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2. 50 million dengue infections occur annually 2.5 billion people live in dengue endemic countries Dengue is now endemic in all WHO regions except the WHO European region. WHO South-east Asia region and Western pacific region -70% of population at risk -75% of disease burden 3. All four serotypes DENV-1 DENV-2 DENV-3 DENV-4 are found INDIA DENV-1&DENV-2 are widely found 4. Infection with one serotype confers lifelong immunity to that serotype only Secondary infection with any other serotype which caused primary infection causes severe form of dengue DHF/DSS 5. ASYMPTOMATIC DSS SYMPTOMATIC Without haemorrhage With unusual haemorrhage No shock Undifferentiated Fever Dengue Fever Dengue Haemorrhagic Fever 6. Primary infection with dengue virus Simple indistinguishable fever from other viral infection URI & GIT symptoms are common 7. Abrupt onset, rising to 39.5-41.4 C Accompanied by frontal or retro-orbital headache Pain behind the eyes,photophobia chillness Last 1-7 days Biphasic: defervesce for 1-2 days recurring with second rash 8. break bone fever is the another name of DF After onset of fever May last several weeks Increase in severity Most common in legs, joints, and lumbar spine; With muscular and joint pains. 9. FIRST RASH: first 1-2 days of fever, transient, generalized, macular and blanching; SECOND RASH 3-6 days. morbilliforms , maculopapular , rubella type Involving the trunk first, spreading to the face and extremities, sparing palms and soles. other rash: petechiae 10. Skin hemorrhages: petechiae, purpura, ecchymoses Gingival bleeding Nasal bleeding Gastro-intestinal bleeding: hematemesis, melena, hematochezia Hematuria Increased menstrual flow 11. FEBRILE PHASE CRICTICAL PHASE RECOVERY PHASE 12. High fever(40-41) Headache Anorexia Vomiting Abdominal pain Tenderness at right costal margin Rash less common 13. Inflate blood pressure cuff to a point midway between systolic and diastolic pressure for 5 minutes Positive test: 20 or more petechiae per 1 inch2 (6.25 cm2) 14. Days 3-7 Progressive leukopenia followed by thrombocytopenia Plasma leakage - pleural effusion /ascites Warning signs-abdominal tenderness,persistent vomiting,liver enlargement,lethargy,restlesness ,mucosal bleeding Shock Organ impairment-hepatitis ,encephalitis,myocarditis DIC and haemorrhage 15. Improvement in general condition Good apetite Stable hemodynamics Isles of white in sea of red PCV stabilizes , increasing WBC count and platelet count 16. Shock-due to plasma leakage pulse pressure