This document presents the case of a 4-year-old girl diagnosed with Dengue Hemorrhagic Fever Grade I. She presented with a 3-day history of intermittent fever up to 101°F. On examination, she displayed no signs of bleeding, shock, or complications. Her environment had many mosquito breeding grounds and lacked preventative measures. The provisional diagnosis was Dengue Hemorrhagic Fever Grade I based on her symptoms, positive Hess test, and relevant exposure history. She was treated with IV and oral fluids, paracetamol, and cetrine. Prevention strategies were discussed at the individual, family, community, and national levels focusing on environmental sanitation, mosquito netting

1. DENGUE HAEMORRHAGIC FEVER
(CASE PRESENTATION)
Dr.Zar Chi Linn

2. HISTORY TAKING
Personal Identification
 Name-Ma YWT
 Age-4 years old
 Sex-Female
 Race & Religion-Myanmar,Buddhist
 Address-Pike Gyi Wal
 Date & Time of Addmission-23rd
July,2018(5:25pm)
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3. Chief Complaint
Fever x 3 Days
History of Present Illness
 Fever - sudden onset, 3 days, intermittent
pattern
highest temp- 101’ F ,
more severe in the evening
Not associated with chills and rigor
No LOA, relieved by taking Ngan-Ni-
Kyaw
and tepid sponging, no history of
MA_GA_LAUNG
 No history of skin bleeding such as
petechiae,purpura,ecchymoses.
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4.  No history of mucous membrane bleeding
such as epistaxis, gum bleeding, coffee
ground vomiting and passing of black stool.
 There is no history of abdominal pain.
 There is no reduced urine output.
 No features of shock such as cold and
clammy extremities, restlessness,
drowsiness, sudden drop in temperature,
oliguria, sweating, palpitation and loss of
consciousness.
 No features of complication such as fits,
headache, projectile vomiting.
 After admission to hospital,Hess Test was
done and shown positive.
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5. Past Medical History
 No history of similar attack.
 No history of measles, malaria and TB.
Past Surgical History
 No relevant past surgical history.
Drug History
 No regular taking drugs, No known
drug allergy.
 No history of taking NSAIDs and
indigenous medicine.
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6. Environmental History
 Mosquitos are plenty in neighborhood.
 There are many mosquito breeding ground
such as barrels, old tyres, buckets and grooves
that don't drain well.
 Water supply is from underground motor pump.
 Water storage in bins.
 They change flower vases once a week.
 No uses of insecticide and larvicide (Abate).
 Day time sleep without mosquito net.
Family History
 There are 5 family members and there is no
similar attack in family and neighbors.
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7. Social History
 Moderate Socioeconomic Status.
Immunization History
 Said to be complete according to EPI
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8. PHYSICAL EXAMINATION
General Examination
 The child is well, alert, interested to
surrounding and lying comfortably on the bed.
 Nutritional status is appropriate for her age.
 The child is afebrile, not dyspnoic.
 Eye - There is no subconjunctival
hemorrhage.
 Nose - No epistaxis
 Mouth - No gum bleeding.Gum and teeth are
healthy.
 Extremities - Hands and legs are warm. No
petechiae, bruises,ecchymoses and recovery
rash.
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9. CVS examination
Pulse rate - 80 / min
Pulse volume - good
BP - 100/70 mmHg
Normal 1st and 2nd heart sounds are heard
over all four areas and no other added sound.
Respiratory System
Inspection - chest wall movement is equal
respiratory rate - 30/min
Palpation - No tracheal shift
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10. Percussion - Normal resonance percussion
note is heard in all three zones of both lungs
anteriorly and posteriorly.
Auscultation - Normal VBS is heard in all
three zones of both lungs anteriorly and
posteriorly with normal intensity and character.
No added sound.
Abdominal Examination
Inspection - Abdomen moves with respiration.
No abdominal distension.
Umbilicus is inverted.
No rash, no scar, no dilated
veins
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11. Light palpation - Abdomen is soft in all 9
regions .No tenderness,
No guarding or rigidity.
No palpable mass.
Deep palpation - Liver and spleen are not
palpable.
Percussion - No ascites.
Auscultation - Bowel sound present and no
liver bruit
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12. Provisional Diagnosis
4 years old girl with Dengue Hemorrhagic
Fever Grade I without complications
Differential Diagnosis
-Acute Viral Infection with Hess Test positive
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13. Point for diagnosis
- Fever for 3 days, high fever, intermittent in
character
- Hess test positive
- Relevant environmental history
- No bleeding manifestations, no feature of
shock, no features of complication
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14. Investigations-Not done
Treatment
23/7/2018 -I.V 25% Glucose 1 ampule (stat)
-ORS ad-lib
-PO Paracetamol ½ x qid
-Digene ½ x qid
24/7/2018 -PO cetrine ½ x tds
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15. Treatment suggested
-Daily monitoring
-PCV and CP(A) daily
-Encourage oral fluids, ORS and feeding
-Give IV fluids if not orally tolerated
-Awareness of Dengue Shock Syndrome.
-Detection of NS 1 Ag and Ig G, Ig M
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16. Problem Analysis
- Mosquito breeding grounds (+)
- No regular changing of water storages
- Day time sleeping without mosquito
nets
- No use of mosquito repellant
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No Prevention
Against Mosquitoes
Rainy Season
Lack of Health
Education
Environmental
Factors(+)
Mosquito Bite
Dengue
Haemorrhagi
c Fever
Hospitalization

17. Problem Solving
Individual Level
-Personal protection to prevent mosquitoes
bites such as wearing long sleeved clothes and
long trousers.
-Use insect repellents.
-Use of mosquito nets while sleeping.
-Having health knowledge about DHF and
prevention methods.
Family level
-Environmental sanitation.
-Drain water from buckets and barrels. All
stored water containers should be covered all
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18. -Discard solid waste and objects where water
collects e.g. bottles,tyres,tins.
-Use of screening of doors and windows.
-Use of insecticides and larvicides(Abate).
-Biocontrol of using fish that eat mosquito larvae.
Community Level
-Mosquitoes fumigation .Building of well
drained grooves and regular check up for
obstruction.
-Destruction of stagnant water.
-Bio control method.
-Environmental sanitation.
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19. National Level
-Health education and increase awareness
about Dengue through mass media such as TV,
newspaper, radio, magazines, journals and
social media.
-Improvement of healthcare system.
-Improvement of maternal education.
-Research for better mosquito control.
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20. THANK YOU FOR YOUR ATTENTION!!!
Have A Nice Day!