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TABLE OF CONTENTS
Definition
2
Mode of
Transmission
.2
Incubation
Period
2
Pathophysiology of
Dengue3
Signs and
Symptoms
.3
Diagnostic
Examination
..4
Grading of
Dengue
.4
Treatment
.4
Geographic areas at high risk for contracting
Dengue.4
Difference Between Dengue and
Malaria.5
Prevention and Control: The 4S Strategy against
Dengue6
Statistical Reports regarding
Dengue.7

Summary
.8

References
.8

Definition
Dengue Hemorrhagic fever : an infectious tropical disease caused by the dengue virus
By etymology:
Dengue: African: dinga
Hemorrhagic: Involves bleeding
Fever: having body temperature above 37.5C
AKA: breakbone fever and dandy fever

Mode of Transmission
Dengue Virus is transmitted through Aedes aegypti (small, black mosquito with white
stripes and is approximately 5 mm in size).It takes about 7 to 8 days to develop the virus in its
body and transmit the disease.female mosquitoes that breed in household water containers and
unused materials on the roof and around the houses. Once infected, a mosquito remains
infective for life. Infected humans circulate the virus in their blood, mosquitoes ingest viruses
when feeding on the infective individual. Humans serve as an amplifying host, though some
monkeys may also serve as a source of the virus. Female mosquitoes can also transmit the
virus transovarially, passing it down to the next generation.
The virus is not contagious and cannot be spread directly from person to person. There
must be a person-to-mosquito-to-another-person pathway.

Incubation Period
The incubation period of dengue fever is approximately four days. The person will come
down with fever and present a discrete macular or maculopapular rash. It is difficult to
distinguish dengue fever from other viral diseases and the person usually recovers in 5 days. In
more severe cases, fever and rash are accompanied by headache, retroorbital pain, myalgia,
backache, sore throat, and abdominal pain. The patients become lethargic and experience
anorexia and nausea.

PATHOPHYSIOLOGY
Predisposing risk factor: Geographical area
Precipitating risk factors: Environmental conditions, immunocompromised, mosquito carrying
dengue virus, soldier, sweaty skin
Replication of virus in mosquito
Bite from mosquito
Spread of virus to circulatory system
Virus spreads throughout the blood, stimulating WBCs thus producing antibodies
Antibodies stick to platelets
Thrombocytopenia
Increased risk for bleeding
Stimulates intense inflammatory response

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Prolonged thrombocytopenia leads to DHF
Capillaries become damaged
Bleeding occurs more often

Signs and Symptoms

The following may appear 5 to 6 days after being bitten by the dengue carrier mosquito:

High fever

Severe headache

Retro-orbital (behind the eye) pain

Severe joint and muscle pain

Nausea and vomiting

Rash

After 3 to 4 days along with the classic dengue signs and symptoms
Due to marked damage to blood and lymph vessels, bleeding from the nose, gums, or
under the skin, causing purplish bruises appear.

Diagnostic Examinations
A physical examination may reveal:

Low blood pressure

Rash

Red eyes

Red throat

Swollen glands

Weak, rapid pulse

Tests may include:

Platelet count

Serologic studies (demonstrate antibodies to Dengue viruses)

Tourniquet test (causes petechiae to form below the tourniquet)

Grading
Grade I:
Fever + Hermans Sign (flushed and redness of skin with lighter color at
the center of the rash
Grade II:
Grade I symptoms + bleeding (epistaxis or nosebleeding, gingival
bleeding,
hematemesis or UGIB)
Grade III:
Grade II + Circulatory Collapse (hypotension, cold clammy skin and weak
pulse)
Grade IV:
Grade III + Shock

Treatment
-

Dengue is caused by a virus hence treatment is only supportive or based on the signs
and symptoms manifested by the client.
Usually rest and increase oral fluid intake is important.
Analgesic for severe headache, joint and muscle pain
NSAIDs should be given with caution and under doctors prescription because it can
contribute to further bleeding complications.

Geographic areas at high risk for contracting Dengue

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred
recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central
America. Cases have also been imported via tourists returning from areas with widespread
dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India,
and the Middle East (similar in distribution to the areas of the world that harbor malaria and
yellow fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning
from the Caribbean, South America, and Asia.
-

DIFFERENCE BETWEEN DENGUE AND MALARIA

ASPECTS
Mode of
Transmission

Location

DENGUE
transmitted mainly by
mosquitoes
(Aedes
Aegypti)
generally appear during
day time
prevalent in Southeast

MALARIA
carried
by
mosquitoes
(Anopheles)
due
to
Plasmodium parasites
show
themselves
at
nightfall, sometimes even
during dawn or dusk
endemic in Africa, Asia,

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Asian countries
Incubation Period

Central and South America

Approximately 7 days

Signs and
Symptoms

- High fever (104 F, 40C)

- Chills
- Headache
- Red eyes, pain in the eyes
- Enlarged lymph nodes
- Deep muscle and joint pains
(during first hours of illness)
- Loss of appetite
- Nausea and vomiting
- Low blood pressure and heart
rate
- Extreme fatigue

Prevention

- Improved
practices.

water

one to three weeks, which

could extend up to 10
months after the initial
contamination

- fever
- shivering
- joint pain
- vomiting
- anemia (caused by hemolysis),
hemoglobinuria
- retinal damage
- convulsions
- classic symptom of malaria is
cyclical occurrence of sudden
coldness followed by rigor and then
fever and sweating lasting four to
six hours

storage

- Implement proper solid waste

disposal.
- Eliminate any sources that
may collect water. Mosquitoes
breed easily in any source of
standing water.
- Appropriate insecticides.
- Always clean and check
drains to ensure they are not
blocked especially during the
rainy season.
- Breed small mosquito-eating
fishes in an artificial pond to
eradicate the mosquito larvae.

Goal: eradicate the mosquito

population
SAME

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- Avoid wearing dark and tight
clothing because mosquitoes
are attracted to dark colours.
Wear loose, white and long
clothes, which cover the whole
body. Mosquitoes find it difficult
to bite through loose clothes
than tight fitting clothes.
- Environmental conditions. It is
suggested to sleep under
mosquito netting or in a room
which has mosquito screens on
the windows. Mosquitoes are
unlikely to bite in an airconditioned room and under
strong fans. Mosquito coils are
also useful to help prevent
mosquitoes from entering the
room.
- Apply mosquito repellants.
Treatment and
Management

Symptomatic

Oral fluids for hydration

oral or intravenous
parasite drugs

anti-malarial

anti-

drugs

Prevention and Control: The 4S Strategy against Dengue

1. Search and destroy possible breeding places of dengue-causing mosquitoes that hold clean
stagnant water. Keep the environment clean. Vases should be frequently changing the water in
them. Make sure all water containers are kept covered.
2. Self-protection measures wear long sleeves or long pants. Avoid dark-colored clothes like
dark shades of blue and black, as dark clothing has been observed to attract mosquitoes.
Mosquito repellant that is safe on the skin will deter mosquito bites. There are organic mosquito
repellant alternatives such as all-natural citronella bug spray. You can also use mosquito coils,
electric vapour mats and mosquito spray during the daytime. Screens and mosquito nets are
also good deterrents against mosquitoes.
3. Seek early consultations see a doctor immediately if you show early signs and symptoms of
dengue.

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4. Say no to indiscriminate fogging. Fogging was considered as a temporary solution against
dengue-carrying mosquitoes. It is only advisable and recommended when outbreaks and
epidemics are positively determined in a particular area. Fogging can only kill the adult infected
mosquito; it cannot get rid of the larvae (kiti-kiti). Indiscriminate fogging will only drive away
other mosquitoes to other places to find new breeding grounds.
The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise
and sunset. It may bite at any time of the day and is often hidden inside homes or other
dwellings, especially in urban areas.
There is currently no vaccination available for dengue fever. There is a vaccine
undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of
clinical trials show that a vaccine may be available by 2015.
Statistical Reports regarding Dengue
In 2011, Bolivia, Brazil, Columbia, Costa Rica, El Salvador, Honduras, Mexico, Peru,
Puerto Rico, and Venezuela reported a large number of dengue cases. Paraguay
reported a dengue fever outbreak in 2011, the worst since 2007. Hospitals were
overcrowded, and patients had elective surgeries canceled due to the outbreak.
The U.S. Centers for Disease Control and Prevention (CDC) reports that from 1946 to
1980, no cases of dengue acquired in the continental United States were reported. Since
1980, a few locally acquired U.S. cases have been confirmed along the Texas-Mexico
border, temporally associated with large outbreaks in neighboring Mexican cities.
A 2009 outbreak of dengue fever in Key West, Fla., showed that three patients who did
not travel outside of the U.S. contracted the virus. Subsequent testing of the population
of Key West has shown that up to 55 of the people living in the area have antibodies to
dengue. In total, 28 people were diagnosed with dengue fever in this outbreak.
Dengue fever is common, in at least 100 countries in Asia, the Pacific, the Americas,
Africa, and the Caribbean. Thailand, Vietnam, Singapore, and Malaysia have all reported
an increase in cases.
According to the CDC, there are an estimated 100 million cases of dengue fever with
several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization
each year. Nearly 40% of the world's population lives in an area endemic with dengue.
The World Health Organization (WHO) estimates that 22,000 deaths occur yearly, mostly
among children.
The mortality (death) rate with DHF is significant. With proper treatment, the World
Health Organization estimates a 2.5% mortality rate. However, without proper treatment,
the mortality rate rises to 20%. Most deaths occur in children. Infants under a year of
age are especially at risk of dying from DHF.

Summary:
Dengue fever is a disease caused by a family of viruses that are transmitted by

mosquitoes.
Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen

glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash,
and headache (and other pains) is particularly characteristic of dengue fever.
Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred

recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and in
Paraguay in South America, and Costa Rica in Central America.
Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to

treat it. For typical dengue fever, the treatment is purely concerned with relief of the
symptoms (symptomatic).
The acute phase of the illness with fever and myalgias lasts about one to two weeks.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children

under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory
collapse (shock).
The prevention of dengue fever requires control or eradication of the mosquitoes

carrying the virus that causes dengue.

There is currently no vaccine available for dengue fever.

References:
Retrieved 24 November 2011 from http://www.thepoc.net/thepoc-features/health-andwellness/health-and-fitness-features/7231-the-4s-strategy-dengue-awareness-preventionphilippines.html
Retrieved 24 November 2011 from http://www.nlm.nih.gov/medlineplus/ency/article/001373.htm
Retrieved 24 November 2011 from http://nursingcrib.com/case-study/dengue-fever-case-study/.
Retrieved 24 November 2011 from http://www.who.int/topics/dengue/en/

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