DENGUE HEMORRHAGIC FEVER

(Acute Infectious Thrombocytopenic Purpura, H-fever, breakbone fever) 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. DHF is an acute febrile infection of sudden onset with clinical manifestation of 3 stages. Most common mosquito-borne viral illness in humans. (Acute Infectious Thrombocytopenic Purpura, H-fever, breakbone fever) Causative Agent: Arbovirus(Serotype 1,2,3,4 group B) with a vector female mosquito Aedis Egypti- a domestic, day-biting with low limited flying movement. It breed in clear stagnant water even in small amount. Mode of Transmission: bite of an infected mosquito (Aedis Egypti), infected persons Source of Infection: The blood of infected person during the first 3 days of the disease Incubation Period: 3-15 days most often 5-6 days Period of Communicability: from the day before the onset to the fifth day of the disease. The degree of communicability depends on the prevalence of infected human and the abundance of Aedis Egypti mosquitoes PATHOPHYSIOLOGY

Manifestations: 1. Invasive Stage: sudden fever, headache, flushed face, infected conjunctiva, dry cough, anorexia with nausea and vomiting, severe abdominal pain and tenderness. 2. Second Stage: 2nd-3rd day: fever and all earlier symptoms, biphasic curve fever, palm and sole are flushed, (+) tourniquet test-petichiae in pressure areas 5th- 7th day: fever subsides, limbs are cool, rash appears on the upper and lower extremities, purplish or brownish mottled appearance in blanched areas, rash lasts for 2-3 days, face and hands appears edematous, with pruritus, with bradycardia Severe cases: CNS involvement, cardiac involvement, and hemorrhagic manifestations 3. Convalescence/Recovery Stage: generalized flushing with interventing areas of blanching appetite regained and blood pressure already stable.

Diagnostic Procedure: 1. Torniquet 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 mins. Release cuff and make an imaginary 2.5 m square or 1 inch square just below the cuff, at the antecubital fossa. Count the number of petechiae. A test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed. 2. Viral Isolation thru cell culture 3. Serology Management: A. Medical and Pharmacological Management -IVF for fluid and electrolytes imbalance (to address hemoconcentration) -antipyretic medications and cooling measures for fever -anticonvulsant drugs and precautions for convulsions -check blood exam regularly -close surveillance B. Nursing Management - isolation of patient (screening or sleeping under the mosquito net) -control measures by eliminating the vector thru changing water of vases once a week, destroy breeding places of mosquito by cleaning surroundings proper disposal of rubber tires, empty bottles and cans, keep containers covered. -control of hemorrhage (avoid bleeding tendencies by using soft bristled toothbrush etc) -control shock (through hydration) -spiritual and emotional support - management for fever

PATHOPHYSIOLOGY Bite from infected mosquito

Entrance of the virus into the bloodstream

Immune response