A Case Study on Dengue Fever

Charmaine Grace T. Abcede

Submitted to Nutrition &Dietetics Department

In Partial Fulfillment at Nutrition Therapy I

April 18, 2016

I. General Information
A. Demographic Profile

Dengue fever is a mosquito-borne disease which is prevalent in tropics and sub-tropics.

It is caused by Dengue Virus transmitted by Aides Egypt and Aides albopictus1. Dengue
virus is a single stranded RNA virus which belongs to the family flaviviridae. There are four
serotypes of the virus DNV1, DNV2, DNV3 and DNV4.

Dengue infections can present as a self-limiting illness or as life-threatening dengue

hemorrhagic fever (DHF) or dengue shock syndrome (DSS) which have mortality rates as
high as 20%2. An estimated 50-100 million cases of Dengue Fever (DF) and about 250,000
500,000 cases of Dengue Hemorrhagic Fever (DHF) occur every year3. The WHO 2009
classification divides Dengue fever into two groups: uncomplicated and severe 2. The 1997
classification had divided dengue into undifferentiated fever, dengue fever (DF), and dengue
hemorrhagic fever (DHF).

Epidemics of Dengue were documented in the 1780s in Asia, Africa and North America.
The first clinical case report of Dengue fever was by Benjamin Rush in 1780 during an
epidemic in Philadelphia. He coined the word break-bone fever. Epidemics of dengue
fever were common thorough out the 20th century in the Asia- Pacific region4. Before 1970,
only 9 countries had experienced severe dengue epidemics. The disease is now endemic in
more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia
and the Western Pacific. The American, South-east Asia and the Western Pacific regions are
the most seriously affected. In South East Asia, the average number of cases of DHF per
year has increased from 10,000 in the 1950s to over 200,000 in the 1990s5.
 Dengue virus was isolated in Japan in 19436. First reported case of Dengue in India was
in the 1940s. First biologically documented epidemic in India was in Calcutta and the
Eastern coast in 1963-647,8. India has documented infections from all four seroptypes9.

This study was undertaken to gather information about the clinical profile of dengue cases in
Bangalore and to compare with trends in other cities. In 2009-10, 991 cases were suspected
to have Dengue Fever at Victoria Hospital. Among these, 328 tested positive (33%) and
were studied in detail.

II. Present illness and chief complaint/ admitting impression and medical diagnosis

III. Past surgery and history of hospitalization

My patient had pneumonia when she was two years old and had been admitted and stayed to
the hospital for 1 and a half month. As far as the mother recalled, her daughter took medicine like
amoxicillin.

IV. Appetite, elimination and sleeping pattern

APPETITE PATTERN- Before hospitalization: The patient eats 3 times a day

and with afternoon snacks after coming from school. According to the SO of the
patient, he eats meat, fish and also vegetables. He doesnt have any allergies on
foods and drugs. His appetite is moderate and usually depends on the food being
served. He didnt complain any difficulty in swallowing. During hospitalization:
The patient has loss his appetite and hasnt eaten a lot. He is on a DAT (Diet as
Tolerated) EDCF (Except Dark Colored Foods).
 ELIMINATION PATTERN- Before hospitalization: The patient does not have
any problem on his elimination pattern. He usually urinates 4-5 times a day
without any difficulty. He added that the color of his urine is light yellow. He
didnt feel any pain in urination. The patient defecates once a day usually early in
the morning before going to school with yellow to brown color. He verbalized that
sometimes however, it is hard in consistency with dark color, which generally
depends on what he eats. During hospitalization: The patient urinates 2-3 times a
day. The color of her urine is yellow. The patient defecates once every two days.

SLEEP-REST PATTERN Before hospitalization: He has the normal 6-8 hours

sleep. He also has his nap time for 1-2 hours a day. Sleeping and watching the
television are his form of rest. During hospitalization: He doesnt have the
adequate time of sleep since he is disturbed with the nurses that enter the room
every now and then, and because of the environmental changes of his
surroundings. He also has inadequate time to rest since he doesnt have enough
time to sleep.

V. Family and socio-economic history

VI. Background of medical diagnosis

VII. Etiology

Dengue infection is caused by dengue virus (DENV), which is a single-stranded RNA

virus (approximately 11 kilogausses long) with an icosahedral nucleocapsid and covered
 by a lipid envelope. The virus is in the family Flaviviridae, genus Flavivirus, and the
type-specific virus is yellow fever.
The dengue virus has 4 related but antigenic ally distinct serotypes: DENV-1, DENV-2,
DENV-3, and DENV-4. Genetic studies of sylvatic strains suggest that the 4 serotypes
evolved from a common ancestor in primate populations approximately 1000 years ago
and that all 4 separately emerged into a human urban transmission cycle 500 years ago in
either Asia or Africa.[3, 29] Albert Sabin spectated these viruses in 1944. Each serotype
is known to have several different genotypes. Viral genotype and serotype, and the
sequence of infection with different serotypes, appear to affect disease severity.

Living in endemic areas of the tropics (or warm, moist climates such as the southern
United States) where the vector mosquito thrives is an important risk factor for infection.
[10, 30, 31, 32, 33] Poorly planned urbanization combined with explosive global
population growth brings the mosquito and the human host into close proximity.
Increased air travel easily transports infectious diseases between populations.

VIII. Incidence

IX. Pathophysiology
Dengue fever is a mosquito-borne viral disease caused by 1 of 4 closely related
but antigenic ally distinct serotypes of dengue virus, serotypes DENV-1 through DEN-4.
[10] Infection with one dengue serotype confers lifelong homonymic immunity and a
very brief period of partial heterotypic immunity, but each individual can eventually be
infected by all 4 serotypes. Several serotypes can be in circulation during an epidemic.

X. Prognosis
Dengue fever is typically a self-limiting disease with a mortality rate of less than
1%. When treated, dengue hemorrhagic fever has a mortality rate of 2-5%. When left
untreated, dengue hemorrhagic fever has a mortality rate as high as 50%. Survivors
usually recover without squeal and develop immunity to the infecting serotype.
The fatality rate associated with dengue shock syndrome varies by country, from 12-44%.
In a 1997 Cuban epidemic, the fatality rate in patients who met criteria for dengue
hemorrhagic fever or dengue shock syndrome was approximately 6%. The mortality rate
associated with dengue fever is less than 1%. Data from the 1997 Cuban epidemic
suggest that, for every clinically apparent case of dengue fever, 13.9 cases of dengue
infection went unrecognized because of absent or minimal symptoms.

A 2005 review from Singapore of 14,209 patients found that useful predictors of death
included the following[41] :

Atypical presentations
Significant comorbid illness
Abnormal serum markers (including albumin and coagulation studies)
Secondary bacterial infections
Factors that affect disease severity include the following:

Patient age
Pregnancy
Nutritional status
Ethnicity
Sequence of infection with different dengue serotypes
Virus genotype
Quality and extent of available medical care
Complications and squeal of dengue virus infections are rare but may include the
following:

Cardiomyopathy
Seizures, encephalopathy, and viral encephalitis
Hepatic injury
Depression
Pneumonia
Iritis
Orchids
Oophoritis
In 20-30% of dengue hemorrhagic fever cases, the patient develops shock, known as the
dengue shock syndrome. Worldwide, children younger than 15 years constitute 90% of
dengue hemorrhagic fever patients[36] ; however, in the Americas, dengue hemorrhagic
fever occurs in both adults and children.
 Although dengue is an extremely important arboreal illness globally, literature evaluating
the economic impact is fairly sparse, with some conflicting findings. A recent expert
panel assessment and 2 studies in the Americas recommended additional research to fill
important information gaps, including disease outcomes and accurate statistics regarding
disease burden, that could better inform future decision making regarding control and
prevention.[42, 43, 44]

A 5-year prospective study in Thai children examined the relative economic burden of
dengue infection in children on the local population. Most disability-adjusted life years
(DALYs) lost to dengue resulted from long-term illness in children who had not been
hospitalized. The infecting serotype appeared to be the major determinant of DALYs lost,
with DEN-2 and DEN-3 responsible for 59%. The mean cost of illness from dengue was
significantly higher than that from other febrile illnesses studied.[40]

A prospective study examined the direct and indirect costs of dengue infection in 1695
pediatric and adult patients in 8 countries. The average illness lasted 11.9 days for
ambulatory patients and 11 days for hospitalized patients. Hospitalized students lost 5.6
days of school. Those at work lost 9.9 work days. Overall mean costs were more than
double (1394 international dollars [I$]) for hospitalized cases. With an annual average of
594,000 cases the aggregate economic cost was estimated to be at least I$587 million,
without factoring in underreporting of disease and dengue surveillance and vector control
z`zcosts. This represents a significant global economic burden in low-income countries.
[44]
XI. Assessment of nutritional status (tabular form)
A. SGA Form/Hospital Form/Dietary Form
B. Anthropometric assessment
C. Clinical
D. Dietary

XII. Drug-nutrient interaction

Generic Name PARACETAOMOL

Brand Name BIOGESIC
Classification Anti-pyretic
 Mechanism of Ampicillinexertsbactericidalaction on bothgm+ve and gm-ve
action organisms. Its spectrum includes gm+veorganisms e.g., Pneumonia
and other Streptococci,L
monocytogenesand gm-vebacteria eg, Mcatarrhalis, Ngonorrhoea,
Nmeningitidis, Ecoli, P mirabilis,Salmonella,Shigella, and
Hinfluenzae.Ampicillinexerts its actionby inhibitingthe synthesis of
bacterial cellwall.
Dosage 460 mgvia IV
Indication Forsusceptibleinfections
Contradiction Hypersensitivity;infectiousmononucleosis
Adverse Effect GI
upset,nausea,vomiting,diarrhoea;blooddyscrasias;urticaria,exfoliativ
edermatitis,rash; fever,seizures;interstitialnephritis
Nursing Should administer them education using aseptic technique
Responsibilities Monitor if there is side effect.
Discontinued if there are any reactions

XIII. NCP
ASSESSMENT PLANNING INTERVENTION INTERVENTION EVALUATION
Subjective Cues: Short term Provide surface To promote core Patient
Nilalagnat ang goal After an cooling such as cooling by condition
anak ko mainit hour of TSB and removing helping reduce improve
po siya, as the nursing of extra clothing. body temperature.
patients mother intervention
verbalized. ,the clients Encouraged To prevent
Objective Cues: temperature increase fluid dehydration
Weakness will subside intake. because increase
Flush skin from 38.9C- in body
Warm to touch 38.0C Provide bed rest. temperature
Pale causes fluid loss
Febrile - 38.9C Administer such as sweating.
Loss of appetite Paracetamol 5ml
NURSING p.o as ordered by To detect further
DIAGNOSIS the physician. existing
Hyperthermia discomfort and
related to promote rest.
infection
Paracetamol are
classified as an
algetic and
antipyretic which
acts on the
 Hypothalamus to
regulate normal
body temperature.

XIV. Food Plan- One day food plan

XV. Analysis of Diet Prescription

XVI. Goals of medical nutrition therapy

XVII. Conclusion and Recommendation

XVIII. Glossary of medical terms

Abdominal: Relating to the abdomen, the belly, that part of the body that contains all of ...

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Abdominal pain: Pain in the belly. Abdominal pain can be acute or chronic. It may reflect ...

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Acetaminophen: A nonaspirin pain reliever or analgesic. Acetaminophen may be given alone t...

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Acute: Of abrupt onset, in reference to a disease. Acute often also connotes an illness th...

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Acute illness: A disease with an abrupt onset and, usually, a short course.

Aerosol: A fine spray or mist. Medications in aerosol form can be administered via a nebul...

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Aspirin: Once the Bayer trademark for acetylsalicylic acid, now the common name for this a...

See the entire definition of Aspirin

Assay: An assay is an analysis done to determine:

1. The presence of a substance an...

See the entire definition of Assay

Back pain: Pain felt in the low or upper back. Causes of pain in the low and upper back in...

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Bacterial: Of or pertaining to bacteria, as in a bacterial lung infection.

Blood pressure: The blood pressure is the pressure of the blood within the arteries. It is...

See the entire definition of Blood pressure

Bradycardia: A slow heart rate, usually defined as less than 60 beats per minute.

CBC: A commonly used abbreviation in medicine that stands for complete blood count, a set...

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CDC: The Centers for Disease Control and Prevention, the US agency charged with tracking a...

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Cell: The basic structural and functional unit of any living thing. Each cell is a small c...

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Centers for Disease Control and Prevention: The US agency charged with tracking and
invest...

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Chills: feelings of coldness accompanied by shivering. Chills may develop after exposure t...

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Coagulation: In medicine, the clotting of blood. The process by which the blood clots to f...

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Contagious: capable of being transmitted from one human to another human via direct or ind...

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Dehydration: Excessive loss of body water. Diseases of the gastrointestinal tract that cau...

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Dengue: Also known as Dengue fever, an acute mosquito-borne viral illness of sudden onset ...
XIX. References
http://www.slideshare.net/mjhernandez23/individual-cstudy-100613-print?qid=43ef6816-
3771-4243-8700-fe027e3cf8b0&v=&b=&from_search=1
https://www.scribd.com/doc/46656876/dengue-fever-syndrome-case-study
https://www.scribd.com/doc/18479720/Case-Study-Dengue