This document discusses dengue hemorrhagic fever (DHF), a severe form of dengue infection caused by dengue viruses and transmitted by Aedes mosquitoes. DHF is characterized by high fever, hemorrhagic phenomena, and shock. It describes the clinical stages and manifestations of DHF as well as treatments focused on fluid replacement and supportive care. Prevention emphasizes eliminating mosquito breeding sites and avoiding mosquito bites to prevent transmission.

2. Hemorrhagic dengue
Dengue shock syndrome
Philippine hemorrhagic fever
Thai hemorrhagic fever
Singapore hemorrhagic 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. An acute febrile infection of
sudden onset with clinical
manifestation of 3 stages:

6.  high fever
 Abdominal pain and headache
 Later flushing which may
accompanied by vomiting,
conjunctival infection and
epistaxis

7. 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

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

10. 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.

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

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

14. 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.

15. SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE
All persons are susceptible. Bothe 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.

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

18. 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)
Serum studies from samples taken during acute illness
and convalescence (High in titer to Dengue antigen)

20. 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.

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

23. 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.

25. The infected individual, contacts and
environment:
Recognition of the disease.
Isolation of patient (screening or sleeping
under the mosquito net)
Epidemiological investigation
Case finding and reporting
Health Education

27. 1. Eliminate the vector by:
 Changing water and scrubbing sides of lower
vases once a week.
 Destroy breeding places of mosquito by
cleaning surroundings
 Proper disposal of rubber tires, empty bottles
and cans.
 Keep water containers covered.
1. Avoid too many hanging clothes inside the
house.
2. Residual spraying with insecticides

29. 1. Search and destroy
2. Self protection
3. Seek early consultation
4. Say no to indiscriminate
fogging

31. Report immediately to the municipal Health Office
any known case outbreak.
Refer immediately to the nearest hospital, cases
that exhibit symptoms of hemorrhage from any part
of the body no matter how slight.
Conduct a strong health education program
directed towards environmental sanitation
particularly destruction of all known breeding places
of mosquitoes.
Assist in the diagnosis of suspect based on the s/sx.
For those without signs of hemorrhage, the nurse
may do the “torniquet” test.
Conduct epidemiologic investigations as a means
of contacting families, case finding and individual as
well as community health education

33. 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..

34. 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.
1. 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.