The document discusses dengue fever in children, including dengue hemorrhagic fever which causes joint and muscle pain and can develop into a severe, potentially deadly infection. It covers the symptoms, diagnosis, and treatment of dengue fever and dengue hemorrhagic fever, noting that supportive care including fluid replacement is the most important treatment and careful monitoring is needed to watch for complications like shock.

1. Dengue in Children
M Priyanka

2. Hemorrhagic dengue
Dengue shock syndrome
Philippine hemorrhagic fever
Thai hemorrhagic fever
Singapore hemorrhagic fever
Breakbone fever

3. Dengue Hemorrhagic Fever is an acute infectious
viral disease usually affecting infants and young
children. This disease used to be called break-bone
fever because it sometimes causes severe joint and
muscle pain that feels like bones are breaking.
is a severe, potentially deadly infection spread by
certain species of mosquitoes (Aedes aegypti).
Philippine Hemorrhagic Fever was first reported in
1953. in 1958, hemorrhagic fever became a notifiable
disease in the country and was later reclassified as
Dengue Hemorrhagic Fever.

5. Flavivirus, Dengue Virus Types
1, 2, 3, & 4
Chikungunya Virus

7. Vector mosquito
Aedis Aegypti ,
Aedis albopictus,
The infected person

8. INCUBATION PERIOD
UNCERTAIN. Probably 6 days to 1
week
PERIOD OF COMMUNICABILITY
Unknown. Presumed to be on the first
week of illness when virus is still present
in the blood.

9. SUSCEPTIBILITY, RESISTANCE AND
OCCURRENCE
All persons are susceptible. Both sexes are equally
affected. Age groups predominantly affected are the
preschool age and school age. Adults and infants are not
exempted. Peak age affected 5-9 years.
Occurrence is sporadic through out the year. Epidemic
usually occur during the rainy seasons June – November.
Peak months are September and October.
Occurs wherever vector mosquito exists. Susceptibility
is universal. Acquired immunity may be temporary but
usually permanent.

14. An acute febrile infection of sudden
onset with clinical manifestation of 3
stages:

15.  Saddble back fever (alteration
febrile and afebrile period of 2-3
days each)
 Abdominal pain and headache
 Later flushing which may
accompanied by vomiting,
conjunctival infection and epistaxis

16. Lowering of temperature
Severe abdominal pain
Vomiting and frequent bleeding from
gastrointestinal tract in the form of
hematemesis or melena
Unstable BP
Narrow pulse pressure
shock

17. Generalized flushing with intervening
areas of blanching appetite regained
Blood pressure already stable

20. Severe, frank type – with flushing, sudden high
fever, severe hemorrhage, followed by sudden
drop of temperature, shock and terminating in
recovery or death.
Moderate – with high fever, but less
hemorrhage, no shock
Mild – with slight fever, with or without petechial
hemorrhage but epidemiologically related to
typical cases usually discovered in the course of
investigation of typical cases.

21. PETECHIAE

22. BRUISES

23. RASH
The rash of dengue fever in the acute stage of the infection blanches
when pressed.

25. Physical Examination may reveal the following:
Low BP
A weak, rapid pulse
Rash
Red eyes
Red throat
Swollen glands
Enlarged liver (hepatomegaly)

26. Warning signs
 Worsening abdominal pain
 Ongoing vomiting
 Liver enlargement
 Mucosal bleeding
 High hematocrit with low platelets
 Lethargy or restlessness
 Serosal effusions

27. DHF is currently defined by the following four
World Health Organization (WHO) criteria:
• Fever or recent history of fever lasting 2–7 days.
• Any hemorrhagic manifestation (a positive tourniquet test, skin
hemorrhages (petechiae, hematomas), epistaxis (nose bleed), gingival
bleeding (gum bleed), and microscopic hematuria, vaginal bleeding,
hematemesis, melena, and intracranial bleeding).
• Thrombocytopenia (platelet count
of <100,000/mm3).
• Evidence of increased vascular permeability (elevated
hematocrit ≥20%; decline in hematocrit after volume-replacement
treatment of ≥20%; pleural effusion or ascites; hypoproteinemia or
hypoalbuminemia).

28. Dengue shock syndrome (DSS) is defined as
any case that meets the four criteria for DHF and
has evidence of circulatory failure manifested by
(1) rapid, weak pulse and narrow pulse pressure
(≤20 mmHg [2.7 kPa]) or (2) hypotension for age,
restlessness, and cold, clammy skin.

29. Test may iclude the following:
Hematocrit
Platelet count
Electrolytes
Coagulation studies
Liver enzymes
Blood gases
Torniquet test (causes petechiae below the torniquet)
X-ray of the chest (may demonstrate pleural effusion)
Serologic studies (demonstrate antibodies to Dengue viruses
- IgG and IgM)
Serum studies from samples taken during acute illness and
convalescence (High in titer to Dengue antigen - NS1)

30. Antibodies & Antigens in Dengue

33. Most people who develop DHF recover
completely within 2 weeks. Some, however,
may go through several weeks to months of
feeling tired and/or depressed. Others
develop severe bleeding problems. This
complication, DHF, is a serious illness which
can lead to shock (very low BP) and is
sometimes fatal especially to children and
young adults.

34. Other complications are the
following:
Shock
Encephalopathy
Residual brain damage
Seizures
Liver damage

36. Supportive and symptomatic treatment should be
provided
For fever, give paracetamol for muscle pains. For
headache, give analgesic. DON’T give ASPIRIN.
Rapid replacement of body fluids is trhe most
important treatment
Includes intensive monitoring and follow-up.
Give ORESOL to replace fluid as in moderate
dehydration at 75 ml/kg in 4-6 hours or up to 2-3L in
adults. Continue ORS intake until patient’s condition
improves.

39. 1. For hemorrhage – keep the px at rest during
bleeding episodes. For nose bleeding, 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. Avoid
unnecessary movement. If transfusion is given,
support the patient during the therapy. Observe
signs of deterioration (shock) such as low pulse,
cold clammy perspiration, prostration..

40. 2. For shock – prevention is the best treatment.
Dorsal recumbent position facilitates circulation.
 Adequate preparation of the patient, mentally and
physically prevents occurrence of shock.
 Provision of warmth-through lightweight covers
(overheating causes vasodilation which
aggravates bleeding).
3. Diet – low fat, low fiber, non-irritating, non-
carbonated. Noodle soup may be given.