DENGUEHEMORRHAGIC FEVER                     By: Dave Jay Sibi. Manriquez BSN, RN          DR Muhammad TUSEEF JAVED
What is DengueHemorrhagic Fever?DR Muhammad TUSEEF JAVEDIPH LAHORE    DR Muhammad TUSEEF JAVED
IINTRODUCTION:    Philippine Hemorrhagic Fever was first reported in 1953. In    1958, hemorrhagic became a notifiable dis...
WHO case definition for DHF:• fever or history of recent fever• thrombocytopenia (platelet count equal to or less than 100...
Occurrence:     Dengue occurrence is sporadic throughout the year.     Epidemic usually occurs during the rainy seasons Ju...
Notifiable Diseases and Deaths by Cause in             the Philippines (2001 – 2004)                     2001             ...
INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN           CEBU CITY (YEAR 2007)  Selected     Number of New Cases           Numbe...
Reservoir / Source of Infection:           • Some source is a vector mosquito, the Aedes           Aegypti or the common h...
Mode of Transmission: Mosquito bite (Aedis Aegypti)Incubation Period:        Probably 6 days to one weekPeriod of         ...
Diagnostic Test:   1.) Tourniquet Test (Rumpel Leads Tests)   • Inflate the blood pressure cuff on the upper arm to      a...
Clinical Manifestations (Public Health Nursing inthe Philippines, 2007):An acute febrile infection of sudden onset with 3 ...
• 7th-10th day (convalescent or recovery   stage)   -generalized flushing with intervening areas of   blanching, appetite ...
Grading of Dengue Fever:The severity of DHF is categorized into four grades:• grade I, without overt bleeding but positive...
MANAGEMENT   DR Muhammad TUSEEF JAVED
 Promote  rest Medication   Paracetamol – for    fever and muscle    pains.   Analgesic – for    headache   DON’T GIV...
   Rapid replacement of body    fluids is the most important    treatment      Give ORESOL to replace       fluid as in ...
   For hemorrhage     Keep patient at rest during      bleeding periods     For epistaxis – maintain an      elevated p...
 Provide support during the  transfusion therapy Diet    Low fat, low fiber, non-     irritating, non-carbonated    No...
PREVENTION  DR Muhammad TUSEEF JAVED
• Eliminate vector by:  – Changing water and scrubbing    sides of lower vases once a    week  – Destroy breeding places o...
OTHER PRECAUTIONS: • When outdoors in an area where   dengue fever has been found   – Use a mosquito repellant   – Dress i...
• Keeping unscreened windows and  doors closed• Keeping window and door screens  repaired• Use of mosquito nets           ...
DR Muhammad TUSEEF JAVED
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Dengue hearhgic fever by dr muhammad tuseef javed

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Dengue hearhgic fever by dr muhammad tuseef javed

  1. 1. DENGUEHEMORRHAGIC FEVER By: Dave Jay Sibi. Manriquez BSN, RN DR Muhammad TUSEEF JAVED
  2. 2. What is DengueHemorrhagic Fever?DR Muhammad TUSEEF JAVEDIPH LAHORE DR Muhammad TUSEEF JAVED
  3. 3. IINTRODUCTION: Philippine Hemorrhagic Fever was first reported in 1953. In 1958, hemorrhagic became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.What is DengueHemorrhagic Fever? • A severe mosquito transmitted viral illness endemic in the tropics. • It is characterized by increased vascular permeability, hypovolemia and abnormal blood DR Muhammad TUSEEF JAVED clotting mechanisms.
  4. 4. WHO case definition for DHF:• fever or history of recent fever• thrombocytopenia (platelet count equal to or less than 100 x 10 /cu mm)• hemorrhagic manifestations such as petechiae or overt bleedingphenomena, and• evidence of plasma leakage due to increase vascular permeabilityInfectious Agent / Etiologic Agent: Flaviviruses; Dengue Virus Types 1, 2, 3, and 4 DR Muhammad TUSEEF JAVED
  5. 5. Occurrence: Dengue occurrence is sporadic throughout the year. Epidemic usually occurs during the rainy seasons June – November. Peak months are September and October. DHF are observed most exclusively among children of the indigenous population under 15 years of age. Occurrence is greatest in the areas of high Aedis Aegypti prevalence. DR Muhammad TUSEEF JAVED
  6. 6. Notifiable Diseases and Deaths by Cause in the Philippines (2001 – 2004) 2001 2002 2003 2004Notifiable Diseases Reported Reported Reported Reported Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue Fever 23,235 13,187 18,039 15,838 Source: National Statistics Office DR Muhammad TUSEEF JAVED
  7. 7. INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN CEBU CITY (YEAR 2007) Selected Number of New Cases Number of Deaths YearCommunicable Disease: total male female total male femaleDengue / DHF 43, 350 … … 416 … … 2007 Source: Department of Health Region VII DR Muhammad TUSEEF JAVED
  8. 8. Reservoir / Source of Infection: • Some source is a vector mosquito, the Aedes Aegypti or the common household mosquito • The infected person DR Muhammad TUSEEF JAVED
  9. 9. Mode of Transmission: Mosquito bite (Aedis Aegypti)Incubation Period: Probably 6 days to one weekPeriod of Presumed to be on the 1st week of illness – when virus is stillCommunicability: present in the bloodSusceptibility and All persons are susceptible. Both sexes are equally affected. The ageresistance: groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years. Susceptibility is universal. DR Muhammad TUSEEF JAVED immunity may be Acquired temporary but usually permanent.
  10. 10. Diagnostic Test: 1.) Tourniquet Test (Rumpel Leads Tests) • Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes • Release cuff and make an imaginary 2.5 cm square or 1 inch just below the cuff, at the antecubital fossa • Count the number of petechiae inside the box • A test is (+) when 2 or more petechiae per 2.5 cm square or 1 inch square are observed 2.) A con firmed diagnosis is established by culture of the virus, polymerase-chain-reaction (PCR) tests, or serologic assays. DR Muhammad TUSEEF JAVED
  11. 11. Clinical Manifestations (Public Health Nursing inthe Philippines, 2007):An acute febrile infection of sudden onset with 3 stages:• 1st-4th day (febrile or invasive stage)-high fever, abdominal pain and headache; later flushing whichmay be accompanied by vomiting, conjunctiva infection andepistaxis.• 4th-7th day (toxic or hemorrhagic stage)-lowering of temperature, severe abdominal pain, vomiting andfrequent bleeding from gastrointestinal tract in the form ofhematemesis or melena. Unstable blood pressure, narrow pulsepressure and shock. Death may occur. Tourniquet test which may bepositive may become negative dueTUSEEFlow or vasomotor collapse. DR Muhammad to JAVED
  12. 12. • 7th-10th day (convalescent or recovery stage) -generalized flushing with intervening areas of blanching, appetite regained and blood pressure already stable.• Dengue shock syndrome is defined as denguehemorrhagic fever plus:*Weak rapid pulse,*Narrow pulse pressure (less than 20 mm Hg) or,*Cold, clammy skin and restlessness DR Muhammad TUSEEF JAVED
  13. 13. Grading of Dengue Fever:The severity of DHF is categorized into four grades:• grade I, without overt bleeding but positive for tourniquet test• grade II, with clinical bleeding diathesis such as petechiae, epistaxis andhematemesis• grade III, circulatory failure manifested by a rapid and weak pulse withnarrowing pulse pressure (20 mmHg) or hypotension, with the presence ofcold clammy skin and restlessness; and• Grade IV, profound shock in which pulse and blood pressure are notdetectable. It is note-worthy that patients who are in threatened shock orshock stage, also known as dengue shock syndrome, usually remainconscious. DR Muhammad TUSEEF JAVED* Grade III and IV are considered to be Dengue Shock Syndrome
  14. 14. MANAGEMENT DR Muhammad TUSEEF JAVED
  15. 15.  Promote rest Medication  Paracetamol – for fever and muscle pains.  Analgesic – for headache  DON’T GIVE ASPIRIN DR Muhammad TUSEEF JAVED
  16. 16.  Rapid replacement of body fluids is the most important treatment  Give ORESOL to replace fluid as in moderate dehydration at 75ml/kg in 4-6 hours or up to 2-3L in adults. Continue ORS intake until paient’s condition improves.  Intravenous fluid DR Muhammad TUSEEF JAVED
  17. 17.  For hemorrhage  Keep patient at rest during bleeding periods  For epistaxis – 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. DR Muhammad TUSEEF JAVED
  18. 18.  Provide support during the transfusion therapy Diet  Low fat, low fiber, non- irritating, non-carbonated  Noodle soup may be given Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration. DR Muhammad TUSEEF JAVED
  19. 19. PREVENTION DR Muhammad TUSEEF JAVED
  20. 20. • Eliminate 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 DR Muhammad TUSEEF JAVED
  21. 21. OTHER PRECAUTIONS: • When outdoors in an area where dengue fever has been found – Use a mosquito repellant – Dress in protective clothing- long-sleeved shirts, long pants, socks, and shoes DR Muhammad TUSEEF JAVED
  22. 22. • Keeping unscreened windows and doors closed• Keeping window and door screens repaired• Use of mosquito nets DR Muhammad TUSEEF JAVED
  23. 23. DR Muhammad TUSEEF JAVED

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