DENGUE FEVER

(BREAK BONE, DANDY FEVER, OR ONYONG-YONG FEVER)

DENGUE FEVER
y Endemic throughout the tropics and subtropics y Caribbean, including Puerto Rico and the US

Virgin Islands since 1969

y Tahiti y The virus was identified in 1940-concern fishing in

Pacific and Asia

DENGUE FEVER
Causative Agent: Dengue viruses Mode of Entry: y Transmitted to human through the bites of infective female Aedes mosquitos.
y Low flying, day biting, parallel landing, tiger

(striped) mosquito; breeds of clean stagnant water.

DENGUE FEVER
SYSTEM AFFECTED: Circulatory system INCUBATION PERIOD: Uncertain. Approximately 6 days to 1 week PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness (virus is still present in the blood).

DENGUE FEVER
SYMPTOMS: 1ST 4 days-febrile or invasive stage1. abrupt high fever 2. Abdominal pain 3. Muscle pain 4. Joint pain 5. Headache Late: 1. Flushing 2. vomiting 3. conjunctival infection 4. epistaxis

DENGUE FEVER
ETIOLOGY:
y Different strains of dengue virus y Transmitted by mosquitoes (genus Aedes) y Aedes Aegypti

DENGUE FEVER
PATHOPHYSIOLOGY:
y Symptoms begin after a 5-10 days incubation period y Illness begins abruptly with a minor stage of 2-4 days

duration followed by rapid deterioration

y Increased vascular permeability, bleeding, and possible

DIC may be mediated by circulating dengue antigenantibody complexes, activation of complement, and release of vasoactive amines.

DENGUE FEVER
In the process of immune elimination of infected cells, proteases and lymphokines may be released and activate complement coagulation cascades and vascular permeability.

DENGUE FEVER
CLINICAL FINDINGS: SUBJECTIVE 1. Headache 2. Nausea 3. Vomiting 4. Loss of appetite 5. Abdominal pain 6. Bone and joint pain

DENGUE FEVER
OBJECTIVE: 1. Anorexia 2. Petechiae 3. Melena 4. Hematochezia 5. Hypotension 6. Fever 7. Rapid pulse 8. Rashes over thorax 9. leukopenia

DENGUE FEVER
DIAGNOSTIC TEST: Tourniquet Test (Rumpel Leads Test)
1. 2. 3. 4. 5.

(Systolic pressure + Diastolic pressure)/2 Keep the pressure for 5 minutes Release 2.5 cm (1 sq. inch) Count the number of petechiae inside the box

POSITIVE: 20 petechaie is present

DENGUE FEVER
Acute convalescent serum (measures an increase in antibody titer for dengue virus type). Serologic studies (demonstrates antibodies to dengue viruses, type-specific) Dengue Dot Platelet count

DENGUE FEVER
MEDICAL TREATMENT: 1. Rehydration (IVF, oresol) 2. Acetaminophen or Paracetamol (do not give ASA) 3. Supportive 4. Symptomatic NURSING INTERVENTION: Preventive Measures 1. No vaccine available

DENGUE FEVER
Preventive Measures:
2. 3. 4. 5. 6. 7.

Personal protection (repellant, net) Early recognition Isolation of patient Epidemiological investigation Case finding and reporting Health education

DENGUE FEVER
CONTROL MEASURES
1. 2.

Eliminate vector Residual spraying with insecticides

COMPLICATIONS 1. Febrile (convulsion) 2. Severe dehydration 3. Seizure 4. Diaphoresis 5. diarrhea

DENGUE FEVER
COMPLICATIONS
6. 7. 8. 9. 10.

Anorexia Malaise Shock Hepatomegaly spleenomegaly

Encephalitis
Description:
y Encephalitis is an inflammation of cerebral tissue, typically

accompanied by meningeal inflammation, that is caused by a viral infection.

y It presents as either acute viral encephalitis or postinfectious

encephalomyelitis.

Encephalitis
Pathophysiology and Etiology
y Acute viral encephalitis, accounting for the vast majority of cases, is

caused by a direct infection of the gray matter containing neural cells.

y Results in perivascular inflammation and neuronal

destruction.
y More common in children, and is most commonly

caused by the herpes simplex virus and, to a lesser degree, by the arboviruses.

Encephalitis
y Pathophysiology and Etiology

y Herpes simplex type 1 is responsible for almost all

cases of herpes simplex encephalitis in children and adults.

y Herpes simplex type 2 is more common in neonates

who are born to mothers with this infection during pregnancy.

Encephalitis
y Postinfectious encephalomyelitis follows a viral or bacterial

infectious process, but organisms do not directly affect the neural tissue in the white matter; however, perivascular inflammation and demyelination do occur in the cerebral tissue.
y The incidence of postinfectious encephalomyelitis has

decreased considerably with immunization against measles, mumps, and rubella and the infrequent administration of vaccines due to the eradication of smallpox.
y Rare in infancy.

Encephalitis
y The most common cause is respiratory or GI infection

1 to 3 weeks before the acute onset of encephalomyelitis symptoms.

y May be caused by specific species of mosquitoes and

ticks (arthropods), which may be seasonal and geographic hosts (eg, California encephalitis, St. Louis equine encephalitis).

Encephalitis
y Herpes simplex encephalitis may result from reactivation of the

virus that has been dormant in the cranial and other ganglia, or to reinfection.
y Direct spread to the brain by the olfactory or trigeminal

nerve is suspected with herpes simplex virus type 1.

encephalitis
y Cytomegalovirus encephalitis should be considered

in patients who have advanced HIV infection, have evidence of the cytomegalovirus in other sites, and have progressive neurologic deterioration.

y Toxoplasma encephalitis is the most common cause

of intracranial mass lesions in patients with AIDS.

Encephalitis
Clinical Manifestations y ICP may result in alteration in consciousness, nausea, and vomiting. y Seizures may be present. y Motor weakness, such as hemiparesis, may be detected. y Increased deep tendon reflexes and extensor plantar response are noted. y Fever may be present. y Headache may indicate signs of meningeal irritation.

Encephalitis
Clinical Manifestations y Bizarre behavior and personality changes may present at onset.
y Hypothalamic-pituitary involvement may result in

hypothermia, diabetes insipidus, SIADH.

y Neurologic symptoms may include superior quadrant visual

field defects, aphasia, dysphagia, ataxia, syndrome of inappropriate antidiuretic hormone (SIADH), and paresthesias.

Encephalitis
Complications

Sequelae of the herpes simplex virus may cause temporal lobe swelling, which can result in compression of the brain stem. This virus may also cause aphasia, major motor and sensory deficits, and Korsakoffs psychosis (amnestic syndrome).

encephalitis
y

Relapse of encephalitis may be seen after initial improvement and completion of antiviral therapy. Mortality and morbidity rates depend on the infectious agent, host status, and other considerations. With herpes simplex, the mortality rate is approximately 30%.

Encephalitis
Diagnostic Test
y

Lumbar puncture with evaluation of CSF is performed to detect leukocytosis, increased mononuclear cell pleocytosis, increased proteins, and normal or slightly lowered glucose.

ENCEPHALITIS
y

Polymerase chain reaction (PCR) analysis of the virus DNA and the detection of intrathecally produced viral antibodies are essential in diagnosing the specific virus (eg, herpes simplex virus, cytomegalovirus). Arbovirus-specific IgM in CSF and a fourfold change in specific IgG antibody are diagnostic for arboviral encephalitis. EEG may demonstrate slow brain wave complexes in encephalitis.

Encephalitis
Diagnostic Test y Gadolinium-enhanced MRI differentiates postinfectious

encephalomyelitis from acute viral encephalitis.

y Enhanced multifocal white matter lesions are seen in

encephalomyelitis, which may remain for months after clinical recovery.

Encephalitis
Diagnostic Test
y Herpes simplex virus encephalitis typically has medial-

temporal and orbital-frontal lobe inflammation and necrosis; there may be low-density abnormalities in the temporal lobes.
y Cytomegalovirus, seen in patients who have advanced HIV

disease, may have enhanced periventricular areas.

y Brain tissue biopsy indicates presence of infectious

organisms.

Encephalitis
Treatment/ Medical Management
y

Differentiate acute viral encephalitis from noninfectious diseases such as sarcoidosis, vasculitism, systemic lupus erythematosis, and others.

In patients who are immunosuppressed, such as HIV+ patients, differentiate acute viral encephalitis from cytomegalovirus encephalitis, toxoplasmic encephalitis, and fungal infections.

Encephalitis
Treatment/ Medical Management
y

Patients with cytomegalovirus may be treated with ganciclovir (Cytovene) and foscarnet (Foscavir), commonly used to treat cytomegalovirus retinitis in HIV+ patients. Pyrimethamine (Daraprim) and sulfadoxine (Fansidar) are commonly used to treat Toxoplasma encephalitis. When encephalomyelitis develops, supportive care is indicated because there is no known treatment; corticosteroids may be used.

Encephalitis
Treatment/ Medical Management
y

Patients with cytomegalovirus may be treated with ganciclovir (Cytovene) and foscarnet (Foscavir), commonly used to treat cytomegalovirus retinitis in HIV+ patients. Pyrimethamine (Daraprim) and sulfadoxine (Fansidar) are commonly used to treat Toxoplasma encephalitis. When encephalomyelitis develops, supportive care is indicated because there is no known treatment; corticosteroids may be used.

y y

Encephalitis
y IV acyclovir over 10 days to 3 weeks duration is indicated for

herpes simplex virus.

y Mothers who have genital herpes simplex virus. Mothers

who have genital herpes simplex may be treated with acyclovir during the third trimester to avoid shedding the virus to their babies.
y Anticonvulsants manage seizures.

Encephalitis
Nursing Management
y Nursing Assessment y Obtain patient history of recent infection, animal

exposure, tick or mosquito bite, recent travel, exposure to ill contacts.

y Before delivery, women should be questioned regarding a

history of congenital herpes simplex virus and examined for evidence of this virus; a cesarean section should be explored with the physician.

Encephalitis
Nursing Management
y Nursing Assessment y Strict universal (standard) precautions should be adhered

to in order to contain drainage from herpetic lesions.

y Vesicular lesions or rashes on neonates should be reported

immediately, because these should indicate active herpes simplex infection.

y Perform a complete clinical assessment.

Encephalitis
Nursing Management y Preventing Injury
y Maintain quiet environment and provide care gently,

avoiding overactivity and agitation, which may cause increased ICP.

y Maintain seizure precautions with side rails padded, airway

and suction equipment at bedside.

y Administer medications as ordered; monitor response and

adverse reactions.

Encephalitis
Nursing Management y Promoting Cerebral Perfusion
y Monitor neurologic status closely. y Observe for subtle changes, such as behavior or

personality changes, weakness, or cranial nerve involvement. Notify health care provider.
y In arbovirus encephalitis, restrict fluids to passively

dehydrate the brain.

Encephalitis
Nursing Management y Promoting Cerebral Perfusion
y Reorient patient frequently. y Provide supportive care if coma develops; may last several

weeks.
y Encourage significant others to interact with patient, and

participate in the patients rehabilitation, even while the patient is in a coma.

Encephalitis
Nursing Management y Relieving Fever
y Monitor temperature and vital signs frequently. y Administer antipyretics and other cooling measures as indicated. y Monitor fluid intake and output, and provide fluid replacement through

IV lines as needed.
y Be alert to signs of other coexisting infections, such as urinary tract

infection or pneumonia, and notify health care provider so cultures can be obtained and treatment started.

Encephalitis
Nursing Management y Managing Aberrations in Thought Processes
y Orient to person, place, time. y Maintain memory book, and provide cues to perform required

activities.
y Avoiding Infectious Disease Transmission y Maintain strict universal (standard) precautions. y Initiate and maintain isolation per facility policy.

Encephalitis
Community and Home Care Considerations y Promote vaccination of patient/family/significant others for measles, mumps, and rubella.
y Pregnant women who have a history of genital herpes

simplex, or their partners, should inform their physician of this history.

y Contacts of rabies-infected patients should be offered rabies

prophylaxis.

Encephalitis
Patient Education and Health Maintenance y Explain the effects of the disease process and the rationale for care.
y Reassure significant others based on patients prognosis. y Encourage follow-up for evaluation of deficits and

rehabilitation progress.
y Educate others about the signs and symptoms of encephalitis

in case of an epidemic.