Dengue

Dengue fever is an acute febrile disease caused by infection with one of the
serotypes of dengue virus. It is a mosquito-borndisease caused by genus Aedes.

Other Names
Breakbone Fever
Hemorrhagic Fever
Dandy Fever
Infectious Thrombocytopenic Purpura.

Mode of Transmission
Dengue virus is primarily transmitted by Aedes mosquitoes,
particularly A. aegypti. These mosquitoes usually live between the latitudes of
35 North and 35 South below an elevation of 1,000 metres (3,300 ft). They
typically bite during the early morning and in the evening,but they may bite and
thus spread infection at any time of day. Other Aedes species that transmit the
disease include A. albopictus, A. polynesiensis and A. scutellaris. Humans are the
primary host of the virus, but it also circulates in nonhuman primates. An
infection can be acquired via a single bite. A female mosquito that takes a blood
meal from a person infected with dengue fever, during the initial 2- to 10-day
febrile period, becomes itself infected with the virus in the cells lining its
gut. About 810 days later, the virus spreads to other tissues including the
mosquito's salivary glands and is subsequently released into its saliva. The virus
seems to have no detrimental effect on the mosquito, which remains infected for
life. Aedes aegypti is particularly involved, as it prefers to lay its eggs in artificial
water containers, to live in close proximity to humans, and to feed on people
rather than other vertebrates.
Dengue can also be transmitted via infected blood products and through organ
donation. In countries such as Singapore, where dengue is endemic, the risk is
estimated to be between 1.6 and 6 per 10,000 transfusions. Vertical
transmission (from mother to child) during pregnancy or at birth has been
reported. Other person-to-person modes of transmission have also been reported,
but are very unusual. The genetic variation in dengue viruses is
region specific, suggestive that establishment into new territories is relatively
infrequent, despite dengue emerging in new regions in recent decades

Signs & Symptoms

Sudden, high fever

Severe headaches
Pain behind the eyes

Severe joint and muscle pain

Fatigue

Nausea
 Vomiting
Skin rash, which appears two to five days after the onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Pathognomonic Sign
Herman's Sign

Diagnostic Test & Procedures

Laboratory criteria for the diagnosis of dengue include 1 or more of the
following:
Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy samples

Demonstration of a fourfold or greater change in reciprocal immunoglobulin G

(IgG) or IgM antibody titers to 1 or more dengue virus antigens in paired serum
samples
Demonstration of dengue virus antigen in autopsy tissue via

immunohistochemistry or immunofluorescence or in serum samples via enzyme

immunoassay (EIA)
Detection of viral genomic sequences in autopsy tissue, serum, or cerebral spinal
fluid (CSF) samples via polymerase chain reaction (PCR) assay
The following laboratory tests should also be performed in the workup of
patients with possible dengue:
Complete blood count (CBC)
Metabolic panel

Serum protein and albumin levels

Liver panel

Disseminated intravascular coagulation (DIC) panel

Characteristic findings in dengue fever are as follows:

Thrombocytopenia (platelet count < 100 x 109/L)

Leukopenia
Mild to moderate elevation of aspartate aminotransferase and alanine
aminotransferase values
In patients with dengue hemorrhagic fever, the following may be present:
Increased hematocrit level secondary to plasma extravasation and/or third-space

fluid loss
Hypoproteinemia

Prolonged prothrombin time

Prolonged activated partial thromboplastin time

Decreased fibrinogen
Increased amount of fibrin split products

Guaiac testing for occult blood in the stool should be performed on all patients in
whom dengue virus infection is suspected. Urinalysis identifies hematuria.
Imaging studies
Chest radiography
Head computed tomography (CT) scanning without contrast: To detect

intracranial bleeding or cerebral edema from dengue hemorrhagic fever

Ultrasonography: To detect fluid in the chest and abdominal cavities, pericardial

effusion, and a thickened gallbladder wall, in dengue hemorrhagic fever

 Medical Management
The management of DHF is actually simple as long as it is detected early.

Oral rehydration therapy. Oral rehydration therapy is recommended for patients

with moderate dehydration caused by high fever and vomiting.
IV fluids. IVF administration is indicated for patients with dehydration.

Blood transfusion and blood products. Patients with internal or

gastrointestinal bleeding may require transfusion, and patients with
coagulopathy may require fresh frozen plasma.
Oral fluids. Increase in oral fluids is also helpful.

Avoid aspirins. Aspirin can thin the blood. Warn patients to avoid aspirins and
other NSAIDs as they increase the risk for hemorrhage.

Nursing Assessment

Assessment of a patient with DHF should include:

Evaluation of the patients heart rate, temperature, and blood pressure.

Evaluation of capillary refill, skin color and pulse pressure.
Assessment of evidence of bleeding in the skin and other sites.

Assessment of increased capillary permeability.

Measurement and assessment of the urine output.

Nursing Interventions

Nursing interventions appropriate for a patient with DHF include:

Blood pressure monitoring. Measure blood pressure as indicated.

Monitoring pain. Note client report of pain in specific areas, whether pain is
increasing, diffused, or localized.
Vascular access. Maintain patency of vascular access for fluid administration or
blood replacement as indicated.
Medication regimen. There must be a periodic review of the medication regimen
of the client to identify medications that might exacerbate bleeding problems.
Fluid replacement. Establish 24-hour fluid replacement needs.
Managing nose bleeds. Elevate position of the patient and apply ice bag to the

bridge of the nose and to the forehead.

Trendelenburg position. Place the patient in Trendelenburgposition to restore

blood volume to the head.

 Prevention:
Early detection and treatment
Sleep under mosquito nets
Use insecticides
Change water of vases and containers