Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitoes that causes fever, headaches, joint and muscle pain. It was first reported in the Philippines in 1953 and is endemic in tropical and subtropical regions. While there is no vaccine or cure, treatment focuses on relieving symptoms and replenishing fluids intravenously. Prevention emphasizes eliminating mosquito breeding sites and self-protection from bites.

2.  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.

3. Meaning
Dengue fever:
An acute mosquito-borne viral illness of
sudden onset with headache, fever, prostration, severe
joint and muscle pain, swollen glands (lymphadenopathy),
and rash. The presence of fever, rash, and headache (the
'dengue triad') is characteristic. Dengue fever is endemic
throughout the tropics and subtropics. Also called
breakbone fever, dandy fever, and dengue.

4. Other Names of DHF
 Hemorrhagic dengue
 Dengue shock syndrome
 Philippine hemorrhagic fever
 Thai hemorrhagic fever
 Singapore hemorrhagic fever

5. Sign and Symptoms
 An acute febrile infection of sudden onset with
clinical manifestation of 3 stages
1. First 4 days – Febrile or Invasive Stage
2. 4th-7th days – Toxic or Hemorrhagic Stage
3. 7th-10th day – Convalescent or Recovery stage

6. First 4 days – Febrile or Invasive
Stage
 high fever
 Abdominal pain and headache
 Later flushing which may
accompanied by vomiting,
conjunctival infection and
epistaxis

7. 4th-7th days – Toxic or Hemorrhagic
Stage
 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

8. 7th-10th day – Convalescent or Recovery
stage
Generalized flushing with intervening areas of
blanching appetite regained
Blood pressure already stable

10. Classification of Dengue Haemorrhagic
Fever
1. Degree I:
Fever accompanied by other clinical symptoms or spontaneous
bleeding, positive tourniquet test, thrombocytopenia and Hemo
concentration.
2. Degree II:
Clinical manifestations of degree I with the manifestation of
spontaneous bleeding under the skin like petekhie, hematoma and
bleeding from other places.
3. Degree III:
Clinical manifestations of degree II, coupled with the circulation
system failure was found manifestation in the form of a rapid and
weak pulse, hypotension with moist skin, cold and anxious patients.
4. Degree IV:
Clinical manifestations in patients with degree III coupled with a
heavy shock was found manifestations with marked tension was
measured and no palpable pulse.

11. 1. Severe, frank type – with flushing, sudden high fever,
severe hemorrhage, followed by sudden drop of
temperature, shock and terminating in recovery or death.
2. Moderate – with high fever, but less hemorrhage, no
shock
3. 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.

12. PETECHIAE

13. BRUISES

15. 1. Vector mosquito
1. Aedis Aegypti ,
2. Aedis albopictus
2. Flavi virus, Dengue Virus Types 1, 2, 3, & 4
3. Chikungunya Virus
4. The infected person

16. Incubation Period
1. Uncertain. Probably 6 days to 1 week
Period of communicability
2. Unknown. Presumed to be on the first week
of illness when virus is still present in the
blood.

17. 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.

18. Investigation
 Physical Examination may reveal the ollowing:
 Low BP
 A weak, rapid pulse
 Rash
 Red eyes
 Red throat
 Swollen glands
 Enlarged liver (hepatomegaly)

19. Tests may include:
 Arterial blood gases
 Blood tests (find signs of the virus in the blood)
 Coagulation studies
 Electrolytes
 Hematocrit
 Liver enzymes
 Platelet count
 Serum studies from samples taken during acute illness and
convalescence (increase in titer to Dengue antigen)
 Tourniquet test (causes petechiae to form below the tourniquet)
 X-ray of the chest (may demonstrate pleural effusion)

20. Positive Torniquet Test

22. 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.

23.  Other complications are the following:
Shock
Encephalopathy
Residual brain damage
Seizures
Liver damage

25. Because Dengue hemorrhagic fever is caused by a virus for
which there is no known cure or vaccine, the only treatment is
to treat the symptoms.
 A transfusion of fresh blood or platelets can correct bleeding
problems
 Intravenous (IV) fluids and electrolytes are also used to correct
electrolyte imbalances
 Oxygen therapy may be needed to treat abnormally low blood
oxygen
 Rehydration with intravenous (IV) fluids is often necessary to
treat dehydration
 Supportive care in an intensive care unit/environment

26. Supportive and symptomatic treatment should be provided
 For fever, give paracetamol for muscle pains.
<1 year – 60md/dose
1-3 year – 60-120mg/dose
3-6 year – 120mg/dose
6-12 year – 240mg/dose
 For headache, give analgesic
 Rapid replacement of body fluids is the most important
treatment
 Includes intensive monitoring and follow-up.

29. 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

31. 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

33. 1. Search and destroy
2. Self protection
3. Seek early consultation
4. Say no to indiscriminate fogging

35. 1. For hemorrhage –
keep the patient 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..

36. 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.
• Provision of warmth-through lightweight covers
(overheating causes vasodilation which aggravates
bleeding).
3. Diet –
low fat, low fiber, non-irritating, non-carbonated.
Noodle soup may be given.