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8/12/2019 Dengue Manuscript Final
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Objectives
To be able to gain knowledge and understanding about the disease process
of dengue, its classification and its prevention and management.
SCOPE OF PRESENTATION
Definition of terms
Alternative Names
Etiologic Agent
Mode of Transmission
Epidemiology
ources of infection
!ncidence
!ncubation "eriod and "eriod of #ommunicability
Disease "rocess of Dengue
Dengue #ase #lassification
"hases of Dengue illness
$aboratory E%aminations
"revention, Management,Treatment and #ontrol
Nursing !nterventions
"rognosis
#heck on $earning
ummary
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DEFINITION OF TERMS
Defervescence& Abatement of a fever as indicated by a reduction in body
temperature
DENV& dengue virus
Epidemiolo!' deals with transmission and control of the disease.
Etioloic "ent& it includes viruses, fungi, proto(oa, bacteria
Incidence' the number of cases of the disease
Inc#b"tion Period & The period between infection and the appearance of
symptoms of the disease
Mode of Tr"nsmission ' it indicates the potential of the disease)
conveyance of the agent to the host
Pronosis&A prediction of the course of a disease
Reservoir' the environment in which the agent is found
Vector' any agent that carries a disease
DEN$%E
An infectious disease caused by any of the four serotypes of flavivirus
*DEN+,DEN+-,DEN+,DEN+/0 which are spread by mos1uitoes in tropicaland subtropical areas.
#haracteri(ed by severe pain behind the eye and in the 2oints and bones and
accompanied by an initial erythema and a terminal rash.
A&TERNATIVE NAMES
3reakbone 4ever
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Dandy 4ever
"hilippine 5emorrhagic 4eve
ETIO&O$IC A$ENT
4lavivirus * DEN+ , - , , /0
Arbovirus namely 6nyong&onyong, #hikungunya, 7est Nile
MODE OF TRANSMISSION
3ite of infective mos1uitoes principally femaleAedes aegypti (urban areas)
and Aedes albopictus (rural areas).
Described as8
Day biting, low flying mos1uito with increased biting activity for two
hours after sunrise and two hours before sunset
3reeds on clear, stagnant water
5as gray wings and white stripes on the body
Aedes "e!pti
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EPIDEMIO&O$'
Dengue is the most rapidly spreading mos1uito&borne viral disease in the
world. !n the last 9: years, incidence has increased :&fold with increasing
geographic e%pansion to new countries and in the present decade from urban
to rural settings.
An estimated 9: million dengue infections occur annually and appro%imately
-.9 billion people live in dengue endemic countries.
3etween -:: and -::;, ,:-:, cases were reported in #ambodia,
Malaysia, "hilippines and +ietnam& the four countries in the 7estern "acific
; *official country reports0. #ompared with
other countries in the same region, the number of cases and deaths remained
highest in #ambodia and the "hilippines in -::;. 6verall, case management
has improved in the 7estern "acific
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AE8 The infection may occur at any age but common among school
children with the peak between / and B years old
EC8 3oth se%es e1ually affected
EA6N8 More fre1uent during rainy season or months
E6
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;&- days on the salivary gland
of the mos1uito
"ortal of Entry in the kin
* Mos1uito 3ite 0
+irus in the blood stimulates the release
of the 73#s including 3 lymphocytes
Antibodies attach to viral antigen and
Performs phagocytosis and dengue
virus replication
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#oagulation defect Thrombocytopenia
3leeding !ncreased
+ascular
"ermeability
5emoconcentration $eakage of "lasma
"leural Effusion
5ypotension
hock
DEAT5
DEN$%E CASE C&ASSIFICATION ACCORDIN$ TO *)O
FM"T6MAT!# DENE +! rade !
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rade !!
rade !!! Dengue hock yndrome
rade !+
#urrently the classification into DF/DHF/DSScontinues to be widely used.
Dengue 4ever ' the type without significant hemorrhages
Dengue 5emorrhagic 4ever ' characteri(ed by abnormal vascular
permeability, hypovolemia, and abnormal blood clotting
mechanism.
$r"de I' 4ever accompanied by non&specific constitutional
symptoms and the only hemorrhagic manifestation is *G0positive
tourni1uet test.
$r"de II' All signs of grade ! plus spontaneous bleeding from thenose, gums, !T.
$r"de III' "resence of circulatory failure as manifested by weak
pulse, narrow pulse pressure, hypotension, cold clammy skin and
restlessness.
$r"de IV' "rofound shock) undetectable blood pressure and pulse
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+ P)ASES OF DEN$%E I&&NESS
I, FE(RI&E
$ast -&= days
5igh&grade fever
4acial flushing
kin erythema
enerali(ed body ache
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5eadache
Anore%ia
Nausea and vomiting
*G0 positive tourni1uet test
"etechiae and mucosal membrane bleeding *e.g. nose and gums0
Decreased in total white cell count
Enlarged and tender liver
5ermans sign * pathognomonic sign0 maculopapular or petechial rash
maybe present that usually start in the distal proportion of the
e%tremities) the skin appear purple with blanched areas with varied
si(es
II,CRITICA&
Time of defervescence *temperature drops to =.9&;H#0 on days &= of
illness
I capillary permeability)I hematocrit level *marks the beginning of critical
phase0
"rogressive leukopenia)J platelet count
"leural effusion and ascites *seen in chest %&ray and abdominal ultrasound0
hock when critical volume of plasma is lost through leakage)preceded by
warning signs * subnormal body temperature0
The conse1uent organ perfusion results in progressive organ
impairment,metabolic acidosis and disseminated intravascular coagulation
which leads to hemorrhage causing J hematocrit in severe shock. !ncreased
total white cell count in patients with severe bleeding.
!mprovement after defervescence said to have non severe dengue and
some progress to critical phase without defervescence.
Those who deteriorate with warning signs are called dengue with warning
signs.
III, RECOVER'
"atient survives the -/&/; critical phase, a gradual reabsorption of
e%travascular compartment fluid takes place in the following /;&=- hours.
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!mprovement on general well being, appetite returns and gastrointestinal
symptoms abate
tabili(ed hematocrit or may be lower due to dilutional effect of reabsorbed
fluid
SEVERE DEN$%E
Defined as one or more of the following8
"lasma leakage that may lead to shock *dengue shock0 and or fluid
accumulation with or without respiratory distress
evere bleeding
evere organ impairment
During the initial stage of shock, the compensatory mechanism which
maintains a normal systolic blood pressure produces tachycardia and
peripheral vasoconstriction
"ulse pressure of -:mm5g or less and rapid weak pulse or hypotension
5igh or progressively rising hematocrit "leural effusion or ascites
#irculatory compromise or shock * tachycardia, cold and clammy e%tremities 0
#apillary refill time greater than secs.
7eak or undetectable pulse or in late shock ) unrecordable blood pressure
ignificant bleeding
Altered level of consciousness
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&A(ORATOR' E-AMINATIONS
Test may include the following8
5ematocrit , "latelet count
Electrolytes
#oagulation studies
$iver en(ymes
Torni1uet test
C&ray of the chest *may demonstrate pleural effusion0
erologic studies *demonstrate antibodies to Dengue viruses0
erum studies from samples taken during acute illness and
convalescence *5igh in titer to Dengue antigen0
PREVENTION AND CONTRO&
Early detection and treatment of cases
#ase finding and reporting
5ealth teaching
!solation of patient *se of mos1uito nets0
Destroy the breeding places
a. #hanging water and srubbing sides of lower vases once a week
b. Destroy breeding places of mos1uito by cleaning surroundings, proper
disposal of rubber tires, empty bottles and cans
c. Avoid too many hanging clothes inside the house
d.
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TREATMENT
Mainly symptomatic and supportive
There are no specific antiviral drugs
I,DEN$%E )EMORR)A$IC FEVER .*IT)O%T S)OC/0
6ral fluid and electrolyte ' should be encouraged to prevent and correct
dehydration which results from hyperpyre%ia, anore%ia and vomiting.
Anti& pyretics Kacetaminophen *do not use aspirin0
Anti& convulsant drugs *i.e dilantin0
5ematocrit *5ct0 determination
5emoglobin *5gt0 determination
"atients should be hospitali(ed and treated immediately when signs and
symptoms of shock are noted.
II, DEN$%E S)OC/ S'NDROME
3lood transfusion
!ndicated when significant signs of bleeding as melena and
hematemesis
7hen thrombocytopenia sets in *platelet count L 9:,:::Kmm 0
"repare fresh whole blood
Transfuse if active bleeding occurs or both 5ct and 5gb level falls
"ersistent bleeding and disseminated intravascular coagulopathy
follow whole blood transfusion with cryoprecipitate
6%ygen
!ndicated for all patients in shock
edatives
May be needed to allay apprehension or agitation
N%RSIN$ INTERVENTIONS
#ontrol measure8 eradication of mos1uitoes
4or5emorrhage '
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a. eep the patient at rest during bleeding episodes.
b. 4or nose bleeding, maintain an elevated position of trunk and put an ice
bag over the forehead. 4or melena, ice bag over the abdomen.
c. !f transfusion is given, support the patient during the therapy. 6bserve
signs of deterioration *shock0 such as low pulse, cold clammy skin.
hock
a. "revention is the best treatment
b. Trendelenburg position facilitates greater blood volume to the head part
4or an%iety of "atient and 4amily&e%plain thoroughly the nature, discomforts
and limitations of activity associated with diagnostic procedures
Diet
a. $ow fat, low fiber, non&irritating, non&carbonated and avoid dark colored
foods
4ever
a. #ooling measures through sponges and administer prescribed drugs.
b. Encouraged fluid intake unless contraindicated
PRO$NOSIS
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$aboratory E%aminations
"revention and #ontrol
Treatment and Nursing !nterventions
"rognosis
REFERENCES
#ommunity 5ealth Nursing ervices in the "hilippines, Department of 5ealth
>thEdition, -:::
Mims Medical Microbiology /thEdition -::;
#ompilation of #ommunicable Diseases in Nursing
Abraham . 3enenson, O #ontrol of #ommunicable Diseases in Man 9th
Edition >>:
*ebsites1
#enters for Disease #ontrol and "revention www.cdc.gov
7orld 5ealth 6rgani(ation www.who.int
7ikipedia The 4ree Encyclopedia http8KKen.wikipedia.orgKwikiKDenguefever
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http://www.cdc.gov/http://www.who.int/http://en.wikipedia.org/wiki/Denguefeverhttp://www.cdc.gov/http://www.who.int/http://en.wikipedia.org/wiki/Denguefever8/12/2019 Dengue Manuscript Final
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