DENGUE FEVER – a tropical disease caused by different strains of dengue virus which are transmitted by

mosquitoes by genus Aedes.

- Acute infectious disease characterized by severe pain behind eye, in joints and bones and
accompanied by erythema and terminal rashes.
- Alternative name: Acute infectious Thrombocytopenic Purpura, Hemorrhagic fever, H-fever

DENGUE HEMORRHAGIC FEVER – cases with gross hemorrhages and with etiologic agent identified,
severely an endemic in Asia. It is usually characterized by abnormal vascular permeability, hypovolemia,
and abnormal blood clotting.

Causative Agents: * 4 serotypes of Dengue Virus (1,2,3 and 4 )

o Female mosquito Aedes Aegypti ( domestic, day-biting with low and limited flying
movements. )

Sources :
Infected persons – virus is present in blood products of the patient during acute phase
Stagnant waters within household and premises which are usually the breeding sites.

Mode of Transmission:
By the bite of an infected Aedes Aegypti mosquito

Incidence rate:
Rainy season – increased rate
Both gender are affected

Pathophysiology:
MANIFESTATIONS:
ONSET
o Hyperpyrexia 39 – 40 degrees Celsius
o Headache
o Flushed and acutely ill
o Dry cough with infected throat
o Anorexia (loss of appetite)
o Nausea-vomiting
o Severe abdominal pain and tenderness
nd rd
2 -3 day
o Persistence of hyperpyrexia
o Flushed palms and soles
o Positive Torniquet Test
o Petechiae all over pressured areas
o HERMAN’S SIGN  pathognomonic sign
th th
5 -7 day
o Fever subsides
o Limbs are cool and rashes appears on lower and upper extremities
o Pruritus
o Edematous face and hands

HEMORRHAGIC MANIFESTATIONS:
o Epistaxis “nosebleed”
o Hematemesis
o Melena
o Bleeding occurs from gums, nose, GIT, uterus and lungs
o Hypotension leading to shock, coma and death

Classification of D.F. according to severity :

 Grade 1 = Fever accompanied by non-specific constitutional symptoms (+) tourniquet
test
 Grade 2 = grade 1 symptoms plus spontaneous bleeding or other hemorrhages
 Grade 3 = circulatory failure manifested by rapid and weak pulse, narrowing pulse
pressure(20mmHg), HPON, with presence of cold clammy skin, and restlessness.
 Grade 4 = profound shock with undetectable blood pressure and pulse

Diagnostic Exams:
1. Torniquet Test = test of tendency for blood capillaries to break down and produce petechial
hemorrhages.
2. Complete blood count (CBC)
Platelet count = 100, 000/mm3 or less
 Hemoconcentration – increase atleast 20% in hematocrit
3. Peripheral blood examination
WBC count – variable, ranging from leucopenia to mild leukocytosis
Thrombocytopenia
Hematocrit level elevated 20%

Complications:
1. SHOCK
Loss of blood, ecchymoses bleeding, restlessness and apprehension are conspicuous,
frequently profuse perspiration, edema of hands and face, vomiting copious coffee
during 4th day.
2.