Hemorrhagic dengue

Dengue shock syndrome

Philippine hemorrhagic fever Thai hemorrhagic fever

Singapore hemorrhagic fever

Dengue

Hemorrhagic Fever is an acute infectious viral disease usually affecting infants and young children. This disease used to be called break-bone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti). Philippine Hemorrhagic Fever was first reported in 1953. in 1958, hemorrhagic fever became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.

An acute febrile infection of sudden onset with clinical manifestation of 3 stages:

high fever Abdominal pain and headache Later flushing which by infection may and accompanied conjunctival epistaxis vomiting,

Lowering of temperature
Severe abdominal pain Vomiting and frequent bleeding

from gastrointestinal tract in the form of hematemesis or melena Unstable BP Narrow pulse pressure shock

Generalized flushing with intervening

areas of blanching appetite regained

Blood pressure already stable

Severe, frank type with flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death. Moderate with high hemorrhage, no shock

fever, but less

Mild with slight fever, with or without petechial hemorrhage but epidemiologically related to typical cases usually discovered in

the course of investigation of typical cases.

PETECHIAE

BRUISES

Flavivirus, Dengue Virus Types

1, 2, 3, & 4
Chikungunya Virus

Vector mosquito
Aedis
Aedis

Aegypti ,
albopictus,

The infected person

INCUBATION PERIOD UNCERTAIN. Probably 6 days to 1 week PERIOD OF COMMUNICABILITY Unknown. Presumed to be on the first week of illness when virus is still present in the blood.

SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE

All persons are susceptible. Bothe sexes are equally

affected. Age groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years. Occurrence is sporadic through out the year. Epidemic usually occur during the rainy seasons June November. Peak months are September and October. Occurs wherever vector mosquito exists. Susceptibility is universal. Acquired immunity may be temporary but usually permanent.

Physical Examination may reveal following: Low BP A weak, rapid pulse Rash Red eyes Red throat Swollen glands Enlarged liver (hepatomegaly)

the

Test may iclude the following: Hematocrit Platelet count Electrolytes Coagulation studies Liver enzymes Blood gases Torniquet test (causes petechiae below the torniquet) X-ray of the chest (may demonstrate pleural effusion) Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (High in titer to Dengue antigen)

POSITIVE TORNIQUET TEST

Most people who develop DHF recover completely within 2 weeks. Some, however, may go through several weeks to months of feeling tired and/or depressed. Others develop severe bleeding problems. This complication, DHF, is a serious illness which can lead to shock (very low BP) and is sometimes fatal especially to children and young adults.

Other
Shock

complications

are

the

following:
Encephalopathy Residual brain damage Seizures

Liver damage

Supportive and symptomatic treatment should be provided For fever, give paracetamol for muscle pains. For headache, give analgesic. DONT give ASPIRIN. Rapid replacement of body fluids is trhe most important treatment Includes intensive monitoring and follow-up. Give ORESOL to replace fluid as in moderate dehydration at 75 ml/kg in 4-6 hours or up to 2-3L in adults. Continue ORS intake until patients condition improves.

The infected individual, contacts and environment: Recognition of the disease. Isolation of patient (screening or sleeping under the mosquito net) Epidemiological investigation Case finding and reporting Health Education

1. Eliminate the vector by: Changing water and scrubbing sides of lower vases once a week. Destroy breeding places of mosquito by cleaning surroundings Proper disposal of rubber tires, empty bottles and cans. Keep water containers covered. 2. Avoid too many hanging clothes inside the

house. 3. Residual spraying with insecticides

1. Search and destroy

2. Self protection
3. Seek early consultation

4. Say no fogging

to

indiscriminate

Report immediately to the municipal Health Office

any known case outbreak. Refer immediately to the nearest hospital, cases that exhibit symptoms of hemorrhage from any part of the body no matter how slight. Conduct a strong health education program directed towards environmental sanitation particularly destruction of all known breeding places of mosquitoes. Assist in the diagnosis of suspect based on the s/sx. For those without signs of hemorrhage, the nurse may do the torniquet test. Conduct epidemiologic investigations as a means of contacting families, case finding and individual as well as community health education

1. For hemorrhage keep the px at rest during

bleeding episodes. For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. For melena, ice bag over the abdomen. Avoid unnecessary movement. If transfusion is given, support the patient during the therapy. Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration..

2. For shock prevention is the best treatment. Dorsal recumbent position facilitates circulation.
Adequate preparation of the patient, mentally and physically prevents occurrence of shock. 1. Provision of warmth-through lightweight covers (overheating causes vasodilation which aggravates bleeding).

3. Diet low fat, low fiber, non-irritating, noncarbonated. Noodle soup may be given.