Life Extension

Dengue
By DR. GARY S. SY
September 1, 2010, 5:04pm

Dengue is a flu-like viral disease spread by bite of infected mosquitoes.

What is dengue fever?
Dengue fever is a flu-like illness spread by the bite of an infected mosquito.
What is dengue hemorrhagic fever?
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.

How is dengue spread?

Dengue is spread by bite of an Aedes mosquito. The mosquito transmits the disease by biting an
infected person and then biting someone else.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old
oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause
malaria, dengue mosquitoes bite during the day.

Signs and symptoms

Dengue fever usually starts suddenly with:
* High fever.
* Rash.
* Severe headache.
* Pain behind the eyes.
* Muscle and joint pain; the severity of the joint pain has given dengue the name “break bone fever.”
* Nausea, vomiting.
* Loss of appetite is common.
* A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but
complete recovery can take as long as a month. Older children and adults are usually sicker than the
young children.
Most dengue result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With
dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and
gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels
can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5
percent of cases, mostly among children and young adults.
How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to
6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons but
can be a source of dengue virus for mosquitoes for about 6 days.
How is dengue diagnosed?
Dengue is diagnosed by a blood test.

Who is at risk for dengue?

Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue
hemorrhagic fever include a person’s age and immune status, as well as the type on infecting virus.
Persons who were previously infected with one or more types of dengue virus are thought to be at
greater risk for developing dengue hemorrhagic fever if infected again.
Treatment
There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of
fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic
fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.
How dengue can be prevented?
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to
areas where dengue occurs. Eliminating mosquito breeding sites in these areas is another key
prevention measure.
Avoid mosquito bites when traveling in tropical area:
Use mosquito repellents on skin and clothing.
When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked
into socks.
Avoid heavily populated residential areas.
When indoors, stay in air-conditioned or screened areas. Use bed nets is sleeping areas are mot
screened or air-conditioned.
If you have symptoms of dengue, report travel history to your doctor.
Eliminate mosquitoes breeding sites in areas where dengue mighty occur:
Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water,
especially old tires.
Regularly change the water in outdoor bird baths and pet and animal water containers.

MANILA, Philippines — The Department of Health (DoH) warned on Saturday that dengue deaths, now
standing at 501 since last January, may reach 800 if vulnerable communities fail to respond to the
situation properly.
Latest figures from the DoH’s National Epidemiology Center (NEC) showed that dengue cases reached
69,594 from January to August 28 this year. This figure is nearly double the 34,997 dengue cases
recorded in the same period in 2009.
Dr. Eric Tayag, NEC director, warned that dengue deaths will potentially surge to 800 if affected
communities fail to observe and sustain a high sense of environmental responsibility.
Malacañang said on Saturday that it is studying the possible declaration of a state of calamity over the
alarming rise of dengue cases in the country.
But Tayag said the DoH is not yet inclined to make such a recommendation at this time.
Nevertheless, he raised the possibility that dengue fatalities may reach 800 if more severe dengue cases
are not given immediate and proper treatment.
Presidential spokesman Edwin Lacierda said over Radyo ng Bayan that the Palace will continue
discussions with DoH officials on whether or not to declare a state of calamity.
“Definitely, we will take the advice of the Secretary of Health (Enrique Ona),” Lacierda said. “They’re
(DoH officials) in the best position to do so (address the dengue situation).”
At this point, he said it is important to keep a high level of public awareness of the threats of dengue in
order to avoid more cases.
Among the crucial areas being monitored by the DoH are Southern Luzon, Metro Manila, and Western
Visayas.
The August 28 NEC report disclosed that the Cordillera Autonomous Region (CAR), and Eastern Visayas
were among the regions with the highest increase in dengue cases.
Tayag said it is difficult to fight dengue if the communities themselves do not make collective effort to
clean their environment.
“It is not only a few households that should do their part, but the whole neighborhood. It doesn’t work if
only few households observe cleanliness in their respective areas. Your mosquitoes could affect the
entire neighborhood,” he told Manila Bulletin in a phone interview.
“People should make cleaning their daily habit,” he said.
In a separate phone interview, Dr. Lyndon Lee Suy, program manager for emerging and re-emerging
infectious diseases, appealed to communities to collectively act against dengue, saying that the DoH is
exhausting all means to stop the increasing number of dengue cases.
“We encourage the community to do their share of responsibility for cleaning their own environment.
What we need is community action,” he said. “We don’t want to anticipate an increase in dengue
deaths.”
Tayag said the DoH reintroduced the “181 formula” — one liter of water, plus 8 teaspoons of sugar, plus
1 teaspoon of salt as an alternative to the oral rehydration solution (oresol) to combat dehydration,
which is among the signs of dengue in its early stage. The patient has to drink the solution every one or
two hours.
“If oresol is not available at health centers, people could prepare this solution at home. They don’t
realize that they could have the treatment at home,” he said.
Health centers are giving out oresol for free, while drugstores and hospitals are selling it at reasonable
prices.
Suy said the “181 formula” is “old” but is being promoted by the DoH to treat mild cases of dengue.
“Instead of going to the hospital, parents could prepare this solution at home. We reminded the public
that we have this old formula, because they might have forgotten it,” Tayag said. He said the DoH has
directed all health centers to campaign for the “181 formula” in their respective communities.
Among the dengue symptoms that are similar to colds, bronchitis, and the regular flu are mild to high-
grade fever with severe headache, pain behind the eyes, muscle and joint pain and rashes.
The NEC report said Regions 2 and the National Capital Region(Metro Manila) have registered a 46.9
percent and 10.9 percent decrease in dengue cases, respectively, while cases in Metro Manila have
increased by 16 percent.
It also disclosed that 78 percent of those who were afflicted with dengue were between one and 20
years old.
Dengue Awareness Month in the Philippines
June 14, 2009, 5:25pm

June has been declared Dengue Awareness Month in the Philippines to build public awareness on the
preventive measures against this mosquito-borne viral disease.
Dengue fever is an acute illness of sudden onset that usually follows a benign course with fever,
headache, exhaustion, rashes, and severe muscle pain, frequently accompanied by sore throat,
dizziness, loss of appetite, vomiting, and diarrhea. It is caused by a bite of a striped Aedes aegypti
mosquito which has previously bitten an infected person. This type of mosquito spreads during rainy
seasons but can breed all year round in standing water in flower pots, plastic bags, tires, and cans.
Dengue strikes people with low levels of immunity. Although the virus is not contagious and cannot be
spread directly from person to person, it is possible to get dengue fever several times. When a person is
infected, physical examination may show low blood pressure, skin rashes, sore throat, rapid pulse,
swollen glands, and enlarged liver.
The signs to watch for are bleeding which easily causes bruising, blood spots in the skin, spitting of
blood, blood in the stool, gum bleeding, and nosebleeding. The common complications of the disease
are pneumonia and inflammation of the heart.
There is no specific medicine or vaccine to treat dengue because it is caused by a virus. The treatment is
to relieve the patient of the symptoms. To treat dehydration and electrolyte imbalances, intravenous
fluids and electrolytes are necessary. Blood transfusions may be needed to control bleeding. Rest is
important.
Statistics show that compared to last year, the number of dengue cases decreased by more than 57
percent this year. The decrease is attributed to the continuing information and educational campaign of
the Department of Health (DoH). The DoH uses television, radio, newspapers, and the Internet in
disseminating advisories on dengue. It also encourages the observance of the 4S strategy against dengue
– Search and destroy, Self-protection measures, Seek early consultation, and Say no to indiscriminate
fogging.
Cleanliness is still the key to prevent dengue but in the presence of its signs and symptoms, immediately
consult a physician for proper care.

Dengue cases rise 90% in Cordillera

By DEXTER A. SEE
June 28, 2010, 2:50pm
BAGUIO CITY – The Cordillera office of the Center for Health Development (CHD) was forced to declare a
heightened alert on the dreaded dengue fever following a 90 percent increase in the cases in the
different parts of the region for the first semester of the year.
Based on reports gathered from 58 hospitals and health centers in the region, dengue fever cases rose
to 550 cases from January 1 to the present compared to the 289 cases registered during the same
period last year.
This year, Ifugao recorded the highest number of dengue fever cases with 187 followed by Mountain
province with 97 with reported clustering of cases in Callutit, Bontoc town.
On the other hand, Benguet registered 72 cases with the capital town of La Trinidad having a significant
increase in individuals affected by dengue fever over the past several weeks.
Earlier, the World Health Organization (WHO) has chosen this mountain resort city as one of its key pilot
areas for its zero dengue program but dengue fever cases are still on the rise, especially in populated
barangays.
Kalinga reported only 27 cases while the conflict-stricken province of Abra had 26 cases during the said
period based on the CHD-CAR report.
Because of the exposure of children in contracting the illness, the health department is now assisting the
Department of Education on massive information and education campaign to combat the continues
increase in the proliferation of dengue-carrying mosquitoes not only in school but also in their
respective houses.
Among the practical preventive measures include the covering of water storage containers to prevent
dengue-carrying mosquitoes from breeding, installation of screens on doors and windows, use of
mosquito nets and insecticides if warranted.
Dr. Myrna Cabotaje, CHD-CAR regional director, explained suspected dengue fever cases must not self-
medicate by taking in aspirin tablet to bring down fever but must be immediately brought to the nearest
health facility for immediate medical attention.
The outset of the rainy season is considered to be the time for the rapid increase in dengue fever cases
because of the existence of many breeding grounds of the mosquitoes in residential and public places.
According to her, people suffering from flu-like symptoms must immediately seek medical attention in
the nearest health facility so that they will be properly diagnosed considering the expected rise in other
rainy day diseases with the same symptoms which could complicate once an infected individual will not
be given the appropriate diagnosis.
Aside from dengue fever, other rainy day illnesses that are expected to increase in the coming days
include the dreaded A (H1N1), cough, colds, diarrhea, ordinary flu, leptospirosis among others.
Cabotaje advised people to keep their resistance strong by eating the right kind of food and keeping
their surroundings clean so that they will be spared from the onslaught of the rainy day diseases which
could result to the untimely death of individuals.
OBJECTIVES
General
This case presentation aims to identify and determine the general heath problems and needs of the
patient with an admitting diagnosis of Dengue Hemorrhagic Fever, Type 1. This presentation also intends
to help patient promote health and medical understanding of such condition through the application of
the nursing skills.
Specific
 To raise the level of awareness of patient on health problems that she may encounter.
 To facilitate patient in taking necessary actions to solve and prevent the identified problems on
her own.
 To help patient in motivating her to continue the health care provided by the health workers.
 To render nursing care and information to patient through the application of the nursing skills.
Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue
viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and
muscle pain that feels like bones are breaking, hence the name. Health experts have known about
dengue fever for more than 200 years.
INTRODUCTION
Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas
of
 Africa
 Southeast Asia and China
 India
 Middle East
 Caribbean and Central and South America
 Australia and the South and Central Pacific
An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to
dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide,
more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases
reported annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have
recently traveled abroad. Many more cases likely go unreported because some health care providers do
not recognize the disease. During the last part of the 20th century, many tropical regions of the world
saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In
addition to typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased
in many parts of the world.
Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4.
You can be infected by at least two, if not all four types at different times during your lifetime, but only
once by the same type.
You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become
infected when they bite infected humans, and later transmit infection to other people they bite. Two
main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of
dengue transmitted in this country. Dengue is not contagious from person to person.
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you
have been bitten by an infected mosquito and include
 High fever, up to 105 degrees Fahrenheit
 Severe headache
  Retro-orbital (behind the eye) pain
 Severe joint and muscle pain
 Nausea and vomiting
 Rash
The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second
rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic
dengue plus
 Marked damage to blood and lymph vessels
 Bleeding from the nose, gums, or under the skin, causing purplish bruises
This form of dengue disease can cause death.
Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the
symptoms of classic dengue and dengue hemorrhagic fever, plus
 Fluids leaking outside of blood vessels
 Massive bleeding
 Shock (very low blood pressure)
This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue
infection. It is sometimes fatal, especially in children and young adults.
OBJECTIVES
General
This case presentation aims to identify and determine the general heath problems and needs of the
patient with an admitting diagnosis of Dengue Hemorrhagic Fever, Type 1. This presentation also intends
to help patient promote health and medical understanding of such condition through the application of
the nursing skills.
Specific
 To raise the level of awareness of patient on health problems that she may encounter.
 To facilitate patient in taking necessary actions to solve and prevent the identified problems on
her own.
 To help patient in motivating her to continue the health care provided by the health workers.
 To render nursing care and information to patient through the application of the nursing skills.
Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue
viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and
muscle pain that feels like bones are breaking, hence the name. Health experts have known about
dengue fever for more than 200 years.
INTRODUCTION
Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas
of
 Africa
 Southeast Asia and China
 India
 Middle East
 Caribbean and Central and South America
 Australia and the South and Central Pacific
An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to
dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide,
more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases
reported annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have
recently traveled abroad. Many more cases likely go unreported because some health care providers do
not recognize the disease. During the last part of the 20th century, many tropical regions of the world
saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In
addition to typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased
in many parts of the world.
Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4.
You can be infected by at least two, if not all four types at different times during your lifetime, but only
once by the same type.
You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become
infected when they bite infected humans, and later transmit infection to other people they bite. Two
main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of
dengue transmitted in this country. Dengue is not contagious from person to person.
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you
have been bitten by an infected mosquito and include
 High fever, up to 105 degrees Fahrenheit
 Severe headache
 Retro-orbital (behind the eye) pain
 Severe joint and muscle pain
 Nausea and vomiting
 Rash
The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second
rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic
dengue plus
 Marked damage to blood and lymph vessels
 Bleeding from the nose, gums, or under the skin, causing purplish bruises
This form of dengue disease can cause death.
Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the
symptoms of classic dengue and dengue hemorrhagic fever, plus
 Fluids leaking outside of blood vessels
 Massive bleeding
 Shock (very low blood pressure)
This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue
infection. It is sometimes fatal, especially in children and young adults.
Who has dengue fever and dengue hemorrhagic fever?
The WHO deems it not appropriate to adopt a detailed clinical definition of dengue fever because of the
variability in the clinical illness associated with dengue infection. There is a need for laboratory
confirmation if technology exists. Otherwise it has proposed the following classification:
Case definition for dengue fever
An acute febrile illness of 2-7 days duration with 2 or more of the following:
 Headache
 Retro-orbital pain
 Myalgia
 Arthralgia
 Rash
 Hemorrhagic manifestations
 Leukopenia
How is the tourniquet test done?
Place the cuff of a sphygmomanometer around the arm in the usual manner and inflate to a pressure
halfway between systolic and diastolic levels. Maintain compression for five minutes and wait two
minutes or more before observation. Describe an area 1-square inch on the volar surface of the forearm
1-1/2 inches distal from the antecubital fossa. Count the petechiae within this prescribed area. A
positive tourniquet test is > 20 petechiae.
Who will need hospitalization?
It is not necessary to hospitalize all patients with suspected DHF, since shock develops in less than 1/3 of
cases. The finding of a continuing drop in the platelet count concurrent with a rise in the hematocrit is
an important indicator of the onset of shock. Repeated platelet and hematocrit determinations are
needed. The critical period is usually on the day of defervescence, typically after the third day of illness.
All patients presenting with dengue shock syndrome should be hospitalized. Those who will require
treatment at home should be monitored for danger signs. The presence of any of the following danger
signs requires hospitalization:
 Spontaneous bleeding (epistaxis, gum bleeding, hematemesis, coffee-ground material per
nasogastric tube, bleeding from venepuncture sites, hematuria, melena, hematochezia,
menorrhagia)
 Persistent abdominal pain
 Persistent vomiting
 Listlessness
 Changes in mental status
 Restlessness
 Weak and rapid pulse
 Cold, clammy skin
 Circumoral cyanosis
 Difficulty of breathing
 Seizures
 Hypotension or narrowing of pulse pressure (<20 mm Hg)
 Platelet count < 100,000 cells per mm3 or 1-2 platelet per oil immersion field
 Hemoconcentration
 Prolonged bleeding time (>5 minutes by Ivy method)
How do you give fluids in dengue hemorrhagic fever?
Fluids must be given for replacement and maintenance purposes. In the febrile stage of DHF, fluid loss
should be replaced with oral rehydrating salt solution. As much as 75 ml/kg body weight can be given in
4 hours.
Intravenous fluid therapy is recommended when danger signs are present, especially during
defervescence. Crystalloids (D5LRS or D5NSS or PLRS or PNSS) can be given at 5-15 ml/kg/hour, with
periodic adjustment according to patient's subsequent response. The vital signs and urine output are
important parameters to monitor response to IVF therapy. It is suggested that you start at a rate of 5
ml/kg/hour and gradually increase this to 15 ml/kg/hr by 3-5 ml/hr increments until you achieve the
desired response.
When the patient is in shock, IVF must be given at a faster rate and bigger volume, the 20/20 rule, that
is, 20ml/kg in 20-30 minutes. The patient usually responds after this dose. If you do not improve the
situation, colloids at 20 ml/kg in 20 minutes may be given. Meanwhile, look for other causes of shock
such as bleeding, which may or may not be obvious.
After adequately replacing the fluid losses, maintenance IVF therapy should be instituted. D5LRS or
D5IMB if < 2 yrs old may be used and should be given at 3 ml/kg/hr up to 2-3 liters per day in adults.
Patients usually require IVF therapy for 24-48 hours.
When do you give blood/blood products in dengue hemorrhagic fever?
Whole blood is indicated to correct anemia and shock, if fluids are not able to provide adequate fluid
resuscitation. When disseminated intravascular coagulation (DIC) is suspected, fresh frozen plasma or
cryoprecipitate is given. A prolonged PTT is also an indication to give these blood products.
Platelet concentrates are not routinely administered. They are useful in the presence of significant
bleeding with platelet counts < 50,000/cu mm or as prophylaxis against spontaneous bleeding when
platelet counts are below 20,000/cu mm.
How often should we monitor platelet count and hematocrit in dengue hemorrhagic fever?
Baseline platelet count should be available at any stage of dengue hemorrhagic fever. Serial
determinations may be required during the defervescence stage to anticipate the onset of shock or to
detect occult bleeding. After recovery with fluid replacement, platelet count and hematocrit may be
repeated just before discharge.
When do you send home patients with dengue hemorrhagic fever?
The absence of danger signs allows the treatment of dengue hemorrhagic fever at home. Hospitalized
patients may be sent home if they have remained afebrile for at least 72 hours or if the danger signs
have resolved.