I.

INTRODUCTION

Dengue hemorrhagic fever (also called H-fever, Breakbone or Dandy fever) is a severe,

potentially deadly infection spread by certain species of mosquitos (Aedes aegypti). Aedes

aegypti, the transmitter of the disease, is a day-biting mosquito which lays eggs in clear and

stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. Four serotypes of

dengue viruses (1, 2, 3, and 4 Group B Arboviruses) are known to cause dengue hemorrhagic fever.

There are three other arboviruses that have been identified with dengue-like diseases namely

Chikungunya, O’nyong nyong and West Nile fever. Dengue hemorrhagic fever occurs when a

person catches a different type of dengue virus after being infected by another one sometime

before. Prior immunity to a different dengue virus type plays an important role in this severe

disease.

The Department of Health (DOH) warned the public about the rising number of dengue cases in

the country, which reached 32,803 cases from January 1 to December 30, 2016. The DOH said the

number of dengue cases is 61% higher than the 7,335 cases recorded during the same period last

year. Dr. Eric Tayag, head of the DOH National Epidemiologic Center, said that the El Nino

phenomenon could have something to do with the increase in dengue cases. He said the number

of dengue cases also shot up in 1988 when the El Nino phenomenon was felt in the country.

Source/s:

1. Infected person- the virus is present in the blood of patients during the acute phase of the

disease and will become a reservoir of virus, accessible to mosquitoes which may transmit

the disease.

2. Standing water within the household and premises are usual breeding places.
Intubation Period:

 4-6 days (minimum=3days; maximum=10 days)

Period of Communicability:

 Unknown. Presumed to be on the 1st week of illness- when virus is still present in the blood.

Susceptibility, Resistance and Occurrence

All persons are susceptible. Both sexes are equally affected. Age groups predominantly affected

are the preschool and school age. Adults and infants are not exempted. Peak age affected 5-9 years.

Occurrence is sporadic throughout the year. Epidemic usually occur during the rainy seasons-June-

November. Acquired immunity may be temporary but usually permanent.

Signs and Symptoms

An acute febrile infection of sudden onset with clinical manifestation of 3 stages:

 First 4 days- Febrile or invasive stage starts abruptly as high fever. Abdominal pain and

headache; later flushing which may be accompanied by vomiting, conjunctival infection,

and epistaxis. Petechiae may be observe in pressure areas usually first on the face or distal

portions of the extremities.

 4th- 7th days- Toxic or hemorrhagic stage- lowering of temperature, severe abdominal pain,

vomiting, and frequent bleeding from gastrointestinal tract in the form of hematesis or

melena. Unstable BP, narrow pulse pressure, and shock may occur. Tourniquet test which

may be negative due to low or vasomotor collapse.

 7th- 10th days- Convalescent or Recovery stage- generalized flushing with intervening areas

of blanching appetite regained and blood pressure already stable.

 Grading of Dengue Fever:

 Grade 1- fever without overt bleeding but with positive tourniquet test

 Grade II- manifestation of grade 1 with clinical bleeding diathesis such as epistaxis, gum

bleeding, GI bleeding and hematemesis.

 Grade III- circulatory failure manifested by a rapid and weak pulse with narrowing pulse

pressure (20mmHg) or hypotension, with the presence of cold clammy skin and

restlessness

 Grade IV- profound shock in which pulse and blood pressure are not detectable. It is

noteworthy that patients who are threatened shock or shock stage, also known as dengue

shock syndrome, usually remain conscious. (Grade III and IV are considered to be Dengue

Shock Syndrome)

Laboratory and diagnostic Test:

1. Tourniquet test (Rumpel Leads test)

 Inflate the blood pressure cuff on the upper arm to a point midway between the systolic

and diastolic pressure for 5 minutes.

 Release cuff and make an imaginary 2.5 cm square or 1 inch just below the cuff, at the

antecubital fossa.

 Count the number of petechiae inside the box.

 A test is (+) when 2o or more petechiae per 2.5 cm square or 1 inch square is observed.

2. A confirmed diagnosis is established by culture of the virus, polymerase chain reaction

(PCR) tests, or serologic assays.

The diagnosis of dengue hemorrhagic fever is made on the basis of the following triad symptoms

and signs: Hemorrhagic manifestations; a platelet count of less than 100,000 per cubic milliliter

(thrombocytopenia); and objective evidence of plasma leakage, shown either by fluctuation of

packed cell volume (greater than 20 percent during the course of the illness) or by clinical signs of

plasm leakage, such as pleural effusion, ascites, or hypoproteinemia. Hemorrhagic manifestations

without capillary leakage do not constitute dengue hemorrhagic fever.

Chen LH & Wilson ME. (2005)