Dengue circulatory shock : What is the mechanism ?
Dengue is a global infectious disease caused by Flavivirus (RNA) transmitted by day biting mosquitoes Ades aegypti .It is primarily a tropical or sub tropical disease , India is marked among the epicentre . 75% of dengue infections are asymptomatic. Among the remaining 25 % only 5 % develop severe dengue and a fraction of them go for a dreaded circulatory and bleeding complication leading to a likely fatality.Severe hypotension is the hall-mark in dengue shock .
The mechanism of shock
The sine-qua non of dengue shock is the capillary leak syndrome .This is due to some unknown vascular toxins acting in micro circulatory network making it exude fluid .This is something similar to septic shock where mal-distriubution of fluids in the extravascular or third spaces occur . This is also referred to as re-distributive or vasodilatory shock due to lack of effective circulatory volume. Significant serous cavity effusions (Both pleural effusion and ascites ) contribute to the shock syndrome . Meanwhile there can be accompanying fluid loss due to vomiting as well .Adding further complexity ,direct cardiac involvement in few in the form of myocarditis can cause lung congestion and confusing the true mechanism of shock .This has important hemodynamic implication as overzealous fluid therapy without recognising a possible myocarditis can be counter productive.Few sick patients will drag the lung into the vicious cycle ending up with ARDS , refractory hypoxia a...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions dengue myocarditis mechanism of dengue shock myocardial involvement in dengue Source Type: blogs
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