Group A

Amino, Ma. Adorada

Aducal, Alex
Bagasbas, Krizzamer
Bondoc, Jose Gabriel
Buliyat, Zaida
Depnag, Kirsty
Fernandez, Zheila
Hofiilena, Marie Chin
Nawvabut, Vinida
Netthip, Nutcha
Ramchandani, Aradhana
Sapkota, Dinesh

Dengue

General data

Pt. A.C. A Construction worker

38 years old, Male, Married, Filipino, Roman Catholic
From Tapuac, Dagupan City
Birthdate of June 19, 1978 at Dagupan City

Date admitted: June 26, 2016 at 8:10PM

Chief Complaint: Fever

History of present illness

6 days prior to admission patient had on and off fever
with body malaise and non-productive cough. Patient
took Paracetamol but was not relived sought for
consultation hence admitted.

Family history
Mother died due to tumor on the neck, only revealed
during autopsy.
No other pertinent data

PE
VS of Temp: 36.5 RR 24 CR 68 BP 90/60mmHg

ROS
Constitutional : (+) fatigue; (+) weakness; (-)weight
loss
Neurologic : No headache ;No syncope ; no seizures ; no
areas of focal weakness ; no sensory problems / numbness ;
tingling or pins and needles ; no history of seizures ; no
dizziness; no scotoma ; no vertigo ; no tremors or other
involuntary movements

Eyes: No significant visual difficulties; blurred vision ; No

diplopia ; no eye pain

ROS
ENT : No problems in hearing; no sore throat no sinus
drainage ; no epistaxis ; no tinnitus

Cardiovascular / PVS : no chest pain or discomfort ;

no PND, no orthopnea ; no palpitation ;no Rheumatic
fever manifestations ( sore throat , fever and joint pains);
no claudication ; pedal edema; no leg cramps

Respiratory : (+) cough ; no difficulty of breathing ; no

hemoptysis ;

ROS
Gastroenterology: no Dysphagia ; no odynophagia ; no change
in appetite ,belching or bloatedness; flatulence ; burping No
nausea ; no vomiting ; no abdominal pain ; no diarrhea/
constipation ; no change in bowel movement ; no melena ; no
hematochezia

GUT : no dysuria or burning pain on urination, incontinence ,

hematuria, nocturia , frequency, polyuria/ oliguria , urgency,
hesitation, dribbling, loss of parabolic curve

Musculoskeletal : No joint pain, swelling or redness ; no

decreased range of motion ; no myalgia

ROS
Endocrine : No diabetes ( 3 Ps ) ; no thyroid disease
( heat or cold intolerance ; Waynes index ) or
hormone replacement ; no hot flashes or night sweats

Immunologic /Hematologic : no easy bruising or

bleeding ; No urticarial/ allergy

Psychiatric : No insomnia , depression, mania or

mood swings ; no psychotropic drugs

Impression
Influenza (Viral)

Differential
Diagnosis

 Chikunggunya
Typhoid Fever

Chikunggunya
In Chikungunya the onset of the disease is more acute
and the duration of fever is much shorter.
A maculopapular rash is more frequent in
Chikungunya, while petechia may occur in dengue
fever.
In Chikungunya the pain is much more pronounced
and localized to the joints and tendons in comparison
of dengue fever, which the pain is generalized.

Signs and symptoms of

patient

Chikunggunya

Fever 37.6

headache

Non productive cough

rash

Body malaise

arthralgias
myalgia
Bleeding dyscrasia

Typhoid fever
An acute illness associated with fever caused by the
Salmonella typhi bacteria.
It can also be caused by Salmonella paratyphi, a
related bacterium that usually caused a less severe
illness

Mode of transmission
Typhoid fever is contracted by drinking or eating the
bacteria in contaminated food or water.
People with acute illness can contaminate the
surrounding water supply through stool, which
contains a high concentration of bacteria.
Bacteria can survive for weeks in water or dried
sewage
About 3-5% of people become carriers of the bacteria
after an acute illness

Patient signs and

sympotoms

Typhoid fever

Fever 37.6

fever

Non productive cough

Headache

Body malaise

Generalized aches and

pains
Poor appetite
lethargy
diarrhea

DENG
UE

Lab work
CBC
Chest XRAY
Urinalysis
DENV (Dengue Virus Test)
Fecalysis

Treatment and
Management

www.cdc.gov/dengue/resources/DENGUE-clinician-guide_508.pdf

Group A
Febrile state 2-7 days and subsequent critical phase(12 days) check for:
CBC
Hydration
Watch out for warning signs and decreasing hematocrit and
platelet
Watch for defervescence

www.cdc.gov/dengue/resources/DENGUE-clinicianguide_508.pdf

OUTPATIENT Managemenet
Control fever
Acetaminophen (do not give ibuprofen, aspirin,)

Prevent dehydration
Watch out for signs of dehydration

Prevent spread of dengue in the house

Watch for warning signs as temperature decline 3-8
days after symptom begin
Signs of bleeding and abdominal pain
www.cdc.gov/dengue/resources/DENGUE-clinicianguide_508.pdf

Group B Patients with warning signs

www.cdc.gov/dengue/resources/DENGUE-clinician-guide_508.pdf

www.cdc.gov/dengue/resources/DENGUE-clinician-guide_508.pdf

Group C Emergency
management

www.cdc.gov/dengue/resources/DENGUE-clinician-guide_508.pdf

www.cdc.gov/dengue/resources/DENGUE-clinicianguide_508.pdf

Evidence Based Medicine

Evidence Base Medicine

Research Article: Coagulopathy in dengue fever
patients
Abhilash Kannan1*, Kala Syamalakumari Narayanan1, Sheetal
Sasikumar2, Jobin Philipose3, Sreerag Alumparambil Surendran3

 1Department of Medicine, Sree Gokulam Medical College (SGMC),

Thiruvananthapuram, Kerala, India
2Junior Resident, Sree Gokulam Medical College (SGMC),
Thiruvananthapuram, Kerala, India
3Final MBBS Student, Sree Gokulam Medical College (SGMC),
Thiruvananthapuram, Kerala, India
Received: 30 June 2014
Accepted: 13 July 2014
*Correspondence: Dr. Abhilash Kannan,

 2014 Kannan A et al. This is an open-access article

distributed under the terms of the Creative Commons
Attribution Non-Commercial License, which permits unrestricted
non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Abstract
Background: The study was done to find out the
prevalence of coagulopathy in Dengue fever patients
with thrombocytopenia and its clinical significance.
Methods: The patients admitted in medical wards
and ICU were included in the study after considering
certain inclusion and exclusion criteria. APTT, PT & Ddimer assays were also done in the study population.
Coagulopathy was considered when APTT values were
41seconds.

 Results: 22.3% of the study population showed evidence of

coagulopathy. Bleeding manifestations significantly increased
with increasing APTT values. There is also significant association
between platelet counts and bleeding manifestations. As platelet
count falls there is a tendency for APTT to rise.
Conclusion: In addition to thrombocytopenia, coagulopathy also
contribute to the presence of bleeding manifestations in dengue
fever patients. There is a significant correlation between bleeding
manifestations with abnormal APTT values. As platelet count
decreases there is tendency for rise in APTT values.

Evidence Base Medicine

Research Article: Managing dengue fever in primary
care: A practical
approach
Malays Fam Physician. 2014; 9(2): 210.
Published online 2014 Aug 31.

Abstract
Dengue is a common cause of illness seen in
primary care in the tropical and subtropical countries.
An understanding of the course of disease
progression, risk factors, recognition of the warning
signs and look out for clinical problems during the
different phases of the disease will enable primary
care physicians to manage dengue fever in an
appropriate and timely manner to reduce morbidity
and mortality.

Conclusion
Dengue fever is a common disease encountered in
primary care especially in the tropical countries. An
understanding of the course of the disease
progression and clinical problems to look out the
different phases of the disease will enable primary
care physicians to manage dengue fever in an
appropriate and timely manner to reduce morbidity
and mortality. With appropriate and timely treatment,
the morbidity and mortality can be reduced. It is
important for primary care doctors to adopt a practical
approach to assess, classify and manage dengue
fever. It is crucial to identify red flags and high-risk
individual and refer them accordingly.

THANK YOU!