HAEMORRHAGIC FEVERS

 

Clinical case description

Acute onset of fever of less than 3 weeks duration in a severely ill patient and any 2 of the following

                 Haemorrhagic or purpuric rash; epistaxis; haematemesis; haemoptysis; blood  in stools Other haemorrhagic symptom and no known predisposing host factors for  haemorrhagic manifestations

Note: During epidemics, most infected patients do not show haemorrhagic symptoms and a specific case definition, according to the suspected or proven disease, has to be used.

DENGUE FEVER

Clinical description

             An acute febrile illness of 2-7 days duration with 2 or more of the following:

             headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, leucopenia.

Laboratory criteria for diagnosis

One or more of the following:

  •  Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy  samples
  •  Demonstration of a fourfold or greater change in reciprocal IgG or IgM  antibody titres to one or more dengue

           virus antigens in paired serum samples

  •  Demonstration of dengue virus antigen in autopsy tissue by immunohistochemistry or immunofluorescence or

          in serum samples by EIA
  • Detection of viral genomic sequences in autopsy tissue, serum or CSF samples by polymerase chain reaction

          (PCR)

       

Case classification
  • Suspected: A case compatible with the clinical description. Probable: A case compatible with the clinical

         description with one or more of the following:

  •  Supportive serology (reciprocal haemagglutination-inhibition antibody titre  1280, comparable IgG EIA titre or

          positive IgM antibody test in late acute or convalescent-phase serum specimen).

  •  Occurrence at same location and time as other confirmed cases of dengue fever.
  • Confirmed: A case compatible with the clinical description, laboratoryconfirmed.

DENGUE HAEMORRHAGIC FEVER

A probable or confirmed case of dengue and Haemorragic tendencies evidenced by

one or more of the following:

  •  Positive tourniquet test
  • Petechiae, ecchymoses or purpura
  • Bleeding: mucosa, gastrointestinal tract, injection sites or other
  • Haematemesis or melaena And thrombocytopenia (100 000 cells or less per mm3) And evidence of plasma

    leakage due to increased vascular permeability, manifested by one or more of the following:

          -20% rise in average haematocrit for age and sex

          - 20% drop in haematocrit following volume replacement treatment compared to baseline

         - signs of plasma leakage (pleural effusion, ascites, hypoproteinaemia) WHO

 Recommended Surveillance Standards WHO/CDS/CSR/ISR/99.2 40

DENGUE SHOCK SYNDROME

All the above criteria, plus evidence of circulatory failure manifested by rapid and weak pulse, and narrow pulse

pressure (£20 mm Hg) or hypotension for age, cold, clammy skin and altered mental status.