvement Patient on steroids, Increased Hct. (Expanded Dengue Syndroms) anticoagulants or B. DHF Gr I & II with / without D. Metabolic and electrolyte immunosuppresants minor bleeds abnormalities Close Monitoring and Hospitalization Tertiary level care Clinical Presentation of Dengue Dengue fever Dengue haemorrhagic fever Dengue shock syndrome Expanded dengue syndrome Dengue fever Headache Myalgia Arthralgia / bone pain (break-bone fever) Rash GIT manifestations: Nausea, vomiting, diarrhea (seen in recent outbreaks) Haemorrhagic manifestations (mild, unusual hemorrhage) Leukopenia (WBC