Dengue Fever

Dengue fever - also known as (breakbone fever, Dandy fever, Infectious Thrombocytopenic
pupura) is an acute febrile infectious disease caused by the dengue virus. Typical symptoms
include headache, a petechial rash, and muscle and joint pains; in a small proportion the disease
progresses to life-threatening complications such as dengue hemorrhagic fever (which may
lead to severe hemorrhage) and dengue shock syndrome (where a very low blood pressure can
cause organ dysfunction).
dengue hemorrhagic fever- a severe, sometimes fatal manifestation of dengue virus

infectioncharacterized by a bleeding diathesis and hypovolemic shock.
Etiologic agent-
a. Flaviviviruses 1, 2, 3, 4, a family of Togaviridae. These are small viruses that containing

single strand RNA
b. Arboviruses group B
Mode of Transmission:
1. By bite of an infected mosquito, principally; Aedes Egypti

 A day biting mosquito (2 hrs after sunrise and 2 hrs before sunset)
 Breed on stagnant water
 Limited movement and usually low flying
 Fine white dots at the base of the wings; with white bands on the legs
Aedes albopictus- may contribute to transmission of dengue virus in rural areas.
Other contributory mosquito:
*Aedes polynesis
*Aedes scutellaris simplex
Incubation period:
4 – 14 days; commonly 7 – 10 days
Period of Communicability:
1. Pt are usually infected to mosquito from the day before the febrile period to the end of it
2. The mosquito became infective from 8 – 12 after the blood meal and remain infetive all
throughout life.
Source of Infection
1. Infected person – the virus is present in the blood of pt. during the acute phase of the dse. And
will become a reservoir of virus, sucked by mosquito which may then transmit the dse.
2. Standing water – any stagnant water along the household and premises are usual breeding
places.
Pathogenesis:
*Infectious virus is deposited in the skin by the vector and initial replication occurs at the site of
infection and in local lymphatic tissues.
*within a few days viremia occurs, lasting until the 4 th or 5th day after onset of symptoms.
*evidence indicates that macrophages are the principal site of replication.
*at the site petechial rash, non-specific changes has been noted which include:
* Endothelial swelling
* Perivascular edema
*(in petechiae) extravasations of blood
*Marked increase in vascular permeability.
*The most serious pathophysilogical abnormality is hypovolemic shock resulting from increased
permeability of the vascular endothelium and loss of plasma from the intravascular space
Clinical Manifestation:
I. Dengue Fever
1.Prodromal symptoms characterized by:
* malaise and anorexia up to 12 hrs
* fever and chills accompanied by severe frontal headache, ocular pain, myalgia wih severe
backache, and arthralgia
2. Nausea and Vomiting
3. Fever is non-remitting and persist for 3 – 7 days
4. rash is more prominent on the extremities and the trunk. It may involve the face in sme
isolate cases.
5. Petechiae usually appears near the end of the febrile period and most common on the
lower extremities.
II. Dengue Hemorrhagic Fever (DHF)
- This severe form of dengue virus infection is manifested by fever, hemorrhagic diathesis,
hepatomegally and hypovolemic shock.
Phases of Illness
1. Initial febrile phase lasting from 2-3 days

 Fever (39-40 C) accompanied by headache
 Febrile convulsions may appear
 Palms and sole are usually flushed
 Positive tourniquet test
 Anorexia, vomiting, myalgias
 Generalized or abdominal pain
 Hemorrhagic manifestation, like positive tourniquet test, purpura, epistaxix and gum
bleeding may be present
2. Circulatory phase
 Fall of temperature accompanied by profound circulatory changes usually on the 3 rd – 5th
day
 Patient become restless, with cool clammy skin
 Cyanosis is present.
 Bleeding diathesis may become more severe with GIT hemorrhage
 Shock may occur due to loss of plasma from the intravascular spaces and
hemoconcentration with markedly elevated hematocrit is present
 Pulse is rapid and weak ; pulse pressure become narrow and blood pressure may drop to an
unobtainable level
 Untreated shock may result to comma metabolic acidosis and death may occur within 2
days
 With effective therapy, recovery may follow in 2 – 3 days.
Classification According to Severity ( Halstead & Nimmanitya)
Grade I
- Fever accompanied by non specific constitutional symptoms and the only hemorrhagic
manifestation is positive (+) tourniquet test
Grade II
- All signs of grade I plus spontaneous bleeding from the nose, gums, GIT
Grade III
- Presence of circulatory failure as manifested by weak pulse, narrow pulse pressure,
hypotension, cols clammy skin and restlessness
Grade IV
- Profound shock, undetectable blood pressure and pulse
Complication
1. Dengue Fever
 Epistaxis; menirrhagia
 Gastroinestinal bleeding
 Concomitant gastrointestinal disorder ( peptic ulcer)
2. DHF
 Metabolic acidosis
 Hyperkalemia
 Tissue anoxia
 Hemorrhage into the CNS or adrenal glands uterine bleeding may occur
 Myocarditis
3. Severe Manifestation
 Dengue encephalopathy- manifested by increasing restlessness, apprehension or anxiety,
disturbed sensorium, convulsion, spacity, and hyporeflexia
Diagnostic Tests:
1. Tourniquet test- screening test done by occluding the arm veins for about 5 minutes to capillary
fragility.
2. Platelet count(decreased)- considered comfirmatory test
3. Hemoconcentration –an increase n at least 20% in hematocrit or steady rise in hematocrit
4. Occult blood determination
Treatment modalities:
There is no effective anti viral therapy for dengue fever.
Treatment is entirely symptomatic:
1. Analgesic drugs other than aspirin maybe required for relief of headache, ocular pain, and
myalgia.
2. Initial phase may require intravenous infusion to prevent from dehydration and replacement of
plasma.
3. Blood transfusion is indicated to all patients In shock
4. O2 therapy is indicated to all patients in shock
5. Sedatives maybe needed to allay anxiety and apprehension
Nursing management
1. Pt. should be kept in mosquito- free envi. To avoid further transmission of infection
2. Keep pt. at rest during bleeding episodes

3. Prompt monitoring of VS
4. For pt. nose bleeding maintain pt position in elevated trunk, apply ice bag to bridge of nose and
to the forehead. Do not hyperextend the neck to avoid swallowing of blood thereby resulting in
bloody stools
5. Observe signs of shock, such as slow pulse, cool clammy skin, prostration and fall of BP
6. If signs of shock occurs restore blood volume, put pt. in trendelenberg position to provide
greater blood volume to the head part.
Prevention and Control
1. Early detection and treatment of cases

2. Insecticide treatment of mosquito nets
3. House spraying
4. Eliminating vector by;
a. Changing water and scrubbing side f lower vases at least once a week.
b. Destroy breeding places of mosquito by cleaning the surroundings
c. Keep water containers covered
5. Avoid too many hanging clothes inside he house

Dengue Fever

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Dengue fever - also known as (breakbone fever, Dandy fever, Infectious Thrombocytopenic

dengue hemorrhagic fever- a severe, sometimes fatal manifestation of dengue virus

a. Flaviviviruses 1, 2, 3, 4, a family of Togaviridae. These are small viruses that containing

1. By bite of an infected mosquito, principally; Aedes Egypti

Aedes albopictus- may contribute to transmission of dengue virus in rural areas.

Other contributory mosquito:

*Aedes scutellaris simplex

4 – 14 days; commonly 7 – 10 days

*evidence indicates that macrophages are the principal site of replication.

*(in petechiae) extravasations of blood

*Marked increase in vascular permeability.

1. Initial febrile phase lasting from 2-3 days

Classification According to Severity ( Halstead & Nimmanitya)

- Profound shock, undetectable blood pressure and pulse

There is no effective anti viral therapy for dengue fever.

Treatment is entirely symptomatic:

2. Keep pt. at rest during bleeding episodes

Prevention and Control

1. Early detection and treatment of cases

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