Dengue Fever

Is a tropical disease caused by different strains of dengue virus which are transmitted by
mosquitoes by the genus Aedes
this type is now known as Philippine, Thai or Singapore- hemorrhagic fever or for short, H-fever,
particularly in the Philippines.
is an acute infectious disease characterized by severe pain behind the eye and in the Joints and
bones and accompanied by an initial erythema and a terminal rash of varying morphology.
Synonyms
o Hemorrhagic Fever or H-fever
o Acute Infectious Thrombocytopenic Purpura.
o Dengue Shock Syndrome
o Breakbone or Dandy Fever
 because the patient is. experiencing pain in the Joints and bones and the way it
makes the patient appear to be walking on his toes.
Dengue Fever Syndrome
o type without significant hemorrhages.
Dengue Hemorrhagic Fever
o cases with gross hemorrhages and with the etiologic agent identified; a severe illness
endemic in most of tropical Asia, characterized by abnormal vascular permeability,
hypovolemia and abnormal blood clotting mechanism.
Etiology and epidemiology
o there are 4 Serotypes of Dengue Virus (1, 2, 3, and 4 Group B Arbovirus)
o This mosquito is domestic, day-biting with low and limited flying movements.
o Chikungunya virus
Sources:
o 1. Infected persons - the virus is present in the blood of patients during the acute phase of
the disease and will become a reservoir of virus, accessible to mosquitoes which may
then transmit the disease.
o 2. Standing water within the household and premises are breeding places.
Mode of Transmission:
o by the bite of an infective Aedes Aegypti mosquito (a day mosquitoes with limited flying
movements). Viruses have been isolated from this mosquito during epidemic.

Factors which favor spread of infection:

o 1. Water stored within household or standing water in premises.
o 2. High human population density; the more crowded the human population the higher
the infection rate.
Incidence:
o 1. Age: the infection may occur at any age but it is common. school children with the
peak between 4 and 6 years old.
o 2. Sex: both sexes equally affected.
o 3. Season: more frequent during rainy season or months.
o 4. Geographical: more prevalent in urban communities or localitie
Incubation Period: 4 to 6 days (minimum, 3 days; maximum. 10 days)

PATHOGENESIS:
o 4 types of dengue virus can cause either classical dengue or hemorrhagic fever (DHF)
o the first attack gives only temporary and partial protection against me viruses
o Thrombocytopenia
  acute excessive consumption of platelets due to generalized intravascular
clotting.
 Decreased blood coagulation factors especially fibrinogen and factors II, V, VII
and II.
 prolonged bleeding and clotting time, prothrombin time, and partial
thromboplastin time with severe thrombocytopenia and fibrigenopenia which are
indications of disseminated intravascular coagulation (DIC)
Manifestations
o Fever, anorexia, vomiting, severe abdominal pain and tenderness
o Liver enlarged
2nd or 3rd day
o hyperpyrexia persists and all the earlier symptoms increase. -
o The temperature often shows a biphasic curve.
o The palms and soles are noticeably flushed.
o Tourniquet test - is often positive (+) from the onset or after a few days.
o Petechiae may be observed in pressure areas usually first on the face or distal portions of
the extremities but sparing the axilla and chest
5th to 7th day
o - the fever subsides ,
o - the limbs are cool and rash appears on the upper and lower extremities, purplish or
brownish motted appearance red with blanched areas about 1 cm or less in size. '
o - The rashes last 2 to 3 days
o - Face and hands appear edematous.
o - Pruritis may be present and at times is annoying. .
o - There mav be bradycardia during convalescence.
o - From this stage on the child begins to improve steadily.
Severe Manifestations
o 1. Central Nervous Manifestations (Dengue Encephalopathv)
 (1) Symptoms: increasing restlessness, apprehension or anxiety, disturbed
sensorium, convulsions, non-transient (more than 8 hours) change in
consciousness. -
 (2) Physical Findings: vomiting, spasticity or hyporeflexia.
 (3) CSF Result: Normal
2. Hemorrhagi[c_Mantfestations:
o (1) Epistaxis:
 purpuric lesions may appear early and extensive ecchymosis later (which is an
extravasation of the blood in the subcutaneous tissues it is marked by a purple
discoloration of the skin); hematemesis or melena (coffee-ground material)
o (4) Hepatomegaly-in 50 to 60% of cases in some countries but reputed as 90 to 96% in
Thai children.
o (5) Shock - manifested by rapid weak pulse with narrowing of pulse ' , pressure (20mm
Hg or less) or hypotension, with cold clammy skin and restlessness.
Laboratory;
o (1) Thrombocytopenia-
 100,000/'mm3 or less.
o (2) Hemoconcentration
 (a) An increase of at least 20%in the hematocrit
 (b) Steady rise m the hematocrit.
o Prolonged prothrombin time
o Reduction of fibrinogen, prothrombin, factor VIII, factor XII, antithrombin III and 2
antiplasmin.
 o In severe cases with liver dysfunction, reduction of factors II, VI, VII, IX andXII.
Serum Proteins - decreased
o Serum Transaminase - increased
o Serum Sodium - decreased
o Metabolic Acidosis
o BUN - increased
o There may be transient heavy albuminuria (presence of serum, albumin, globulin and
other protein in urine).
o Occult blood - presence in the stool is often found.
PREVENTION;
o 1 .Control of the mosquito vector is the most important a. Standing water in the
household and premises should be properly drained. b. Flower vases, empty tins, old tires
and other receptacles in the yard are good breeding places of mosquitoes.
o 2. Mosquito bites should be avoided by usual measures.
o 3. A vaccine against different types of dengue virus is in progress.
TREATMENT:
o This is mainly symptomatic and supportive.
o There are no specific antiviral drugs.
o In most cases, early and effective replacement of plasma loss with plasma expander
and/or fluid and electrolyte solution results in a favorable outcome.
NURSING INTERVENTIONS:
o Isolation of the patient: recommended.
o Control Measures - eradication of mosquitoes (elimination of breeding places and
fogging).
o Any disease or condition, associated with hemorrhage is enough to cause alarm.
Immediate control of hemorrhage and close observation of the patient for vital signs of
leading to shock.
o Nursing measures are directed towards symptoms as they occur but immediate medical
attention must be sought.

Intervention for hemorrhage

o - keep the patient at rest during bleeding episodes.
o - for nosebleedmg, maintain an elevated position of trunk and promote vasoconstriction
in nasal mucosa membrane through an ice bag over the forehead.
For Shock
o prevention is the best treatment.
o dorsal recumbent position facilitate circulation.
o adequate preparation of the patient, mentally and physically prevents occurrence of shock
o provision warmth through light-weight covers (overheating causes vasodilation which
aggravates bleeding),
o restore blood volume, elevating foot part and trunk (Trendelenberg) allows greater blood
volume at head part.
For anxiety
o explain thoroughly the; nature, the discomforts and limitations of activity associated with
the diagnostic procedures.
o - encourage family participation in the patient's care.
o - create a, comfortable atmosphere for the patient's family.
For fever
o cooling measures through sponges. Administer prescribed drugs;
o encourage fluid intake unless contraindicated.