This action might not be possible to undo. Are you sure you want to continue?
Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
Dengue hemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region. Is an acute viral infection caused by a bite of an infected mosquito; Common during rainy season and commonly affects young population; Causative Agents: Dengue virus 1, 2, 3, 4 Incubation Period: 3 - 7 days; Transmission Dengue viruses are transmitted to humans through the bites of infective female Aedes Aegyptimo sq u it oes.
-low-flying (3 ft) -day-biting( 2 hours after the sunrise and 2 hours before the sunset) -usually found in urban areas; -with white stripes on legs; -resides on stagnant water
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;A edes mosquitoes may acquire the virus when they feed on an individual during this period. Clinical Manifestations: G rade IFever, 3-7 days duration, low-to-moderate grade; Anorexia Abdominal pain Bone and joint pains (³breakbone fever´)
Pain behind the eyes Vomiting Petechiae ***Herman¶srash ± generalized flushing of the skin with center isle in the skin (+) Tourniquet test ± to determine vascular resistance and platelet function. epistaxis gum bleeding melena hematochezia vomiting of coffee-ground material ± G rade III grade II + any sign of circulatory collapse or impending shock. ± > 20 petecchiae per in2 (ANTECUBITAL FOSSA) ± G rade II grade I + any sign of spontaneous bleeding. clammy skin restlessness or change in LOC Grade IV (or Dengue Shock Syndrome) signs of hypovolemic shock absence of BP and peripheral pulses tachycardia/ bradycardia altered LOC or coma ATHOPHYSIOLOGY . hypotension tachycardia tachypnea weak and rapid peripheral pulses cold.
but Aalbopictus and other Aedes species can also transmit dengue with varying degrees of efficiency. dengue virus 3 (DENV-3). dengue has an incubation period of 3-14 days (average 4-7 d) while viral replication takes place in target dendritic cells. causing them to move on to finish a meal on another individual. and endothelial cells. Once inoculated into a human host. and duration Of cellular and humoral immune response to both the initial and subsequent virus infections. and dengue virus 4 (DENV-4). Each serotype is known to have several different genotypes. such as dendritic cells. Aaegypti is the predominant highly efficient mosquito vector for dengue infection. Albert Sabin speciated these viruses in 1944. dengue virus 2 (DENV-2). Dengue viruses are transmitted by the bite of an infectedA edes (subgenusStegomyia) mosquito. viral serotypes: dengue virus 1 (DENV-1). transmission occursafter 8-12 daysof viral replication in the mosquito's salivary glands (extrinsic incubation period). resulting in severe fluid . In addition. but are killed by temperatures of less than 10°C. Mosquitoes acquire the virus when they feed on a carrier of the virus. Entire families who develop infection within a 24. Humans serve as the primary reservoir for dengue. a 5. They inflict an innocuous bite and are easily disturbed during a blood meal. primarily those of the reticuloendothelial system. The mosquito can transmit dengue if it immediately bites another host. Recovery is usually complete by 7-10 days. Globally. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity. The major pathophysiological abnormalities caused by dengue hemorrhagic fever and dengue shock syndrome include the rapid onset of plasma leakage. often breeding around dwellings in small amounts of stagnant water found in old tires or other small containers discarded by humans. but each individual can eventually be infected by all 4 serotypes. and damage to the liver. reportedly as long as 1 year. presumably from the bites of a single infected vector. Infection of target cells. hepatocytes.9 The eggs ofA edes mosquitoes withstand long periods of desiccation. but antigenically distinct.Dengue infection is caused by 1 of 4 related. FemaleA edes mosquitoes are daytime feeders. Dengue hemorrhagic fever or dengue shock syndrome usually develops around the third to seventh day of illness. approximately at the time of defervescence.to 7-day acute febrile illness ensues. making them efficient vectors. The mosquito remains infected for the remainder of its 15. altered hemostasis. Following incubation. however. certain nonhuman primates in Africa and Asia also serve as hosts but do not develop dengue hemorrhagic fever. are not unusual. result in the production of immune mediators that serve to shape the quantity. type.to 36-hour period. Vertical transmission of dengue virus in mosquitoes has been documented. Genetic studies of sylvatic strains suggest that the 4 viruses evolved from a common ancestor in primate populations approximately 1000 years ago and that all 4 viruses separately emerged into a human urban transmission cycle 500 years ago in either Asia or Africa. Aedes mosquito species have adapted well to human habitation. Several serotypes can be in circulation during an epidemic.to 65-day lifespan.
Liver damage manifests as increases in levels of alanine aminotransferase and aspartate aminotransferase. CT. The activation of cytokines. Thrombocytopenia ± less than 100. Bleeding is caused by capillary fragility and thrombocytopenia and may manifest in various forms. and deranged coagulationparameters(PT. certain dengue strains. infection was demonstrated in more than 90% of hepatocytes and Kupffer cells with minimal cytokine response (tumor necrosis factor [TNF]± alpha. interleukin [IL]±2). Cuban studies have shown that stored serum sample analysis demonstrated progressive loss of cross-reactive neutralizing antibodies to DENV-2 as the interval since DENV-1 infection increased. This phenomenon is called antibodydependent enhancement. particularly those of DENV-2. Lymphocytosis. or aPTT) Laboratory Studies y Complete blood cell count findings include the following: o Leukopenia. nonneutralizing antibodies to one dengue serotype.000/mm3. Plasma leakage is caused by increased capillary permeability and may manifest as hemoconcentration. as well as pleural effusion and ascites. Most patients who develop dengue hemorrhagic fever or dengue shock syndrome have had prior infection with one or more dengue serotypes. has been correlated with disease severity. TNF receptors.losses and bleeding. soluble CD8. Chest X-ray ± presence of pleural and pericardial effusion. Bleeding parameters (BT. with atypical lymphocytes. low albumin levels. In persons with fatal dengue hepatitis. In addition. with increased T-cell activation and apoptosis. when bound by macrophage and monocyte Fc receptors. commonly develops before . and soluble IL-2 receptors. DIAGNOSTIC EXAMINATION Hemoconcentrat ion ± more than 20% increase from the baseline Hct. ranging from petechial skin hemorrhages to life-threatening gastrointestinal bleeding. have been proposed to result in increased viral entry and replication and increased cytokine production and complement activation. often with lymphopenia. This is similar to that seen with fatal yellow fever and Ebola infections.PTT). including TNF-alpha. PT. Increased concentrations of interferon have been recorded 1-2 days following fever onset during symptomatic secondary dengue infections. Some researchers suggest T-cell immunopathology may play a role. is observed near the end of the febrile phase of illness. In individuals with low levels of neutralizing antibodies. in part because more epidemics of dengue hemorrhagic fever have been associated with DENV-2 than with the other serotypes. have been proposed to be more virulent.
o Low albumin levels are a sign of hemoconcentration. attempting laboratory confirmation of dengue infection is important. o Metabolic acidosis is observed in those with shock and must be corrected rapidly. and platelet counts than patients with other febrile illnesses in dengue-endemic populations. Because the signs and symptoms of dengue fever are nonspecific. o Low fibrinogen and elevated fibrin degradation product levels are signs of disseminated intravascular coagulation. The platelet count should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever. o Elevated BUN levels are observed in those with shock. Findings are as follows: o Prothrombin time is prolonged. A recent systematic review found that patients with dengue had significantly lower total WBC.defervescence or shock. The hematocrit level should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever and every 3-4 hours in severe cases of dengue hemorrhagic fever or dengue shock syndrome. Acute kidney injury is uncommon. y Liver injury panel findings include the following: o Transaminase levels may be mildly elevated into the several thousands in patients with dengue hemorrhagic fever who have acute hepatitis. y Typing and crossmatching of blood should be performed in cases of severe dengue hemorrhagic fever or dengue shock syndrome because blood products may be required. PCR. and viral isolation. neutrophil. Platelet counts of less than 100.000 cells/ L are seen in dengue hemorrhagic fever or dengue shock syndrome and occur before defervescence and the onset of shock. y Serum specimens should be sent to the laboratory for serodiagnosis. oo Thrombocytopenia has been demonstrated in up to 50% of dengue fever cases. y Basic metabolic panel findings include the following: o Hyponatremia is the most common electrolyte abnormality in patients with dengue hemorrhagic fever or dengue shock syndrome. o . oo A hematocrit level rise of greater than 20% is a sign of hemoconcentration and precedes shock. y Coagulation studies may help to guide therapy in patients with severe hemorrhagic manifestations. o Activated partial thromboplastin time is prolonged.
. However. including complemen fixation (CF).Serodiagnosis is made based on a rise in antibody titer in paired IgG or IgM specimens. neutralization test (NT). CSF. o In order to provide a more rapid reliable diagnosis. and IgG ELISA are also used. a single positive result on ELISA (PanBio IgM or IgG) was found to have a high rate of false positivity and should be confirmed using a second more specific diagnostic technique. hemagglutination inhibition (HI). and c orticosteroids should be avoided. and a thickened gallbladder wall. Imaging Studies y Chest radiography: Right-sided pleural effusion is typical. Acetaminophen may beused to treatpatients with symptomaticfever. and easily used modality in the evaluation of potential dengue hemorrhagic fever. clinically available PCR studies are being developed. Positive and reliable ultrasonographic findings include fluid in the chest and abdominal cavities. dengue hemorrhagic fever was predicted in 12 patients before hemoconcentration criteria had been met MEDICAL MANAGEMENT Dengue fever is usually a self-limited illness. Results vary depending on whether the infection is primary or secondary. pericardial effusion. urine. although other tests. nonsteroidal anti-inflammatorydrugs (NSAIDs). y Cultures of blood. Aspirin. Pleural effusion was the most common sign. a recent study involving 158 patients examined the role of daily serial ultrasonographic examinations of the thorax and abdomen in the evaluation of patients with suspected dengue hemorrhagic fever. o A recent European study found that. Plasma leakage was detected in some patients within 3 days of fever onset. cost-effective. Bilateral pleural effusions are common in patients with dengue shock syndrome. and other body fluids should be performed as necessary to exclude or confirm other potential causes of the patient's condition. if only a single serum sample is available. Patients with known or suspected denguefever should have their platelet countand hematocritmeasured daily from the third day of illnessuntil 1-2 daysafter defervescence. Thickening of the gallbladder wall may presage clinically significant vascular permeability. Based on ultrasonographic findings. Patients witha r ising hematocritlevel or falling platelet count should have intravascular . and only supportive care is required. o The IgM capture enzyme-linked immunosorbent assay (MAC-ELISA) has become the most widely used assay. The utility of previous studies was limited because of the use of single studies for evaluation. y Serial ultrasonography o Ultrasonography is a potentially timely.
or hypotension. limited clinical information suggests that a plasma expander may be administered. Starch. require admission for intravenous fluid administration. Patients who improve can continue to be monitored in an outpatient setting. similarly to nondengue forms of immune thrombocytopenic purpura. such as tachycardia. altered mental status. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. Patients with internal or gastrointestinal bleeding may require transfusion. decreased urine output. Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. If the patient does not improve after this. narrowed pulse pressure. if it is rising. clinically improved condition o Adequate urine output o Stable hematocrit level o . the hematocrit value should be determined. blood loss should be considered. One recent study has suggested that starch may be preferable because of hypersensitivity reactions to dextran. cool or mottled skin. The authors proposed that. Patients who do not improve should be admitted to the hospital for continued hydration. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. or albumin 5% at a dose of 10-20 mL/kg may be used. A recent case report demonstrated good improvement following intravenous anti-D globulin administration in two patients. rise in hematocrit levels. diminished pulse amplitude. prolonged capillary refill time. and. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. At this time. If this fails to correct the deficit. Patients with dengue hemorrhagicfever or dengue shock syndrome may be dischargedf rom the hospital when they m eet thef ollowing criteria: o Afebrile for 24 hours without antipyretics o Good appetite. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding. Patients who develop signs of dengue hemorrhagic fever warrant closer observation Patients who develop signs of dehydration. Patients with coagulopathy may require fresh frozen plasma. Patients who are resuscitated from shock rapidly recover. Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. intravenous anti-D produces Fc receptor blockade to raise platelet counts. they usually require intravenous fluids for no more than 24-48 hours. dextran 40.volume deficitsreplaced. After patients with dehydration are stabilized. patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued.
and leaves that gather to form "cups" and catch water. the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes.´ Anti-ulcer drugs -Antacids -AlMgOH -H2-antagonists ± Cimetidine. as well as discarded plastic food containers. has become established in the United States.000 cells/ l -Supportive and symptomatic management. Vector control is implemented using environmental management and chemical methods. several Latin American and Caribbean countries.A edesaegypti breeds primarily in man-made containers like earthenware jars. Advise screening and environmental sanitation. and quiet room for rest. used automobile tyres and other items that collect rainwater. Full diet / DAT EXCEPT DARK-COLORED FOODS. Proper solid waste disposal and improved water storage practices. ³Avoid ASPIRIN´. L ansopraz ole -Mucosal protectors ±Sucralfat e -Paracetamol -Plasma expanders ± Dextran NURSING MANAGEMENT Provide a comfortable. The rapid geographic spread of this species is largely attributed to the international trade in used tyres. Famotidine -Proton pump inhibitors ±Omeprazole. Watch out for bleeding manifestations. a secondary dengue vector in Asia. dim. Clean all stagnant water and water containers and make sure to cover these. Nizatidine. a breeding habitat. Correction of fluid and electrolyte imbalance. metal drums and concrete cisterns used for domestic water storage. parts of Europe and Africa.A edesalbopi ctus. In recent years. Prevention and control At present. including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes. In Asia and the Americas. Ranitidine.At least 48 hours since recovery from shock o Absence of respiratory distress Platelet count greater than 50. . In Africa the mosquito also breeds extensively in natural habitats such as tree holes.
mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success. particularly those that are useful in households. and the procedure is costly and operationally difficult. However.g. one aspect of human being which are greatly affected and the one which we have to be most concern of would be in the side of our heath and well being. luxuries mode of entertainment. prevents mosquito breeding for several weeks but must be re-applied periodically. It is considered as one of the acute febrile diseases caused by one of the four closely related virus serotype of the genus flavivirus. muscle and joint pains which will give name to Breakbone Fever or Bonecrusher. As it is. nausea. There are also rashes characterized by bright red petechaie commonly seen on the lowers limbs and on the chest. or diarrhea. water storage vessels. clothes for fashion. New technologies were being invented. vomiting. GOAL General Goal: . adaptation to life and environment. Small. It is considered as one of the tropical country and so disease can spread through out the country. One example of these is disease is what we called Dengue Fever and dengue Hemorrhagic Fever (DHF). It can be transmitted by Aedes Aegypti mosquito to humans usually attacking during the day. INTRODUCTION We live in our world today where everything seems to be in a fast face. Regular monitoring of the vectors' susceptibility to widely used insecticides is necessary to ensure the appropriate choice of chemicals. With all of these. perceptions. the mosquito-killing effect is transient. During outbreaks. Proper attention of health care provider should be given including good assessment. One will experience onset of fever. jewelries. early detection or diagnosis and medications which are essential for total interference of prevention. severe headaches. It s just like having a new mode of socialization. In the Philippines there are many diseases illness arising because of environmental changes that may be caused by human activities and geographical conditions. cultures. emergency vector control measures can also include broad application of insecticides as space sprays using portable or truckmounted machines or even aircraft. etc. beliefs. we cannot deny that things change over or in a certain period of time. variable in its effectiveness because the aerosol droplets may not penetrate indoors to microhabitats where adult mosquitoes are sequestered.The application of appropriate insecticides to larval habitats. There may also be gastritis associated to abdominal pain. e.
headache. a. management and treatment to be able to render effective nursing care to the client. Before that diagnosis.4 FAMILY HISTORY According to his grandmother the only disease that the family has genetically is Diabetes Mellitus and no other diseases noted. Specific Goal: To be familiar with the etiology of the disease To know the pathophysiology of the disease To be aware of the signs and symptoms To know its complications To be knowledgeable on how to prevent the disease To know the treatment and how to apply it To know the diagnostic exam a. CJS is currently on the secondary level of education at Roosevelt College at Malanday.2 PRESENT ILLNESS Four days prior to admission. Marikina City. the patient had an intermittent fever associated with abdominal pain.3 PAST MEDICAL YEARS It was according to the patient that he wasn't been hospitalized yet not until when he was diagnosed with Dengue Fever Syndrome. and Mrs. near their place. . he was already experiencing fever and his mom gives him a Paracetamol for remedy.5 SOCIAL HISTORY CJS is the son of Mr.To be knowledgeable about the nature of Dengue Fever Syndrome. a. and general flushing of the skin with on and off vomiting.1 CHIEF COMPLAIN The patient complains of abdominal pain. a. fever and general flushing of skin with on and off vomiting. SJ. a. A few hours prior to admission still the above sign and symptoms remain but already have (-) vomiting with accompanying chills and was diagnosed with Dengue fever Syndrome. headache.
6 ENVIRONMENTAL HISTORY According to the patient the environment that the family have has an open drainage. Furthermore he has no other vices except for computer games. C. Hence. As a remedy his mom gave him Paracetamol to lower his body temperature.His father works as a seaman while his mother is a housewife. According to CJS. It was described by the patient that there are parts of their house that is deprived from light. his parent decided to bring him to the hospital. he was diagnosed with Dengue Fever Syndrome (DFS) and was admitted under the service of Dra. a. his grandmother is also living with them. Del Valle. headache and general flushing of the skin with on and off vomiting. he eats vegetables and fish instead he prefers eating hotdogs. The house is cleaned by his mother and grandmother. After school hours. started experiencing fever that persist only at night. his grandmother and his mother were the ones responsible in all the household chores. As the above signs and symptoms persists. wherein big rats and cockroaches can be seen. HISTORY OF ILLNESS During the mid of August. Except from fever he s also experiencing abdominal pain. . ¡ Upon the physical assessment and after several diagnostic procedures that the patient had undergone. he goes directly to the computer shop together with his brother and friends. CJS.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.