Professional Documents
Culture Documents
Hemorrhagic Fever
Grupo ni Louie
Introduction
Philippine Hemorrhagic fever was first reported in 1953. In 1958, hemorrhagic fever became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic fever. Dengue cases usually peaks in the months of July to November and lowest during the month of February to April
Etiologic Agent
Dengue virus types 1, 2, 3 and 4
Source of infection
Immediate source is a vector mosquito the
, Aedes
Mode of Transmission
Mosquito bite (
Aedes Aegypti)
Incubation Period
Uncertain, Probably 6
days to one
week.
Period of Communicability
Unknown. Presumed to be on the first week of illness when virus is still present in the blood.
Susceptibility
Both sexes Both sexes are equally are equally affected. All person affected. All person
Peak age affected Peak age affected 5-9 years of age. 5-9 years of age.
Age groups Age groups predominantly affected predominantly affected are the preschool are the preschool
Occurrence is sporadic throughout the year. Epidemic usually occur during the rainy season as June
Early Symptoms
Malaise
Fever Headache
Vomiting
Decrease appetite
Shock-like state
Sweaty (diaphoretic)
Cold, clammy extremities
Febrile Toxic
Convalescent
Febrile
First 4 days (DOH) Abrupt onset of high fever > 39-40 degrees Headache Malaise Nausea and Vomiting Muscle pain
Toxic
Convalescent
The rash in dengue is The rash in dengue is called "Herman's rash". called "Herman's rash". It appears on the upper It appears on the upper and lower extremities, and lower extremities, purplish or violaceous red purplish or violaceous red with blanched areas about with blanched areas about 1 cm or less in size. 1 cm or less in size.
Categories of DHF
Category I Category II Category III Category IV
Category II plus Category III plus Circulatory profound failure shock with Cold clammy skin undetectable Weak thready pulse and pulse blood Narrow pulse pressure pressure ( less than 20mm/Hg) Hypotension Restlessness History or Category I plus Presence presence of of one or more Danger fever 2-7 days Signs (especially duration, with a defervescence) (+) tourniquet Restlessness test or presenceChanges in sensorium of skin flushing Cold, clammy skin or petechial Sudden onset of rash abdominal pain Difficulty of breathing Circumoral cyanosis Seizures Spontaneous bleeding (gum bleeding, epistaxis, rashes, petechiae)
Clinical Diagnosis of DHF is base on four major characteristic manifestations Sustained high fever, lasting 2-7 days Hemorrhagic tendencies such as positive torniquet test, petechiae, epistaxis, bleeding GI tract, injection sites Thrombocytopenia ( < 100,000 platelets/mm3 ) Evidence of plasma leakage
Pathophysiology
Vasculopathy
A positive tourniquet test indicating the increased capillary fragility is found in the early febrile stage. It may be a direct effect of dengue virus as it appears in the first few days of illness during the viremic phase.
Tourniquet test (capillary fragility test or Tourniquet test (capillary fragility test or Rumpel Leads test) a presumptive test Rumpel Leads test) a presumptive test which is positive in the presence of more which is positive in the presence of more than 20 petechiae within an inch square, than 20 petechiae within an inch square, after 5 minutes of test after 5 minutes of test
Platelet dysfunction
PD as evidenced by the absence of
adenosine diphosphate (ADP) release, was initially demonstrated in patients with DHF during the convalescent stage. The platelet dysfunction might be the result of exhaustion from platelet activation triggered by immune complexes containing dengue antigen.
Coagulopathy clotting disorder During the acute febrile stage, mild prolongation of the prothrombin time and partial thromboplastin time, as well as reduced fibrinogen levels.
There are four distinct, but closely related, viruses that cause dengue DEN 1, DEN 2, DEN 3 and DEN 4.
Recovery from infection by one provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. There is good evidence that sequential infection increases the risk of more serious disease resulting in DHF.
Medical Treatment
Symptomatic and supportive relief Rapid replacement of Fluids (most important treatment) like oresol and IV Start IVF using D5LRS or D5 0.9NaCl or plain LRS Give fresh whole blood at 1-ml/KBW if there is significant blood loss or if hematocrit continues to fall despite fluid resuscitation
Medical Treatment
Give fresh whole blood at 1-ml/KBW if here is significant blood loss or if hematocrit continues to fall despite fluid resuscitation Give platelets when platelet count is below 150,000/uL or if there is significant blood loss and platelet count is below 150,000/uL, or there is continuous bleeding and hematocrit remains normal.
Outlook (Prognosis)
With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive
Physical Assessment
CATEGORY General Appearance Vital Signs FINDINGS The patient looks weak and with eyebags. Temperature: 40.5 Respiration: 30 cpm Pulse Rate: 110 Blood Pressure: 90/40 Upon inspection, the patient was noted to have flushed skin color The patients natural hair color is black. Soft and shiny. Upon inspection the skull is symmetrically aligned. No signs of lesions. Eyes and eyebrows are symmetrically aligned with equal distribution of hair on both eyebrows. PERRLA The color of both ears is the same with the facial skin and is symmetrically aligned. No ear discharge is noted. The external nose is symmetric and straight same color as with the facial skin. There is no nasal flaring. No obstruction in both nasal cavities Appears to be a little bit dry but not bluish or cyanotic. No lesions, cracks or warts are present The patient can move his head freely, no nodules palpated in the cervical area Normal respiration, symmetrical chest expansion, clear breath sounds, negative retraction. Normal cardiac rate, symmetrical peripheral pulse noted. Normal bowel sound. Soft non tender abdomen Motor @ 4/5 upper and lower extremities Both appear to be symmetric Conscious and oriented
Ears Nose
Day 1
In day 1, a 3-year old male patient carried by his mother was admitted with a chief complaint of fever. Ten hours prior to consultation, the patient had a high grade fever and vomiting for several hours according to the mother. The patient had a high grade fever of 40.5 0C and BP: 90/40. Diet as tolerated was ordered. Upon assessment the patient is positive for tonsillopharyngitis. . Anti-biotics was also part of his medication to treat his tonsilopharyngitis. Ampicillin testing was done and had negative result. At 1000H, patient had a febrile seizure with temperature 41.80C, Paracetamol was given. Stool examination was requested and the fecalysis result was normal, the stool was soft, yellow colored stool. At 0100H, the patient experienced chills with temperature of 38.80C. Paracetamol was given, patients temperature went down to 370C.
Day 4
In day 4, a significant drop in his temperature was noted, as low as 36.8 oC which is a sign that the patient is entering into the toxic stage of Dengue Fever. This state of defervescence, is a period where the number of patients platelet is at its lowest. It is at this time where his attending physician ordered another Laboratory request for CBC and PC to check if Patient Xs platelet count is below the normal range of 150,000 to 350,000 /L, which is referred to as thrombocytopenia. Hemoglobin, hematocrit, RBC WBC and Platelet count are within normal limits. Segmenters are slightly decrease with the value of 0.36 which is below the normal value of 0.50-0.70. After the significant drop of the clients temperature, Patient X temperature were elevated again for eight hours, a normal phenomenon for a DHF patient before entering into the convalescent stage. The patient had general rashes with itchiness.
Day 5 & 6
In day 5, the patient is afebrile and positive for Hermans sign. In day 6, the patient is afebrile and still positive for Hermans sign. Additional medication was ordered Ascorbic acid with dosage of 100mg/5mL to be taken 1 tsp everyday. Diagnosis of Dengue Hemorrhagic Fever II was resolved. The patient was discharged.
Drug Study
Please refer to hardcopy provided
NCP
Please refer to hardcopy provided