3. INTRODUTION:
Dengue Virus – One of four closely related but
antigenic ally distinct virus serotypes.
[DEN-1,DEN-2,DEN-3 & DEN-4] of the genus Flavi
Virus.
Dengue Fever is transmitted by the bite of an
Aedes mosquito infected with a Dengue Virus.
when it bites a person with engue virus in their
blood.
4. It Can’t be spread directly from one person to
another person.
Dengue Viruses are Arboviruses causing disease
condition.
These infections may be a symptomatic or may
lead to
Classical Dengue Fever
Dengue haemorrhagic fever without shock.
Dengue haemorrhagic fever with shock
5. DEFINITION
Dengue is an infecyion caused by Dengue
viruse which is spread in human beings by Aedes
Aegypti and Aedes Alvopictus mosquitoes. The
fever caused by dengue is called Dengue Fever.
6. HISTORY:
In 15th to 19th Centuries – A aegypti spread out of Africa.
In 1779 & 1780 – Spread to Aisa, Africa & North
America.
Until 1940 – In frequent epidemics outbreaks.
1906- confirmed that transmission by the Aedes
mosquitoes.
During and after 2nd World War – attributed to ecologge
disruption
1953 – sever form of diseases first reported in
Philippines.
1970- It become a major cause of child mortality.
Till 2014-there is a long intervals [10-40 years] between
major epidemics.
7. EPEDEMIOLOGY:
Common in more than 110 cpuntries.
50 to 528 million people hospitalized world wide a year
And 25,000 deaths.
In 2000 year
12 countries in Southest Asia
3 million infections
6000 deaths annually.
22 countries in Africa
20% population get infection.
Rates of dengue increased 30 told between 1960 &
2010.
8. Due to urbanization, population growth, increased
international travel global warming.
Past 40 years- increase number of cases.
2.5 to 3 billion people live in where dengue viruses is
transmitted.
50 million infection
5,00,000 cases of dengue hemorrhagic fever 12,000
deaths.
Children mainly.
2008- South East Asia Region and Western Pacific
Region
70% of DHF
Indonesia, Thailand & Myanmar India, Bangladesh,
Maldives,Shrilanka
9. Current emerging situation of dengue in INDIA:
IN 2012: 47,029 dengue fever
242 deaths.
10. Dengue is an actue viral infection caused by atleast
4 serotypes [1,2,3 & 4] of dengue virus
It occur epidemically or endemically.
It start during the rainy season when the breeding
of the vector mosquitoes in generally abundant.
Temperature also plays an important role in the
transmission of dengue virus by mosquitoes.
Mosquitoes kept at 260 Celsius fail to transmit
DEN-2 Virus.
11. TRANSMISSION OF DISEASE:
The reservoir of infection is both man and mosquito.
Cycle is :
Man
Mosquito
Man
Ades aegypti is the main vactor.
Vector of Diseases
– Aedes Albopictus.
-Ades polynesiens
-Ades scutellaris complex.
12. MANIFESTATION OF THE DENGUE FEVER :
DENGUR VIRUS INFECTION
A symptomaic
Undifferentiated
(viral syndrome)
Dengue Fever
(syndrome)
without
haemorrhag
with unusual
haemorrhag
Symptomatic
Dengue
haemorrhagic
Fever
No shock
Dengue Shock
Syndrome
14. 1. CLASSICAL DENGUE FEVER :-
All ages & both sex are cuceptible.
Incubation period – 3 to 10 days.
Sign & Symtoms :
-Sudden Chills
-High fever
-intense headache.
-muscle & Joint Pain.
-within 24 hours retro orbital pain.
-photo phobia.
15. Common Symptoms:-
-extreme weakness
-anorexia
-constipation
-altered test sensation
-Abdominal tenderness
-Sore Throat
-General depression.
Fever is usually between 390 Celsius & 400 Celsius
It lasts for about 5 days.
The case fatality is exceedingly low.
Infection with one dengue serotype gives immunity
againsy that particular serotype and practical protection
against others.
16. 2. DENGUE HAEMORRHAGIC FEVER:
It is a severe foam of dengue fever.
Caused by infection with more than one dengue
virus.
Dengue Shock Syndrome :
A more severe foam of the disease characterized
by shock & haemoconcentration.
The course of dengue illness can be divided into
three phases-
Febrile Phase
Critical Phase
Recovery Phase.
17. 1. FORBILE PHASE :
- Incubation period of our to six days.
Symptoms:-
High Fever
Facial flushing & headache
Anorexia
Vomitting
Epigastric discomfort
Tenderness at right lostal margin
Abdominal pain
Fever
Temperature level – 40. C to 41. C
Febrile convulstion occur in infants.
18. Major Pathophysiologic changes
Plasma Leakage
Abnormal heamostasis
Rising heamatocrit value
Moderate throm bocytopenics
This two are distinctive & constants findings
19. 2. CRITICAL PHASE:-
- 3 to 7 days of illness
- Temperature level – 37.5. C to 38. C or less
- increase capillary permeability
- increasing heamatocrit levels
-significant plasma leakage lasts 24-48 hours.
This marks are beginning of the critical phase.
For Diagnostic evaluation:-
Chest X-Ray
Abdominal ultrasound
Pleural effusion & ascites may be clinically detectable
depending on the degree of plasma leakage & the volume of
fluid therapy.
Shock occurs when a critical volume of plasma is lost through
leakage.
20. Symptoms :- Abdominal pain
Tenderness
Persistent vomiting
Clinical fluid accumulation
Mucosal bleeding
Lethargy
Restlessness
Liver enlargement more than 2 cm.
Body temperature – subnormal
With prolonged shock:
21. Consequent organ hypoperfusion
Organ impairment
Metabolic acidosis
Disseminated intravascular coagulation.
Leucopenia – total white cell count may increase in
patient with server bleeding.
Sever hepatitis
Encephalitis
myocarditis
Cases of dengue with warning signs will probably
recover with early intravenous rehydration.
Some cases will deteriorate to server dengue.
22. 3. RECOVERY PHASE:
- After the critical phase 48-72 hours are recovery phase
- 8 to 10 days of illness.
General well being improve
Appetite returns
Gastrointestinal symptoms abate
Heamodynamic status stabilize
Dieresis ensues.
Some may experience generalized pruritus
Bradycardia & electro cardiographic changes are common
during this stage.
Haematocrit stabilizes.
During this phase excessive fluid therapy is associated with
pulmonary oedema or congestive heart failure.
23.
24. SEVERE DENGUE
Plasma leakage
Lead to shock
Fluid accumulation with or without respiratory
distress
Sever bleeding
Sever organ impairment
25. It take place around 4 to 5 days of illness
increase vascular
permeability
hypovolamia
shock
26. In initial stage of shock
Compensatory mechanism maintains normal systolic
blood pressure.
& produce tachycardia
Peripheral vasoconstriction
With reduced skin perfusion
Patient with sever dengue may have:
Coagulation abnormalities
Thrombocytopenia
Hypoxia
Acidosis
And it leads to multiple organ failure.
Disseminated intravascular coagulation.
28. CLINICAL DIAGNOSIS
fever - acute onset
-high fever
-2 to 7 days
hemorrhagic manifestation
-petechiae, purpura ecchymosis
-epistaxis, gum bleeding
-hematemesis or melena
enlargement of liver
29. GRADING OF SEVERITY OF DENGUE HEMORRHAGIC
FEVER:-
Grad 1 :-
nonspecific fever
Positive tourniquet test
Grad 2:-
spontaneous bleeding
Addition to grad 1
Grad 3:-
circulatory failure
rapid and weak pulse
hypotension
cold clammy skin
restlessness
grad 4:-
profound shock
undetectable blood pressure and pulse
30. LABORATORY DIAGNOSIS
complete blood count
Thrombocytopenia (1000000/mm3 or less)
Heamoconcentration
Heamatocrit increased by 20% or more of baseline
value
Leukopenia
Electrolyte imabalance
Acidaemia
Elevated BUN
31. TREATMENT:-
There is no specific treatment for classic dengue fever
and like most people you will recovery completely within
2 weeks
It is a symptomatic and supportive
Bed rest is a advisable during the acute febrile phase
Antipyretic s or sponging is required to keep body
temperature below 39 0 C
Salicylates and ibuprofen should be avoided.
Paracetamol may be prescribed
Analgesics or a mild sedatives may be required for
those with severe pain
ORS solution is recommended for patient with excessive
sweating, nausea, vomiting or diarrhea to prevent
dehydration.
32. MANAGEMENT :-
Mainly symptomatic
Antipyretics may be indicated but salicylates and
ibuprofen should be avoided
Increased fluid intake
Fluid and electrolyte replacement by IV fluids,
isotonics etc.
Plasma expanders, is clinically indicated
Fresh frozen plasma may be indicated in some
cases
Blood transfusion
(exceptionally rare case)
Bed rest
33. NURSING MANAGMENT:
Early detection treatment & notification.
Observe clinical features of dengue.
Monitor carefully the patient.
The treatment should be started without waiting for
investigation on the basis of symptoms.
Dengue fever is controlled by suitable antipyretics.
Patient needs immediate hospitalization for maintaining
fluid and electrolyte balance and blood transfusion.
Emotional & spiritual support may be appropriate.
34. HEALTH EDUCATION:-
Give health education to the patient
To prevent mosquito bite people are advised to:
-use mosquito net
-use mosquito repellant cream
-cover whole body parts
-avoid exposed arms and legs.
To prevent mosquito breeding places. People are
advised to:
- Clean and remove breeding places
-cleaning and drying of man made water containers.
- Change the water in flower vases every week
35. PREVENTION AND CONTROL:-
At present, there is no effective vaccine against dengue
fever.
Therefore the best way to prevent the disease is to take
appropriate personal preventive measures against
mosquito bites:
Vector control is the only feasible and effective control
measure available today
Aerosol and liquid spray has to be applied for effective
killing
Mosquito coil to be placed near possible entrance
Wear long sleeved clothes and long trousers when
going outdoors.
Mosquito bed net could be used when the room is not
air conditioned.
Keeping unscreened windows and doors closed.
36. Advice for parents on source reduction in the home:
Cover all the water containers tightly
Change the water in flower vases every week
Clean the surrounding area of your house
Use an insecticide spray in the house to kill adult
mosquitoes.
37. COMPLICATIONS
Brain damage from prolonged shock or intracellular
hemorrhage
Myocarditis
Encephalopathy
Liver failure