Dengue Shock Syndrome Announcements Hubert Yeargan 登革休克综合征休伯特耶根公告.pptVIP

Dengue Divya Bappanad Karapitya Hospital Galle, Sri Lanka Initial Presentation HPI: 18 yo Sri Lankan male in USOH until developed fever, myalgias and vomiting x 3 days. On basketball team and day prior to fever participated in game with no complaints. PMH: none Medications: none Immunizations: up to date SH: student, lives with mother in nearby community outside Galle, + electricity and running water, no siblings, no recent travel. Physical Exam Vitals: T 40C BP 110/80 supine 90/70 standing HR 96 RR 16 SpO2 not available Gen: Alert, Ill appearing HEENT: PERRLA, EOMI, + conjunctival injection, OP clear, MM dry Neck: No LAD CV: RRR, no m/g/r Lungs: CTAB, no w/r/r Ab: +BS, soft, NT, ND, no HSM Ext: No edema Skin: No petechia Studies WBC 5.2 86% N, 12% L and 1.2% M, Hgb 14 and Platelets 16,000 Dengue IgM + and IgG + CXR: clear Continued Clinical Course Day 2 Coffee ground emesis Transfused FFP, plts and has transfusion rx Day 3 Increased work of breathing Transferred to ICU and intubated Abx, plts and steroids Day 4 Hypotension, decreased urine output with worsening hypoxia Started on pressors Progressive Deterioration Day 6 Abdominal compartment syndrome Paracentesis with 1.5 L removed Day 7 Worsening hypotension, decreased urine output and difficulty ventilating Day 10 Withdrawal of ventilatory support Dengue Epidemiology Incidence 2.5 billion people in over 100 endemic countries 50 million people infected annually with 500,000 cases of DHF and approx 20,000 deaths Wide spectrum of illness although most subclinical or asymptomatic Dengue virus Flavivirus: Single Stranded RNA virus Serotypes: DEN-1 to DEN-4 DEN-2 and DEN-3 severe disease with secondary dengue infections Epidemiology Vector Mosquito Primarily Aedes Aegypti Aedes albopictus, Aedes polynesiensis and other Aedes species also Most female Ae. aegypti appear to spend lifetime in or around the houses where they emerge as adults. Suggest people rather than mosquitoes, rapidly move the