Transcript File

Hemorrhagic dengue
Dengue shock syndrome
H - Fever
Breakbone fever
dandy fever
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.
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.
Dengue (pronounced DENG-gay)
can affect anyone but tends to be
more severe in people with
compromised immune systems.
Because it is caused by one of four
serotypes of virus, it is possible to
get dengue fever multiple times.
However, an attack of dengue
produces immunity for a lifetime to
that particular serotype to which
the patient was exposed.
 Dengue Hemorrhagic Fever is a more
severe form of the viral illness. Symptoms
include headache, fever, rash, and
evidence of hemorrhage in the body.
Petechiae (small red or purple splotches or
blisters under the skin), bleeding in the nose
or gums, black stools, or easy bruising are
all possible signs of hemorrhage. This form
of dengue fever can be life-threatening and
can progress to the most severe form of the
illness, dengue shock syndrome.
How is dengue fever
contracted?
 The virus is contracted from the bite of a
striped Aedes aegypti mosquito that has
previously bitten an infected person. The
mosquito flourishes during rainy seasons but
can breed in water-filled flower pots, plastic
bags, and cans year-round. One mosquito
bite can cause the disease.
 The virus is not contagious and cannot be
spread directly from person to person. There
must be a person-to-mosquito-to-anotherperson pathway.
An acute febrile infection of
sudden onset with clinical
manifestation of 3 stages:

high fever

Abdominal pain and headache

Later
flushing
accompanied
conjunctival
epistaxis
which
by
may
vomiting,
infection
and
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
Generalized flushing with intervening
areas of blanching appetite regained
Blood pressure already stable
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.
PETECHIAE
BRUISES
Flavivirus, Dengue Virus Types
1, 2, 3, & 4
Chikungunya Virus
Vector mosquito
Aedis
Aegypti ,
Aedis
albopictus,
The infected person
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.
SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE
All persons are susceptible. Bothe 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.
Physical Examination may reveal
following:
Low BP
A weak, rapid pulse
Rash
Red eyes
Red throat
Swollen glands
Enlarged liver (hepatomegaly)
the
Test may iclude 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)
POSITIVE TORNIQUET TEST
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. This complication,
DHF, is a serious illness which can lead to
shock (very low BP) and is sometimes fatal
especially to children and young adults.
Other
complications
are
following:
Shock
Encephalopathy
Residual brain damage
Seizures
Liver damage
the
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 trhe 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.
The
infected
individual,
contacts
and
environment:
Recognition of the disease.
Isolation of patient (screening or sleeping
under the mosquito net)
Epidemiological investigation
Case finding and reporting
Health Education
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
1. Search and destroy
2. Self protection
3. Seek early consultation
4. Say no
fogging
to
indiscriminate
Report immediately to the municipal Health Office
any known case outbreak.
Refer immediately to the nearest hospital, cases
that exhibit symptoms of hemorrhage from any part
of the body no matter how slight.
Conduct a strong health education program
directed
towards
environmental
sanitation
particularly destruction of all known breeding places
of mosquitoes.
Assist in the diagnosis of suspect based on the s/sx.
For those without signs of hemorrhage, the nurse
may do the “torniquet” test.
Conduct epidemiologic investigations as a means
of contacting families, case finding and individual as
well as community health education
1. For hemorrhage – keep the px 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..
2. For shock – prevention is the best treatment.
Dorsal
recumbent
position
facilitates
circulation.
Adequate preparation of the patient,
mentally and physically prevents occurrence
of shock.
1. Provision
of warmth-through lightweight
covers (overheating causes vasodilation
which aggravates bleeding).

3. Diet – low fat, low fiber, non-irritating, noncarbonated. Noodle soup may be given.
 In medicine and biology, transmission is the
passing of a communicable disease from an
infected host individual or group to a conspecific
individual or group, regardless of whether the
other individual was previously infected.
 Sometimes transmission can specifically mean
infection of a previously uninfected host.
 The term usually refers to the transmission of
microorganisms directly from one person to
another by one or more of the following means:
 droplet contact – coughing or sneezing on
another person
 direct physical contact – touching an
infected person, including sexual contact
 indirect physical contact – usually by
touching soil contamination or a
contaminated surface
 airborne transmission – if the microorganism
can remain in the air for long periods
 fecal-oral transmission – usually from
contaminated food or water sources
Incubation period
 is the time elapsed between exposure
to a pathogenic organism, a chemical
or radiation, and when symptoms and
signs are first apparent. The period
may be as short as minutes to as long
as thirty years in the case of variant
Creutzfeldt–Jakob disease.
Period of
Communicability
the time during which the
patient is infectious to others.
Infectious
Capable of causing infection.
Caused by or capable of
being transmitted by infection.
Caused by a pathogenic
microorganism or agent.
Contagious
 Capable of being transmitted from one
person to another by direct or indirect
contact.
 Capable of transmitting disease;
carrying a disease.