Clara Amosco

Jonathan Antonio
Bryan Bajet
Kenneth Carbonell
Post Graduate Interns- DFCM
27/F
Single
Roman catholic
Seen for the first time at the
OPD last Sept.9, 2018.
FEVER
 Fever (Tmax 38.5 C)

5 days PTC Headache

No vomiting No arthralgia
No abdominal No myalgia
pain
No Bleeding (+) Good
Episodes Appetite
3 days PTC Still with above signs
and symptoms
 Persistence of above signs
and symptoms

1 day PTC Body malaise

Decrease appetite
On day of
Persistence of fever CVMC
consult
 Integumentary: No pruritus, no rashes
 CNS: No chills/tremors , no seizure episodes
 HEENT: no retro orbital pain, no blurring of vision, no
swollen glands, no epistaxis; no gum bleeding, no sore throat
 Cardiorespiratory: no shortness of Breath, no Cough and
colds, no Night Sweats, no Difficulty of breathing, no
chest pain, no palpitations
 GIT: no hematochezia no melena, no diarrhea, no flank
pain, no hypogastric pain, no suprapubic pain
 GUT: no dysuria , no frequent urination, no urinary urgency,
no oliguria, no hematuria, no tea-colored urine
 July 2018- UTI (resolved)
 No previous accidents nor operations.
 No allergies to foods and drugs.
 No history of hospitalizations
 (-) HPN (-) Bronchial Asthma
 (-) DM (-) Thyroid disease
 (-) PTB Exposure
 (-) Hx of wadding, trekking, or recent traveling
 (-) hx of blood Transfusions
 (+) Measles,mumps, chickenpox (childhood)
• Non- smoker
• Occasional alcoholic beverage drinker
• High school undergraduate
• Works at a sari-sari store
• (+) neighborhood history of dengue
• (-) history of multiple partners and IV-drug use
• LMP: Sept.5, 2018
 No heredofamilial diseases reported on both
maternal and paternal side.
 (-) HPN (-) DM
 (-) Asthma (-) cardiac dse
 (-) thyroid dse (-) PTb
 (-) Cancer
 General survey: conscious and coherent,
ambulatory and not in
cardiorespiratory distress
 Vital signs:
Temperature: 36.5 °C (axillary RA)
Heart rate: 96 bpm
Respiratory rate: 20 cpm
BP: 110/80 mmHg
 Anthropometric Measurements:
Height: 150cm
Weight: 45 kg
BMI: 20 kg/m2
• Skin: No pallor, no jaundice,
warm to touch; with
good skin turgor, no lesions
• HEENT: Anicteric sclerae; pink
palpebral conjunctiva, no naso-
aural discharges,no sinus
tenderness,no tonsillopharyngeal
congestion,no lymphadenopathy, no
neck rigidity.
•
• Chest and Lungs: Symmetric chest expansion; no
retractions; clear breath sounds
• Heart: Adynamic precordium, PMI at
5th ICS left midclavicular line;
normal rate, regular rhythm,
no murmur.
• Abdomen: Flat, normoactive bowel
sounds; soft abdomen; no
palpable masses, No
Costovertebral angle tenderness,
no suprapubic tenderness
• Extremities: no edema;Capillary refill
time 2 seconds; full and
equal pulses, torniquet
test negative, no calf
tenderness

• Neurologic No neurologic deficits

Salient Features:
27 year old, Female
Intermittent fever
Headache
Body malaise
With Hx.Dengue Cases in the area(high
index of suspicion)
 Infectious Non-Infectious

Influenza
Probable Dengue Drug reactions
Chikungunya Acute Appendicitis
HIV Seroconversion illness Acute Cholecystitis
Measles Malignancy
Meningo/Encephalitis Urinary Tract Infection
Febrile Seizures
Diarrheal diseases
Leptospirosis
Infectious

Probable Dengue
Chikungunya
RULE IN RULE OUT
Intermittent Fever Bleeding dyscrasias
Headache Arthralgias
Myalgias
 RULE IN
Intermittent Fever
Headache

(+) high index of suspicion in the area

Probable Dengue
 For Complete blood count

 Hgb:126g/L
 Hct:0.362%
 PC:159
 Wbc:2.76 (leukopenia)
 N: 58.7
 L:29.2
 M: 11.7
 E: 0.0
 B: 0.4
 Dengue without warning signs
  Increase Oral fluid intake ( 8-10 glasses/day or approx. 2L
per day
 For Repeat serial CBC monitoring tomorrow (8am)
 Give Paracetamol 500mg/tab q4 for fever >/= 37.8’C
 Isopunosine cap, 1 cap BID x 3 days
 Adequate Bed Rest
 Tepid sponge if still with high fever
 For Repeat serial CBC monitoring tomorrow (8am)
 Instruct patient to come back anytime at nearest
hospital/emergency department if any of the following
symptoms occur: severe abdominal pain, persistent
vomiting, bleeding (e.g. black(e.g. black stools, red spots or
patches on the skin, bleeding from nose and gums, vaginal
bleeding), not passing urine for more than 4–6 hours.
  Day 7 of illness, Day 1 afebrile
 No Subjective complaints

 Hgb:119g/L
 Hct:0.345%
 PC:121
 Wbc:2.67 (decrease)
 N: 70.4
 L:21.2
 M: 7.9
 E: 0.2
 B: 0.3
 Plan: Repeat CBC tomorrow AM
  Day 6 of illness, Day 2 afebrile
 No Subjective complaints

 (+) Petechial rashes at both upper extremeties

 Hgb:134g/L
 Hct:0.385%
 PC:72
 Wbc:4.79 (slight increase)
 N: 24.9
 L:56.9
 M: 14.7
 E: 0.1
 B: 3.4
 Plan: Repeat CBC at 4pm today
  Day 7 of illness, Day 3 afebrile (seen at Medicine ER)
 No Subjective complaints

 (+) Petechial rashes at both upper extremeties

 Hgb:122g/L
 Hct:0.354%
 PC:58
 Wbc:7.47 (increasing)
 N: 22.9
 L:64.4
 M: 13.4
 E: 0.6 Plan: Continue Paracetamol
500mg/tab q4 for fever
 B: 0.7
Add: Omeprazole 40mg/cap ODBB
Repeat CBC tomorrow
Dengue
•is a mosquito-borne infection
•major international public health
concern.
•tropical and sub-tropical regions,
urban and semi-urban areas.
 Dengue virus (DEN) is a small single-
stranded RNA virus comprising four
distinct serotypes
 (DEN-1 to -4). These closely related
serotypes of the dengue virus belong to
the genus Flavivirus, family Flaviviridae.
 The various serotypes of the
dengue virus are transmitted to
humans through the bites
 of infected Aedes mosquitoes,
principally Ae. aegypti
After an incubation period of 4--10 days, infection by any
of the four virus serotypes can produce a wide spectrum
of illness, although most infections are asymptomatic or
subclinical.

The dengue virus enters via the skin while an infected

mosquito is taking a bloodmeal.
Dengue infection is a systemic and dynamic disease. It has
a wide clinical spectrum that includes severe and
non-severe forms of clinical manifestations. After the
incubation period, the illness begins abruptly and will be
followed by 3 phases: febrile, critical and recovery phase.

CLINICAL COURSE OF DENGUE

INFECTION
 1. Febrile Phase

CLINICAL COURSE OF DENGUE

INFECTION
 2.Critical phase

CLINICAL COURSE OF DENGUE

INFECTION
 Warning Signs

CLINICAL COURSE OF DENGUE

INFECTION
 3.Recovery Phase

CLINICAL COURSE OF DENGUE

INFECTION
 ALL of the following conditions must be
present
 1. No fever for 48 hours
 2. Improvement in clinical status (general
well-being,
 appetite, hemodynamic status, urine
output, no respiratory
 distress)
 3. Increasing trend of platelet count
 4. Stable hematocrit without intravenous
fluids
 Survival is directly related to intense and
early management of the cases..