DengueandDengue Hemorrhagic FeverPrepared by: Carol B. Cainday, SNBSN 2A
Dengue FeverAny of a group of viral infections, including denguehemorrhagic fever, Ebola virus disease, and yellow fever that occurprimarily in tropical climates, are usually transmitted to human byarthropods or rodents, and are characterized by high fever,petechiae, internal bleeding, hypotension, and shock.Is an acute febrile disease caused by infection with one ofthe serotypes of dengue virus which is transmitted by mosquito genusAedes.
Dengue Hemorrhagic FeverDengue Hemorrhagic Fever is a severe, sometimesfetal manifestation of dengue virus infection characterizedby a bleeding diathesis and hypovolemic shock.
Adults are also found within or close-by humanenvironments, often biting indoors or in sheltered areasnear the house; biting is predominantly by day inshaded areas but may also occur early in the night.Can be an important domestic pest but is ofprincipal concern as major vector of Dengue fever
Alternative names Hemorrhagic Dengue, Dengue Shock Syndrome, Philippine Hemorrhage fever, High Hemorrhagic Fever, and Singapore Hemorrhagic Fever. Breakbone fever.
Causative AgentThe DF and DHF caused by:Flaviviruses 1, 2, 3, 4, a family ofTogaviridae are small viruses that contain singlestrand RNA.Arboviruses group B
Incubation PeriodThe incubation period is three to fourteendays; seven to ten days.
Aedes aegypti, the transmitter of the disease, is aday-biting mosquito which lays eggs in clear andstagnant water found in flower vases, cans, rainbarrels, old rubber tires, etc. The adult mosquitoesrest in dark places of the house.Mode of Transmission
Mode of TransmissionThe infection is transmitted by the bite of an infected femalemosquito- Aedes aegypti (they appear two hours after sunrise and two hoursbefore sunset) and the mosquito usually bites at day time. Mosquito breedson stagnant water. The mosquito becomes infected by biting a patient withdengue infection. Once the mosquito becomes infected, it remains so forlife. The female mosquitoes can survive up to 3 weeks under normaltemperature and humidity. Female mosquitoes get infected after feeding onviraemic host. It takes 8-11 days for a mosquito which has fed on aninfectious case to propagate the virus to levels sufficient to transmit. Theambient temperature range for dengue transmission is 16 degrees C to 40degrees C. Below 16 degrees C Aedes Aegypti ceases to bite.
CLINICAL SIGNS AND SYMPTOMSLow blood pressureWeak, rapid pulseRashRed eyesRed throatSwollen glandsEnlargement of liverHigh Fever, up to 105degrees farenheitSevere HeadacheRetro-orbital (behind the eye)painNausea and vomiting of coffee-colored matterMalaise and Anorexia up to12 hoursJoint & muscle painDark-colored stools
LABORATORY EXAMINATION/DIAGNOSTICPROCEDUREA doctor or other health care worker candiagnose dengue fever by doing a blood test. Thetest can show whether the blood sample containsdengue virus or antibodies to the virus. Inepidemics, dengue is often clinically diagnosed bytypical signs and symptoms.
TREATMENTThere is no effective antiviral therapy for dengue fever. Thetreatment is entirely symptomatic.Analgesic drugs other than aspirin maybe required for reliefof headache, ocular pain, and myalgia.Initial phase may require intravenous infusion to preventdehydration and replacement of plasma.Blood transfusion is indicated in patient with severe bleedingOxygen therapy is indicated to all patient in shockSedatives maybe needed to allay anxiety and apprehension
NURSING CARE MANAGEMENTPatient should be kept-in-mosquito-free environment toavoid further transmission of infection.Keep patient at rest during bleeding episodesVital signs must be promptly monitoredFor nose bleeding, maintain patient’s position in elevatedtrunk, apply ice bag to the bridge of nose and to the forehead.Observe sign of shock, such as slow pulse, cold clammyskin, prostration, and fall of blood pressure.Restore blood volume by putting the patient in Trendelenbergposition to provide greater blood volume to the head part.
HEALTH EDUCATION AND PREVENTION• Advise the people to maintain cleanliness of their environment.• Teach the people to determine the signs and symptoms ofDengue Fever to have an early detection.• Treat mosquito nets with insecticides• House spraying is advisedEliminate vector by:Changing water and scrubbing sides of lower vases once a week.• Destroying the breeding places of mosquitoes by cleaning thesurroundings.• Keeping the water containers covered.• Avoid to many hanging clothes inside the house.
4S strategy against Dengueaccording to DOHSearch and destroypossible breeding places of dengue-causing mosquitoeslike flower pots, vases, discarded plastic bags, bottles, oldtires, cans, earthen jars, coconut husks, roof gutters, waterdrums, and other containers that might hold clean stagnantwater. Preventing dengue can be easier achieved by doing yourpart in keeping the environment clean. Change water in vasesfrequently. Make sure all water containers are kept covered.
Self-protection measuresinclude wearing long sleeves or long pants. It is also bestto avoid dark-colored clothes like dark shades of blue and black,as dark clothing has been observed to attract mosquitoes. Applymosquito repellant on the skin to deter mosquito bites. Mosquitorepellant lotions and liquid sprays are available on the market;however, parents are cautioned against using strong repellants onsmall children because of potentially harsh chemicals. There areorganic mosquito repellant alternatives such as all-naturalcitronella bug spray. You can also use mosquito coils, electricvapour mats and mosquito spray during the daytime. Screensandmosquito nets are also good deterrents against mosquitoes.
Seek early consultationbecause dengue is crucial. See a doctor immediatelyif you show early signs and symptoms of dengue.Say no to indiscriminate fogging.In the past, fogging was considered as a temporarysolution against dengue-carrying mosquitoes. At present,fogging is only advisable and recommended when outbreaks andepidemics are positively determined in a particular area.Fogging can only kill the adult infected mosquito; it cannot getrid of the larvae, locally known as kiti-kiti. Indiscriminatefogging will only drive away other mosquitoes to other places tofind new breeding grounds.