Dengue Manuscript Final

8/12/2019 Dengue Manuscript Final

1/16

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

1


2/16

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

2


3/16

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

3


4/16

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


5/16

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


6/16

;&- 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


7/16

#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 !

7


8/16

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

8


9/16

+ P)ASES OF DEN$%E I&&NESS

I, FE(RI&E

$ast -&= days

5igh&grade fever

4acial flushing

kin erythema

enerali(ed body ache

9


10/16

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.

10


11/16

!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

11


12/16

&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.


13/16

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 '

13


14/16

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


15/16

$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

15
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/Denguefever


16/16

16

Documents

Dengue Manuscript Final