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is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti) DHF was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand. By 1970 nine countries had experienced epidemic DHF and now, the number has increased more than fourfold and continues to rise. Today emerging DHF cases are causing increased dengue epidemics in the Americas, and in Asia, where all four dengue viruses are endemic, DHF has become a leading cause of hospitalization and death among children in several countries. Causative Agent o The causative agent of Dengue Fever (also known as the Devil's Crunch or Breakbone Fever) is the Dengue Fever Virus (DENV) a member of the Flaviviridae family and the Flavivirus species. o However, there are four serotypes of the Dengue fever virus, aptly named DENV-1, DENV-2, DENV-3 and DENV-4 and within these serotypes there are clades and strains that are inherently different in nature. o However, as a conclusion, one would say the DENV virus is the agent of Dengue Fever. Pathophysiology o (Refer to next page) Clinical Manifestations o Classification according to severity ( Halstead & Nimmanitya) Grade I High grade fever (3-5 days) Headache, peri-orbital pain Joint & bone pain Abdominal pain Nausea & vomiting Petechial formation Herman’s sign – generalized flushing of the skin Grade II signs & symptoms of grade I + bleeding Epistaxis GI bleeding Gum bleeding Grade III grade II + circulatory failure Cold, clammy skin Altered VS decreased BP rapid, weak pulse increased RR Grade IV grade III + hypovolemic shock o Clinical Manifestations by throughout the phases of illness Initial Febrile phase (2-3 days) Fever 38 c – 40 c o Accompanied by headache Flushing of palms and soles (+) Tourniquet test Anorexia, vomiting Maculopapular or petechial rash Hermans’s sign
avoid eating dark colored foods to avoid false indication of bleeding Gingival bleeding offer ice chips. use of soft bristle toothbrush during oral care Hematemesis Observe for signs of shock Programs of the Government for DHF o 4S Laban sa Dengue Search and Destroy Self-Protection Measures Seek Early Consultation Say no to indiscriminate fogging o Clean Technique C – hemically treated mosquito nets L – arvae eating fish E – nvironmental sanitation (4pm habit) A – ntimosquito soaps (basil. oregano) . Circulatory Phase (starts n the 3rd-5th day) Restless Cool. clammy skin Cyanosis may be notable Profound thrombocytopenia at the onset of shock Rapid and weak pulse Possibility of a narrowed pulse pressure and a drop of BP to an unobtainable level Diagnostic Evaluation o Tourniquet test (Rumpel-Leede test) presumptive test that checks for capillary fragility pediatric: 5-10 mins adults: 10-15 mins o Positive if > 20 petechiae formation in 1 square inch is evident o Platelet count–confirmatory test ↓ platelet o Hematocrit (↓) Collaborative Management o Symptomatic and Supportive Oral Fluids and Intravenous fluid replacement Antipyretics as indicated Aspirin containing medications precautions Platelet transfusion as indicated Blood transfusion as indicated if severe bleeding happened Nursing Management o Monitor for presence of bleeding Nosebleed cold compress and application of direct pressure to Melena cold compress over stomach area. eucalyptus. citronel) N – atural mosquito repellants (neem tree.
. canicola fever. canefield fever. Death may occur between the 9th and 16th days. Humans are the end of the line of the disease. L. including rats. Pomona. and Pretibial fever Leptospirosis is among the world's most common diseases transmitted to people from animals. and convulsions. Fever subsides with lysis. or when the contaminated material is ingested. Clinical Manifestations o Septic Stage marked by febrile lasting from four to seven days. canicola. coma. icterohemorrhagiae. batavia. and CHF are also seen in severe cases. javinica o Characteristic of Leptospira spirochete motile both gram-positive and gram-negative characteristics poor staining. black jaundice. L. cats. Fort Bragg fever. raccoons. Outside of tropical areas. also known as Weil's syndrome. o Humans are considered incidental hosts to the disease because transmission of the disease between people is rare. dark-field or phase-contrast microscopy are necessary beta-hemolytic o Wild mammals seem to serve as the primary reservoir of most leptospiral serovars. anorexia. leptospirosis cases have a relatively distinct seasonality with most cases occurring in spring and autumn Source of infection: urine of rats Mode of transmission: Skin penetration o Population at risk: Farmers Sewage workers Miners Slaughterhouse workers People living in areas frequented by flood Pathogenesis o Causative Agent Leptospira pyrogenes. Rats are considered the most important reservoir. nanukayami fever. and cattle. pigs. as they are the most common source worldwide. or vegetation by urine excreted from infected animals. Iritis. There is an abrupt onset of remittent fever. dogs. with CSF findings of aseptic meningitis Oliguria and anuria with progressive renal failure Shock. & other species like L. o Transmission occurs by contamination of water. 7-day fever. therefore. There is also respiratory distress. the eyes. meningeal manifestations like disorientation. at best. L. Humans can become infected upon contact of the contaminated material with abraded skin. mucous membranes. Leptospira manilae. The organism has been found in more than 160 mammals. soil.LEPTOSPIROSIS is caused by infection with bacteria of the genus Leptospira and affects humans as well as other animals. o Convalescence relapse may occur during the 4th to 5th weeks. abdominal pain and severe prostration. with very rare exceptions. o Immune or toxic stage with or without jaundice and lasts for 4-30 days. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin. L. chills. headache. Dogs are often carriers of leptospires. Rat Catcher's Yellows. headache. or with the mucous membranes. which can cause problems because of their close association with people.
Diagnostic Evaluation o Leptospira Agglutination Test A serologic test “considered” the gold standard on diagnosing leptospirosis. . o Penicillin and other B. Use of proper protection like boots and gloves when work requires exposure to contaminated water. Drain potentially contaminated water when possible. o The clinical assessment and epidemiologic history are more important. o Leptospira Antigen-Antibody Test o BUN/Creatinine o Enzyme-linked immunosorbent assay (ELISA) o Liver Function Test Aspartate aminotransferase (AST) Alanine aminotransferase (ALT Gamma-glutamyltransferase o Generally. to prevent infection in high risk areas. o Early recognition and treatment is MORE important to prevent complications of the severe disease and mortality.lactam antibiotics o Erythromycin if allergic to Penicillin Nursing Management o Symptomatic and supportive o Eye care (Darken the room) o Monitor urine output (complication kidney failure) o Medication regimen explanation o Promotion of skin integrity to ease pruritus o Health Teachings Provide education to clients telling them to avoid swimming or wading in potentially contaminated water or flood water. it is not necessary to confirm the diagnosis or wait for the result of the tests before starting treatment. Control rats in the household by using rat traps or rat poison. Medical Management o Antibiotics: Tetracycline (not given to < 8 yrs old and pregnant women) o Doxycycline may be used as a prophylaxis 200–250 mg once a week. maintaining cleanliness in the house.
Pathophysiology of Dengue .
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