Dengue fever, also known as breakbone fever, is a mosquito-borne disease caused by the dengue virus, primarily transmitted by the Aedes aegypti mosquito. It presents in three phases: febrile, critical, and recovery, with symptoms including high fever, headache, and muscle pain, while severe cases can lead to complications such as dengue hemorrhagic fever and dengue shock syndrome. Management includes fluid resuscitation, supportive care, and monitoring for warning signs to prevent severe outcomes.

1. PRESENTED BY:-
PANKAJ SINGH RANA
NURSE PRACTITIONER
IN CRITICAL CARE

3. INTRODUCTION
Dengue fever is a
painful debilitating
mosquito born
disease caused by
any one of four
closely related
dengue virus

4. DEFINITION
• Dengue fever is also known as breakbone fever
is a mosquito born tropical disease caused by
the mosquito bite.
• The alternative name for dengue, "breakbone
fever", comes from the associated muscle and
joint pains.
• It is caused by the female aedes aegypti
mosquito bite, which transmit the dengue virus
to human.

5. INCIDENCE
Each year an estimated 100 millions
cases of dengue occur world wide.
• The global incidence of dengue has
grown dramatically in recent decades.
• In INDIA the cases has increase sharply
over past five years there have been
38,000 so far in 2013.

6. Tropical regions are :-
 Indian sub continent
 Mexico
 Africa
 Southern China

7. PHASES

8. Febrile Phase x 7days
High fever 40 °C (104 °F)
headache
generalized arthalgia
myalgia
petechiae
bleeding from mucus membrane.
A rash occurs in 50–80%

9. Critical Phase x 2days
Leukopenia
thrombocytopenia.
Increase capillary permeability
leading to plasma leakage that lead
to metabolic acidosis.
In children febrile phase is common
carries nausea, vomiting,
thrombocytopnea.

10. Recovery phase x 2-3 days
Stabilize hemodynamic status
increase urine output
overall clinical improvement.
Increase in fluid overload can cause
cerebral edema.

11. SIGN & SYMPTOMS
• Fever ( more than 105 )
• Headache
• Muscle, joint pain
• skin rash ( appear 4-5 days after fever )
• Pain behind eyes
• Nausea
• Vomiting
• Mild bleeding

13. WARNING SIGNS
• Severe abdominal pain
• Persistent vomiting
• Vomit with blood
• Drowsiness or irritability
• Dyspnoea
• Swollen lymph node
• Prostration
• diarrhea

14. DIAGNOSTIC
TEST

15. WHO-proposed clinical
definition of dengue
PROBABLE DENGUE
• • Exposure in an endemic area
• • Fever
Two of:
• Nausea/vomiting
• Rash
• Aches/pains
• Positive tourniquet test
• Leucopenia
• Any warning sign
• Laboratory confirmation important
• Needs regular medical observation and
instruction in the
warning signs
• If there are no warning signs,
need for hospitalisation is
• influenced by age,
comorbidities, pregnancy and
social factors

16. Dengue with warning signs
• Probable dengue plus one of:
• Abdominal pain or tenderness
• Persistent vomiting
• Signs of fluid accumulation, e.g. pleural effusion or
• ascites
• Mucosal bleed
• Lethargy
• Hepatomegaly > 2 cm
• Rapid increase in haematocrit with fall in platelet
• count
• Needs medical intervention, e.g. intravenous fluid

17. • Severe dengue
• • Severe plasma leakage leading to:
• Shock (dengue shock syndrome)
• Fluid accumulation with respiratory distress
• • Severe haemorrhagic manifestations, e.g. GI
• haemorrhage
• • Severe organ involvement:
• Liver AST or ALT ≥ 1000 U/L
• CNS: impaired consciousness
• Cardiomyopathy
• Other organs, e.g. renal impairment
• Needs emergency medical treatment and specialist care with
intensive care input.

19. LABORATORY FEATURES
• include leucopenia, neutropenia, thrombocytopenia
• elevated alanine aminotransferase (ALT) or
aspartate aminotransferase (AST)
• serology or detection of dengue viral material in
blood by RT-PCR

20. • Dengue-specific IgG and IgM ELISA { positive for IgM
antibodies on or after day 5 of the fever}
IgM ELISA has a sensitivity of 83.9–98.4% and
a specificity of 100%
Dengue 2 virus enhancement in asthmatic
and non asthmatic individual.Guzman MG,
Kouri G, Soler M, Bravo J, Rodríguez de
La Vega A, Vazquez S, Mune M

21. • Extravasation of fluid due to vascular leakage can be
detected radiologically (chest radiography for pleural
effusions, echocardiography for pericardial effusions,
ultrasonography for ascites).
[Dengue haemorrhagic fever in children:
ten years of clinical experience].Méndez A,
González G
Biomedica. 2003 Jun; 23(2):180-93.

22. PREVENTION

24. MANAGEMENT
• Bleeding prevention & control.
• Fluid & water replacement.
• Symptoms relief & fever control.

25. NURSING MANAGEMENT
• Increased body temperature related to infection as evidence
by vital sign monitoring.
• Hypovolemic shock related to hemorrhage.
• Fluid volume deficit related to migration of intravascular fluid
into extravascular fluid.
• Impaired nutrition less than body requirement related to
decreased appetite.

27. PROGNOSIS
• For the majority of peoples the people infected with
dengue virus fever the prognosis is excellent.
• Although they are likely to feel very ill during first 1-2
week of acute illness.
• Overall the fatality rate is about 1% for all denge
fever infection.

28. COMPLICATION
• A small percentage of individual who have dengue fever can develop
a more serious form of disease.
• Dengue haemorrhagic fever and disseminated intravascular
• coagulation
• Dengue shock syndrome
• Hepatitis, cerebral haemorrhage or oedema, encephalitis,
• cranial nerve palsies, rhabdomyolysis, myocarditis
• Vertical transmission if infection within 5 wks of delivery

29. MOST OF YOU GET CONFUSED THAT
WHAT IS DENGUE HEMMORAHAGIC
FEVER AND DENGUE SHOCK
SNDROME
ALWAYS REMEMBER
THEY ARE THE COMPLICATION OF
DENGUE FEVER

30. DENGUE HEMORRHAGIC FEVER
– High damage to lymphatic system.
– High fever.
– Bleeding from nose
– Liver enlargement
– Damage to blood vessels

35. DENGUE SHOCK
SYNDROME
• It can trigger Dengue Shock Syndrome
– Massive bleeding
– Death
– Dehydration
– Febrile convulsion

37. MANAGMENT
1.) Supportive measures
2.) Fluid Resuscitation
Crystalloids and Colloids
3.) Blood Component Therapy
• Packed Red Blood Cells
• Fresh Frozen Plasma / Cryoprecipitate
• Platelet concentrate
4.) Oxygen therapy
5.) Inotropes - Dopamine,Dobutamine, Epinephrine,
Norepinephrine, Milrinone

39. THANK YOU SONIKA MAM FOR YOUR
GUIDANCE