PATHOPHYSIOLOGY

Predisposing factors >geographical area tropical Precipitating factors >environmental conditions >immunocompromised >presence of mosquitoes carrying dengue virus >sweaty skin

Aedesaegyptibites the host, injecting the virus
S/S: >redness >itchiness in the area

Virus incubates in the circulation for 3-14 days Virus disseminates rapidly into the blood Stimulation of the WBC which includes B lymphocytes which produces and secretes Ig, monocytes/macrophages, and neutrophils
Diagnostic - Hematology >increased WBC around 12,900/mm3 (Normal: 5,000-10,000/mm3) >increased lymphocytes 49% (Normal: 20-40%)

Antibodies attach to the viral antigens, and then macrophages perform phagocytosis within the cells and dengue virus replicate in the cells
Diagnostic - Hematology >decreased monocytes 4%(Normal: 8-14%) >decreased neutrophils 49% (Normal: 50-70%)

Recognition of dengue viral antigen on monocyte Release of cytokines which consist of vasoactive agents such as interleukins, tumor necrosis factor, urokinase, and platelet activating factor which stimulate WBCs and pyrogen release Entry to spleen Entry to spleen Entry to bone marrow

Dengue
S/S >febrile 38.6°C >flushed skin, warm to touch >diaphoresis >headache >whitish spots >body weakness

Virus ultimately targets liver and spleen parenchymal cells where infection produces apoptosis/cell death Cellular direct destruction and infection of red bone marrow precursor cells Hepatosplenomegaly S/S >abdominal pain Diagnostic UTZ >minimal hepatosplenomegaly Diagnostic Blood Chem >SGOT 558.0 >U/L Up to 46 Thrombocytopenia S/S >reddish sclera in both eyes >petechiae Diagnostic Hematology >decreased platelet Dengue Hemorrhagic Fever Increase number and size of the pores in the capillaries which leads to a leakage of fluid from the blood to the interstitial spaces S/S >+1 bipedal edema >weak bounding pulse Pleural effusion S/S >profuse nonproductive cough with white sputum with blood spots noted >shallow and rapid respiration >crackles/rales Ascites S/S >abdominal distention >hypoactive bowel sounds Recovery Complications: >intense bleeding >pulmonary edema >shock >very low BP >liver cirrhosis >death .

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