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. Symptoms By Mayo Clinic staff Many people, especially children and teens, may experience no signs or symptoms during a mild case of dengue fever. When symptoms do occur, they usually begin four to 10 days after the person is bitten by an infected mosquito. Signs and symptoms of dengue fever most commonly include:

number of clot-forming cells in your bloodstream falls. This can cause:

Bleeding from the nose and mouth Severe abdominal pain Persistent vomiting Bleeding under the skin, which may look like bruising Problems with your lungs, liver and hear

Fever, up to 106 F (41 C) Headaches Muscle, bone and joint pain Pain behind your eyes You might also experience:

Dengue is transmitted by the bite of an Aedesmosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world.Symptoms appear 314 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults (WHO) For dengue nursing care plans click here Other names of Dengue: H-Fever (Hemorrhagic Fever) Dengue Shock Syndrome Breakbone Fever due to prominent muscle and joint pain Dandy Fever Dengue Fever/Dengue Fever Syndrome Is a tropical disease caused by different strains of dengue virus which are transmitted by Aedes Aegypti mosquitos. It is an acute infectious disease characterized by severe pain behind the eye and the joints andbones and accompanied by rash. No bleeding occurs.

Widespread rash Nausea and vomiting Minor bleeding from your gums or nose Most people recover within a week or so. In some cases, however, symptoms worsen and can become life-threatening. Blood vessels often become damaged and leaky, and the

Dengue Shock Syndrome Medical emergency due to loss of plasma and requires immediate administration of IVF to expand plasma volume. Dengue Hemorrhagic Fever Those cases with gross hemorrhages. A severe illness characterized by abnormal vascular permeability, hypovolemia and abnormal blood clotting mechanism

Incubation Period 4-6 days (minimum: 3 days; maximum: 10days) Pathophysiology Each of the 4 types of Dengue virus can cause either classical or dengue hemorrhagic fever. Virus enters the blood stream Neutralizing antibodies are produced principally against the virus type Because of the production of antibodies, and the response of the immune system to the initial attack, constitutional signs and symptoms are manifested Because of the increasing antigen-antibody complex Increased capillary fragility brought about by a strong immune complex reaction the produce toxic substance like histamine, serotonin and bradykinin which damages the capillary wall in an attempt to repair lesions, clotting occurs DISSEMINATED INTRAVASCULAR COAGULATION Increased capillary permeability loss of plasma from intravascular space Thrombocytopenia acute excessive consumption of platelets due to generalized intravascular clotting Decreased blood coagulation factors initiated by lesions in the capillary wall SIGNS AND SYMPTOMS OF DENGUE HEMORRHAGIC FEVER Signs and symptoms depend on the Grade: Grade I (+) fever lasting 3 5 days Abdominal pain Anorexia, nausea and vomiting Pain behind the eyes

Causative Agent

4 serotype of the dengue virus (1,2,3 and 4 Group B Arbovirus) the 4 viruses are antigenically close to each other however, they only give partial cross protection after being infected by any of them Aedes Aegypti Bite of the Female Aedes Aegypti (day biting, low flying, breeds in stagnant water, in urban areas). Why female? It is because that they use the blood obtained for laying of eggs. It is the primary vector for the transmission of dengue. Sources:

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1. Infected Persons virus is present in the blood of patients during the acute phase of the disease and will become a reservoir of the virus 2. Standing water will serve as a breeding place for the mosquitoes Mode of transmission By the bit of an infective Aedes Aegypti mosquito

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Joint pains (+) eveidence of vascular changes petechiae Hermans sign general flushing of the skin Grade II signs and symptoms of Grade I + Bleeding

steady rise in hematocrit 1. 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.

Gum bleeding, epistaxis, hematemesis, melena, hematochezia Grade III signs and symptoms of Grade II + Circulatory failure

Treatment: 1. Symptomatic 2. No specific antiviral drugs 3. In most cases, early and most effective replacement of plasma loss with plasma expander and or fluid electrolytes solution results in a favorable outcome.

Hypotension, rapid but weak pulse Grade IV signs and symptoms of Grade III + Shock

For Dengue Fever Syndrome

Diagnosis 1. Clinical 1. Fever acute in onset, high and continuous, lasting for 7-10 days 2. Tourniquet test (Rumpel-Leede test)

test to determine capillary fragility

1. Presence of bleeding (petechiae, purpura, ecchymosis, epistaxis, gum bleeding, hematemesis, melena) 1. Laboratory 1. thrombocytopenia 100,000/ mm3 or less 2. Hemoconcentration

a. Oral fluid and electrolyte replacement - encouraged to prevent and correct dehydration which results from fever b. For fever antipyretics like Acetaminophen but not aspirin c. Hematocrit Determination useful guide in therapy as this reflects the degree of plasma leakage and the need for IV fluid test is recommended daily until the 3rd until patient is afebrile for 1-2 days. d. Close surveillance continuous monitoring of BP/Hct/Platelet For Dengue Shock Syndrome

a increase of at least 20% in the hct

1. IVF (5% Dextrose in 0.3 NaCl is initially given) 2. Plasma volume expanders 3. During fluid reabsorption phase (decreasing Hct)

- slow down rate of administration of IVF - if fluid overload occurs, give Furosemide 1 mg/kg IV stat doses d. Oxygen is indicated for all patients in shock

For Dengue Hemorrhagic Syndrome 1. Blood Transfusion 1. when significant bleeding occurs 2. when platelet count is less than 50,000/mm3 - prepare fresh whole blood - transfuse if active bleeding occurs and if hematocrit and hemoglobin level falls

1. Oxygen Indicated Prognosis 1. Grade I and II Good 2. Grade III Guarded 3. Grade IV Serious Nursing Intervention 1. Control Measure Eradication of mosquitoes by eliminating breeding places 1. 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 2. For hemorrhage 1. 1. keep patient at rest during bleeding episodes 2. observe for signs of deterioration 3. control bleeding 4. For Shock a. prevention is the best treatment b. restore blood volume