A Report On Dengue Hemorrhagic Fever: Submitted by
A Report On Dengue Hemorrhagic Fever: Submitted by
A Report On Dengue Hemorrhagic Fever: Submitted by
Submitted By:
Submitted to:
Dr. Robert Denopol
December 2009
DENGUE HEMORRHAGIC FEVER
Introduction:
Identification:
A severe mosquito transmitted viral illness endemic in the tropics, much in South
and Southeast Asia especially in the Philippines. It is characterized by increased vascular
permeability, hypovolemia and abnormal blood clotting mechanisms. WHO case definition
for DHF: 1) fever or history of recent fever, 2) thrombocytopenia (platelet count equal to
or less than 100 x 10 /cu mm), 3) hemorrhagic manifestations such as petechiae or overt
bleeding phenomena, and 4) evidence of plasma leakage due to increase vascular
permeability.
Illness is biphasic; it begins abruptly with fever, and in children, with mild upper
respiratory complaints often anorexia, facial flush and mild GI disturbances. Coincident
with defervescence and decreasing platelet count, the patient’s condition suddenly
worsens, with marked weakness, severe restlessness, facial pallor and often diaphoresis,
severe abdominal pain and circumoral cyanosis. GI hemorrhage is an ominous prognostic
sign that usually follows a prolonged period of shock.
Infectious Agent:
The viruses of dengue fever are flaviviruses and include serotypes 1, 2, 3 and 4
(dengue 1, -2, -3, -4); Chikungunya virus
Occurrence:
Dengue occurrence is sporadic throughout the year. Epidemic usually occurs during
the rainy seasons June – November. Peak months are September and October. It occurs
wherever vector mosquito exists. DHF / DSS are observed most exclusively among
children of the indigenous population under 15 years of age. Occurrence is greatest in the
areas of high Ae. Aegypti prevalence.
Reservoir:
The viruses are maintained in a human Aedes Aegypti mosquito cycle in the
tropical urban centers
Mode of Transmission:
By the bite of infective mosquitoes, principally Ae. Aegypti. This is day biting
specie, with increased biting activity for 2 hours after sunrise and several hours before
sunset.
Incubation Period:
Period of Communicability:
Not directly transmitted from person to person. Patients are infective for
mosquitoes from shortly before to the end of the febrile period, usually a period of 3-5
days. The mosquito becomes infective 8-12 days after the viremic blood meal and
remains so for life.
All persons are susceptible. Both sexes are equally affected. The age groups
predominantly affected are the preschool age and school age. Adults and infants are not
exempted. Peak age affected 5-9 years.
Susceptibility is universal. Acquired immunity may be temporary but usually
permanent.
Diagnostic Test:
The diagnosis of dengue hemorrhagic fever is made on the basis of the following triad
of symptoms and signs: Hemorrhagic manifestations; a platelet count of less than 100,
000 per cubic millimeter; and objective evidence of plasma leakage, shown either by
fluctuation of packed-cell volume (greater tan 20 percent during the course of the
illness) or by clinical signs of plasma leakage, such as pleural effusion, ascites or
hypoproteinemia. Hemorrhagic manifestations without capillary leakage do not
constitute dengue hemorrhagic fever.
MANAGEMENT:
PREVENTION:
The best way to prevent dengue fever is to take special precautions to avoid contact
with mosquitoes.
Eliminate 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
Because Aedes mosquitoes usually bite during the day, be sure to use precautions
especially during early morning hours before daybreak and in the late afternoon before
dark.
Sources:
http://www.nscb.gov.ph/secstat/d_vital.asp
http://www.who.int/csr/resources/publications/dengue/012-23.pdf
Public Health Nursing in the Philippines by the Publications Committee, National League
of Philippine Government Nurses, Incorporated