viernes, 10 de abril de 2009

DENGUE HEMORRÁGICO

Dada la actualidad de este tema en estos tiempos les voy a postear algo de data de esta forma grave de la enfermedad del dengue extraída de la Enciclopedia Médica de la Biblioteca Nacional de Medicina de EEUU.

NOMBRES ALTERNATIVOS:
Dengue hemorrágico; Fiebre por dengue hemorrágico; Síndrome de shock por dengue; Fiebre hemorrágica de Filipinas; Fiebre hemorrágica tailandesa; Fiebre hemorrágica de Singapur.

DEFINICIÓN:
Es una infección grave y potencialmente mortal que se propaga por medio de ciertas especies de mosquitos ( Aedes aegypti ).

CAUSAS, INCIDENCIA Y FACTORES DE RIESGO:
Se sabe que cuatro diferentes virus de dengue causan la fiebre del dengue hemorrágico. Esta afección ocurre cuando una persona contrae un virus de dengue diferente, después de haber sido infectado previamente por otro tipo en algún momento. La inmunidad previa a un tipo de virus del dengue diferente juega un papel importante en esta grave enfermedad.
En todo el mundo se presentan más de 100 millones de casos de fiebre del dengue cada año y un pequeño porcentaje progresa hasta convertirse en fiebre del dengue hemorrágico.
Entre los factores de riesgo para la fiebre del dengue hemorrágico se pueden mencionar tener anticuerpos para el virus del dengue a partir de una infección previa, ser menor de 12 años, ser mujer o de raza blanca.

SINTOMAS
Los síntomas iniciales de la fiebre del dengue hemorrágico son similares a los de la fiebre del dengue, pero después de varios días el paciente se vuelve irritable, inquieto y sudoroso. Estos síntomas van seguidos de un estado parecido al shock.
El sangrado puede aparecer como manchas de sangre pequeñas sobre la piel (petequias) y parches de sangre más grandes bajo la piel (equimosis). Las lesiones menores pueden causar sangrado.
El shock puede causar la muerte. Si el paciente sobrevive, la recuperación comienza después de un período de crisis de un día.

Los síntomas iniciales son, entre otros, los siguientes:

Disminución del apetito
Fiebre
Dolor de cabeza
Dolores articulares
Malestar general
Dolores musculares
Vómitos

Los síntomas de la fase aguda son, entre otros, los siguientes:

Inquietud seguida por
equimosis
erupción generalizada
petequias
empeoramiento de los síntomas iniciales
Estado parecido al shock
extremidades frías y pegajosas
sudoración (diaforesis)

SIGNOS Y EXAMENES:
Un examen físico puede indicar lo siguiente:

Agrandamiento del hígado (hepatomegalia)
Hipotensión
Erupción
Ojos inyectados en sangre
Enrojecimiento de la garganta
Adenopatía
Pulso acelerado y débil

Los exámenes complementarios pueden abarcar los siguientes:

Gasometría arterial
Estudios de coagulación
Electrolitos
Hematocrito
Enzimas hepáticas
Conteo de plaquetas
Estudios serológicos que muestran anticuerpos contra los virus del dengue
Estudios séricos de muestras tomadas durante la fase aguda de la enfermedad y la convalecencia (aumento en el título del antígeno de dengue)
Prueba del torniquete (ocasiona la formación de petequias por debajo del torniquete)
Radiografía de tórax (puede mostrar derrame pleural)

TRATAMIENTO
Debido a que la fiebre del dengue hemorrágico es causada por un virus para el cual no se conoce cura ni vacuna, sólo es posible el tratamiento de los síntomas.
Una transfusión de plasma fresco o plaquetas puede corregir problemas de sangrado.
Los líquidos y electrolitos intravenosos también se usan para corregir los desequilibrios electrolíticos.
Es posible que se requiera oxigenoterapia para tratar niveles de oxígeno en la sangre que están anormalmente bajos.
La rehidratación con líquidos intravenosos con frecuencia es necesaria para tratar la deshidratación.
Tratamiento complementario en un ambiente/unidad de cuidados intensivos

EXPECTATIVAS (pronóstico)
La mayoría de los pacientes con fiebre del dengue hemorrágico se recupera con los cuidados oportunos y agresivos; sin embargo, la mitad de los pacientes sin tratamiento que entran en shock no sobrevive

COMPLICACIONES
Encefalopatía
Daño hepático
Daño cerebral residual
Convulsiones o crisis epiléptica
Shock

SITUACIONES QUE REQUIEREN ASISTENCIA MEDICA
Consulte con el médico si tiene síntomas de fiebre del dengue y ha estado en un área en donde se sabe que se presenta esta enfermedad, especialmente si ha tenido esta fiebre antes

PREVENCIÓN
No existe vacuna disponible para prevenir la fiebre del dengue. Use protección personal, como ropa que cubra todo el cuerpo, repelente contra mosquitos que contenga DEET, mosquiteros y, de ser posible, viaje durante períodos de mínima actividad de los mosquitos (a la noche). Los programas de control de mosquitos también pueden reducir el riesgo de infección. además, como el mosquito crece en aguas quietas (no hace falta que estén estancadas) es importante eliminar toda fuente de agua (floreros, bebedero de animales, etc.) que pueda favorecer el crecimiento de la larva del virus.

REFERENCIAS
Halstead SB. Dengue fever/dengue hemorrhagic fever. In: Cohen J, Powderly WG, Berkley SF, Calandra T, Clumeck N, Finch RG, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa; Churchill Livingstone Elsevier; 2005: chap 184.

Tsai TF, Vaughn DW, Solomon T. Flaviviruses (yellow fever, dengue, dengue hemorrhagic fever, Japanese encephalitis, West Nile encephalitis, St. Louis encephalitis, tick-borne encephalitis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 149

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