Dengue Case In Davao City

• Dengue is endemic • Health care providers respond differently • Because dengue infections have a wide array of manifestations ranging from asymptomatic to fatal shock syndromes • The pathologic mechanisms underlying DHF are not always

Suspected ØAn acute febrile illess of 2-7 days duation w/ 2 or more of the following: vHeadache vRetro-orbital Pain vMyalgia vArthralgia vRash vHemorrhagic manifestations (petechiae, TT+, etc.) vLeukopenia

Probable ØA case compatible w/ the suspected case classification w/ one or more of the ff: vSupportive serology (a reciprocal hemogglotination-inhibition antibody titre >or= 1280, a comparable IgG ELISA titre or a positive IgM antibody test on a late acute or convalescent-phase serum specimen) vOccurrence at the same location and time as other confirmed cases of dengue fever

Confirmed • A case compatible with the clinical description and Laboratory criteria of: Serological Confirmation – Demonstration of a fourfold or greater change in IgG antibody titres to one or more dengue virus antigens in paired serum samples – Anti-dengue IgM ELISA positive (P/N >or= 2)

Confirmed v Virological confirmation – Isolation of the dengue virus from serum or autopsy samples – Demonstration of the Dengue Virus Antigen by Immunofluorescence or Immunoperoxidase test – Demonstration of Dengue Virus Genome by RT-PCR using Dengue concensus and Serotype specific primers – Samples for Virological Confirmation • 1-2 ml serum sample preferably obtained 3-5 days after onset of fever • Serum samples

Case Definition for DHF WHO case definition for DHF, the following must all be present: Fever or history of acute fever, lasting 2-7 days, occasionally biphasic. Bleeding (haemorrhagic tendencies), evidenced by at least one of the following:

– a positive tourniquet test (TT) – petechiae, ecchymosis, or purpura – bleeding from the mucosa, gastrointestinal tract, injection sites or other locations – haematemesis or melena

Thrombocytopaenia (100,000 cells per mm3 or less) Evidence of plasma leakage due to increased vascular permeability, manifested by at least one of the following:

– a rise in the haematocrit equal or greater than 20% above average for age, sex and population – a drop in the haematocrit following volume-replacement treatment equal to or greater than 20% of baseline – signs of plasma leakage such as pleural effusion, ascites, and hypoproteinaemia.

case definition for DSS • the four criteria above for DHF (fever, haemorrhagic tendencies, • thrombocytopaenia, and plasma leakage) must all be present plus evidence of circulatory failure