This document provides a case study on a 10-year-old female patient diagnosed with dengue fever. It includes an introduction to dengue fever, the patient's profile, physical assessment findings, laboratory results, and nursing care plan. Key findings include the patient presenting with fever, abdominal pain, and vomiting. Laboratory tests showed low platelet count and a positive torniquet test, confirming dengue fever syndrome. The patient's activities of daily living were affected as she had limited range of motion and could no longer attend school or help with chores due to weakness from the disease.

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Our Lady of Fatima University
College of Nursing
Regalado, Quezon City
A Case Study on
Dengue Fever
In Partial Fulfillment
of the Requirements in
Nursing Care Management 102A
Related Learning Experience

2. Presented by:
BSN 2Y2-4
Group 21
Gianchand, Olivia P.
Manuel, Janine M.
Second Semester
S.Y 2011-2012
I. Introduction
Dengue Fever is an infectious disease carried by mosquitoes and caused by any of the
four closely related, but antigenically distinct, virus serotypes; Dengue type 1, Dengue type 2,
Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. This disease
used to be called “break-bone” fever because it sometimes causes severe joint and muscle pain
that feels like bones are breaking, hence the name, there may also be gastritis associated to
abdominal pain, nausea, vomiting, or diarrhea. Infection with one of this serotype provides
immunity to only that serotype of life, to a person living in a Dengue-endemic area can have
more than one Dengue infection during their lifetime. Dengue fever through the four different
Dengue serotypes are maintained in the cycle which involves humans and Aedesaegypti or
Aedesalbopictus mosquito through the transmission of the viruses to humans by the bite of an
infected mosquito. Dengue cannot be transmitted or directly spread from person to person. It can
be transmitted by AedesAegypti mosquito to humans usually attacking during the day and
shortly after the rainy season in tropical and subtropical areas of Africa, Southeast Asia and
China, India, Middle East, Caribbean and Central and South America, Australia and the South

3. and Central Pacific. After virus incubation for eight to 10 days, an infected mosquito is capable,
during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female
mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs)
transmission, but the role of this in sustaining transmission of the virus to humans has not yet
been defined.
The incidence of dengue has grown dramatically around the world in recent decades.
Some 2.5 billion people, two fifths of the world's population, are now at risk from dengue. WHO
currently estimates there may be 50 million dengue infections worldwide every year. There is no
specific treatment for dengue fever. Health experts have known about dengue fever for more
than 200 years.
II. Objectives
General:
This study aims to identify and determine the general health problems and needs of the
patient with an admitting diagnosis of Dengue Fever. It also intends to help patient promote
health and medical understanding of such condition through the application of the nursing skills.
Specific:
1.) To raise the level of awareness of patient on health problems that she may encounter.

4. 2.) To facilitate patient in taking necessary actions to solve and prevent the identified
problems on her own.
3.) To help patient in motivating her to continue the health care provided by the health
workers.
4.) To render nursing care and information to patient through the application of the
nursing skills.
III. Patient’s Profile
A. Biographical Data
1. Name: Ms. C.T.
2. Address: Barangay 309,Sampaloc, Manila
3. Age: 10
4. Birthdate: June 19,2001
5. Sex: Female
6. Race: Filipino
7. Marital status: Single
8. Occupation: N/A
9. Religion: Catholic
10. Health Care financing and usual source of Medical Care:
Supported by the patient’s parents

5. A. Working Diagnosis
Dengue Fever Syndrome
B. Chief Complaint and Reason for Visit:
Fever
C. Past Medical History:
Our patient was never admitted to the hospital. Until she was diagnosed with dengue
fever syndrome. Before Ms. C.T. was diagnosed to have dengue, she had fever and was given
Paracetamol by her mother at home.
D. Family History of Illness:
The patient has a family history of hypertension. According to her, both of her parents
have hypertension.
E. History of Present Illness:
Four days prior to admission, the patient had on and off fever. She would usually have
fever in the afternoon. As a remedy, the patient’s mother gave Paracetamol to reduce her body
temperature. Aside from fever, Ms. C.T. also experienced abdominal pain, headache, general
flushing of the skin and vomiting.
As the signs and symptoms persisted, her mother decided to bring her to the hospital.
After the physical assessment and diagnostic tests, Ms. C.T. was diagnosed to have Dengue
Fever Syndrome by the attending physician.
IV. Physical Assessment

6. Assessment Normal Findings Actual Findings Interpretation
Body Build,
Height & Weight
Proportionate
Varies With
Lifestyle
Proportionate Varies
With Lifestyle
Proportionate body there
is no evidence of physical
problems
Posture And Gait Stands normally Stands normally Relaxed, erect posture;
coordinated movement
Body And Breath
Odor
No Body Or Breath
Odor
No Body Or Breath
Odor
Proper hygiene
maintenance
Signs Of Distress No Distress Noted distress noted Because of lack of sleep,
distress noted
Attitude Cooperative Cooperative Thinks normally, proper to
the situation
Affect Or Mood Appropriate To The
Situation
Appropriate To The
Situation
She acts and think
normally appropriate to
the situation
Quantity, Quality
And Organization
Of Speech
Understandable,
Moderate Pace,
Thought
Association
Understandable,
Moderate Pace,
Thought Association
Can speak normally, with
normal voice tone
Relevance And
Association
Thought Exhibits
Logical Sequence
Make Sense, Has
Sense Of Reality
Logical Sequence
Make Sense, Has Sense
Of Reality
Talking with sense means
she thinking normally
Skin
Assessment Normal Findings Actual Findings Interpretation
Uniformity Of
Skin Color
Uniformity Except
In Areas Expose
To The Sun
Uniformity Except In
Areas Expose To The
Sun
Uniformity of skin,
except areas expose to
light and some areas of
lighter
pigmentation(conjunctiv
as, palms, lips, nail beds)
Edema No Presence Of
Edema
No Presence Of Edema No water retention
Skin Lesion Freckles, some
birthmarks, some
flat and raised
nevi;no abraisions
or other lesions
No reckles,some
birthmarks,some flat
and raised nevi;no
abraisions or other
lesions
No lesion noted in the
body
Skin Moisture Moisture In Skin
Folds & Axillae
Moisture In Skin Folds
& Axillae
Some body parts that
having sebaceous glands
are moisture
Skin
Temperature
Uniform, Within
Normal Range
Uniform, slightly
above normal range
Low grade fever

7. Skin Turgor Skin Springs Back
To Previous State
When Pinched
Skin Springs Back To
Previous State When
Pinched, except the
part with edema
Skin stays pinched or
tented or moves back
slowly
Skull and Face
Assessment Normal Findings Actual findings Interpretation
Head Rounded And
Symmetrical,
Smooth Skull
Contour, No
Nodules
Rounded And
Symmetrical, Smooth
Skull Contour, No
Nodules
Normal, no signs of any
deformities and signs of
skull contour and nodules
Face Light to deep
brown,smooth and
symmetric facial
movement
Pinkish,smooth and
symmetric facial
movement
Fever causes flushing of
the skin
Eyes and Vision
Eyebrows Evenly Distributed,
Symmetrical, Skin
Intact
Evenly Distributed,
Symmetrical, Skin
Intact
Properly distributed, equal
Eyelids Skin Intact, No
Discharges, No
Discoloration,
Symmetrical
Skin Intact, No
Discharges, No
Discoloration,
Symmetrical
Can blink normally
Eyelashes Equally
Distributed,
Slightly Curved
Outward
Equally Distributed,
Slightly Curved
Outward
Turned outward, equally
distributed, muscle
normally contract
Conjunctiva Shiny, Smooth
,Sometimes
Appear Red Or
Pink
Pale conjunctiva Pale, possible anemia
Lacrimal Gland No Edema Or
Tearing
No Edema Or Tearing Normal no evidence of
any swelling or tenderness
Cornea Transparent, Shiny,
Smooth, Blinks
Transparent, Shiny,
Smooth, Blinks When
Corneal sensitivity test
active,trigeminal nerve is

8. When Cornea Is
Touched
Cornea Is Touched intact,cornea clarity and
texture normal.
Pupils Black Color,smooth
border,PERRLA
Black Color, smooth
border,PERRLA
Pupils are equal,constrict
to light dilate in the dark
Eyes(Visual
Acuity)
Can see without
using eyeglasses
Can’t see without
eyeglasses
Nearsightedness, can see
only when objects are near
Ears and Hearing
Auricles Color Is Uniform,
Symmetric, Mobile,
Firm pinna Recoils
When Folded
Color Is Uniform,
Symmetric, Mobile,
Firm pinna Recoils
When Folded
Color same as facial
skin,auricle aligned with
outer canthus of the eye.
Response To
Normal Voice
Tone
Normal Voice
Tone Audible
Cannot hear Normal
Voice Tone
Abnormal cannot hear
Normal voice, normal
voice tones
Nose and Sinuses
Nares Symmetric,
Straight, No
Discharges, Non
Swelling, Uniform
Color, Not Tender
Symmetric, Straight,
No Discharges, Non
Swelling, Uniform
Color, Not Tender
No presence of lesions,air
moves freely as the client
breaths
Lining Of Nose Nasal Septum In
Midline
Nasal Septum In
Midline
Normal and in midline
Mouth
Lips And Buccal
Mucosa
Pink, Soft,
Symmetrical,moist
Pink, Soft,
Symmetrical,dry
Due to fever which
causes dehydration
Teeth And Gums Complete Complete No tooth decay,smooth
shiny tooth enamel,no
dentures
Tongue In Midline, Freely
Movable, Pink
In Midline, Freely
Movable, Pink
In Central
position,moist,slightly
rough ;thin whitish
coating,normal,can move
freely

9. Palates And Uvula,
Tonsils
Light Pink, No
Discharges, Present
Gag Reflex
Light Pink, No
Discharges, Present
Gag Reflex
No discoloration, palates
are lighter pink hard
palate
Neck and Musculoskeletal System
Shape And
Symmetry
Symmetrical Symmetrical Positioned in midline
Spinal Deformities Vertically Aligned Vertically Aligned Normal, no deformities
Inspect Neck
Muscles
Symmetrical With
Head Centered
Symmetrical With Head
Centered
No swelling or
masses,coordinated,smoot
h movements with no
discomfort
Observe Head
Movement
Coordinated,
Smooth, Movement
With No
Discomfort, Equal
Strength
Coordinated, Smooth,
Movement With No
Discomfort, Equal
Strength
No discomfort, can hyper
extends, laterally flexes
and rotates
Muscle Size Is
Symmetrical, No
Contracture,
Normally Firm
Size Is Symmetrical, No
Contracture, Normally
Firm
Equal strength,
symmetrical, normal
Bones No Deformities,
No Swelling Or
Tenderness
No Deformities,
No Swelling Or
Tenderness
Normal, can move freely,
no swelling, deformities or
tenderness
Joints No Swelling, No
Tenderness
No Swelling, No
Tenderness
Normal, no signs of
swelling in area, no
tenderness
Range Of Motion Varies To Some
Degrees
Limited range of
motionin one or more
joints
Can stand and walk, but
limited range of motions
due to muscular pain
brought by the condition
V. Activities of Daily Living
Functional Health
Pattern
Before her present
condition
During her present
condition
Interpretation
Health Perception
and Health
Management
Perceives herself as a strong
healthy child.
Reports to mother when she
Thinks that she is
weak and not healthy
Complies with
The patient had
changed her
perception about
her health because

10. feels sick
Visits the health center for
check-up when sick.
medications of the signs and
symptoms
brought by the
disease
Nutritional and
Metabolic
Eats 3 times daily. The
usual food intake would be
composed of meat
vegetables
Drinks 5 glasses of water
per day and drinks juice in
school
Same amount of food
is taken. Avoids
eating dark colored
food
Drinks 8 glasses of
water. Juice is
eliminated in her diet
Dark colored food
was avoided to
easily detect
blood in stool
Fluid intake was
increased due to
replace fluid loss.
Juice and other
acidic food were
eliminated to
avoid irritation to
gastric mucosa
Elimination Moves bowel once a day
without difficulty
Soft firm stool
Voids fair amount of urine
without difficulty in normal
frequency
Clear, yellow urine
Same bowel
movement frequency
Same urine
elimination frequency
Same amount and
quality of feces and
urine
The condition did
not affect her
elimination
pattern
Activity – Exercise Her usual routine was to go
to school in the morning and
watch television after doing
her homework. Also helps
in household chores
Doesn’t go to school
anymore. Can’t do any
household chores.
Spends time by talking
to her mother and
playing games in her
mother’s cellphone
Her usual activity
was affected
because she feels
weak due to her
condition.
Sleep-Rest Has 8 hours of sleep
everyday
Deep, uninterrupted sleep
Gets enough energy from
sleep
Doesn’t need any sleep aids
Has maximum of7
hours of interrupted
sleep
Takes nap in the
afternoon to
compensate lost
sleeping hours
Inadequate sleep
due to noisy
environment and
interrupted sleep
due to compliance
to the medication

11. Cognitive-
Perceptual
Normal hearing acuity and
does not use hearing aid
Uses eyeglasses
Able to comprehend easily
Normal hearing acuity
and does not use
hearing aid
Uses eyeglasses
Able to comprehend
easily
The patient’s
condition has no
effect on
cognition and
perception
Self-Perception and
Self-Concept
Pattern
Perceives herself as a good
daughter and student. She
shows interest in music.
Feels that she may get
lower grades in school
because of being
absent. She is
concerned of not being
able to attend her choir
rehearsals.
Being confined in
the hospital made
her unable to go
to school and do
rehearsals
VI. Development Tasks
Industry vs. Inferiority
At the age of ten, the significant task of the patient is being aware of themselves as
individuals. People at this age work hard at being responsible, being good and doing things right.
Ms. C.T. is starting to recognize her special talents and continue to discover interests as her
education improves. During the assessment, she had verbalized that she is worried of getting
low grades since she can’t listen to class discussion anymore. She also mentioned that there is a
choir competition that she should have attended if she were not in the hospital. It is obvious that
the patient is able to perform her task as a school age child. This will surely help her in building
self-confidence which is important to possess as she grows older.
VII. Laboratory/Diagnostic Findings
CBC and Platelet Count

12. Norms Result Analysis
Hemoglobin 115-155 116 normal
Hematocrit 0.40-0.48 0.41 normal
WBC Count 5.0-10.0 12.8 Due to infection
Lymphocytes 0.2-0.4 0.08 Due to viral infection
Segmenters 0.6-0.7 0.63 normal
Platelets 150-450 110 Due to infection
Torniquet test
10 petichiae per square inch
Interpretation: Positive for Dengue fever syndrome
VIII. Anatomy and Physiology
BLOOD
Blood is a specialized bodily fluid that delivers necessary substances to the body's cells
such as nutrients and oxygen and transports waste products away from those same cells. It is
composed of blood cells suspended in a liquid called blood plasma. Plasma, which comprises
55% of blood fluid, is mostly water (90% by volume), and contains dissolved proteins, glucose,
mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product
transportation), platelets and blood cells themselves. The blood cells present in blood are mainly
red blood cells (also called RBCs or erythrocytes) and white blood cells, including leukocytes
and platelets. The most abundant cells in vertebrate blood are red blood cells. These contain
hemoglobin, an iron-containing protein, which facilitates transportation of oxygen by reversibly
binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon
dioxide is almost entirely transported extracellularly dissolved in plasma as bicarbonate ion.
Blood is bright-red when its hemoglobin is oxygenated. It is circulated around the body through
blood vessels by the pumping action of the heart.
Blood performs many important functions within the body including: supply of oxygen to
tissues (bound to hemoglobin, which is carried in red cells), supply of nutrients such as glucose,

13. amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins, removal of
waste such as carbon dioxide, urea, and lactic acid, immunological functions, including
circulation of white blood cells, and detection of foreign material by antibodies, coagulation,
which is one part of the body's self-repair mechanism, messenger functions, including the
transport of hormones and the signaling of tissue damage, regulation of body pH (the normal pH
of blood is in the range of 7.35 - 7.45) (covering only 0.1 pH unit), regulation of core body
temperature
Blood accounts for 7% of the human body weight, with an average density of
approximately 1060 kg/m3, very close to pure water's density of 1000 kg/m3. The average adult
has a blood volume of roughly 5 liters, composed of plasma and several kinds of cells
(occasionally called corpuscles); these formed elements of the blood are erythrocytes (red blood
cells), leukocytes (white blood cells), and thrombocytes (platelets). By volume, the red blood
cells constitute about 45% of whole blood, the plasma constitutes about 54.3%, and white cells
constitute 0.7%. Whole blood (plasma and cells) exhibits non-Newtonian fluid dynamics; its
flow properties are adapted to flow effectively through tiny capillary blood vessels with less
resistance than plasma by itself. In addition, if all human hemoglobin were free in the plasma
rather than being contained in RBCs, the circulatory fluid would be too viscous for the
cardiovascular system to function effectively.
PLATELETS
Platelets, or thrombocytes, are small, irregularly-shaped anuclear cells, 2-4 µm in
diameter, which are derived from fragmentation of precursor megakaryocytes. The average
lifespan of a platelet is between 8 and 12 days. Platelets play a fundamental role in hemostasis
and are a natural source of growth factors. They circulate in the blood of mammals and are
involved in hemostasis, leading to the formation of blood clots. If the number of platelets is too
low, excessive bleeding can occur. However, if the number of platelets is too high, blood clots
can form (thrombosis), which may obstruct blood vessels and result in a stroke and/or a heart
attack. An abnormality or disease of the platelets is called a thrombocytopathy, which could be
either a low number of platelets (thrombocytopenia), a decrease in function (thrombasthenia), or

14. an increase in the number of (thrombocytosis). There are disorders that reduce the number of
platelets, such as heparin-induced thrombocytopenia (HIT) or thrombotic thrombocytopenic
purpura (TTP) that typically causes thromboses, or clots, instead of bleeding.
A thrombus or blood clot is the final product of blood coagulation, through the
aggregation of platelets and the activation of the humoral coagulation system. Thrombus is
physiologic in cases of injury, but pathologic in case of thrombosis. Some of the conditions in
which blood clots develop include atrial fibrillation (a form of cardiac arrhythmia), heart valve
replacement, a recent heart attack, extended periods of inactivity (see deep venous thrombosis),
and genetic or disease related deficiencies in the blood's clot. Platelet - High and low counts. A
normal platelet count in a healthy person is between 150 and 400 (x 109/L of blood). Both
thrombocytopenia (or thrombopenia) and thrombocytosis may present with coagulation problems
IX. Pathophysiology
Bite of aedesaegypti mosquito carrying a virus
↓
Virus is deposited in the skin then into the circulation
↓
Infects cells and generate cellular response
↓
Initiates destruction ofthe platelet
↓
Increased potential for hemorrhage
↓
Stimulates intense inflammatory response
Release of exogenous pyrogens body releases anti inflammatory
↓ mediators (histatin,kinins)
↑ WBC (Neutrophils & Macrophages) ↓

15. ↓ Vascular response
Release of endogenous pyrogens↓
↓ Redness and heat
Reset ofhypothalamic thermostat ↓
↓ Headache, , Epistaxis, Vomiting
Fever Abdominal pain, Circulatory collapse
Muscle contract to Blood vessels constrict ↓
produce more heat to prevent loss of body heat Shock
↓ ↓ ↓
SHIVERING CHILLS DEATH

16. X. Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
"Limangarawngnil
alagnatanganakko,
" as verbalized by
client's mother.
Objective:
Flushed skin
Warm to touch
Restlesness
Vital Signs:
Temp: 38.0 °C
RR: 38 bpm
Hyperthermia
related to Infection
as evidenced by
increased body
temperature of 38.0
°C
Short Term Goal:
After 1 hour of
nursing
intervention, client
will maintain
normal core
temperature of
36.5-37.5.
Independent
 Promote surface cooling by
means of tepid sponge bath.
 Administer replacement
fluids and electrolytes.
 Maintain bed rest.
 Remove excess clothing or
blankets.
 Provide air condition/fan if
appropriate.
Dependent
 Administer antipyretics per
physician's order.
 To decrease temperature
by means through
evaporation and
conduction.
 To support circulating
volume and tissue
perfusion.
 To reduce metabolic
demands and oxygen
consumption.
 To facilitate fast recovery.
Short Term Goal:
After 1 hour of
nursing
intervention, client
maintained a core
temperature of 36.5
- 37.5.

17. XI. Drug Study
DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE
EFFECTS
NURSING
RESPONSIBILITIES
Acetaminophen
Paracetamol
Brand Name:
Tylenol
Analgesic, muscle
relaxant, uricosurics
Decreases
fever by
inhibiting the
effects of
pyrogens on
the
hypothalamic
heat regulating
centers and by
a hypothalamic
action leading
to sweating
and
vasodilation.
Relieves pain
by inhibiting
prostaglandin
synthesis at the
CNS but does
not haves anti-
inflammatory
action because
of its minimal
effect of
peripheral
prostaglandin
synthesis.
Relief of mild
to moderate
pain, treatment
of fever.
Hypersensitivity:
Intolerance to tartrazine,
alcohol, table sugar,
saccharin.
Stimulation,
drowsiness,
nausea,
vomiting,
abdominal pain,
hepatoxicity,
hepatic seizure,
renal failure,
leucopenia,
neutropenia,
hemolytic
anemia,
thrombocytopeni
a, pancytopenia,
rash, urticaria,
hypersensitivity,
cyanosis,
anemia,
jaundice,
pancytopenia,
CNS stimulation,
delirium
followed by
vascular
collapse,
convulsion,
coma and death.
Tell the patient to read the
label on other OTC drugs.
Advise patient to avoid
taking more than one
product containing
paracetamol
(Acetaminophen) at one
time; as this may cause
toxicity if taken
concurrently.
Advise patient to avoid
alcohol; acute poisoning
with liver damage may
result; acute toxicity
includes symptoms of
nausea, vomiting and
abdominal pain. Physician
should be notified
immediately.

18. XII. Discharge Planning
MEDICATION
 Give acetaminophen in case the temperatures increases.
 Give oresol to replace fluid in the body.
EXERCISE
 Perform activities of daily living(ADL’s) as tolerated
 Enough rest
TREATMENT  Increased oral fluid intake.
HEALTH TEACHING
 D - discuss the possible source of infection of the disease.
 E - educate the family/patient on how to eliminate those vectors.
 N - never stocked water in a container without cover.
 G - gallon, container and tires must have proper way of disposal.
 U - use insecticides at home to kill or reduce mosquito.
 E - encourage the family of the patient to clean the surroundings to
destroy the breeding places of mosquito
OPD FOLLOW-UP
 Observe carefully for symptoms
 Give instruction about what symptoms to watch for so she can
alert clinician if additional symptoms occur between visits
 Follow-up check ups
DIET  Encourage nutritious foods like vegetables, meat and fruits.

19. How does Dengue affectthe Body?
Dengue infection is caused by 1 of 4 related, but antigenically distinct, viral serotypes:
dengue virus 1 (DENV-1), dengue virus 2 (DENV-2), dengue virus 3 (DENV-3), and dengue
virus 4 (DENV-4). Albert Sabin speciated these in 1944. Each serotype is known to have several
different genotypes. Dengue viruses are small, spherical, single-stranded enveloped RNA viruses
of the family Flaviviridae, genus Flavivirus.
Infection with one dengue serotype confers lifelong homotypic immunity and a very brief
period of partial heterotypic immunity, but each individual can eventually be infected by all 4
serotypes. Several serotypes can be in circulation during an epidemic.
Dengue viruses are transmitted by the bite of an infected Aedes mosquito. Globally,
aaegypti is the predominant highly efficient mosquito vector for dengue infection, but A
albopictus and other Aedes species can also transmit dengue with varying degrees of efficiency.
Aedes mosquito species have adapted well to human habitation, often breeding around
dwellings in small amounts of stagnant water found in old tires or other small containers
discarded by humans. Female Aedes mosquitoes are daytime feeders. They inflict an innocuous
bite and are easily disturbed during a blood meal, causing them to move on to finish a meal on
another individual, making them efficient vectors. Entire families who develop infection within a
24- to 36-hour period, presumably from the bites of a single infected vector, is not unusual.
Humans serve as the primary reservoir for dengue; however, certain nonhuman primates
in Africa and Asia also serve as hosts. Mosquitoes acquire the virus when they feed on a carrier
of the virus. The mosquito can transmit dengue if it immediately bites another host. In addition,
transmission occurs after 8-12 days of viral replication in the mosquito’s salivary glands
(extrinsic incubation period). The mosquito remains infected for the remainder of its 15- to 65-
day lifespan. Vertical transmission of dengue virus in mosquitoes has been documented. The
eggs of Aedes mosquitoes withstand long periods of desiccation, reportedly as long as 1 year, but
are killed by temperatures of less than 10°C.
Once inoculated into a human host, dengue has an incubation period of 3-14 days
(average 4-7 d). Following incubation, a 5- to 7-day acute febrile illness ensues. Recovery is
usually complete by 7-10 days. DHF or DSS usually develops around the third to seventh day of
illness, approximately at the time of defervescence. The major pathophysiological abnormalities
that occur in DHF and DSS are plasma leakage and bleeding. Plasma leakage is caused by
increased capillary permeability and may be manifested by hemoconcentration, as well as pleural

20. effusion and ascites. Bleeding is caused by capillary fragility and thrombocytopenia and may
present various ways, ranging from petechial skin hemorrhages to life-threatening
gastrointestinal bleeding.
Most patients who develop DHF or DSS have had prior infection with one or more
dengue serotypes. In individuals with low levels of neutralizing antibodies, nonneutralizing
antibodies to one dengue serotype, when bound by macrophage and monocyte Fc receptors, have
been proposed to result in increased viral entry and replication, and increased cytokine
production and complement activation. This phenomenon is called antibody-dependent
enhancement. In addition, certain dengue strains, particularly those of DEN-2, have been
proposed to be more virulent, in part because more epidemics of DHF have been associated with
DEN-2 than with the other serotypes.
Classification ofDengue Hemorrhagic Fever
Grade I
There is fever accompanied by non-specific constitutional symptoms and the only
hemorrhagic manifestation is positive tourniquet test
Grade II
All signs of Grade I plus bleeding from the nose,gums, GIT are present.
Grade III
There is presence of circulatory failure as manifested by weak pulse, narrow pulse
pressure, hypotension, cold clammy skin and restlessness
Grade IV
There is profound shock, undetectable blood pressure, and pulse.
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