PATHOPHYSIOLOGY OF DENGUE

RISK FACTORS: Unscreened house, living near a stagnant water or canal, unprotected or uncovered containers with water, previous dengue infection; compromised immune system

Initial Infection: DENGUE FEVER

FOUR DISTINCT SEROTYPE OF DENGUE VIRUS: DEN1, DEN2, DEN3, DEN4

Virus enters dermal tissues or blood vessels at the site of a mosquito bite

Once inside, the host immune response is activated: Monocyte/macrophages will encounter the antigen

Monocyte/macrophages releases pyrogen (fevercausing chemicals)

Hypothalamus is stimulated to increase the bodys thermostatic set-point

Virus infects a monocyte

Dengue viruses circulate in the peripheral blood and lymphatic system

Onset of fever (5-7 days) Overcrowding of virus in the bone marrow Decreased bone marrow functioning
Decreased production of platelets

Bone pain

Host develops an antibody to that specific serotype of dengue virus only (ex. DEN1)

Virus reaching bone marrow replicate and causes destruction to precursor cell (megakaryocyte cells that produce platelets)

leukocytopenia

With proper management (rest, increased fluid intake, antipyretic-analgesic medi cation, proper nutrition), a person recovers from Dengue Fever.

Thrombocytopenia
Hemorrhagic symptoms: >petechiae >gingival bleeding

Infection with either DEN-2, 3, or 4 through another mosquito bite

SECOND INFECTION: DENGUE HEMORRHAGIC FEVER

Previously formed antibodies (DEN-1) cannot neutralize the new serotype of dengue virus

Formation of an ANTIGENANTIBODY complex in a process called antigen dependent enhancement (ADE)

This complex is recognized by receptors on macrophages which then internalize/phagocitize the antigen-antibody complex and promotes its replication within the macrophages

Affected macrophages release vasoactive substances (histamine and kinin

Increases vascular permeability

Vascular leakage or plasma leakage

Decreased Blood Volume

Thrombocytopenia

DENGUE SHOCK SYNDROME

HYPOVOLEMIA: s/sx: decrease hct; hypotension; weak, thready pulse; cold clammy skin; pallor; cyanotic nail beds; poor capillary refill

Hemorrhage

Circulatory Collapse

SHOCK

DEATH