Response of the thrombocytopenia associated with dengue. When dengue virus bites you, its symptoms appear only after four to six days. Dengue hemorrhagic fever is characterized by a leakage phase or critical phase usually lasting cas e pre s e n tatio n 48 hours following an initial febrile phase 2,3. Le van tuan 1, phan thi tuyet nga 1, trinh thi hong hanh 1, nguyen thi thu tram 1, pham tho duoc 1.
It is estimated that there are currently 50100 million cases of dengue every year worldwide, including more than 500,000 reported cases of dengue hemorrhagic fever and dengue shock syndrome. Generally, most dengue infections are classified as simple dengue fever. Chikungunya virus more likely to cause high fever, severe polyarthralgia, arthritis, rash, and lymphopenia dengue virus more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death patients with suspected chikungunya should be managed as dengue until dengue has been ruledout. Dengue hemorrhagic fever nursing care management and study guide. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue. Symptoms include a high fever, headaches, joint and muscle pain, vomiting, and a rash.
Feb 26, 2019 dengue fever is a viral infection commonly found in the tropical and subtropical regions that is carried and spread by the aedes aegypti mosquito currently, there are no vaccines to protect. Thrombocytopenia in dengue infection raises concern about bleeding risk. Uma maheswara rao4 1pg in pediatrics, department of pediatrics, alluri sitarama raju academy of medical sciences, eluru, 534004,west godavari district, a. Dengue fever df is the most prevalent mosquitoborne viral illness in the world endemic in more than 100 countries, with 2. Dengue fever dengue hemorrhagic fever is now one of the most important public health problems in tropical developing countries and also has major economic and societal consequences. European centre for disease prevention and control. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. I ask because i believe it is a greatly overplayed relationship in the minds of many clinicians. However, often it is difficult to differentiate df from dhf in the early phase febrile phase of the illness. Mar 19, 20 clinical manifestations of dengue and dengue hemorrhagic fever undifferentiated fever classic dengue fever dengue hemorrhagic fever dengue shock syndrome 14. Infection by any one of the four serotypes of dengue virus denv remains asymptomatic in the vast majority.
Current and historical conditions indexed list of current and historical nationally notifiable conditions. Infection with one serotype of denv provides immunity to that. Corticosteroid responsive prolonged thrombocytopenia in a. Crystalloid fluid resuscitation and standard dic treatment are critical to the childs survival. Dengue haemorrhagic fever world health organization. Pdf entomological investigation of dengue vectors researchgate. Bone marrow suppression by virus and peripheral destruction of platelets have been implicated. Severe thrombocytopenia in dengue fever and vitamin b12 level. Dengue virus infection dvi is a prevalent and potentially fatal viral disease associated with coagulopathy. Dengue pronounced as dengee dengue fever is a highly debilitating mosquitoborne disease mostly seen in tropical countries. Dengue and thrombocytopenia by sandeep saluja 24 jun, 2017. With a focus on understanding the possible mechanism of thrombocytopenia in denv. It can also become dengue shock syndrome, which causes massive bleeding and shock.
Covert covid19 and falsepositive dengue serology in. Thrombocytopenia in dengue fever is a common and very serious complication. Guidelines for treatment of dengue fever dengue haemorrhagic fever in small hospitals dengue is the most important emerging tropical viral disease of humans in the world today. A randomized clinical trial of human interleukin11 in dengue fever associated thrombocytopenia. Study on the effectiveness of transfusion program in dengue patients receiving platelet transfusion nagarekha kulkarni abstract aims. Commonly dengue, malaria, scrub typhus and other rickettsial infections, meningococci, leptospira and certain viral infections present as fever with thrombocytopenia. Pathogenesis of dengue haemorrhagic fever and its impact. The patients were white women aged 32, 37, 40, 41, and 67 years in whom dhf had been diagnosed on the basis of clinical and serological elisa with a positive igm result findings.
A dengue serological test was performed on 1,100 85% of the patients with a positive result in 763 69%, hi test on 243 patients 22%, igg dengue blot on 489 patients 44% and igm dengue blot on 25 patients 2. Case report corticosteroidresponsive prolonged thrombocytopenia following dengue haemorrhagic fever k. Diagnosis may involve a complete blood count and spinal tap to rule out other diseases. Effect of vitamin e on thrombocytopenia in dengue fever vaish. Clinical features of dengue virus infection are usually nonspecific ranging right from selflimiting disease like fever, headache, myalgia, rashes, and arthralgia to dengue haemorrhagic fever and dengue shock syndrome. Each year, there are 50 million dengue infections and 500,000. It is a mosquitoborn disease caused by genus aedes. It is estimated that there are currently 50100 million cases of dengue every year worldwide, including more than 500,000 reported cases of dengue hemorrhagic fever and dengue shock syndrome dhfdss. Dengue infected patients manifest a spectrum of symptoms and in severe cases the fate is mortality. Dengue is probably the most important arthropodborne viral disease in terms of human morbidity and mortality. Occasionally these patients can go on to develop a stormy course with multiorgan dysfunction requiring intensive care unit admission associated with high morbidity and mortality. Boonpucknavig s, boonpucknavig v, bhamarapravati n, nimmannitya s.
A dengue serological test was performed on 1100 85% of the 0 patients. Pathogenesis of dengue haemorrhagic fever and its impact on. Several factors have been attributed to increased morbidity and mortality in dengue with altered haematological and coagulation parameters playing an important role. The provisional diagnosis was dengue fever as the clinical picture was typical of the infection. Viral virulence, infection enhancing antibodies, cytokines and chemical mediators in the setting of intense immune activation are the key players implicated in the pathogenesis of dhf. Dengue is a major health problem and ranks as the most important mosquito borne viral disease in the world. Introduction d engue is one of the most significant arboviral diseases of humans worldwide. Dengue fever is a virus transmitted to humans through bites from the aedes mosquito, a daybiting mosquito. Introduction dengue fever df and dengue hemorrhagic fever. There is no specific antiviral treatment currently available for dengue fever. Thromboelastometry analysis of thrombocytopenic dengue. Pdf incidence of thrombocytopenia in seropositive dengue. May i please seek members views on the role of thrombocytopenia in diagnostics and therapeutics of dengue.
Initial symptoms are common to all patients, but the clinical manifestations of the severe forms rapidly evolve with symptoms including high fever. This study aims to determine frequency of coexisting dengue fever and malaria in thrombocytopenic patients presenting with acute febrile illness so that magnitude of the condition could be assessed. Learn more dengue clinical case management elearning pathophysiology of severe dengue. Dengue fever is often characterised with incubation period varying from 3 to 14 days is followed by a febrile illness consisting of suddenonset fever. The first dengue hemorrhagic fever epidemic in the americas occurred in cuba in 1981 and involved serotype 2 dengue denv2, with hundreds of thousands of cases of dengue in both children and adults, 24,000 cases of dengue hemorrhagic fever, 10,000 cases of dengue. The second case is a 57yearold woman with no relevant past medical, travel, or contact history, who presented to a regional hospital on feb, 2020, with fever, myalgia, a mild cough of 4 days, and 2 days of diarrhoea. Serious thrombocytopenia due to dengue hemorrhagic fever. Severe thrombocytopenia in dengue fever and vitamin b12. The affected patients usually present with high fever almost all cases 28 and present a positive tourniquet test. Dengue and dengue hemorrhagic fever centers for disease. May 03, 2019 a child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as this severely ill pediatric icu patient did. See a healthcare provider if you develop a fever or have symptoms of dengue.
In order to enable the transmission of the illness. Thrombocytopenia and platelet transfusions in dengue. In 763 69% of them evidence was found of a present or previous dengue. Symptoms typically begin three to fourteen days after infection. Demonstration of yellow fever and dengue antigens in formalinfixed paraffinembedded human liver by immunohistochemical. Dengue fever symptoms and signs include rash, fever, headache, and joint pain. Dengue haemorrhagic fever typical cases of dhf are characterized by four major clinical manifestations. Dengue fever is an acute febrile disease caused by infection with one of the serotypes of dengue virus.
Sirduring the 2002 dengue hemorrhagic fever dhf outbreak in brazil, we treated 5 patients in recife with dhf. Take acetaminophen tylenol or panadol as needed for fever and pain. Background dengue causes significant morbidity and mortality in the tropical countries. A hallmark of dengue infection is thrombocytopenia which causes concern for the patients and treating doctors. Do not take aspirin, ibuprofen advil, or naproxen aleve, since these may increase bleeding. X dont give platelet transfusions for a low platelet count.
Dengue fever and dengue haemorrhagic fever are important arthropodborne viral diseases. The world health organization who has provided a number of free publications about dengue. Maternal and fetal outcome of dengue fever in pregnancy. This study aimed to evaluate the incidence of thrombocytopenia in seropositive dengue patients. Clinicohaematological profile and outcome of dengue fever. Dengue fever df illness caused by any of the four serotypes of dengue virus flavivirus is currently the most important mosquito borne viral disease in the tropical areas of the world. Pdf controversies in dengue pathogenesis researchgate. Undifferentiated fevermay be the most common manifestation ofdengueprospective study found that 87% of patientsinfected were either asymptomatic or only mildlysymptomaticother prospective.
Dengue fever is a viral disease spread by aedes aegypti diptera. Thrombocytopenia is a common laboratory finding in df and almost always found in dengue haemorrhagic fever shock syndrome. Clinicohaematological profile and outcome of dengue fever in. The importance of platelet counts in dengue infection. Introduction in the city of balikpapan, dengue hemorrhagic fever dhf is the leading cause of hospital admission for ages below 5 years of age and the fifth most common cause of death. Our study suggests that b12 deficiency may responsible for severe thrombocytopenia. Immunofluorescence study of skin rash in patients with dengue hemorrhagic fever. Thrombocytopenia is a common laboratory finding in dengue infection. Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses.
It is estimated that there are between 50 and 100 million cases of dengue fever df and about. Intravenous immunoglobulin for severe thrombocytopenia in. Thrombocytopenia is frequently observed in mild and severe cases of dengue. The findings could be used to plan that all patients with acute febrile illness with thrombocytopenia must be screened for dengue fever. Figure 1 evolution of the situation of dengue and dhf dengue hemorrhagic fever in the americas, 19802007. Dec 07, 2018 some patients with dengue fever go on to develop dengue hemorrhagic fever, a severe and sometimes fatal form of the disease.
Dengue fever 3 associated problems dengue can occasionally affect several other body systems,15 either in isolation or along with the classic dengue symptoms. Uma maheswara rao 4 1 pg in pediatrics, department. Pdf a randomized clinical trial of human interleukin11. However, it usually resolves as the patient recovers from the infection. Dengue haemorrhagic fever and dengue shock syndrome dss are serious compli cations of dengue infection that occur primarily in children. Dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever df or dengue haemorrhagic fever dhf with plasma leakage that may lead to hypovolaemic shock dengue shock syndrome, dss figure 2. Laboratory diagnosis and diagnostic tests dengue ncbi. Thrombocytopenia in patients with dengue virus infection. Department of health and human services centers for. The presence of thrombocytopenia was determined in 1,300 patients with dengue haemorrhagic fever dhf 1,198. We aimed to describe the prevalence and characteristics of coagulation abnormalities in dengue fever. A study of ns1 antigen and platelet count for early diagnosis. Thrombocytopenia progression in dengue cases during the 2010. Clinicohaematological profile and outcome of dengue fever in children c.
Dengue fever df is the most prevalent and expanding arboviral disease in humans, and its incidence is increasing. Dengue and dengue hemorrhagic fever 1 dengue and dengue hemorrhagic fever information for health care practitioners dengue is a mosquitoborne disease caused by any one of four closely related dengue viruses denv1, 2, 3, and 4. L may be observed in dengue fever but it is a constant feature of dengue haemorrhagic fever. The clinical features of df frequently depend on the age of the patient. Dengue fever is common in tropical areas, so take extra precautions if you travel somewhere with this type of climate. Case report open access dengue hemorrhagic fever and. Adequate hydration and paincontrol medications will help to manage dengue fever symptoms. However, no specific treatment is available for dengue fever induced thrombocytopenia. Dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever df or dengue haemorrhagic fever dhf with plasma leakage. Clinical spectrum among symptomatic infection ranges from undifferentiated fever viral syndrome, dengue fever df, and dengue haemorrhagic fever dhf to the expanded dengue. Health experts have known about dengue fever for more than 200 years. These data suggest that treatment of severe thrombocytopenia accompanying dhf with antid may be a useful and safe therapeutic option. Dengue is a febrile illness that can have a fatal outcome in severe cases.
So far, the coagulation profile of dvi patients with thrombocytopenia has not been assessed through a viscoelastic test such as rotational thromboelastometry. A tertiary teaching hospital during a recent outbreak of dengue fever in the area. Such patients may develop hypovolaemic shock resulting from plasma leakage. In some cases, dengue turns into dengue hemorrhagic fever, which causes bleeding from your nose, gums, or under your skin. Plasma leakage and intrinsic coagulopathy are the pathological hall marks in dengue haemorrhagic fever dhf. Pdf research into the pathogenesis of dengue fever has exploded over the last halfcentury, with issues that were. Chikungunya virus more likely to cause high fever, severe polyarthralgia, arthritis, rash, and lymphopenia dengue virus more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death patients with suspected chikungunya should be managed as dengue until dengue. Several recent studies have investigated the causes of thrombocytopenia in dengue. Jun 15, 2003 s ir during the 2002 dengue hemorrhagic fever dhf outbreak in brazil, we treated 5 patients in recife with dhf. Effects of filgrastim on thrombocytopenia in patients with. Autochthonous cases of dengue in spain and france, 1. Clinical observation of 15 thai children with dengue hemorrhagic fever. Occasionally these patients can go on to develop a stormy course with multiorgan dysfunction.
In most of the cases of dengue fever in pregnancy, no serious harm has been noted. Aug 15, 2001 dengue fever df is the most prevalent and expanding arboviral disease in humans, and its incidence is increasing. Since the 1980s, the dengue virus has caused major epidemics in sri lanka, notably in 2001 and 2004, resulting in 4304 and 15 457 new cases with 54 and 88 deaths, respectively. This disease used to be called breakbone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. The cdc estimates that there are 50 to 100 million cases of df and several. Dengue fever is a disease transmitted to humans via mosquito bites. It is a viral infection where a human acts as the reservoir while the disease is transmitted by mosquitoes.
Thrombocytopenia may occur in patients with either mild or severe cases of dengue infection and are associated in the early days of dengue infection. Dengue management dos and donts x dont use corticosteroids. In 2015, north india had the most recorded number of cases in the last decade. Laboratory and human studies have suggested a direct correlation between activation and depletion of platelets, with a sharp drop occurring on day 4 of fever.
Dengue fever and malaria in thrombocytopenic patients. Alterations in thrombopoiesis in patients with thrombocytopenia produced by dengue hemorrhagic fever. Dengue and thrombocytopenia connecting our members with. Thrombocytopenia in dengue fever and the role of platelet. They are not indicated and can increase the risk of gi bleeding, hyperglycemia, and immunosuppression. Thrombocytopenia is common in patients with dengue virus denv infections. The present study was done to analyze the haematological findings and correlate the same with the. Patients with dengue hemorrhagic fever and dengue shock syndrome were excluded.
Thrombocytopenia, often combined with leukopenia, is an early and consistent feature of dengue that is usually observed in the period between day 3 and day 8 following the onset of illness. National center for emerging and zoonotic infectious diseases. However, measures were taken to exclude an alternative infective process such as infective endocarditis. The presence of thrombocytopenia was determined in 0 patients with clinically suspected dengue haemorrhagic fever dhf 1198. Persistent thrombocytopenia following dengue fever. Dengue infection is a global health problem affecting an estimated population of 50100 millions every year. Corticosteroidresponsive prolonged thrombocytopenia. Hence there is a lacunae in diagnosing dengue virus infection early both in relation to clinical features and laboratory tests.
Its symptoms include high fever, joint pain, headache and pain in the back of eyes the most prominent sign of the dengue. Dengue fever is a mosquitoborne tropical disease caused by the dengue virus. Several factors have been attributed to increased morbidity and mortality in dengue. Travelers can prevent dengue you can buy products containing. Dengue and dengue hemorrhagic fever 1 dengue and dengue hemorrhagic fever information for health care practitioners dengue is a mosquitoborne disease caused by any one of four closely related dengue. It is more common in children but with increasing rate of adult dengue fever. Dengue causes serious infection in humans, resulting in morbidity and mortality in most tropical and subtropical areas of the world. As the outbreaks of dengue fever increasing in india, one state after other getting affected, it is very essential to know more about this disease and prevalence, any change in the viral strain.
Pdf intensive entomological investigations were carried out in seven. The who guidelines for 2009 reaffirmed that a rapid decline or platelet count below 150,000mm 3 of blood are one of the indicators of clinical dengue. Transmitted by aedes mosquitoes and epidemic in most tropical areas, the disease may have a high attack rate among people of any age, regardless of whether they are residents of or travelers to areas of endemicity. Thrombocytopenia in patients with dengue virus infection and correlation between circulating soluble micb protein level and platelet counts. Dengue fever frequently causes thrombocytopenia for which there is no satisfactory treatment. Dengue is considered the most prevalent mosquitoborne viral disease worldwide and sometimes turns out to be lifethreatening. It is a caused by a flavivirus with four distinct serotypes dv1, dv2, dv3, and dv4. Data of 51 patients with dengue fever with thrombocytopenia, or dengue like fever with thrombocytopenia patients in whom reduction in fever.
To evaluate the effect of vitamin e on thrombocytopenia in dengue fever. Thrombocytopaenia is usually observed in the period between day 3 and day 8 following the onset of illness. A study of ns1 antigen and platelet count for early diagnosis of dengue infection santosh shivajirao tathe, chincholkar vv, kulkarni dm, nilekar sl, ovhal rs, and halgarkar cs 1department of microbiology, s. Antibodydependent enhancement of disease and severe dengue. Dengue is a mosquitoborne disease caused by any one of four closely related dengue viruses. Thrombocytopenia in patients with dengue virus infection and. It is more common in children but with increasing rate of adult dengue fever victims, the number of infected pregnant women has also in creased. Study on the effectiveness of transfusion program in. Changing epidemiology of dengue hemorrhagic fever in. This is called dengue shock syndrome dss and can be fatal.
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