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gue fever
Laboratory
– C o m p lete blo o d co unt (C B C ) and d ifferentials with p latelet co unt: leuk o p enia and
thro m bo cy to p enia are co m m o n with ≤ 1 0 0 0 0 0 p l3atelets/ m m .
– H aem ato crit is th e o nly test th at sh o w s h aem o co ncentratio n and th erefo re
d ifferentiates d engue fever fro m d engue haem o rrhagic fever (h aem ato crit elevated
2 0 % abo ve average fo r the age and sex: e.g. if the average haem ato crit fo r the relevant
p o p ulatio n is 3 5 % , a haem ato crit o f 4 2 % co rresp o nd s to an increase o f 2 0 % ).
– C o nfirm atio n o f the d iagno sis:
C o nfirm the aetio lo gy at the beginning o f an ep id em ic with sero lo gy (E L I S A o r rap id
tests): elevated I gG and I gM anti-d engue antibo d ies co nfirm a recent infectio n.
The I gM / I gG ratio d ifferentiates p rim ary infectio n ( h igh ratio ) fro m a seco nd ary
infectio n (lo w ratio ), and therefo re risk o f sho ck .
A n increase in antibo d ies between two sam p les (fro m the beginning and end o f an
ep iso d e) co nfirm s an acute infectio n. The sero ty p e is id entified by sero lo gy o r P C R .
Treatment
– Dengue fever
• G ive paracetamol P O ( see Fever, p age 2 6 ) ; w rap th e p atient in a w et clo th .
A cety lsalicy lic acid (asp irin) is strictly co ntra-ind icated .
• P revent o r treat m o d erate d eh y d ratio n ( p lenty o f fluid s, o ral reh y d ratio n salts,
fo llo w Treatment plans A or B to treat dehydration, W H O , p ages 3 1 6 to 3 2 0 ).
– Dengue haemorrhagic fever (Grades I and II)
• H o sp italise and o bserve child ren und er 1 5 y ears, p atients p resenting with significant
o r rep eated h aem o rrhages, p atients with less than 2 0 0 0 0 p latelet3s/ m m and all
p atients having d ifficulty eating o r d rink ing.
• M o nito r vital signs (p ulse, blo o d p ressure, resp irato ry rate and urine o utp ut) every
3 ho urs and haem ato crit every 6 ho urs. L o o k fo r the signs that p reced e sho ck .
• A d m inister Ringer Lactate: 7 m l/ k g/ ho ur fo r 6 ho urs then ad ap t acco rd ing to the
clinical evo lutio n and haem ato crit.
I f there is an im p ro vem ent: p ro gressively red uce the rate to 5 m l/ k g/ ho ur th en
3 m l/ k g/ ho ur and sto p the infusio n after 2 4 to 4 8 ho urs.
If there is no im p ro vem ent: increase to 1 0 m l/ k g/ ho ur, then 1 5 m l/ k g/ ho ur.
P lace the p atient und er a m o squito net.
IM injectio ns are co ntra-ind icated .
– Dengue shock syndrome: emergency +++ (Grades III and IV)
• A d m inister Ringer Lactate: 1 0 to 2 0 m l/ k g in less than 2 0 m inutes, to be rep eated if
necessary , until a cum ulative vo lum e o f 3 0 m l/ k g is reached .
If vital signs and haem ato crit im p ro ve: change to 1 0 m l/ k g/ ho ur and then ad ap t
acco rd ingly .
I f there are no signs o f im p ro vem ent: ad m inister o xy gen and im m ed iately check
haem ato crit:
– if the haem ato crit is still elevated o r has risen: plasma substitute 1 0 to 2 0 m l/ k g
infused in less than 1 0 m inutes. R ep eat if necessary , until a cum ulative vo lum e o f
3 0 m l/ k g is reached , then give 1 0 to 2 0 m l/ k g/ ho ur until im p ro vem ent in the
vital signs is seen.
202
Laboratory
– C o m p lete blo o d co unt (C B C ) and d ifferentials with p latelet co unt: leuk o p enia and
thro m bo cy to p enia are co m m o n with ≤ 1 0 0 0 0 0 p l3atelets/ m m .
– H aem ato crit is th e o nly test th at sh o w s h aem o co ncentratio n and th erefo re
d ifferentiates d engue fever fro m d engue haem o rrhagic fever (h aem ato crit elevated
2 0 % abo ve average fo r the age and sex: e.g. if the average haem ato crit fo r the relevant
p o p ulatio n is 3 5 % , a haem ato crit o f 4 2 % co rresp o nd s to an increase o f 2 0 % ).
– C o nfirm atio n o f the d iagno sis:
C o nfirm the aetio lo gy at the beginning o f an ep id em ic with sero lo gy (E L I S A o r rap id
tests): elevated I gG and I gM anti-d engue antibo d ies co nfirm a recent infectio n.
The I gM / I gG ratio d ifferentiates p rim ary infectio n ( h igh ratio ) fro m a seco nd ary
infectio n (lo w ratio ), and therefo re risk o f sho ck .
A n increase in antibo d ies between two sam p les (fro m the beginning and end o f an
ep iso d e) co nfirm s an acute infectio n. The sero ty p e is id entified by sero lo gy o r P C R .
Treatment
– Dengue fever
• G ive paracetamol P O ( see Fever, p age 2 6 ) ; w rap th e p atient in a w et clo th .
A cety lsalicy lic acid (asp irin) is strictly co ntra-ind icated .
• P revent o r treat m o d erate d eh y d ratio n ( p lenty o f fluid s, o ral reh y d ratio n salts,
fo llo w Treatment plans A or B to treat dehydration, W H O , p ages 3 1 6 to 3 2 0 ).
– Dengue haemorrhagic fever (Grades I and II)
• H o sp italise and o bserve child ren und er 1 5 y ears, p atients p resenting with significant
o r rep eated h aem o rrhages, p atients with less than 2 0 0 0 0 p latelet3s/ m m and all
p atients having d ifficulty eating o r d rink ing.
• M o nito r vital signs (p ulse, blo o d p ressure, resp irato ry rate and urine o utp ut) every
3 ho urs and haem ato crit every 6 ho urs. L o o k fo r the signs that p reced e sho ck .
• A d m inister Ringer Lactate: 7 m l/ k g/ ho ur fo r 6 ho urs then ad ap t acco rd ing to the
clinical evo lutio n and haem ato crit.
I f there is an im p ro vem ent: p ro gressively red uce the rate to 5 m l/ k g/ ho ur th en
3 m l/ k g/ ho ur and sto p the infusio n after 2 4 to 4 8 ho urs.
If there is no im p ro vem ent: increase to 1 0 m l/ k g/ ho ur, then 1 5 m l/ k g/ ho ur.
P lace the p atient und er a m o squito net.
IM injectio ns are co ntra-ind icated .
– Dengue shock syndrome: emergency +++ (Grades III and IV)
• A d m inister Ringer Lactate: 1 0 to 2 0 m l/ k g in less than 2 0 m inutes, to be rep eated if
necessary , until a cum ulative vo lum e o f 3 0 m l/ k g is reached .
If vital signs and haem ato crit im p ro ve: change to 1 0 m l/ k g/ ho ur and then ad ap t
acco rd ingly .
I f there are no signs o f im p ro vem ent: ad m inister o xy gen and im m ed iately check
haem ato crit:
– if the haem ato crit is still elevated o r has risen: plasma substitute 1 0 to 2 0 m l/ k g
infused in less than 1 0 m inutes. R ep eat if necessary , until a cum ulative vo lum e o f
3 0 m l/ k g is reached , then give 1 0 to 2 0 m l/ k g/ ho ur until im p ro vem ent in the
vital signs is seen.
202
