“Dengue Fever: A Comprehensive Study on Pathophysiology, Transmission, Management, and Nursing Care”

Dengue Fever is an acute viral infection caused by the Dengue Virus (DENV), a member of the Flaviviridae family, transmitted to humans through the bite of an infected female Aedes aegypti mosquito. Commonly known as “Breakbone Fever,” it produces severe muscle and joint pain, high fever, and characteristic skin rash.

The disease has four distinct serotypes (DENV-1 to DENV-4), and infection with one serotype provides lifelong immunity only against that type, allowing multiple infections over a lifetime. After an incubation period of 4–10 days, patients may experience a sudden onset of fever, headache, retro-orbital pain, nausea, vomiting, and body ache. In severe cases, plasma leakage, bleeding, and organ failure can occur, leading to Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS).

Diagnosis is confirmed through NS1 antigen, IgM/IgG antibodies, CBC, and PCR testing. There is no specific antiviral therapy, and management remains supportive, focusing on fluid replacement, temperature control with paracetamol, and close monitoring for warning signs. Aspirin and NSAIDs are avoided due to the risk of bleeding.

Prevention depends on mosquito control measures, public awareness, and personal protection through repellents, covering water containers, and wearing protective clothing. The Dengvaxia® vaccine may be used in previously infected individuals to reduce disease severity.

From a nursing perspective, care involves continuous monitoring of vital signs, hydration status, and bleeding tendencies, alongside patient and family education regarding early symptom recognition and mosquito prevention. With timely and effective management, most patients recover fully within two weeks, and the mortality rate remains below 1%.

1. DENGUE FEVER
Edward Daniel
Worldwide Nursing Community
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Waziristan


Definition
Dengue fever is an acute viral infection caused by the Dengue virus (DENV), which is
transmitted to humans through the bite of infected female, mainly Aedes aegypti and It is
also called “Breakbone fever” because it causes severe muscle and joint pain.

Causative Agent
 Virus: Dengue Virus (DENV)
 Family: Flaviviridae
 Genus: Flavivirus
 Types (Serotypes):
There are 4 serotypes of the dengue virus:
1. DENV-1
2. DENV-2
3. DENV-3
4. DENV-4
Infection with one type gives lifelong immunity
to that type, but not to others so a person can get
dengue multiple times.
Mode of Transmission
 Vector: Female Aedes mosquito (especially Aedes aegypti).
 Biting time: Early morning and late afternoon (daytime biter).
 Transmission cycle:
1. Mosquito bites a person infected with dengue.
2. Virus multiplies inside mosquito (8–12 days).
3. When the mosquito bites another healthy person → virus enters bloodstream →
causes infection.
Incubation Period

4 to 10 days after the mosquito bite (before symptoms appear).

2. Pathophysiology (Mechanism of Disease)
1. Virus entry: Enters the blood through mosquito bite.
2. Infection of cells: Virus infects white blood cells and multiplies.
3. Immune response: Body releases chemical mediators (cytokines).
4. Increased capillary permeability: Fluid leaks from blood vessels →
causes plasma leakage, low blood pressure, and shock.
5. Low platelet count: Virus affects bone marrow → decreases
platelet production → risk of bleeding.
6. Organ involvement: Severe cases can affect liver,
brain, heart, and kidneys.\
Classification (WHO)
A. Dengue without warning signs
 Fever with two of these: nausea, rash, body pain, low
WBC count, positive tourniquet test.
B. Dengue with warning signs
 Abdominal pain, persistent vomiting, fluid accumulation,
mucosal bleeding, lethargy, enlarged liver, increase in hematocrit.
C. Severe dengue (Dengue hemorrhagic fever / Dengue shock syndrome)
 Severe plasma leakage, shock, severe bleeding, or severe organ involvement.
Signs and Symptoms
Stage Symptoms
Early (2–7 days)
Sudden high fever (up to 104°F or 40°C), severe headache, pain behind
eyes, joint & muscle pain (“breakbone pain”), nausea, vomiting, skin rash
Critical Phase
Drop in fever, but condition worsens; bleeding gums, nosebleeds, blood in
vomit or stool, abdominal pain, restlessness, cold clammy skin
Recovery Phase
Improvement after fluid replacement, appetite returns, rash may reappear,
slow recovery over 1–2 weeks

Complications
 Dengue Hemorrhagic Fever (DHF)
 Dengue Shock Syndrome (DSS)
 Severe bleeding
 Organ failure (liver, kidneys, brain)
 Seizures (in children)
 Death (in untreated severe cases)


3. Diagnosis
 History & Physical Exam
 Laboratory Tests:
o CBC: Low platelets (<100,000/mm³), low WBC, high hematocrit
o NS1 antigen test: Detects virus early (day 1–5)
o IgM & IgG antibody tests: Detect immune response
o PCR (Polymerase Chain Reaction): Detects viral RNA (most specific)
Treatment
There is no specific antiviral treatment for dengue.
Treatment is supportive and symptomatic:
A. Mild Dengue:
 Rest
 Plenty of fluids (ORS, water, soup, juice)
 Paracetamol for fever (avoid aspirin or ibuprofen)
 Monitor for warning signs
B. Severe Dengue:
 Hospitalization required
 IV fluid therapy (to prevent shock)
 Blood transfusion (if severe bleeding)
 Oxygen therapy if needed
 Monitoring vital signs and urine output
Prevention
There is no complete cure, so prevention is key:
A. Mosquito Control
 Remove standing water (old tires, flower pots, containers)
 Use insect repellents and mosquito nets
 Cover water tanks
 Spray insecticides in and around homes
B. Personal Protection
 Wear long-sleeved clothes
 Use window screens
 Use mosquito repellents (DEET-based)

4. C. Community Measures
 Fumigation in dengue-affected areas
 Public awareness campaigns
 Report suspected cases to health authorities
D. Vaccination
 Dengvaxia® (CYD-TDV):
o Available in some countries
o Recommended only for individuals previously infected with dengue (not for
first-time infection)
Nursing Management
A. Assessment:
 Monitor temperature, pulse, blood pressure
 Observe for bleeding (gums, stool, urine)
 Monitor platelet count and hematocrit
 Assess hydration status (urine output, skin turgor)
B. Nursing Diagnoses:
1. Risk for deficient fluid volume related to plasma leakage
2. Hyperthermia related to infection
3. Risk for bleeding related to low platelet count
4. Anxiety related to disease process and hospitalization
C. Nursing Interventions:
 Encourage oral fluids; if not possible, IV fluids
 Monitor vital signs frequently
 Avoid IM injections
 Provide cool sponging for fever
 Educate patient/family about mosquito prevention
 Report warning signs immediately
D. Evaluation:
 Fever reduced
 Platelet count improved
 No bleeding
 Patient understands preventive measures
Prognosis
 Mild cases: Full recovery within 2 weeks.
 Severe cases: Can be life-threatening if not treated early.
 With proper care, fatality rate <1%.

5. Summary Table
FEATURE DESCRIPTION
CAUSATIVE AGENT Dengue virus (Flavivirus, DENV 1–4)
VECTOR Female Aedes aegypti mosquito
INCUBATION 4–10 days
SYMPTOMS Fever, headache, muscle pain, rash, low platelets
COMPLICATIONS DHF, DSS, bleeding, organ failure
TREATMENT Supportive (fluids, paracetamol)
PREVENTION Mosquito control, personal protection, vaccination
DIAGNOSIS NS1 antigen, IgM/IgG, CBC, PCR
NURSING CARE Hydration, monitoring bleeding, patient education on





Prepared by:
EDWARD DANIEL
Worldwide Nursing Community