Dengue

  1. Discuss the management of Dengue Shock Syndrome (DNB 1997/1)10
  3. Dengue Fever (DNB 2003/2)15
  4. Define DHF and DSS and outline the treatment of DSS (DNB 2005/1)10
  5. Diagnosis and management of DHF and DSS (DNB 2006/1)10
  6. Outline the WHO criteria for diagnosis of dengue hemorrhagic fever. Draw an algorithm for volume replacement for a child with DHF and >20% increase in hematocrit (DNB 2009/1)3+7
  7. Define DHF and DSS. How does DHF differ from dengue fever with hemorrhage? Describe treatment of DSS (DNB 2009/2)2+2+1+5
  8. Classify severity of dengue hemorrhagic fever. Write in brief the management of dengue shock syndrome (DNB 2011/1)4+6
  9. What are the fluid, metabolic and biochemical changes in a child with severe dengue? Discuss the underlying pathophysiology (DNB 2013/1)10
  10. Define severe dengue and describe the WHO guidelines for its management. Enumerate the indications for transfusion in dengue (DNB 2014/1)2+6+2
  11. Describe the WHO guidelines for its management.Enumerate complications of Severe Dengue (DNB 2016/1)4+4
  14. Fluid therapy in DHF (DNB 2019/1)5
  15. Fluid management in Dengue Shock Syndrome and its complications (DNB 2019/2)5
  18. Management of Dengue Shock Syndrome (DNB 2022/2)5,(DCH 2024/1)5
  20. Severe dengue management in 15 kg child (DCH 2023/2)5
  21. Management of a 10-year-child with dengue shock (DNB 2024/1)5
PYQ

  1. Pathogenesis of bleeding and shock in Dengue fever (DNB 1998/2)10
  2. Pathophysiology of Dengue fever (DNB 2021/2)5
  3. Classification of dengue fever (DNB 2022/2)5
  4. Dengue and its classification (DCH 2023/2)5

Pathophysiology of Dengue

graph TD
    A[Infected Aedes Mosquito Bite] --> B{DENV Infection};
    B --> C[Primary Infection];
    B --> D[Secondary Infection
Different Serotype];

    C --> E[Asymptomatic or
Dengue Fever DF];

    D --> F[Antibody-Dependent Enhancement ADE];
    F --> G[Increased Viral Entry into Monocytes/Macrophages];
    G --> H[Increased Viral Replication & High Viral Load];

    H --> I(Cytokine Storm);
    H --> J(Complement Activation);

    I --> K[Increased Vascular Permeability];
    J --> K;

    K --> L[Plasma Leakage];
    H --> M[Thrombocytopenia
Platelet Depletion];

    L & M --> N[Dengue Hemorrhagic Fever DHF];
    N --> O[Dengue Shock Syndrome DSS];

    subgraph "Host Immune Response"
        F
        I
        J
    end

    subgraph "Key Pathological Events"
        K
        L
        M
    end

    subgraph "Clinical Manifestations"
        E
        N
        O
    end

    style F fill:#f9f,stroke:#333,stroke-width:2px
    style K fill:#f9f,stroke:#333,stroke-width:2px
    style O fill:#c00,stroke:#333,stroke-width:2px,color:#fff

Antibody dependent enhancement (ADE)

cytokine storm

Vasculopathy

Coagulopathy

Clinical features

Febrile phase

Critical phase

Convalescent phase

Approach to dengue

graph TD
    A["Febrile patient in endemic area"] --> B{"Assess for Dengue"};
    B --> C{"History & Physical Exam\nLook for rash, myalgia, headache"};
    C --> D["Tourniquet Test"];
    C --> E["CBC with Platelet Count"];
    
    E --> F{"Any Warning Signs?"};
    F -- No --> G["Group A: Ambulatory Care"];
    F -- Yes --> H{"Group B: In-patient Care"};

    G --> G1["Advise adequate hydration & nutrition"];
    G1 --> G2["Paracetamol for fever (Avoid NSAIDs)"];
    G2 --> G3["Educate on warning signs"];
    G3 --> G4["Daily follow-up until afebrile for 48h"];
    G4 --> F;

    H --> H1["Obtain baseline Hematocrit (HCT)"];
    H1 --> H2["Start IV fluid therapy\n(Isotonic crystalloids)"];
    H2 --> H3["Monitor vitals, fluid balance,\nHCT, platelets"];
    H3 --> I{"Patient Improves?"};

    I -- Yes --> J["Gradually reduce IV fluids"];
    J --> K["Discharge when stable, afebrile,\ngood urine output, and rising platelet count"];
    
    I -- "No, develops signs of severe dengue" --> L{"Group C: Severe Dengue"};
    
    L --> M["Urgent admission to HDU/ICU"];
    M --> N["Manage shock with\ncrystalloid/colloid resuscitation"];
    N --> O["Manage severe bleeding\nwith blood transfusion"];
    O --> P["Manage organ failure"];

    subgraph "Initial Assessment"
        C
        D
        E
    end

    style F fill:#ffdfba,stroke:#333,stroke-width:2px
    style L fill:#ffb3ba,stroke:#c00,stroke-width:2px
    style G fill:#baffc9,stroke:#333,stroke-width:1px
    style H fill:#ffdfba,stroke:#333,stroke-width:1px

Severe Dengue

PYQ

  1. Define severe dengue (DNB 2016/1)2

mindmap
  root((Dengue))
    ("Warning Signs")
      ("Abdominal pain 
or tenderness")
      ("Persistent vomiting")
      ("Clinical fluid 
accumulation")
      ("Mucosal bleed")
      ("Lethargy, 
restlessness")
      ("Liver enlargement 
 #62; 2 cm")
      ("Lab: increase in HCT
with rapid decrease
in platelet count")
    ("Severe Dengue Criteria")
      ("Severe plasma leakage
leading to shock
( DSS )")
      ("Severe bleeding")
      ("Severe organ impairment
( liver, CNS, heart )")

Lab features

PYQ

  1. Diagnostic lab tests for dengue fever (DNB 2018/1)4