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Guidelines  on  Management  of  Dengue  Fever  &   Dengue  Haemorrhagic  Fever   In  Adults

Ministry  of  Health  -­  Sri  Lanka

National  

Guidelines

 

In Collaboration with the Ceylon College of Physicians December 2010

e guidelines, published in December 2010, supersede the previous guidelines on Clinical Management of Dengue Fever / Dengue Haemorrhagic Fever published byEpidemiology Unit, Ministry of Health in 2005. ese guidelines were developed based on the best available evidence at the time of writing. It is expected to be used in the clinical management of dengue infection in Sri Lanka. e guidelines will be reviewed periodically when new evidence becomes available. Please forward your comments and suggestions to the following address by post or e-mail. eEpidemiologist Epidemiology Unit 231, De Saram Place Colombo -10 E-mail: chepid@sltnet.lk Electronic version is available on www.epid.gov.lk ISBN 978-955-0505-12-8

Contents
Foreword Preface I Preface II Acknowledgements List of Contributors 1. 2. Introduction The Natural Course of the Illness 2.1 Febrile phase 2.2 Critical phase (leakage phase) 2.3 Convalescent phase (recovery phase) 3. 4. 5. 6.Diagnosis at OPD Level & by the Primary Care Physician Criteria for Admission Management of those who Do Not Need Admission Inward Patients 6.1 Introduction 6.2 Detection of critical phase (onset of plasma leakage) 6.3 Early detection of shock 6.4 Monitoring patients during hospital stay 6.5 Management of inward patients 6.6 Options of Fluid for Resuscitation 6.7 ABCS 6.8 Indications for BloodTransfusion 6.9 Indications for Haemodynamic Support 7. 8. Management of Hepatitis and Hepatic Encephalopathy in DHF Dengue in Pregnancy 8.1 Management of pregnant patients with DF/DHF close to delivery 9. Myocardial Involvement in Dengue v vi vii viii ix 1 2 3 3 4 6 7 8 9 9 9 9 10 12 18 18 19 20 21 22 22 23 24 24 24 24 24

10. Place of Adjunctive Therapy in the Management of DHF 10.1 Platelettransfusion 10.2 Fresh frozen plasma transfusion 10.3 Steroids and I.V. immunoglobulin 10.4 Recombinant Factor VII

10.5 Antibiotics 10.6 Frusemide 10.7 Tranexamic acid 11. Transferring a patient to another Institute 12. Discharge 13. Laboratory Diagnosis 14. Outbreak Response Plan for Hospitals Annexures Monitoring chart during pre-critical phase Monitoring chart during critical phase References25 25 25 26 27 28 29 31 31 32 33

Foreword
Dengue haemorrhagic fever (DHF) has become a major public health problem in Sri Lanka in recent years. A large number of suspected Dengue fever (DF) and DHF patients are seen at both out-patient departments as well as at inward levels in most hospitals in the country regularly. e number of deaths due to dengue show an upward trend despite the casefatality rate remaining under 1% probably due to the high case load used as the denominator. erefore, a thorough evaluation of the clinical management could reduce the mortality further due to this disease. I hope that these guidelines on clinical management of dengue fever and dengue haemorrhagic fever prepared by the Epidemiology Unit in collaboration with the Ceylon College of Physicians will bea vital tool for all clinical practitioners in order to further strengthen clinical management. Dr. Ravindra Ruberu Secretary Ministry of Health

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Preface I
Dengue Fever (DF) is currently the most important mosquito-borne viral infection of public health signi cance in Sri Lanka, with thousands of patients acquiring the infection each year. During the Last two to three years we havewitnessed hyperendemicity with more severe manifestations such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) leading to considerable morbidity and mortality with a signi cantly high case fatality rate. ese guidelines on clinical management of dengue fever have been developed by a team of physicians who are experienced in the eld, in consultation with the Ceylon College of...