DENGUE Fever and other symptoms of dengue fever

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ALTERNATIVE NAMES
 Hemorrhagic dengue
 Dengue shock syndrome
 Philippine hemorrhagic fever
 Thai hemorrhagic fever
 Singapore hemorrhagic fever

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INTRODUCTION
 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.
 It 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.

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Global Status of Dengue
Fever
 New infections annually -- 50 mn
 Death -- 24,000 annually
 People at risk -- 2.5 to 3 bn
 Hospitalized cases- 50,000 /yr (90%
affected are children)
 Disease burden -- 4,65,000
 Disability Adjusted Life Years (DALY)
 Half of the world lives in HOT ZONE

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World distribution of Dengue
Fever

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Outbreak in Pakistan
 The first case of Dengue Fever was
detected in Pakistan in the year 1994 in
Karachi.
 The first outbreak of Dengue Fever was in
the year 2006.
 Since then dengue cases detected per
year are on the rise.

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Characteristics of Mosquito
Aedes Mosquito
 One distinct physical
feature – black and
white stripes on its
body and legs
 Bites during the day
 Lays its eggs in
clean, stagnant
water

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Characteristics of Mosquito
 Only the female Aedes
mosquito feeds on blood
because they need the
protein found in blood to
produce eggs
 Male mosquitoes feed
only on plant nectar
 On average, a female
Aedes mosquito can lay
about 300 eggs during
her life span of 14 to 21
days

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Virus vector and transmission
 Causes dengue and dengue
hemorrhagic fever
 Is an arbovirus
 Transmitted by mosquitoes
 Composed of single-stranded RNA
 Has 4 serotypes (DEN-1, 2, 3, 4)

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Virus vector and transmission
 Each serotype provides specific lifetime
immunity, and short-term cross-immunity.
 All serotypes can cause severe and fatal
disease.
 Genetic variation within serotypes.
 Some genetic variants within each
serotype appear to be more virulent or
have greater epidemic potential.

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Replication and Transmission
of Dengue Virus
 1. Virus transmitted to human in mosquito
saliva
 2. Virus replicates in target organs
 3. Virus infects white blood cells and lymphatic
tissues
 4. Virus released and circulates in blood
 5. Second mosquito ingests virus with blood
 6. Virus replicates in mosquito midgut and
other organs, infects salivary glands
 7. Virus replicates in salivary glands

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SIGNS AND SYMPTOMS
 An acute febrile infection of sudden
onset with clinical manifestation of 3
stages:

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FIRST 4DAYS- Febrile or
Invasive Stage
 High fever
 Abdominal pain and headache
 Later flushing which may accompanied
by vomiting, conjunctival infection and
epistaxis

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4th
-7th
days-Toxic or
Haemorrhagic Stage
 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

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7th
-10th
Days- Convalescent
or Recovery Stage
 Generalized flushing with intervening
areas of blanching appetite regained
 Blood pressure already stable

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 Manifestation of Dengue Fever
  Dengue Fever (DF)
  Dengue Hemorrhagic Fever
 (DHF)
  Dengue Shock Syndrome (DSS)

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CLASSIFICATION
 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.

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SOURCES OF INFECTION
 Vector mosquito
Aedis Aegypti ,
Aedis albopictus,
 The infected person

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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.

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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.

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EXAMS AND TESTS
 Physical Examination may reveal the
following:
 Low BP
 A weak, rapid pulse
 Rash
 Red eyes
 Red throat
 Swollen glands
 Enlarged liver (hepatomegaly)

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Test may include 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)

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COMPLICATIONS
 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.
 DHF is a serious illness which can lead to
shock (very low BP) and is sometimes fatal
especially to children and young adults.

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Other complications are the
following:
 Shock
 Encephalopathy
 Residual brain damage
 Seizures
 Liver damage

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MANAGEMENT
 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 the 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.

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Chemeri Vax Dengue
 A tetravalent vaccine
 Uses Yellow Fever vaccine as base
 20% sero conversion
 Still under research

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METHODS OF PREVENTION
AND CONTROL
 The infected individual, contacts and
environment
 Recognition of the disease.
 Isolation of patient (screening o sleeping
under the mosquito net)
 Epidemiological investigation
 Case finding and reporting
 Health Education

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CONTROL MEASURES
 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.
 2. Avoid too many hanging clothes inside
the house.
 3. Residual spraying with insecticides

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MANAGEMENT
 For hemorrhage – keep the patient 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.

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 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).
 Diet – low fat, low fiber, non-irritating
noncarbonated. Noodle soup may be given.

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