DENGUE FEVER
• An acute febrile mosquito-borne tropical disease caused by the
dengue virus.
• Vector: female Aedes Aegypti.
EPIDEMIOLOGY:
Case of dengue in the Philippines as of 2012: 80,742. (DOH)
Pathophysiology:
Classification:
Course of illness:
Classification:
History/PE
o Take note the date of onset of fever/illness.
o Warning signs
o Mental status
o Tourniquet test
Laboratory:
o CBC
o UA
o AST, ALT
o Chest x ray
o If with bleeding: PT, APTT.
Management:
Dengue Fever without Danger Signs
General measures:
-Bed Rest
-Suficient fluid intake
-Paracetamol as needed
o Patient with stable hematocrit can be sent home, advise for
return to hospital of with development of warning sign.
o Monitor regularly for signs of progressing disease, improving WBC
count, deverference, warning signs until out of critical phase
Dengue Fever with Danger Signs
Adequate hydration:
o Encourage OFI if tolerated
o If not, start IVF
o Initial 5-7 ml/kg/hr for 1-2 hours
o Reduce to 3-5 ml/kh/hr for 2-4 hrs
o Reduce further to 2-3 ml/kg/hr or less based on clinical
response.
If HCT remains the same or rises minimally, continue with 2-3
Course of illness: ml/kg/hr for another 2-4 hours
LLOYD F. ALIAS
#Matatag 2016
If worsening of vitals and rapidly rising Hct, increase rate to 5-10
ml/kg/hr, for 1-2 hrs
Reduce IVF gradually until adequate UO and/or fluid intake or Hct
decreases below baseline.
DIFFRENTIAL DIAGNOSIS
Monitoring:
• Malaria - Malaria is caused by a parasite that is passed from one
o Baseline Hct then every 6-12 hrs human to another by the bite of infected Anopheles mosquitoes.
o Serum glucose and other tests for organ function
Points to support Points to against
Severe Dengue
Endemic in the Remittent fever
o Initial resuscitation: crystalloids at 5-10 ml.kg.hr for 1 hour Region No Chills
o If with improvement: May reduce IVF to 5-7 ml/kg/hr for 1-2 Fever No seizures
Headaches
hours, 3-5 ml/kg/hr for 2-4 hrs and then reduced further
Nausea and vomiting
depending on hemodynamic status. IVF maintained over 24 to 48
Body weakness
hours.
o If unstable: Recheck Hct after initial IV bolus
o If Hct still high(>50 %), give a second bolus of crystalloid solution
or 10-20 ml/kg/hr for 1 hour (if with improvement, reduce rate to • Typhoid Fever - also known as enteric fever, is a potentially fatal
7-10 ml/kg/hr) multisystemic illness caused primarily by Salmonella enterica.
o If Hct decreases, may indicate bleeding and need to crossmatch
and tranfuse blood. Points to support Points to against
Management of Hypotensive Shock: Fever (-) Rose spots
Headache Remittent fever
o Resuscutation with crystalloid or colloid at 20 ml/kg bolus for 15 Malaise (-) Diarrhea
minutes Abdominal pain and (-)
o If(+) improvement, give IVF: 10 ml/kg/hr for 1 hours then reduce tenderness Hematochezia
gradually Thrombocytopenia
o If still unstable: check Hct, assess need for further fluid
resuscitationn.
• Letospirosis - Leptospirosis is a disease caused by bacteria
PROGNOSIS:
(Leptospira interrogans) that produce a wide range of symptoms
• Death has occurred in 40–50% of patients with shock, but with
adequate intensive care deaths should occur in <1% of cases Points to support Points to against
CRITERIA FOR DISCHARGING INPATIENTS • Fever
• Head ached
• Absence of fever for at least 3 days without use of antipyretics or • Body weakness
Cryotherapy • Loss of appetite
• Return of appetite • Abdominal pain
• Visible clinical improvement • Vomiting
• Good urine output •
• Stable hematocrit •
• No respiratory distress from pleural effusion or ascites
• Platelet count of more than 100,000 per mm3
PREVENTION
DOH program: 4S
o Search and destroy
o Seek early consultation
o Self protection
o Say no to indiscriminate fogging
IMMUNIZATION
LLOYD F. ALIAS
#Matatag 2016
