Dengue Fever

Dengue fever • Is an acute febrile (accompanied by fever) disease. • Caused by a single-stranded RNA flavivirus • Carried by Aedes mosquitoes, usually prevalent in tropical and subtropical reigons. • also known as breakbone fever, because of the severe pain induced in the muscles and joints, although it does not actually break bones. • The geographical spread includes northern Australia, northern Argentina, and the entire Singapore, Malaysia, Taiwan, Thailand, Vietnam, Indonesia, Honduras, Costa Rica, Panama, Philippines, Pakistan, India, Sri Lanka, Bangladesh, Mexico, Suriname, Dominican Republic, Puerto Rico, Jamaica, Bolivia, Brazil, Guyana, Venezuela, Barbados, Trinidad and Samoa. • In Mexico, cases have increased by 600% since 2001 • Researchers in Thailand have developed a live attenuated vaccine which is currently being tested in clinical trials. • In Vietnam, health officials urged local citizens to round up tiny crustaceans and place them in water tanks and wells, the crustaceans which are not harmful to humans, eat the mosquitoes that carry dengue, and it was reported that on the communities where this strategy was used there is complete elimination of the disease. Signs & Symptoms •

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Incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. So it could be a week after the individual was bitten before the signs and symptoms start to manifest. Starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104° F (40° C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen. Fever and other signs of dengue last for two to four days, followed by rapid drop in temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

Dengue Hemorrhagic Fever • • • • • • •

A specific syndrome that tends to affect children under 10. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). Starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis). There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Nursing Interventions: Dengue is a self-limited illness but recovery might take a few weeks. Independent:  Close monitoring of vital signs in critical period (between days 2 to day 7 of fever) is critical.  Increased oral fluid intake is recommended to prevent dehydration.  Treatment is purely concerned with relief of the symptoms (symptomatic). Dependent:  Because dengue is caused by a virus, there is no specific medicine or antibiotic to treat it.  Aspirin and nonsteroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding tendency associated with some of these infections.  Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).  (DHF) Oxygen and sedatives may be administered. Collaborative:  A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there are significant bleeding.  The presence of melena or blood in the stool may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion.