Transcript DENGUE

an acute infectious disease manifested initially with
fever
 It is transmitted by Aedes aegypti, a day-biting
mosquito which lays eggs in clear and stagnant
water found in flower vases, cans, rain barrels, old
rubber tires, etc. The adult mosquitoes rest in dark
places of the house.
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http://www.doh.gov.ph/healthadvisories/dengue
Epidemiology
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A total of 16,317 dengue cases were admitted
to different sentinel hospitals nationwide
from January 1 to August 1, 2009. This is 37.2
% lower compared to last year same time
period (25,969).
National Epidemiology Center:
http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
National Epidemiology Center:
http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
Number of cases were below the alert threshold for morbidity weeks
2-3, 5-8 and 27 to 30.
Number of cases reached the epidemic threshold from 19th to 23rd
morbidity weeks
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Most of the cases were from the following
regions: National Capital Region (23%),
Region XI (13%),Region IV-A (12%), Region VI
(12%), Region XII (9%), and Region III (6%).
National Epidemiology Center:
http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
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Ages of cases ranged from less than a month
to 96 years old (median = 12 years).
Majority of cases were male (53%). Seventy
seven percent of cases belonged to the 1 to
20 years age group
Case fatality ratio greater than 1 were noted
among age groups <1, 1 to 10, and 40 years
old
National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
There were 165 deaths (CFR 1.0%). Admitted cases with CFR greater
than 1 came for Region I, II, CAR, III, VI,VII, VIII, X, & CARAGA(Table 1).
National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9
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Patient: AJB, 19 y/o, M
Date of Birth: 03 May 1990
CS: S
Address: Tondo, Manila
Religion: Roman Catholic
Chief Complaint
4 days PTA
3 days PTA
• lower back pain, malaise and one episode of dark brown watery
stool
• No consultation was done
• self medicated with Biogesic (paracetamol) 500mg every 4 hours
• NO IMPROVEMENT NOTED
• severe headache, graded 10/10, (diffuse and pounding)
undocumented high fever (by feel), facial flushing
• generalized myalgia, retroorbital pain, 10/10 generalized
burming abdominal pain, aggravated by movement; Food
intake offered.
• He also experienced vomiting (3 episodes), anorexia and
weakness. Patient was also irritable.
• no noted epistaxis, gum bleeding, rashes, melena, nor
hematochezia
• medicated with Biogesic (paracetamol), 500 mg every 4 hours
but there was no noted improvement
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2 days PTA
symptoms remains unresolved hence they consulted at the USTH emergency room.
Temperature noted to be 39⁰C. CBC
urinalysis and a chest X-ray was requested ,results were all unremarkable.
patient was given Paracetamol 500mg/tablet, 1 tablet every 6 hours for fever more than
38.5⁰C, myonal 50 mg/capsule tid for 3 days and celecoxib 200mg/capsule prn. He was
observed for 7 ½ hours and was sent home.
• symptoms were still unresolved which prompted to consultation at
usth
Few hours PTA • CBC and stool examination was done.
• Comparison with the previous CBC showed a decreasing platelet
(22 August
count
2009, 10:00
PM)
• ADMISSION
2:00 AM, 23
August 2009
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Complete vaccine
Fever with convulsion at the age of 3
(+) Ulcer (high school)
(+) primary complex (5y/o) - took medications
for 6 months
(+) dislocation of the 2nd digit of the left foot
secondary to trauma s/p cast (2007)
(-) allergies, asthma, HTN, DM, heart disease,
CA, thyroid disease
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a smoker (1 pack year)
occasional alcoholic drinker (6-10 bottles)
denies illicit drug use and not sexually active.
has been living with his maternal aunt since
birth.
sedentary lifestyle since.
He’s not fond of eating street food and
prefers home cooked meals, particularly
meat dishes.
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(+) Hypertension-maternal grandparents,
uncle (2), aunt (2)
(+) COPD-maternal grandmother
(+) DM- maternal grand parents
(+) heart disease - grandfather
(+) stroke - grandfather
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(-) cancer
(+) myoma - aunt
(+) allergies - aunt
(+) asthma - mother
(+) arthritis - mother, aunt
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No jaundice, pruritus
No blurring of vision, photosensitivity, eye
itchiness, redness, pain or lacrimation
No deafness, tinnitus, ear discharge
No epistaxis, colds, nasal discharge
No oral lesions, gum bleeding, ulcers
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No cough, dyspnea, hemoptysis
No chest pain, palpitations, orthopnea, PND,
palpitations, syncope
No urinary frequency, urgency, hesitancy,
hematuria, flank pain, nocturia
No polyuria, polydipsia, polyphagia, heatcold intolerance, tremors
No seizures, dizziness, mental changes
On Admission
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Conscious, coherent, oriented
to time, place and person,
follows command, recent and
remote memory intact, GCS
15
CN I-XII intact
Motor: grossly graded 5/5 on
all extremities
Cerebellar: can do APST and
FTNT with ease
Sensory: No sensory deficit
DTRs: ++
(-) Babinski, (-) nuchal rigidity
On Interview
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Conscious, coherent, oriented
to time, place and person,
follows command, recent and
remote memory intact, GCS
15
CN I-XII intact
Motor: 5/5 on all extremities
Cerebellum: FTNT with ease
DTR’s ++ on all extremities
No sensory deficit
No Babinski, nuchal rigidity
On Admission
Conscious, coherent,
ambulatory, not in
cardiorespiratory distress
 Pink palpebral conjunctiva,
anicteric sclera
 BP 110/60 PR 92bpm
regular RR 28cpm, regular,
T=39 C
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On Interview
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Patient is coherent,
oriented as to time and
place and ambulatory
Pink palpebral conjunctiva,
anicteric sclera
Tonsils not enlarge,
nonhyperemic posterior
pharyngeal wall
Temperature: 36.5 C
PR 64 bpm,regular , +2 RR:
28 cpm BP:120/70
On Admission
On Interview
(-) murmurs no heaves,
thrills,
 Adynamic precordium, AB
5th LICS MCL,
 s1>s2 at apex, s2>s1 base,
 ,no cyanosis, no edema
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(-) murmurs, heaves, nor
thrills
 Adynamic precordium,
Apex beat at the 5th LICS,
midclavicular line
 S1>s2 at the apex, S2>S1 at
the base
 No cyanosis, edema on the
left distal forearm
On Admission
On Interview
no alar flaring
(-) use of accessory muscles,
(-) supraclavicular retractions,
not equal tactile and vocal
fremiti, decreased on both
lower lung field
 Flat abdomen, (-) visible
pulsations, (-) striae, NABS,
soft, no masses, (+) direct
epigastric tenderness
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Not in respiratory distress,
Symmetrical chest expansion,
no retractions, clear breath
sounds, no wheeze nor
crackles, symmetrical tactile
and vocal fremiti
 Abdomen is flat, tympanitic,
inverted umbilicus, no striae
nor scars
 Pain on the epigastrum on
moderate palpation
On Admission
On Interview
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Liver edge, kidneys, spleen
not palpable, trube’s space
not obliterated
Liver span 9cm,RMCL
+ Hematoma on R and L
antecubital fossa
+ petechiae on R lateral
arm
+ Rashes on all extremities
with predominance on the
distal part