Breakbone fever
Introduction
Dengue fever is an acute viral infection caused
by the dengue virus, which is transmitted to
humans through the bite of infected Aedes
aegypti and Aedes albopictus mosquitoes. It is
one of the most common mosquito-borne viral
diseases, especially in tropical and subtropical
regions of the world.
Introduction
• It is one of the most common mosquito-borne
viral diseases, especially in tropical and
subtropical regions of the world. The disease
is characterized by sudden onset of high fever,
severe headache, pain behind the eyes,
muscle and joint pains (often called
“breakbone fever”), nausea, vomiting, and
skin rash.
Definition
Dengue is an acute mosquito-borne viral infection caused by
the dengue virus (DENV), transmitted mainly by Aedes aegypti
mosquitoes, characterized by sudden high fever, headache,
muscle and joint pain, rash, and in severe cases leading to
dengue hemorrhagic fever or dengue shock syndrome.
.WHO
• Dengue fever, also known as dengue, is a mosquito-borne
viral illness common in tropical and subtropical regions
worldwide. It’s caused by the dengue virus, which is
transmitted through the bite of an infected Aedes mosquito,
particularly Aedes aegypti.. { UNICEF}
Incidence
• The incidence of dengue fever is high in children age 5 to 10
with most cases are non severe children under 5 years old
and infants are at higher is cough developing severe live
threatening dengue.
• According to the national centre for vector born diseases
control, India reported 19447 cases of dengue and 16
deaths until April 30/20/24 experts says that women and
children are experiencing higher rates of dengue compared
to previous years
• According to survey done by wh0 2025 out of a total one
not for cases 90 children ( 85.7%)had non severe dengue
and only 15 (14.3%) had severe dengue with the identified
symptoms of fever vomiting abdominal pain in children
• Dengue is a major global health issue, with an estimated 390
million infections annually (96 million clinically manifest)
and 5.6 billion people at risk
Epidemology
Classification of dengue
• Dengue virus infection
Asymptomatic dengue
• Asymptomatic dengue fever is a dengue virus infection
where a person is infected and can transmit the virus to
mosquitoes but does not develop any symptoms, or
experiences very mild, self-managed symptoms that go
unnoticed or are misattributed to other illnesses. While it
doesn’t show typical signs like fever, headache, or muscle
pain, it is a significant factor in the overall spread of the
disease because these individuals can unknowingly spread
the virus.
Symptomatic dengue
• Symptomatic dengue fever is a mosquito-borne viral
illness that causes flu-like symptoms, including high fever,
headache, pain behind the eyes, muscle and joint pain,
nausea, vomiting, and a rash. While many people with
dengue have mild to moderate symptoms that resolve
within a week or two, a small portion can develop severe
dengue, which requires immediate hospital care and can
include severe abdominal pain, persistent vomiting, and
bleeding.
Simple / undefined fever
Infant children’s and adults have been infected with the
dengue virus, esspitially for the first time may develop a
simple fever in distinguishable from other viral infections.
Dengue fever
Dengue fever is most common in adults adolescence it is
generally and accurate February illness and sometimes by
facing fever with severe headache miles rashes lecopenia
and thrombocytopenia maybe absorbed
Dengue haemorrhagic fever
Dengue haemorrhagic fever (DHF) is a severe complication of
dengue fever, caused by a virus transmitted by mosquitoes,
that can lead to plasma leakage, shock, organ failure, and
potentially death. The course of disease can be divided in to
three phases.
1. Febrile phase :- Dehydration ,high fever ,neurologic disturbances
,febrile seizures.
2. Critical phase :- Shock from plasma leakage ,severe haemorrhage,
organ impairment.
3. Recovery phase :- Hypervolemia ,pulmonary oedema.
Risk factors
1. Living in tropical /subtropical regions
2. Rainfall
3. Standing water sources where Aedes mosquitoes
breeds.
4. Poor environmental sanitation .
5. High density population .
6. Previous dengue infection .
7. Children and elderly with low immunity.
Clinical manifestations
1. Onset of high fever
2. Severe headache
3. Muscle and joint pains
4. Nausea & vomiting
5. Abdominal pain & discomfort
6. Plasma leakage ,petechiae , echymosis
7. Thrombocytopenia &leukopenia
8. Dengue shock syndrome
9. Gastrointestinal bleeding
Diagnostic findings
1. History collection &physical examination
2. Polymerase chain reaction(PCR)
3. (IgG) & (IGM)
4. Complete blood count (CBC)
5. Liver function test (LFT)
Management
• There is no treatment for dengue fever
• Adequate hydration Is crucial,
• Pain relievers such as Acetaminophen should be used To
reduce Symptoms.
• Aspirin and ibuprofen used to Lower the temperature.
• Oral fluids and electrolyte therapy are recommended.
• Cold sponge to maintain the temperature
• IV fluids administration
Nursing management
• Assess the patient condition
• Close monitoring of vital signs , hydration status, and
haematological parameters are essential.
• Assess for signs of dehydration such as decreased urine output
• Dry mucous membranes And poor skin turgor .
• IV fluids may be administered to maintain hydration And to
prevent
Hypovolemic shock .
• Educate the patient and their families about transmission of
disease.
Nursing diagnosis
ACUTE PAIN :-related to headache, retro-orbital pain,
muscle, and joint pain, as evidenced by a patient’s verbal
complaints of pain.
Hyperthermia :- related to the infectious process, as
evidenced by an elevated body temperature and flushed
skin.
Fluid Volume Deficit :- related to vascular leakage, increased
capillary permeability, and poor fluid intake, as evidenced
by dry mucous membranes, decreased urine output, and
weak pulse.
Risk for bleeding :-related to impaired liver function,
potential thrombocytopenia (low platelet count), and
leukopenia (low white blood cell count), which are common
in dengue fever.
Complications
1. Dengue Haemorrhage fever (DHF)
2. Dengue Shock Syndrome(DSS)
3. Acute Respiratory Distress Syndrome
4. Neurological :- Seizures , meningitis
5. Organ failure
Prevention
Prevention of mosquito bites :-
*Using of mosquito repellents
*Use mosquito nets & install screens
* Use coils and vaporizers
Control mosquito Breeding :-
*Eliminate standing water
* Proper disposal of waste and garbage
*Applying insecticides to waste storage
Vaccination
Tetravalent dengue vaccine is a type of dengue vaccine
designed to protect against all four distinct types
(serotypes) of the dengue virus, which are DENV-1, DENV-2,
DENV-3, and DENV-4.
Dose :-3 divided doses administered at 6 months intravels
0.5 ML /one dose
Route :- subcutaneous
Schedule :- Three –doses series given 6 months apart
