Dengue

OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING DHAMTARI (C.G)

1. PRESENTED BY:-
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING

2. INTRODUCTION
Dengue fever is a
painful debilitating
mosquito born
disease causedby
any one of four
closely related
denguevirus

3. DEFINITION
Dengue fever is transmitted by the bite of an
Aedesmosquito infected with a dengue
virus. The mosquito becomes infected when
it bites a person with dengue virus in
theirblood. It can’t be spread directly from
one person to another person.

4. DEFINITION
•Dengue fever is also known as breakbonefever
is a mosquito born tropical disease caused by
the mosquitobite.
•Thealternativenamefordengue,"breakbone
fever",comesfromtheassociatedmuscleand
jointpains.
•It is caused by the female aedes aegypti
mosquito bite, which transmit the dengue virus
tohuman.

5. INCIDENCE
Each year an estimated 100millions
cases of dengue occur worldwide.
•The global incidence of dengue has
grown dramatically in recentdecades.
•In INDIA the cases has increasesharply
over past five years there have been
38,000 so far in2013.

6. Tropical regions are:-
Indian subcontinent
Mexico
Africa
SouthernChina

9. PHASES

10. Febrile Phase x7days
High fever 40 °C (104°F)
headache
generalizedarthalgia
myalgia
petechiae
bleeding from mucusmembrane.
A rash occurs in50–80%

11. Critical Phase x2days
Leukopenia
thrombocytopenia.
Increase capillary permeability
leading to plasma leakage thatlead
to metabolicacidosis.
Inchildrenfebrile phase iscommon
carries nausea, vomiting,
thrombocytopnea.

12. Recovery phase x 2-3days
Stabilize hemodynamicstatus
increase urineoutput
overall clinicalimprovement.
Increase in fluid overload cancause
cerebraledema.

14. SIGN &SYMPTOMS
•Fever ( more than 105)
•Headache
•Muscle, jointpain
•skin rash ( appear 4-5 days after fever)
•Pain behindeyes
•Nausea
•Vomiting
•Mildbleeding

16. WARNINGSIGNS
•Severe abdominalpain
•Persistentvomiting
•Vomit withblood
•Drowsiness orirritability
•Dyspnoea
•Swollen lymphnode
•Prostration
•diarrhea

17. Dengue with warningsigns
•Probable dengue plus oneof:
•Abdominal pain ortenderness
•Persistentvomiting
•Signs of fluid accumulation, e.g. pleural effusionor
•ascites
•Mucosalbleed
•Lethargy
•Hepatomegaly > 2cm
•Rapid increase in haematocrit with fall inplatelet
•count
•Needs medical intervention, e.g. intravenousfluid

18. •Severedengue
•• Severe plasma leakage leadingto:
•Shock (dengue shocksyndrome)
•Fluid accumulation with respiratorydistress
•• Severe haemorrhagic manifestations, e.g.GI
•haemorrhage
•• Severe organinvolvement:
•Liver AST or ALT ≥ 1000U/L
•CNS: impairedconsciousness
•Cardiomyopathy
•Other organs, e.g. renalimpairment
•Needs emergency medical treatment and specialist care with
intensive careinput.

22. DIAGNOSTIC
TEST

23. WHO-proposedclinical
definition ofdengue
PROBABLEDENGUE
•• Exposure in an endemicarea
••Fever
Twoof:
•Nausea/vomiting
•Rash
•Aches/pains
•Positive tourniquettest
•Leucopenia
•Any warningsign
•Laboratory confirmationimportant
•Needs regular medical observationand
instruction inthe
warningsigns
•If there are no warning signs,
need for hospitalisationis
•influenced by age,
comorbidities, pregnancy and
socialfactors

25. LABORATORYFEATURES
•include leucopenia, neutropenia,thrombocytopenia
•elevated alanine aminotransferase (ALT)or
aspartate aminotransferase(AST)
•serology or detection of dengue viral materialin
blood byRT-PCR

26. •Dengue-specific IgG and IgM ELISA { positive forIgM
antibodies on or after day 5 of thefever}
IgM ELISA has a sensitivity of 83.9–98.4%and
a specificity of100%
Dengue 2 virus enhancement in asthmatic
and non asthmatic individual.Guzman MG,
Kouri G, Soler M, Bravo J, Rodríguez de
La Vega A, Vazquez S, MuneM

27. •Extravasation of fluid due to vascular leakage can be
detected radiologically (chest radiography for pleural
effusions, echocardiography for pericardial effusions,
ultrasonography forascites).
[Dengue haemorrhagic fever in children:
ten years of clinical experience].Méndez A,
GonzálezG
Biomedica. 2003 Jun;23(2):180-93.

30. MANAGEMENT
•Bleeding prevention &control.
•Fluid & waterreplacement.
•Symptoms relief & fevercontrol.

40. NURSINGMANAGEMENT
•Increased body temperature related to infection as evidence
by vital signmonitoring.
•Hypovolemic shock related tohemorrhage.
•Fluid volume deficit related to migration of intravascular fluid
into extravascularfluid.
•Impaired nutrition less than body requirement related to
decreasedappetite.

42. PROGNOSIS
•For the majority of peoples the people infected with
dengue virus fever the prognosis isexcellent.
•Although they are likely to feel very ill during first 1-2
week of acuteillness.
•Overall the fatality rate is about 1% for all denge
fever infection.

43. COMPLICATION
•A small percentage of individual who have dengue fever candevelop
a more serious form ofdisease.
•Dengue haemorrhagic fever and disseminatedintravascular
•coagulation
•Dengue shocksyndrome
•Hepatitis, cerebral haemorrhage or oedema,encephalitis,
•cranial nerve palsies, rhabdomyolysis,myocarditis
•Vertical transmission if infection within 5 wks ofdelivery