Tuesday, June 23, 2020

Dengue fever tips

Dengue fever (dengue) is an acute infectious disease caused by the transmission of dengue virus through mosquito vectors. Dengue virus infection can lead to recessive infection, dengue fever, and dengue hemorrhagic fever. Dengue hemorrhagic fever is rare in my country. Typical clinical manifestations of dengue fever include rapid onset, high fever, headache, severe soreness in muscles, bones and joints, rash in some patients, bleeding tendency, enlarged lymph nodes, decreased white blood cell count, and decreased platelets. The disease is mainly endemic in tropical and subtropical regions. my country, Guangdong, Hong Kong, and Macao are endemic areas of dengue fever. Because the disease is spread by Aedes mosquitoes, the epidemic has a certain seasonality, generally from May to November each year, and the peak is from July to September. In the new epidemic areas, the population is generally susceptible, but the incidence is mainly adults, and in the endemic areas, the incidence is mainly children.

Dengue virus is a flavivirus genus in the Flaviviridae family. It is a single-stranded positive-strand RNA virus. The virus is resistant to low temperatures. It can survive in human serum at -20 ℃ for 5 years and -70 ℃ for more than 8 years. But it is not heat-resistant. It can be inactivated in 30 minutes at 50°C or 2 minutes at 100°C. It is not resistant to acid. It can be inactivated with detergent, ether, ultraviolet light and 0.65% formaldehyde solution. Four dengue viruses of serotypes have been isolated, all of which are pathogenic. Aedes mosquitoes (including Aedes aegypti and Aedes albopictus) are their main hosts, and patients and insidious infections are the main sources of infection. The patient was most infectious within 1 day to 3 days after the onset. A small number of patients can also isolate the virus from the blood on the third day after the fever.

Dengue virus enters the human body through the bite of Aedes mosquitoes, enters the blood circulation after the capillary endothelial cells and monocyte-phagocytic cell system proliferate, forming the first toxemia. It then localizes and replicates in the mononuclear-phagocytic cell system and lymphoid tissue, and is released into the blood again, forming a second toxemia. Dengue virus and the anti-dengue virus antibodies produced by the body form an immune complex that activates the complement system, resulting in increased vascular permeability. At the same time, the virus can inhibit bone marrow, resulting in white blood cells, thrombocytopenia and bleeding tendency.

Dengue virus is a flavivirus genus in the Flaviviridae family. It is a single-stranded positive-strand RNA virus. The virus is resistant to low temperatures. It can survive in human serum at -20 ℃ for 5 years and -70 ℃ for more than 8 years. But it is not heat-resistant. It can be inactivated in 30 minutes at 50°C or 2 minutes at 100°C. It is not resistant to acid. It can be inactivated with detergent, ether, ultraviolet light and 0.65% formaldehyde solution. Four dengue viruses of serotypes have been isolated, all of which are pathogenic. Aedes mosquitoes (including Aedes aegypti and Aedes albopictus) are their main hosts, and patients and insidious infections are the main sources of infection. The patient was most infectious within 1 day to 3 days after the onset. A small number of patients can also isolate the virus from the blood on the third day after the fever.

Dengue virus enters the human body through the bite of Aedes mosquitoes, enters the blood circulation after the capillary endothelial cells and monocyte-phagocytic cell system proliferate, forming the first toxemia. It then localizes and replicates in the mononuclear-phagocytic cell system and lymphoid tissue, and is released into the blood again, forming a second toxemia. Dengue virus and the anti-dengue virus antibodies produced by the body form an immune complex that activates the complement system, resulting in increased vascular permeability. At the same time, the virus can inhibit bone marrow, resulting in white blood cells, thrombocytopenia and bleeding tendency.

At present, there is no definitive and effective pathogen treatment for this disease, and the main support and symptomatic treatment measures are taken.

1. General treatment

The patient lives in an isolation ward with anti-mosquito equipment. In the acute phase, you should rest in bed until your body temperature and platelet count return to normal and there is no tendency to bleed. The diet should be liquid or semi-liquid, nutritious and easily digestible food. Pay attention to clean the mouth and skin to keep the stool smooth.

2. Lower body temperature

For patients with high fever, physical cooling should be used first, such as ice compress, alcohol bath, and analgesic and antipyretic drugs should be used with caution. For patients with high fever and severe toxic blood symptoms, short-term application of small doses of adrenal cortex hormones, such as oral prednisone.

3. Fluid replacement

For those who sweat a lot and have diarrhea, make oral rehydration first, pay attention to water, electrolyte and acid-base balance. If necessary, intravenous fluid replacement should be used to correct dehydration, hypokalemia, and metabolic acidosis, but be alert to the possibility of inducing cerebral edema, intracranial hypertension, and cerebral hernia.

4. Reduce intracranial pressure

For cases of severe headache and intracranial hypertension, rapid intravenous infusion of 20% mannitol injection should be applied in time. At the same time, intravenous infusion of dexamethasone can help reduce cerebral edema and reduce intracranial pressure. Patients with suppressed respiratory centers should be treated with artificial ventilator in time.

5. Hemostasis

For those with bleeding tendency, general hemostatic drugs such as carbachol and vitamin K are given. When the amount of bleeding is large, whole blood or platelets can be transfused.

Prognosis

Dengue fever is an infectious disease with a self-limiting tendency. The course of disease in patients without complications is about 10 days. The disease usually has a good prognosis. The majority of deaths are severe patients.

prevention

1. Manage the source of infection

Endemic or potentially endemic areas should do a good job of monitoring and forecasting dengue fever outbreaks, early detection, early diagnosis, and timely isolation and treatment. Specific laboratory tests should be performed as soon as possible to identify light patients. Suspected patients should be medically observed, and patients should be isolated in the hospital room with screens and screen doors, and the isolation time should be no less than 5 days. Strengthen frontier health and quarantine.

2. Cut off the transmission route

Mosquito control and mosquito control are the fundamental measures to prevent this disease. Improve the sanitary environment, eliminate breeding grounds for Aedes mosquitoes, and clear up stagnant water. Spray mosquito repellent to eliminate adult mosquitoes.

3. Protect susceptible people

Improve the disease resistance of the crowd, pay attention to a balanced diet, combine work and rest, exercise properly, and enhance physical fitness. Apply insect repellent to susceptible people during the epidemic to prevent mosquito bites.

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