Dengue fever physical examination: Difference between revisions

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Revision as of 19:22, 14 June 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The physical examination in Dengue fever should be directed to ward identifying signs that the patient has severe disease warranting admission or in-hospital observation.

Vital Signs

Tachycardia, postural hypotension, and hypotension could indicate dehydration. Patients who are triaged to home management should urinate at least every 6 hours.

The tourniquet test

Skin

Petechiae may be present.

The above picture is a rash typically associated with Dengue fever.

Mental Status

Lethargy and restlessness are warning signs that the patient should be monitored.

HEENT

Mucosal bleeding is a warning signs that the patient should be monitored.

Lungs

Pleural effusion is a warning sign the capillary leak may be occurring and that the patient should be monitored.

Abdomen

Abdominal pain or tenderness are warning signs that the patient should be monitored.
Liver enlargment >2 cm is a warning signs that the patient should be monitored.
Ascites is a warning signs that the patient should be monitored.

Extremities

Pedal edema or evidence of fluid accumulation

Appearance of the Patient

a petechial rash with thrombocytopenia and relative leukopenia.

Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

Weak rapid pulse,
Narrow pulse pressure (less than 20 mm Hg)

or,

Hypotension for age;
Cold, clammy skin and restlessness.

References

@@ Line 39: / Line 39: @@
-• assessment of haemodynamic status (Textbox D);
+===Appearance of the Patient===
-• checking for quiet tachypnoea/acidotic breathing/pleural effusion;
+ a petechial rash with [[thrombocytopenia]] and relative [[leukopenia]].
-===Appearance of the Patient===
-The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with [[thrombocytopenia]] and relative [[leukopenia]].
-There exists a [[World Health Organisation|WHO]] [http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/index.html definition of dengue haemorrhagic fever] that has been in use since 1975; all four criteria must be fulfilled:
-# [[Fever]]
-# [[Bleeding|Haemorrhagic]] tendency (positive [[tourniquet test]], spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody [[diarrhea]])
-# [[Thrombocytopenia|Thrombocytopaenia]] (&lt;100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
-# Evidence of plasma leakage ([[hematocrit]] more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, [[pleural effusion]], [[ascites]], hypoproteinaemia)
 '''Dengue shock syndrome''' is defined as dengue haemorrhagic fever plus: