How to treat dengue fever?

It depends on the severity of symptoms and whether the treatment is timely. If it is mild, it is easier to treat. If the condition is serious, the so-called dengue shock syndrome will appear. If it is not treated in time, it will be life-threatening! If you suspect that you have it, you must go to the hospital at once, without delay!

Here is some information:

First of all, typical dengue fever

① Typical dengue fever

1. All patients have a fever. The onset is acute, first chills, and then the body temperature rises rapidly, reaching 40℃ within 24 hours. It usually lasts for 5 ~ 7 days, and then suddenly drops to normal, with irregular heat type. In some cases, the body temperature drops to normal on the 3rd to 5th day, and then rises again on the 1 day, which is called bimodal fever or saddle fever. Children's cases have a slow onset and a low fever.

2. Symptoms of systemic toxic blood fever are accompanied by systemic symptoms, such as headache and low back pain, especially severe pain in bones and joints, just like fractures or fractures. In severe cases, the activity is affected, but the appearance is not red and swollen. Symptoms of digestive tract may include loss of appetite, nausea, vomiting, abdominal pain and diarrhea. The pulse accelerates in the early stage and slows down in the later stage. In severe cases, fatigue and weakness are exhausted.

3. The rash appears in the course of 3-6 days, which is maculopapular rash or measles-like rash, scarlet fever-like rash and red maculopapular rash, and even becomes hemorrhagic rash. The rash is distributed all over the body, limbs, trunk and head and face, and it often feels itchy. The rash lasts for 5-7 days. There was no desquamation and pigmentation after the rash appeared.

4. Hemorrhage: 25 ~ 50% cases have bleeding in different degrees, such as gingival bleeding, nosebleed, gastrointestinal bleeding, hemoptysis, hematuria, etc.

5. Most other people have superficial lymphadenopathy. About 1/4 cases have hepatomegaly and elevated ALT, and some cases may have jaundice, and the beam-arm test is positive.

(2) Mild dengue fever is similar to influenza, with short-term fever, mild systemic pain, rare or no rash, and often accompanied by superficial lymphadenopathy. Because of atypical symptoms, it is easy to misdiagnose or leak rash.

(3) Severe dengue fever has all the symptoms of typical dengue fever in the early stage, but it suddenly gets worse on the third to fifth day of illness, showing severe headache, vomiting, delirium, coma, convulsion, sweating, sudden drop in blood pressure, stiff neck and dilated pupils. Some cases have gastrointestinal bleeding and hemorrhagic shock.

Second, dengue hemorrhagic fever.

It can be divided into two types: mild dengue hemorrhagic fever and severe dengue shock syndrome.

(1) Dengue hemorrhagic fever began to show typical dengue fever. Fever, myalgia and low back pain, but joint pain is not significant, but bleeding tendency is serious, such as nosebleed, hematemesis, hemoptysis, hematuria and hematochezia. There are often a lot of bleeding in more than two organs, and the amount of bleeding is greater than 100ml. Hematocrit increased by more than 20% due to blood concentration, and the platelet count was100×109/L. Although the amount of bleeding in some cases was small, the bleeding site was located in important organs such as brain, heart and adrenal gland, which was life-threatening.

(2) Dengue fever shock syndrome has typical manifestations of dengue fever; During the course of the disease or after the fever has gone down, the condition suddenly worsens, with obvious bleeding tendency and peripheral circulation failure. It is characterized by wet and cold skin, fast and weak pulse, gradually decreasing pulse pressure difference, even undetectable blood pressure drop, irritability, lethargy, coma and so on. The situation is very dangerous. If not rescued in time, he can die within 4 ~ 6 hours.

[diagnosis]

First, epidemiological data In the dengue epidemic season, whenever there are a large number of high fever cases in epidemic areas or ports and tourist areas that may be imported from abroad, we should all think of this disease.

Second, the clinical manifestations should be considered in cases of fever, rash, severe pain in bones and joints and lymphadenopathy; There are obvious bleeding tendencies, such as bleeding spots, purple spots, nosebleeds, bloody stools and so on. Patients with positive bundle arm test, concentrated blood and thrombocytopenia should consider dengue hemorrhagic fever; Dengue shock syndrome should be considered when there is obvious bleeding tendency and peripheral circulation failure during the course of the disease or after the fever has gone down. However, the confirmation of the first case or the first batch of patients and the determination of new epidemic areas must be combined with laboratory examination.

Third, the laboratory inspection

(1) White blood cells decreased after hemogram disease, reaching a low point (2× 109/L) on the 4th to 5th day, and returned to normal 1 week after fever, which was classified as neutropenia and relative increase of lymphocytes. You can see toxic particles and nuclei moving to the left. Thrombocytopenia 1/4 ~ 3/4 cases, the lowest being13×109/l.

Urine and cerebrospinal fluid may be slightly abnormal in some cases.

(2) Commonly used serological tests include complement fixation test, erythrocyte agglutination inhibition test and neutralization test. The titer of single serum complement fixation test exceeded 1: 32, and the titer of erythrocyte agglutination inhibition test exceeded 1: 1280, which was of diagnostic significance. Diagnosis can be made when the titer of double serum antibody in recovery period is more than 4 times higher than that in acute period. Neutralization test has high specificity, but it is difficult to operate. Neutralization index over 50 is positive.

(3) Virus classification: Inoculate the serum of patients with acute phase into the brain of newborn mice (1 ~ 3 days old), monkey kidney cell line or chest muscle of Aedes albopictus to isolate the virus. The positive rate of 1 disease day reached 40%, then gradually decreased, and the virus could still be isolated during the course of12 days. Recently, the Aedes albopictus cell line C6/36 was used for virus isolation, and the positive rate was as high as 70%. The second-generation isolate of C6/36 cell culture can be used as virus hemagglutinin for erythrocyte agglutination inhibition test of virus typing, or as complement binding antigen for complement binding test typing, so as to achieve the purpose of rapid diagnosis.

[Differential diagnosis]

Dengue fever should be differentiated from influenza, measles, scarlet fever and drug eruption. Dengue shock syndrome of dengue hemorrhagic fever should be differentiated from jaundice hemorrhagic leptospirosis, epidemic hemorrhage, septicemia, epidemic cerebrospinal meningitis and yellow fever.

[therapy]

There is no specific treatment for this disease, and the following points should be paid attention to during treatment:

First of all, the general treatment in the acute phase should be bed rest, liquid or semi-liquid diet, isolation in the ward with anti-mosquito equipment until the fever completely disappears, so it is not easy to go to the fields prematurely to prevent the disease from getting worse. Keep skin and mouth clean.

Second, symptomatic treatment (a) high fever should be based on physical cooling. For patients with obvious bleeding symptoms, alcohol bath should be avoided. Antipyretic and analgesic drugs are not effective in reducing fever and can induce hemolysis in patients with G-6PD deficiency, so they should be used with caution. For patients with severe poisoning symptoms, short-term use of low-dose adrenocortical hormone, such as oral prednisone 5mg3 times a day.

(2) Keep the balance of water and electricity. Patients with sweating or diarrhea should be encouraged to take oral rehydration. Patients who often vomit, can't eat or dehydrate, and have insufficient blood volume should be given intravenous infusion in time, but they should be highly alert to the aggravation of illness and the occurrence of meningoencephalitis caused by infusion reaction.

(3) Patients with bleeding tendency can use hemostatic drugs such as Anluoxue, Zhixuemin, Vitamin C and K, etc. For cases of massive hemorrhage, fresh whole blood or platelets should be infused, and a large dose of vitamin K 1 should be injected intravenously, and Yunnan Baiyao should be taken orally. Patients with severe upper gastrointestinal bleeding can take cimetidine orally.

(4) Shock cases should be infused quickly to expand blood volume and supplement plasma and plasma substitutes. DIC patients should not receive whole blood to avoid blood concentration.

(5) In case of cerebral type, 20% mannitol (250~500ml) should be used in time for rapid intravenous injection, and dexamethasone should be given intravenously at the same time, so as to reduce intracranial pressure and prevent cerebral hernia.