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Description
Some patients with dengue fever go on to develop dengue hemorrhagic fever, a severe and
sometimes fatal form of the disease.
Dengue fever is an acute febrile disease caused by infection with one of the serotypes of
dengue virus. It is a mosquito-born disease caused by genus Aedes.
Dengue is also known as Breakbone Fever, Hemorrhagic Fever, Dandy Fever, Infectious
Thrombocytopenic Purpura.
Dengue hemorrhagic fever is a fatal manifestation of dengue virus that manifest with
bleeding diathesis and hypovolemic shock.
These viruses are related to the viruses that cause the West Nile infection and yellow
fever.
Pathophysiology
Initial phase. The initial phase of DHF is similar to that of dengue fever and other febrile
viral illnesses. The virus is deposited in the skin by the vector, within few days viremia
occurs, lasting until the 5th day for the symptoms to show.
Hemorrhagic symptoms. Shortly after the fever breaks or sometimes within 24 hours
before, signs of plasma leakage appear along with the development of hemorrhagic
symptoms.
Vascular leakage. Vascular leakage in these patients results in hemoconcentration and
serous effusions and can lead to circulatory collapse.
Progression. If left untreated, DHF most likely progresses to dengue shock syndrome.
Dengue is a reportable disease in the United States; known or suspected cases should be reported
to public health authorities.
Globally, 2.5 to 3 billion individuals live in approximately 112 countries that experience
dengue transmission.
Annually, approximately 50-100 million individuals are infected.
Dengue fever has a mortality rate of less than 1%.
When treated, DHF has a mortality rate of 2-5%, but when left untreated, the mortality
rate is as high as 50%.
Dengue fever may occur at any age but is more common among children.
Causes
Aedes Aegypti
Flavivirus. It is caused by infection of one of the four serotypes of dengue virus, which is
a Flavivirus, a genus of single-stranded nonsegmented RNA virus.
Aedes aegypti. Dengue virus is transmitted by day-biting mosquitoes of the genus Aedes
that breeds in stagnant water. It has white dots at the base of its wings, with white bands
on the legs.
Incubation period. It has an incubation period of three to ten days.
Clinical Manifestations
Symptoms, which usually begin 4 to 6 days after infection and may last to up to 10 days, include:
Symptoms of Dengue
There are many ways to prevent dengue fever but there are no vaccines available yet.
Avoid crowded places. Stay away from heavily populated residential areas.
Mosquito repellents. Use mosquito repellents that are mild for the skin, even indoors.
Proper clothing. When outdoors, wear long-sleeved shirts and long pants tucked into
socks.
Mosquito-free environment. Make sure window and door screens are secure and free of
holes or use mosquito nets.
Stagnant water. Empty or cover bottles, cans, and any containers with stagnant water as
these can become breeding places of mosquitoes.
Complications
Dengue cases may be not adequately recognized in the United States, and as a result, many cases
often end up with complications.
Laboratory criteria for the diagnosis of dengue virus may include 1 of the following:
Dengue virus isolation. Isolation of the dengue virus from serum, plasma, leukocytes, or
autopsy samples.
Immunoglobulin titers. Demonstration of a fourfold or greater change in reciprocal
immunoglobulin or IgM antibody titers to one or more dengue virus antigens in paired
serum samples.
Immunohistochemistry. Demonstration of the dengue virus antigen in autopsy tissue via
immunohistochemistry or immunofluorescence.
Polymerase chain reaction. Detection of viral genomic sequences in autopsy tissue,
serum, or cerebrospinal fluid samples via PCR.
Complete blood count. In DHF, there may be presence of increases hematocrit level
secondary to plasma extravasation and/or third-space fluid loss.
Decreased platelet count. This test confirms dengue.
Guaiac test. Guaiac testing for occult blood in the stool should be performed on all
patients suspected with dengue virus infection.
Medical Management
Oral rehydration therapy. Oral rehydration therapy is recommended for patients with
moderate dehydration caused by high fever and vomiting.
IV fluids. IVF administration is indicated for patients with dehydration.
Blood transfusion and blood products. Patients with internal or gastrointestinal
bleeding may require transfusion, and patients with coagulopathy may require fresh
frozen plasma.
Oral fluids. Increase in oral fluids is also helpful.
Avoid aspirins. Aspirin can thin the blood. Warn patients to avoid aspirins and other
NSAIDs as they increase the risk for hemorrhage.
Nursing Management
Nursing Assessment
Nursing Diagnosis
Based on the assessment data, the major nursing diagnoses for a patient with DHF are:
Nursing Interventions
Evaluation
A patient with DHF discharged from the health care facility should be instructed to:
Avoid diuretics. Avoid caffeine and alcohol as indicated to reduce effects of diuresis.
Follow-up appointments. Comply with the recommended medical and laboratory
follow-ups.
Oral care. Recommend use of soft toothbrush to reduce risk of injury to the oral mucosa.
Diet. Foods rich in vitamin K should be recommended to promote blood clotting.
Education. Educate patient on the use of mosquito nets and insecticides.
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