Introduction

Dengue has been called the most

important mosquito-transmitted viral
disease in terms of morbidity and
mortality.
 Dengue fever is a benign acute febrile
syndrome occurring in tropical regions.
 What is Dengue Fever?
 Dengue (pronounced den' gee) is a disease caused by
any one of four closely related viruses (DEN-1, DEN-2,
DEN-3, or DEN-4). The viruses are transmitted to
humans by the bite of an infected mosquito. In the
Western Hemisphere, the Aedes aegypti mosquito is the
most important transmitter or vector of dengue viruses,
although a 2001 outbreak in Hawaii was transmitted by
Aedes albopictus. It is estimated that there are over 100
million cases of dengue worldwide each year.The
geographical spread is similar to malaria, but unlike
malaria, dengue is often found in urban areas of tropical
nations, including Puerto Rico, Singapore, Malaysia,
Taiwan, Thailand, Indonesia, Philippines, India, Brazil
and Venezuela.
 Dengue Hemorrhagic Fever is a more
severe, often fatal form of Dengue Fever.
The two types of fever are caused by the
same group of virus as dengue; the only
differences are observed in the symptoms.
 Grade I

 Fever accompanied by nonspecific

constitutional symptoms; the only
haemorrhagic manifestation is a positive
tourniquet test.
 Grade II

 Spontaneous bleeding in addition to the

manifestations of Grade I patients, usually
in the form of skin and/or other
hemorrhages.
 Grade III

 Circulatory failure manifested by rapid and

weak pulse, narrowing of pulse pressure (20
mmHg or less) or hypotension, with the
presence of cold clammy skin and restlessness.
 Grade IV

 Profound shock with undetectable blood

pressure and pulse.
 Causes

 Causative agent:
Dengue virus types 1-
4( Flavivirus)
 Chikungunya Virus

 Vector:Aedes Aegypti
 Dengue viruses are transmitted to humans through the
bites of infective female Aedes mosquitoes. Mosquitoes
generally acquire the virus while feeding on the blood of
an infected person. After virus incubation for eight to 10
days, an infected mosquito is capable, during probing and
blood feeding, of transmitting the virus for the rest of its
life. Infected female mosquitoes may also transmit the
virus to their offspring by transovarial (via the eggs)
transmission, but the role of this in sustaining transmission
of the virus to humans has not yet been defined.
 Infected humans are the main carriers and multipliers of
the virus, serving as a source of the virus for uninfected
mosquitoes. The virus circulates in the blood of infected
humans for two to seven days, at approximately the same
time that they have a fever; Aedes mosquitoes may
acquire the virus when they feed on an individual during
this period.
 Sign and Symptoms
 Fever
 Abrupt onset, rising to 39.5-41.4°C
 Accompanied by frontal or retro-orbital headache
 Lasts 1-7 days, then defervesces for 1-2 days
 Biphasic, recurring with second rash but not as high
 Rash
 Initial rash transient, generalized, macular, and
blanching; occurs in first 1-2 days of fever
 Second rash occurring within 1-2 days of
defervescence, lasting 1-5 days
 Second rash morbilliform, maculopapular, sparing
palms and soles
 Occasionally desquamates
 Bone pain
 Absent in dengue hemorrhagic fever (DHF)/dengue shock
syndrome (DSS)
 After onset of fever
 Increases in severity
 Not associated with fractures
 May last several weeks
 Most common in legs, joints, and lumbar spine

 Miscellaneous symptoms
 Nausea and vomiting
 Cutaneous hyperesthesia
 Taste aberrations
 Anorexia
 Abdominal pain (severe in DHF/DSS)
 Physical
 Fever
 Signs of intravascular volume depletion
 Hypotension with narrowed pulse pressure
 Delayed capillary refill
 Hemorrhagic manifestations
 Positive tourniquet test
 Petechiae, purpura, epistaxis, gum bleeding, GI
bleeding, menorrhagia
 Rash
 Hepatomegaly (inconsistent)
 Generalized lymphadenopathy
 Complete blood count
 Hemoconcentration (hematocrit increased 20%)
 Thrombocytopenia (platelet count <100 x 109/L)

 Chemistry panel
 Electrolyte imbalances
 Acidemia
 Elevated BUN (Blood Urea Nitrogen)

 Liver function tests

 Elevated transaminases
 Hypoproteinemia

 Stool test
 Imaging Studies

 Chest radiography
 Bronchopneumonia
 Pleural effusion

 Head CT scan without contrast

 For altered level of consciousness
 Intracranial bleeding
 Cerebral edema
 Complications
 Brain damage from prolonged shock or
intracranial hemorrhage
 Myocarditis
 Encephalopathy
 Liver failure
There is no vaccine available to prevent dengue
fever.

Use personal protection such as:

 full-coverage clothing,
 netting,
 mosquito repellent containing DEET, and
if possible, travel during periods of
minimal mosquito activity.
 Breeding Site Of
Dengue Mosquitoes!!
Because Dengue hemorrhagic fever is caused by a virus
for which there is no known cure or vaccine, the only
treatment is
to treat the symptoms.

 Rehydration with intravenous (IV) fluids is

often necessary to treat dehydration.
 IV fluids and electrolytes are also used to
correct electrolyte imbalances.
 A transfusion of fresh blood or platelets can
correct bleeding problems.
 Oxygen therapy may be needed to treat
abnormally low blood oxygen.
 Monitor the vital signs, it is when the patient
is afebrile that signs of dengue shock
syndrome should be noted.
 Be sure that dark colored foods like
chocolates & dinuguan should be avoided
because signs of bleeding has to be ruled out.
 Watch out for signs of bleeding like nose
bleeding, gum bleeding, blackish stool or
vomiting out of blood & refer to the doctor
ASAP.
 Laboratory results should be facilitated &
report to the doctor immediately!
 Always see to it that the NGT is intact, if it
had been inserted to the patient.
 Monitor intake and output.
 Provide fluids to avoid dehydration.
 Morens states that the rapid clinical response to
aggressive fluids and electrolytes in even
moribund children with DHF/DSS "is among the
most dramatic events in clinical medicine."
Treated promptly, children in shock and coma
can wake up and return to near normalcy within
hours.
 Convalescence may be prolonged, with
weakness and mental depression.d
 Continued bone pain, bradycardia, and
premature ventricular contractions (PVCs) are
common.
 Survival is related directly to early hospitalization
and aggressive supportive care.
 Dengue fever is not contagious through person-
to-person contact.
 Complete blood count
 Hemoconcentration (hematocrit increased 20%)
 Thrombocytopenia (platelet count <100 x 109/L)

 Chemistry panel
 Electrolyte imbalances
 Acidemia
 Elevated BUN (Blood Urea Nitrogen)

 Liver function tests

 Elevated transaminases
 Hypoproteinemia

 Stool test