DENGUE FEVER

DEFINITION
Dengue fever is an acute febrile disease caused by
infection with one of the serotypes of dengue virus,
which is transmitted by mosquito genus Aedes.
It refers to a benign form of disease with systemic
symptoms, fever, and often rash associated with pain
and in the joints, bones, and behind the eyes.
Dengue hemorrhagic fever is a severe,
sometimes fatal manifestation of the dengue virus
infection characterized by a bleeding diathesis and
hypovolemic shock.
ETIOLOGIC AGENT
1. Flaviviruses 1, 2, 3, 4, a family of Togaviridae, are
small viruses that contain singles-stranded RNA.
2. Arboviruses group B

MODE OF TRANSMISSION
1. Bite of an infected mosquito, principally the
Aedes aegypti
a. Aedes aegypti is a day-biting mosquito (they
appear two hours after sunrise and two hours
before sunset)
b.It breeds in areas of stagnant water.
c. It has limited, low-flying movement.
d.It has fine white dots as the base of the wings
and while bands on the legs.
2. Aedes albopictus may contribute to the
transmission of the dengue virus in rural
3. Other contributory mosquitoes:
e. Aedes polynensis
f. Aedes scutellaris simplex

INCUBATION PERIOD
The incubation period is three to fourteen days; commonly
seven to ten days.
PERIOD OF COMMUNICABILITY
1. Patients are usually infective to the mosquito from a day
before the febrile period to the end of it.
SOUCRES OF INFECTION
2. Infected of persons the virus is present in the blood of
patients during the acute phase of the disease and will
become a reservoir of the virus, sucked by mosquitoes, which
may then transmit the disease.
3. Standing water any stagnant water in the household and
its premises are usual breeding places of these mosquitoes.
INCIDENCE
4. Age Dengue fever may occur at any age, but it is common
among children and peaks between four to nine year old.
5. Sex Both sexes can be affected.
6. Season It is more frequent during the rainy season.
7. Location Dengue fever is more prevalent in urban

PATHOGENESIS AND PATHOLOGY

1. The infectious virus is deposited in the skin by the vector
and initial replication occurs at the site of infection and in
local lymphatic tissues.
2. Within a few days, viremia occurs, lasting until the 4 th or
5th day after the onset of symptoms.
3. Evidence indicates that macrophages are the principal site
of replication.
4. At the site of petechial rash, non-specific changes are
noted, which include endothelial swelling, perivascular
edema, and edema, and extravasation of blood.
5. There is marked increase in vascular permeability,
hypotension, hemoconcertration, thrombocytopenia with
increased platelet agglutinability, and or moderate
disseminated intravascular coagulation.
6. The most serious pathophysiological abnormality is
hypovolemic shock resulting from the increased
permeability of the vascular endothelium and loss of
plasma from the intravascular space.

CLINICAL MANIFESTATIONS
A.Dengue fever
1 prodromal symptoms characterized by:
a. Malaise and anorexia up to 12 hours
b. Fever and chills accompanied by severe frontal
headache, ocular pain, myalgia with severe
backache, and arthralgia
2. Nausea and vomiting
3. Fever is non-remitting and persists for three to
seven days.
4. Rash is more prominent on the extremities and the
trunk. It may involve the face in some isolated
cases.
5. Petechiae usually appears near the end of the
febrile period and most commonly on the lower
extremities.

PHASES OF THE ILLNESS

1.Initial febrile phases lasting from two to
three days
a. Fever (39 40 0C) accompanied by headache
b. Febrile convulsions may appear
c. Palms and sole are usually flushed
d. Positive tourniquet test
e. Anorexia, vomiting, myalgia
f. Maculopapular or petechial rash may be present
and usually starts in the distal portion of the
extremities (sparing the axilla and chest,) the skin
appears purple, with blanched areas of varying size
(Hermans sign, considered pathognomonic to the
disease).
g. Generalized or abdominal pain
h. Hemorrhagic manifestations like positive tourniquet

2. Circulatory phase
a. There is a fall of temperature accompanied by
profound circulatory changes, usually on the 3 rd to 5th
days.
b. Patient becomes restless, with cool, clammy skin.
c. Cyanosis is present.
d. Profound thrombocytopenia accompanies the onset of
shock.
e. Bleeding diathesis may become more severe and lead
to GIT hemorrhage.
f. Shock may occur due to loss of plasma from the
intravascular spaces; hemoconcertration with
markedly elevated hematocrit is present.
g. Pulse is rapid and weak; pulse pressure becomes
narrow and blood pressure may drop to an
unobtainable level.
h. Untreated shock may result in coma; metabolic

CLASSIFICATION ACCORDING TO SEVERITY

(Halstead &Nimmanitya)
Grade I
There is fever accompanied non-specific
constitutional symptoms and the only hemorrhagic
manifestation is positive (+) in the tourniquet test.
Grade II
All signs of grade I, plus spontaneous bleeding from
the nose, gums, and GIT, are present.
Grade III
There is the presence of circulatory failure, as
manifested by a weak pulse, narrow pulse pressure,
hypotension, cold, clammy skin, and restlessness.
Grade IV
There is profound shock, and undetectable blood
pressure and pulse.

COMPLICATIONS
1.Dengue fever
a. Epistaxis; menorrhagia
b. Gastrointestinal bleeding
c. Concomitant gastrointestinal disorder (peptic
ulcer)
2. D H F
d. Metabolic acidosis
e. Hyperkalemia
f. Tissue anoxia
g. Hemorrhage into the CNS or adrenal glands
h. Uterine bleeding may occur
f. Myocarditis
3. Severe manifestations
Dengue encephalopathy is manifested by increasing
restlessness, apprehension or anxiety, disturbed

DIAGNOSTIC TESTS
1. Tourniquet test screening test, done by occluding the arm
veins for about five minutes, to detect capillary fragility
2. Platelet count (decreased) confirmatory test
3. Hemoconcentration an increase of a least 20% in the
hematocrit or a steady rise in the hematocrit
4. Occult blood
5. Hemoglobin determination
TREATMENT MODALITIES
There is no effective antiviral therapy for dengue fever.
Treatment is entirely symptomatic.
6. Analgesic drugs other than aspirin may be required for
relief from headache, ocular pain, and myalgia.
7. Initial phase may require intravenous infusion to prevent
dehydration and replacement of plasma.
8. Blood transfusion is indicated in patients with severe
bleeding.
9. Oxygen therapy is indicated for all patients in shock.
10.Sedatives may be needed to allay anxiety and

NURSING MANAGEMENT
1.Patient should be kept in a mosquito-free
environment to avoid further transmission of
infection.
2.Keep patient at rest during bleeding episodes.
3.Vital signs must be promptly monitored.
4.In cases of nose bleeding, keep the patients
trunk elevated; apply ice bag to the bridge of
nose and to the forehead.
5.Observe for signs of shock, such as slow pulse,
cold, clammy skin, prostration, and fall of blood
pressure.
6.Restore blood volume putting the patient in
Trendelenberg position to provide greater blood
volume to the head part.

COMMON NURSING DIAGN OSIS

1. Altered body temperature
2. Fear
3. Anxiety
4. Knowledge
5. Activity intolerance
PREVENTION AND CONTROL
6. Health education
7. Early detection and treatment of cases will not worsen the
victims condition.
8. Treat mosquito nets with insecticides.
9. House spraying is advised.
10.Eliminate vector by:
a. Changing water and scrubbing sides of flower vases once a
week,
b. Destroying the breeding places of mosquitoes by cleaning the
surroundings, and
c. Keeping the water containers covered.
6. Avoid hanging too many clothes inside the house.