Dengue Hemorrhagic Fever (Breakbone fever, dandy fever or bone crusher disease) Dengue fever is a disease caused by a family

of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands(lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles. Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed. Mode of transmission: bite of the female Aedes aegypti Vector: mosquito is domestic, day-biting with low and limited flying movements *mosquito is infective after a period of 8-14days Breeding places: stagnant water, flower vases, uncovered barrels, buckets, discarded tires, wet floor, toiler bowls Types of dengue: Grade I (+) fever lasting 3 5 days y y y y y y y Abdominal pain Anorexia, nausea and vomiting Pain behind the eyes Joint pains (+) eveidence of vascular changes petechiae Hermans sign general flushing of the skin

Grade II signs and symptoms of Grade I + Bleeding y Gum bleeding, epistaxis, hematemesis, melena, hematochezia

Grade III signs and symptoms of Grade II + Circulatory failure y Hypotension, rapid but weak pulse

Grade IV signs and symptoms of Grade III + Shock

Signs and Symptoms y y y y y Sudden onset of fever (2-7days) Myalagia & arthalagia Petichae Gastritis with abdominal pain, nausea, emesis (vomiting), loss of apetite, diarrhea For severe cases: epistaxis (nose bleeding), gum bleeding, hematemesis (blood vomiting), melena (black, tar-like stool. GI bleeding)

Treatment y y y y y A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correctelectrolyte imbalances Platelet concentrate transfusion if platelet count is critically low Non-aspirin analgesics Supportive care (bed rest, increase fluid intake)

Possible Complications y Encephalopathy

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Liver damage Residual brain damage Seizures Shock

Prevention y y y y Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal, elimination of stagnant water in domestic environment and improved water storage practices. Aerosol and liquid spray has to be applied directly to the adult mosquito for effective killing, e.g. household pesticides. Mosquito coil and electric mosquito mat/ liquid has to be placed near possible entrance, such as window, for mosquito. Wear long-sleeved clothes and long trousers when going outdoors. Bodies could be protected from mosquito bite by applying insect repellent (containing DEET) on the clothes and exposed part of the body especially when you travel to Dengue Fever endemic areas. Mosquito bednet could be used when the room is not air-conditioned. Search and destroy bleeding places Say no to fogging

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Diagnosis Clinical 1. Fever acute in onset, high and continuous, lasting for 7-10 days 2. Tourniquet test (Rumpel-Leede test) y test to determine capillary fragility Presence of bleeding (petechiae, purpura, ecchymosis, epistaxis, gum bleeding, hematemesis, melena) Laboratory 1. thrombocytopenia 100,000/ mm3 or less 2. Hemoconcentration y a increase of at least 20% in the hct y steady rise in hematocrit Confirmatory test 1. Serologic test simplest and most rapid method of confirming clinical diagnosis of dengue infection 2. Isolation of the virus most reliable although this is complicated and requires time. 19 Nursing Intervention y Eradication of mosquitoes by eliminating breeding places Any disease or condition with hemorrhage is enough to cause alarm. Immediate control of hemorrhage enclose observation of the patient for the vital sign leading to shock For hemorrhage 1. keep patient at rest during bleeding episodes 2. observe for signs of deterioration 3. control bleeding For Shock 1. prevention is the best treatment 2. restore blood volume