Dengue: Dengue Hemorrhagic Fever, Resulting in Bleeding, Low Levels of Blood Platelets and

Dengue
Is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage.
Etiologic agents
Flaviviruses 1,2,3,4, a family of Togaviridae, are small viruses that contain single-stranded RNA. Arboviruses Group B
Mode of transmission
Bite of an infected mosquito, principally Aedes aegypti o Day biting mosquito (appear two hours after sunrise and two hours before sunset). o Breeds in areas of stagnant water. o It has limited, low-flying movement. o It has white dots at the base of the wings and white bands on the legs Aedes albopictus may contribute to the transmission of the dengue virus in rural.
Incubation Period
3-14 days; commonly 7-10 days.
Period of Communicability
Patients are usually infective to the mosquito from a day before the febrile period to the end of it. The mosquito becomes infective from day 8-12 after blood meal and remains infective throughout its life
Sources of Infection
Infected persons Standing water
Incidence
Age any age, but most common among children and peaks between four to nine years old. Sex both sexes. Season more frequent on rainy season. Location more prevalent on urban communities.
Pathogenesis
Virus is deposited in the skin by the vector and initial replication occurs at the site of infection and in local lymphatic tissues. Within a few days, viremia occurs, lasting until 4 th or 5th day after the onset of symptoms. Evidence indicates that macrophages are the principal site of replication. At the site of petecheal rash, non specific changes are noted, which include endothelial swelling, perivascular edema, and extravasation of blood. There is marked increase in vascular permeability, hypotension, hemoconcentration, thrombocytopenia, with increased platelet agglutinability, and or moderate disseminated intravascular coagulation. The most serious pathophysiological abnormality is hypovolemic shock resulting from increased permeability of the vascular endothelium and loss of plasma from the intravascular space.
Clinical Manifestations
Dengue fever o Prodromal symptoms characterized by: Malaise and anorexia up to 12 hours Fever and chills accompanied by severe frontal headache, ocular pain, myalgia with severe backache, and arthralgia. o Nausea and vomiting o Non remitting fever for three-seven days. o Rash ids more prominent on the extremities and the trunk. It may involve the face in some isolated cases. o Petechiae usually appears near the end of the febrile period and most commonly on the lower extremeties. Dengue Hemorrhagic fever o Manifested by fever, hemorrhagic diathesis, hepatomegaly, and hypovolemic shock.
Classification According to Severity

Grade I o There is fever accompanied with non specific constitutional symptoms and the only hemorrhagic manifestation is positive to tourniquet test. Grade II o All signs of Grade I, plus spontaneous bleeding from the nose, gums, and GIT, are present Grade III o Presence of circulatory failure, as manifested by a weak pulse, narrow pulse pressure, hypotension, cold clammy skin, and restlessness. Grade IV o There is a profound shock, and undetectable blood pressure and pulse.
Complications
Epistaxis Gastrointestinal bleeding Concomitant GI disorder (peptic ulcer) Metabolic acidosis Hyperkalemia Tissue anoxia Hemorrhage into the CNS or adrenal glands Uterine bleeding may occur Myocarditis
Diagnostic tests
Tourniquet test o Done by occluding the arm veins for about 5 minutes, to detect capillary fragility Platelet count o Decreased platelet count is a confirmatory test Hemoconcentration o Increase of at least 20% in the hematocrit or a steady rise in hematocrit Occult blood Hemoglobin determination
Treatment Modalities
There is no effective antiviral therapy for dengue fever. Treatment is entirely symptomatic. Analgesics drugs other than aspirin for relief from headache, ocular pains, and myalgia Initial phase may require intravenous infusion to prevent dehydration and replacement of plasma Oxygen therapy is indicated in patients with severe bleeding Oxygen therapy is indicated for all patients in shock Sedatives may be needed to allay anxiety and apprehension
Prevention and Control

Health Educations Early detection and treatment of cases will not worsen the victims condition Treat mosquito nets with insecticides House spraying is advised Destroy breeding places of mosquitoes by cleaning the surroundings Avoid hanging too many clothes inside the house
University of Perpetual Help System Laguna

Dr. Jose G. Tamayo Medical University Sto. Nino, Binan, Laguna
COLLEGE OF NURSING
SUBMITTED TO:
Maam Evelyn Del Rosario RN MAN
SUBMITTED BY:
Torres, France John E. Canarias, Garly Bayson, Avie

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Dengue: Dengue Hemorrhagic Fever, Resulting in Bleeding, Low Levels of Blood Platelets and

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Dengue

Classification According to Severity

Prevention and Control

University of Perpetual Help System Laguna

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