Peptic Ulcer Disease

Dengue
Case Presentation

General Data
 Patient F. M., 15 year old female from
Baliwasan, Zamboanga City.

Chief Complaint
 Fever
Case Presentation

History of Present Illness

 1 day prior to admission, patient
noted vomiting of 4 episodes
characterized as what she ate prior
and watery. No medications were
taken and no consults were done.
Case Presentation

History of Present Illness

 The night prior to admission, patient
started experiencing undocumented
fever. Paracetamol was taken but
afforded no relief. Persistence of
symptoms prompted the her to seek
consult and hence, admission at
Zamboanga City Medical Center.
Case Presentation

Past Medical History

 No previous hospitalizations nor surgeries
done.

Personal and Social History

 She lives with her siblings, cousins and
grandparents. Currently a 3rd year high
school student. Loves dancing. Denies
substance use, suicidal ideation and safety
risks. Identifies as a female, attracted to
males.
Case Presentation

Physical Examination
Vital Signs:
 BP /60 mmHg
100

 Temperature 38.8°C
 Pulse Rate 140 CPM
 Respiratory Rate 23 BPM
 O2 Saturation 97%
 Height 152 cm
 Weight 48 kg
Case Presentation

Physical Examination
General Appearance:
 Awake, weak looking, not in respiratory distress.
Skin:
 With pallor. No rashes. Warm to touch.
EENT:
 Pale palpebral conjunctivae. Dry lips. Pale oral
mucosa.
Chest/Lungs:
 Equal chest expansion. Clear breath sounds.
Case Presentation

Physical Examination
Heart:
 Adynamic precordium. Tachycardic. No
murmurs.
Abdomen:
 Flat. Normoactive bowel sounds.
Nontender.
Extremities:
 Good pulses. Capillary refill time less than
3 seconds.
Case Discussion

I. Clinical Diagnosis
Primary Clinical Diagnosis:
 Dengue with warning signs

 Basis: Vomiting, sudden onset of fever,

weak looking, pallor, pale palpebral
conjunctivae, dry lips and pale oral
mucosa.
Case Discussion
Case Discussion

I. Clinical Diagnosis
Secondary Clinical Diagnosis:
 Malaria

 Basis: Vomiting, fever, weak looking,

pallor, pale palpebral conjunctivae, dry
lips and pale oral mucosa.
Case Discussion
II. Paraclinical Diagnostic Procedures
Primary Clinical Diagnosis:
 Dengue with warning signs

Secondary Clinical Diagnosis:

 Malaria

Diagnostic Procedure 1:
 Complete blood count with platelet count (PHP 175.00)

Diagnostic Procedure 2:
 Dengue NS1(PHP 450.00) – Most sensitive at 1-5th day of illness.

Diagnostic Procedure 3:
 Malarial smear (PHP 75.00)
Case Discussion

III. Treatment
Medications
 No antiviral therapy available
 Fever control
▪ Antipyretics
Case Discussion

III. Treatment
Other interventions
 Maintain adequate intravascular volume
 Shock
▪ Crystalloid fluid resuscitation
 Bleeding
▪ Platelet transfusion if severe
thrombocytopenia and/or active, uncontrolled
bleeding
Case Discussion

III. Treatment
Prevention
 Mosquito control
▪ ↓ Standing water breeding sites
▪ Insecticides
 Personal protective measures
▪ Repellant use
Case Discussion
IV. Prevention and Health Promotion
Final Diagnosis:
 Dengue with warning signs

Viral disease, mosquito transmission

 Characterized by febrile illness
 AKA break-bone fever
Four serotypes
 DENV-1 through DENV-4
 IgG response to specific type → lifetime immunity
 Limited, transient cross-protectivity across viral types
Vector
 Primarily Aedes aegypti and A. albopictus
Case Discussion

IV. Prevention and Health

Promotion
Pathogenesis
 Aedes mosquito bite → dengue virus skin
introduction → local infection, response
→ dissemination → viremia (2-6 days
later) → circulating leukocyte infection
(especially) monocytes → viral
replication, release → fever