14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 24.014
Session: Arboviruses
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Jumping over the sharp edge of dengue shock syndrome
V. Pinto
Faculty of Medicine, University of Peradeniya., Kandy, Sri Lanka
Background: Dengue is a mosquito-borne viral infection which sometimes can lead to a
potentially lethal complication called Dengue Hemorrhagic Fever (DHF) and dengue shock
syndrome (DSS). In severe cases, the patient may rapidly go into a critical state of shock and
die within 12 to 24 hours. Major pathophysiological hallmark of DHF is an increasing vascular
permeability leading to leakage of plasma and hypovolaemic shock. Also the haematological
abnormalities, leucopenia, thrombocytopenia, immune complex formation, vasculopathy,
thrombopathy myocarditis and Disseminated Intravascular Coagulopathy (DIC) with massive
bleeding contribute to shock and fatal outcome. They also can complicate with pericardial and
pleural effusions, ascitis and Liver failure.
Methods: With the available data of case studies with 11 mortalities and 3 successfully managed
cases two phases of fluid derangement were identified in severe DHF. Namely leaking phase and
auto transfusion phase which can lead to more complex situations like pulmonary oedema.
Both phases were very difficult to diagnose as well as to manage since the situations can
complicate with internal bleeding and myocarditis.
Serveral protocols had been forwaded and the aggressive management according to the
protocols is proved to be effective. Though these protocols were not addressing the different
phases, a clear identification of each phase was mandatory since each phase has complete
opposite management strategies.
Results: Evidences were forwaded from retrospective analysis and management of 9 fatalities of
DHF, and successfully managed patient with DHF grade IV who was complicated with
Hypotension ascitis, bilateral pleural effusion mild pericardial effusion and acute liver failure .
Conclusion: These comparison of dilemmas of identifying the phases and complications and
maintenance of critical fluid balance will be discussed in this paper . .
This will also prove the importance of early involvement of the intensive care for the management
of patients with DHF with severe leakage.