Name: Salve, Marc Gleazon C.

Sec: BSN 3C Area: Medical Ward

Dengue Fever

Overview:
Dengue fever is a viral illness caused by the dengue virus, which is transmitted to humans primarily
through the bite of infected mosquitoes, particularly the Aedes aegypti mosquito. This virus belongs to
the Flaviviridae family and is spread in tropical and subtropical regions around the world. Dengue fever
can manifest with a wide range of symptoms, from mild flu-like symptoms to severe and potentially life-
threatening complications. The severity of the disease can vary depending on various factors, including
the individual's immune status and the specific strain of the virus.

Signs and Symptoms:

Symptoms of dengue fever typically appear 4 to 10 days after being bitten by an infected mosquito.
Common signs and symptoms include:
1. High Fever: Dengue fever often begins with a sudden onset of high fever, typically lasting for 2 to 7
days.
2. Severe Headache: Intense headaches, often described as a severe throbbing pain behind the eyes, are
common in dengue fever.
3. Pain Behind the Eyes and Muscle/Joint Pain: Dengue fever can cause severe pain behind the eyes,
muscle aches, and joint pain, often referred to as "breakbone fever."
4. Nausea and Vomiting: Many individuals with dengue fever experience nausea, vomiting, and loss of
appetite.
5. Skin Rash: A rash may develop on the skin, typically starting on the arms and legs and spreading to
the trunk. The rash is often described as maculopapular or petechial.

While most cases of dengue fever are relatively mild and self-limiting, in some individuals, the disease
can progress to a more severe form known as dengue hemorrhagic fever (DHF) or dengue shock
syndrome (DSS). These severe forms of dengue are characterized by symptoms such as severe
abdominal pain, persistent vomiting, rapid breathing, fatigue, restlessness, bleeding from the nose or
gums, difficulty breathing, and signs of circulatory failure.

There is currently no specific antiviral treatment for dengue fever, so management typically involves
supportive care to relieve symptoms and prevent complications. Prevention efforts focus on controlling
mosquito populations and reducing exposure to mosquito bites, such as using insect repellent, wearing
protective clothing, and eliminating mosquito breeding sites.

Warning Signs
Sudden high fever: Dengue fever often begins with a sudden onset of high fever, typically ranging from
102°F to 105°F (39°C to 40.5°C).
Severe headache: Intense headache, especially behind the eyes, is a common symptom of dengue fever.
Pain behind the eyes: Dengue fever can cause severe pain behind the eyes, which may worsen with eye
movements. Joint and muscle pain: Aching muscles, joints, and bones are common with dengue fever.
This symptom is often described as severe joint pain or "breakbone fever."
Fatigue: Feeling unusually tired or fatigued is another common symptom of dengue fever.
Nausea and vomiting: Some individuals with dengue fever may experience nausea, vomiting, or both.
Skin rash: A rash may develop two to five days after the onset of fever. It typically appears on the arms,
legs, and torso and may be accompanied by itching.
Mild bleeding: In some cases, mild bleeding such as nosebleeds, bleeding gums, or easy bruising may
occur. Severe bleeding is rare but can be a sign of dengue hemorrhagic fever, a more severe form of the
disease.
Abdominal pain: Some individuals with dengue fever may experience abdominal pain or tenderness.

Epidemiology:
The disease is now endemic in more than 100 countries in the WHO Regions of Africa, the Americas, the
Eastern Mediterranean, South-East Asia and the Western Pacific. The Americas, South-East Asia and
Western Pacific regions are the most seriously affected, with Asia representing around 70% of the global
disease burden.

Dengue is spreading to new areas including Europe, and explosive outbreaks are occurring. Local
transmission was reported for the first time in France and Croatia in 2010 and imported cases were
detected in 3 other European countries.

The largest number of dengue cases ever reported globally was in 2019. All regions were affected, and
dengue transmission was recorded in Afghanistan for the first time. The American Region reported 3.1
million cases, with more than 25 000 classified as severe. A high number of cases were reported in
Bangladesh (101 000), Malaysia (131 000) Philippines (420 000), Vietnam (320 000) in Asia.

Dengue continues to affect Brazil, Colombia, the Cook Islands, Fiji, India, Kenya, Paraguay, Peru, the
Philippines, the Reunion Islands and Vietnam as of 2021.

1. Local Epidemiology:
- At the local level, the epidemiology of dengue fever varies depending on factors such as climate,
geography, urbanization, and socioeconomic conditions.
- Local surveillance systems monitor dengue fever cases, outbreaks, and trends in transmission
dynamics. Health authorities track the incidence of dengue fever, including severe cases requiring
hospitalization.
- Local factors such as mosquito control measures, access to healthcare, and public health interventions
influence the burden and spread of dengue fever within communities.

2. National Epidemiology:
- Nationally, the WHO collaborates with health ministries and agencies to collect data on dengue fever
prevalence, incidence, and impact.
- National surveillance systems monitor dengue fever outbreaks, track disease trends over time, and
assess the effectiveness of control measures.
- National governments implement strategies for dengue prevention and control, including vector
control programs, public awareness campaigns, and vaccination campaigns where available.
4. Global Epidemiology:
- Globally, the WHO oversees efforts to address dengue fever as a significant public health concern.
- Global surveillance networks monitor dengue fever trends, outbreaks, and emerging challenges.
- The WHO provides guidance on dengue prevention and control strategies, promotes research into
vaccines and therapeutics, and supports capacity-building efforts in affected countries.
- International collaborations, such as the Global Dengue Network, facilitate knowledge exchange,
research collaboration, and coordinated responses to dengue outbreaks and epidemics.

Pathophysiology:
- Viral Transmission: Dengue virus is transmitted to humans through the bite of infected Aedes
mosquitoes.
- Viral Replication: The virus enters the bloodstream and infects immune cells, replicating
rapidly.
- Immune Response: The immune system responds to the virus, triggering inflammation and
cytokine release.
- Endothelial Dysfunction: Dengue virus directly infects endothelial cells, leading to increased
vascular permeability and plasma leakage.
- Thrombocytopenia and Coagulopathy: Dengue fever is associated with low platelet count and
coagulation abnormalities, increasing the risk of bleeding.
- Organ Involvement: Severe cases of dengue fever can lead to multi-organ dysfunction,
including liver, kidney, and cardiovascular complications.

Risk Factors:
- Previous infection with DENV increases the risk of the individual developing severe dengue.
- Urbanization (especially unplanned), is associated with dengue transmission through multiple social
and environmental factors: population density, human mobility, access to reliable water source, water
storage practice etc.
- Community’s risks to dengue also depend on population’s knowledge, attitude and practice towards
dengue, as well as the implementation of routine sustainable vector control activities in the community.
- Consequently, disease risks may change and shift with climate change in tropical and subtropical areas,
and vectors might adapt to new environment and climate.

Nursing Management:
Assessment and Monitoring: Nurses assess symptoms, monitor vital signs, and watch for warning signs
of severe dengue.
Fluid Management: Nurses ensure adequate hydration through oral or intravenous fluids to prevent
dehydration, a common complication.
Pain and Fever Management: Nurses administer appropriate medications to alleviate pain and reduce
fever, avoiding NSAIDs and aspirin due to the risk of bleeding.
Skin Care: Nurses provide soothing skin care to relieve itching associated with the rash and prevent skin
damage.
Nutritional Support: Nurses encourage a balanced diet to maintain adequate nutrition, especially for
patients with reduced appetite.
Patient Education: Nurses educate patients and families about dengue fever symptoms, preventive
measures, and when to seek medical help.
Psychosocial Support: Nurses offer emotional support and reassurance to patients experiencing anxiety
or stress due to their illness.
Collaboration: Nurses work closely with other healthcare professionals to coordinate care, monitor
response to treatment, and ensure patient safety.

Medical Management:
Fluid Management: Maintaining hydration is essential, particularly in cases of dengue fever with plasma
leakage and dehydration. Oral rehydration solutions or intravenous fluids may be administered to
replace fluids and electrolytes lost due to fever, vomiting, and diarrhea. Monitoring of fluid balance and
vital signs is crucial to prevent complications such as hypovolemic shock.
Fever Control: Analgesics such as acetaminophen (paracetamol) are commonly used to alleviate fever
and reduce discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be
avoided, as they may increase the risk of bleeding.
Pain Management: Dengue fever can cause severe muscle and joint pain (dengue myalgia and
arthralgia). Analgesics such as acetaminophen can help relieve pain and discomfort.
Monitoring and Observation: Close monitoring of clinical signs and symptoms is essential, especially for
patients with severe dengue or warning signs of complications. Regular assessments of vital signs, fluid
status, hematocrit, platelet count, and urine output are necessary to detect any deterioration in the
patient's condition.
Blood Transfusion: In cases of severe dengue with significant bleeding or hematocrit elevation, blood
transfusion may be required to replace lost blood components such as red blood cells and platelets.
However, transfusion should be used judiciously and guided by clinical indications.
Treatment of Complications: Patients with severe dengue (dengue hemorrhagic fever or dengue shock
syndrome) may require intensive care management, including respiratory support, vasopressor therapy,
and blood component transfusions. Prompt recognition and treatment of complications are essential to
improve patient outcomes.
Avoidance of NSAIDs and Aspirin: NSAIDs and aspirin should be avoided in patients with dengue fever,
as they can increase the risk of bleeding and other complications. Acetaminophen is the preferred
antipyretic and analgesic medication for dengue fever.
Follow-Up Care: Patients recovering from dengue fever should be monitored closely during the
convalescent phase to ensure resolution of symptoms and complications. Follow-up assessments may
include laboratory testing to evaluate hematologic parameters and organ function.