Dengue is transmitted by the bite of an Aedesmosquito infected with any one of the four dengue viruses.

It occurs in tropical and sub-tropical areas of the world. Symptoms appear 314 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults. Other names of Dengue: H-Fever (Hemorrhagic Fever) Dengue Shock Syndrome Breakbone Fever due to prominent muscle and joint pain Dandy Fever

Dengue Fever/Dengue Fever Syndrome Is a tropical disease caused by different strains of dengue virus which are transmitted by Aedes Aegypti mosquitos. It is an acute infectious disease characterized by severe pain behind the eye and the joints and bones and accompanied by rash. No bleeding occurs. Dengue Shock Syndrome Medical emergency due to loss of plasma and requires immediate administration of IVF to expand plasma volume. Dengue Hemorrhagic Fever Those cases with gross hemorrhages. A severe illness characterized by abnormal vascular permeability, hypovolemia and abnormal blood clotting mechanism Causative Agent: 4 serotype of the dengue virus (1,2,3 and 4 Group B Arbovirus) the 4 viruses are antigenically close to each other however, they only give partial cross protection after being infected by any of them

Aedes Aegypti Bite of the Female Aedes Aegypti (day biting, low flying, breeds in stagnant water, in urban areas). Why female? It is because that they use the blood obtained for laying of eggs. It is the primary vector for the transmission of dengue. Sources: 1. Infected Persons virus is present in the blood of patients during the acute phase of the disease and will become a reservoir of the virus 2. Standing water will serve as a breeding place for the mosquitoes

Mode of transmission By the bit of an infective Aedes Aegypti mosquito Incubation Period 4-6 days (minimum: 3 days; maximum: 10days) Pathophysiology: Each of the 4 types of Dengue virus can cause either classical or dengue hemorrhagic fever. Virus enters the blood stream Neutralizing antibodies are produced principally against the virus type Because of the production of antibodies, and the response of the immune system to the initial attack, constitutional signs and symptoms are manifested Because of the increasing antigen-antibody complex

1. Increased capillary fragility brought about by a strong immune complex reaction the produce toxic substance like histamine, serotonin and bradykinin which damages the capillary wall in an attempt to repair lesions, clotting occurs DISSEMINATED INTRAVASCULAR COAGULATION 2 .Increased capillary permeability loss of plasma from intravascular space 3. Thrombocytopenia acute excessive consumption of platelets due to generalized intravascular clotting 4. Decreased blood coagulation factors initiated by lesions in the capillary wall

SIGNS AND SYMPTOMS OF DENGUE HEMORRHAGIC FEVER Signs and symptoms depend on the Grade: Grade I (+) fever lasting 3 5 days o o o o o o o Abdominal pain Anorexia, nausea and vomiting Pain behind the eyes Joint pains (+) eveidence of vascular changes petechiae Hermans sign general flushing of the skin

Grade III signs and symptoms of Grade II + Circulatory failure o Hypotension, rapid but weak pulse

Grade IV signs and symptoms of Grade III + Shock

Diagnostic Test For Dengue Hemorrhagic Fever A specific diagnostic test for dengue fever is needed for rapid detection, confirmation of acute condition, detection of dengue antibodies and separation of dengue viral RNA or protein in tissue specimen or serum. Serological Tests Acute dengue virus infection is most frequently confirmed by the use ofserological tests. Dengue viral antigen can be detected for early diagnosis of the disease. These tests are available in many countries. The tests are carried out to detect dengue and also to ascertain the acuteness of the infection. If there is four times are higher increase in the dengue antibodies between initial and later samples, the infection is confirmed as acute. MAC-ELISA The MAC-ELISA test is used for rapid confirmation of dengue fever. It needs to be repeated every 10 to 14 days if the initial test was negative. The samples collected initially and later can be analyzed through what is called hemaggulation inhibition (HI) or made to undergo enzyme immunoassays for definite confirmation or denial of acute dengue infection. Complex Tests There are some complex tests called complement fixation and neutralising antibody which are not possible in every medical centre. Since these assays are very technically demanding, they are possible only in specialised laboratories. Dengue Virus Isolation Separation of dengue virus or detecting dengue viral RNA in a patients sample of serum or tissue gives a confirmation of the infection. But these assays have limited application because of their complex techniques. They are generally performed for the purposes of different types of medical research. The dengue fever diagnostic tests are many and each has a different purpose. The most useful ones for the general public are serological rapid dengue tests because they help in early diagnosis and initiation of treatment.

Treatment: Symptomatic No specific antiviral drugs In most cases, early and most effective replacement of plasma loss with plasma expander and or fluid electrolytes solution results in a favorable outcome.

Medical Management: A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment

Nursing Management: Supportive and symptomatic treatment should be provided: Promote rest Medication Paracetamol for fever Analgesic (Acetaminophen (Tylenol) and codeine) for severe headache and joint and muscle pains o Aspirin and nonsteroidal anti-inflammatory drugs should be avoided Rapid replacement of body fluids is the most important treatment o Give ORESOL to replace fluid as in moderate dehydration at 75ml/kg in 4-6 hours or up to 2-3L in adults. Continue ORS intake until paients condition improves. o Intravenous fluid For hemorrhage o o Keep patient at rest during bleeding periods For epistaxis maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. o For melena ice bag over the abdomen. Provide support during the transfusion therapy Diet o Low fat, low fiber, non-irritating, non-carbonated o Noodle soup may be given Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration. o o

For shock o o Place in dorsal recumbent position to facilitate circulation Provision of warmth through lightweight covers (overheating causes vasodilation which aggravates bleeding)

PREVENTION: The best way to prevent dengue fever is to take special precautions to avoid contact with mosquitoes. Eliminate vector by: o Changing water and scrubbing sides of lower vases once a week o Destroy breeding places of mosquito by cleaning surroundings o Proper disposal of rubber tires, empty bottles and cans o Keep water containers covered

Because Aedes mosquitoes usually bite during the day, be sure to use precautions especially during early morning hours before daybreak and in the late afternoon before dark.

Other precautions include: When outdoors in an area where dengue fever has been found o Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus o Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes Keeping unscreened windows and doors closed Keeping window and door screens repaired Use of mosquito nets

Research: Dengue Hemorrhagic Fever

Submitted by:
Ponce, Katrina P. BSN3B-Group 6