denguefever登革热.ppt
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denguefever登革热.ppt
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Denguefever,ZhaozhixinThe3rdaffiliatedhospitalofSunYat-SenU,WHATISDENGUEFEVER?
Anacute,self-limited,febriledisease.DenguevirusaremaintainedinacyclethatinvolveshumansandAedesaegyptiprimarilyadiseaseofthetropicsOCCURSINtwoforms:
Denguefever(DF)Denguehaemorrhagicfever(DHF),Clinicalmanifestations,DF:
fever,headache,myalgias,bonepain.Lymphadenopathy,skinrash.LeukopeniaDHF:
highfever,haemorrhage,hepatomegalyevidencesof“leakycapillaries”signsofcirculatoryfailure(dengueshocksyndrome,DSS.),Whyshouldwelearnit?
2500millionatriskfromdengueperyear.Epidemicinmorethan100countriesinAfrica,America,EasternMediterranean,SoutheastAsiaandtheWesternpacific.TheglobalprevalenceofDHFgrowndramaticallyinrecentdecades:
1970/1995:
4foldincrease.Themostimportantmosquito-transmittedviraldiseaseintermofmortalityandmorbidity.,Etiology,Denguevirus:
envelopedRNAvirusClassified:
familyofFlaviviridae.Serumtype:
1-4causescloselyrelatedillness,severeandfataldiseasebutantigenicallydistincthomotypicimmunity:
lifelongheterotypicimmunity:
shortperiodbutcross-responsemayworsenthesecondinfectionbyaanotherserumtype.,HowDFtransmitted?
Sourcesofinfection:
patientsandanyonewhowithCovertinfectionTransmittedvectors:
AedesaegyptiisthemostcommonvectorsotherAedesmosquitosarelesseffiecitent:
Ae.albopictus,Ae.polynesiesisPrimarilyadaytimefeederLivesaroundhumanhabitationThehost:
allsusceptibleifnevercameacrossdenguefever.,Howdengueviruscausethedisease?
(pathogenesisandclinicalpresentations),Denguevirus,Bloodstream,Mononuclear-phagocytesystem,secondviremia,Antigenantibodycomplexes,complementsystem,incubation,Lymphadenopathy,hepatomegly,Bonemarrowdepress,Vascularpermeability,Rash,haemarrhagic,feverBonepains,etc,Imfllamatorymaterials,riskfactorsforDHF,ImportantriskfactorsforDHFincludeVirusfactors:
theserotype:
2isthepredominatingthestrain:
virulentstrainHostfactors:
geneticpredispositiontheageChildren:
experiencedapreciousdengueinfectionInfantswithwaninglevelsofmaternaldengueantibody.immunestatus:
ifthereareenhancingAb.,Enchancingantibody,AmechanismofDHF/DSSisheterotypicantibodiesenhancementofvirusreplicationinmacrophagesworsenthecondition,NeutralizingantibodytoDengue1virus,Dengue1virus,HomologousAntibodies(同型抗体)FormNon-infectiousComplexes,Non-neutralizingantibody,Complexformedbyneutralizingantibodyandvirus,Heterologous(异型的)ComplexesEnterMoreMonocytes,WhereVirusReplicates,Non-neutralizingantibody,Dengue2virus,Complexformedbynon-neutralizingantibodyandDengue2virus,Firstinfection,heterotypicantibodies,failtoneutralizevirusoftheotherserumtypeinfection,thenumberofinfectedmonocytes,activationofcytotoxiclymphocytes,rapidreleaseofcytokines,plasmaleakage,viraluptakeandthereplicationinthemononuclearphagocytes.,haemorrhage,Haemoconcentrationorshock,pathophysiologicalchangesoccurinDHF/DSS:
Increasedvascularpermeabilityhaemoconcentration(Hct20%)lowpulsepressureothersignsofshock.Disorderinhaemostaisis:
vascularchangesthrombocytopeniacoagulopathy.,CLINICALPRESENTATIONS,Incubation:
5-8daysClinicalfeaturesdependontheageofthepatient:
Infantsandyoungchildrenundifferentiatedfebriledisease,withmaculapapularrash.Olderchildrenandadultseitheramildfebrilesyndromeortheclassicdisease.,ManifestationOfDengueVirusInfections,UndifferentiatedFever,themostcommonmanifestationofdengue87%ofstudentsinfectedwereeitherasymptomaticormildlysymptomaticstudiesincludingallage-groupsalsodemonstratesilenttransmission,Denguefever(DF),1.fever,Abruptonset,risingto39.5-41.4CAccompaniedbyfrontalorretro-orbitalheadachePainbehindtheeyeschillnessLast1-7daysBiphasic:
defervescefor1-2daysrecurringwithsecondrashbut:
Tnotashigh,2.Bonepains,breakbonefeveristheanothernameofDFAfteronsetoffeverMaylastseveralweeksIncreaseinseverityMostcommoninlegs,joints,andlumbarspine;Withmuscularandjointpains.,3.Rash,firstrash:
first1-2daysoffever,transient,generalized,macularandblanching;Secondrash3-6days.morbilliforms,maculopapular,rubellatypeInvolvingthetrunkfirst,spreadingtothefaceandextremities,sparingpalmsandsoles.otherrash:
petechiae,4.Hemorrhage,Skinhemorrhages:
petechiae,purpuraGingivalbleedingNasalbleedingGIbleeding:
hematemesis,melena,hematocheziaHematuriaIncreasedmenstrualflow,Physicalexams
(1),FeverConjunctivalinjection,pharyngealerythemaRash:
Measles-likerashoverchestandupperlimbsGeneralizedlymphadenopathy,Physicalexams
(2):
TourniquetTest,Method:
Inflatebloodpressurecufftoapoint:
midwaybetweensystolicanddiastolicpressurefor5minutesPositivetest:
20ormorepetechiaeper1inch2(6.25cm2),ClinicalformsofDF(china),MildtypeTypicaltypeSeveretype:
Unusualbleedingsmeningoencephalit
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