Case Study on Dengue

8/3/2019 Case Study on Dengue

1/19

Our Lady of Fatima University

College of NursingRegalado, Quezon City

A Case Study on

Dengue Fever

In Partial Fulfillmentof the Requirements in

Nursing Care Management 102ARelated Learning Experience

Presented by:

BSN 2Y2-4Group 21

Gianchand, Olivia P.

Manuel, Janine M.

Second Semester

S.Y 2011-2012


2/19

I.Introduction

Dengue Fever is an infectious disease carried by mosquitoes and caused by any of the

four closely related, but antigenically distinct, virus serotypes; Dengue type 1, Dengue type 2,

Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. This disease

used to be called break-bone fever because it sometimes causes severe joint and muscle pain

that feels like bones are breaking, hence the name, there may also be gastritis associated to

abdominal pain, nausea, vomiting, or diarrhea. Infection with one of this serotype provides

immunity to only that serotype of life, to a person living in a Dengue-endemic area can have

more than one Dengue infection during their lifetime. Dengue fever through the four different

Dengue serotypes are maintained in the cycle which involves humans and Aedes aegypti or

Aedes albopictus mosquito through the transmission of the viruses to humans by the bite of an

infected mosquito. Dengue cannot be transmitted or directly spread from person to person. It can

be transmitted by Aedes Aegypti mosquito to humans usually attacking during the day and

shortly after the rainy season in tropical and subtropical areas of Africa, Southeast Asia and

China, India, Middle East, Caribbean and Central and South America, Australia and the South

and Central Pacific. After virus incubation for eight to 10 days, an infected mosquito is capable,

during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female

mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs)

transmission, but the role of this in sustaining transmission of the virus to humans has not yet

been defined.

The incidence of dengue has grown dramatically around the world in recent decades.

Some 2.5 billion people, two fifths of the world's population, are now at risk from dengue. WHO

currently estimates there may be 50 million dengue infections worldwide every year. There is no

specific treatment for dengue fever. Health experts have known about dengue fever for more

than 200 years.


3/19

II. Objectives

General:

This study aims to identify and determine the general health problems and needs of the

patient with an admitting diagnosis of Dengue Fever. It also intends to help patient promote

health and medical understanding of such condition through the application of the nursing skills.

Specific:

1.) To raise the level of awareness of patient on health problems that she may encounter.

2.) To facilitate patient in taking necessary actions to solve and prevent the identified

problems on her own.

3.) To help patient in motivating her to continue the health care provided by the health

workers.

4.) To render nursing care and information to patient through the application of the

nursing skills.


4/19

III. Patients Profile

A. Biographical Data

1. Name: Ms. C.T.2. Address: Barangay 309,Sampaloc, Manila3. Age: 104. Birthdate: June 19,20015. Sex: Female6. Race: Filipino7. Marital status: Single8. Occupation: N/A9. Religion: Catholic10.Health Care financing and usual source of Medical Care:

Supported by the patients parents

A. Working Diagnosis

Dengue Fever Syndrome

B. Chief Complaint and Reason for Visit:

Fever

C. Past Medical History:

Our patient was never admitted to the hospital. Until she was diagnosed with dengue

fever syndrome. Before Ms. C.T. was diagnosed to have dengue, she had fever and was given

Paracetamol by her mother at home.

D. Family History of Illness:

The patient has a family history of hypertension. According to her, both of her parents

have hypertension.


5/19

E. History of Present Illness:

Four days prior to admission, the patient had on and off fever. She would usually have

fever in the afternoon. As a remedy, the patients mother gave Paracetamol to reduce her body

temperature. Aside from fever, Ms. C.T. also experienced abdominal pain, headache, general

flushing of the skin and vomiting.

As the signs and symptoms persisted, her mother decided to bring her to the hospital.

After the physical assessment and diagnostic tests, Ms. C.T. was diagnosed to have Dengue

Fever Syndrome by the attending physician.

IV. Physical Assessment

Assessment Normal Findings Actual Findings Interpretation

Body Build,Height & Weight

ProportionateVaries With

Lifestyle

Proportionate VariesWith Lifestyle

Proportionate body thereis no evidence of physical

problems

Posture And Gait Stands normally Stands normally Relaxed, erect posture;

coordinated movement

Body And Breath

Odor

No Body Or Breath

Odor

No Body Or Breath

Odor

Proper hygiene

maintenance

Signs Of Distress No Distress Noted distress noted Because of lack of sleep,

distress noted

Attitude Cooperative Cooperative Thinks normally, proper to

the situation

Affect Or Mood Appropriate To The

Situation

Appropriate To The

Situation

She acts and think

normally appropriate tothe situation

Quantity, QualityAnd Organization

Of Speech

Understandable,Moderate Pace,

ThoughtAssociation

Understandable,Moderate Pace,

Thought Association

Can speak normally, withnormal voice tone

Relevance And

AssociationThought Exhibits

Logical Sequence

Make Sense, HasSense Of Reality

Logical Sequence

Make Sense, Has SenseOf Reality

Talking with sense means

she thinking normally


6/19

Skin

Assessment Normal Findings Actual Findings Interpretation

Uniformity Of

Skin Color

Uniformity Except

In Areas ExposeTo The Sun

Uniformity Except In

Areas Expose To TheSun

Uniformity of skin,

except areas expose tolight and some areas of

lighter

pigmentation(conjunctiv

as, palms, lips, nail beds)

Edema No Presence Of

Edema

No Presence Of Edema No water retention

Skin Lesion Freckles, somebirthmarks, some

flat and raised nevi;no abraisions or

other lesions

No reckles, somebirthmarks, some flat

and raised nevi; noabraisions or other

lesions

No lesion noted in thebody

Skin Moisture Moisture In Skin

Folds & Axillae

Moisture In Skin Folds

& Axillae

Some body parts that

having sebaceous glandsare moisture

Skin

Temperature

Uniform, Within

Normal Range

Uniform, slightly

above normal range

Low grade fever

Skin Turgor Skin Springs Back

To Previous StateWhen Pinched

Skin Springs Back To

Previous State WhenPinched, except the

part with edema

Skin stays pinched or

tented or moves backslowly

Skull and Face

Assessment Normal Findings Actual findings Interpretation

Head Rounded And

Symmetrical,Smooth Skull

Contour, NoNodules

Rounded And

Symmetrical, SmoothSkull Contour, No

Nodules

Normal, no signs of any

deformities and signs ofskull contour and nodules

Face Light to deep

brown, smoothand symmetric

facial movement

Pinkish, smooth and

symmetric facialmovement

Fever causes flushing of

the skin


7/19

Eyes and Vision

Eyebrows Evenly Distributed,

Symmetrical, SkinIntact

Evenly Distributed,

Symmetrical, SkinIntact

Properly distributed, equal

Eyelids Skin Intact, NoDischarges, No

Discoloration,Symmetrical

Skin Intact, NoDischarges, No

Discoloration,Symmetrical

Can blink normally

Eyelashes EquallyDistributed,

Slightly CurvedOutward

Equally Distributed,Slightly Curved

Outward

Turned outward, equallydistributed, muscle

normally contract

Conjunctiva Shiny, Smooth

,Sometimes

Appear Red OrPink

Pale conjunctiva Pale, possible anemia

Lacrimal Gland No Edema Or

Tearing

No Edema Or Tearing Normal no evidence of

any swelling or tenderness

Cornea Transparent, Shiny,

Smooth, BlinksWhen Cornea Is

Touched

Transparent, Shiny,

Smooth, Blinks WhenCornea Is Touched

Corneal sensitivity test

active, trigeminal nerve isintact, cornea clarity and

texture normal.

Pupils Black Color,

smooth border,PERRLA

Black Color, smooth

border, PERRLA

Pupils are equal, constrict

to light dilate in the dark

Eyes(VisualAcuity)

Can see withoutusing eyeglasses

Cant see withouteyeglasses

Nearsightedness, can seeonly when objects are near

Ears and Hearing

Auricles Color Is Uniform,Symmetric, Mobile,

Firm pinna RecoilsWhen Folded

Color Is Uniform,Symmetric, Mobile,

Firm pinna RecoilsWhen Folded

Color same as facial skin,auricle aligned with outer

canthus of the eye.

Response ToNormal Voice

Tone

Normal VoiceTone Audible

Cannot hear NormalVoice Tone

Abnormal cannot hearNormal voice, normal

voice tones


8/19

Nose and Sinuses

Nares Symmetric,

Straight, NoDischarges, Non

Swelling, UniformColor, Not Tender

Symmetric, Straight,

No Discharges, NonSwelling, Uniform

Color, Not Tender

No presence of lesions,air

moves freely as the clientbreaths

Lining Of Nose Nasal Septum InMidline

Nasal Septum InMidline

Normal and in midline

Mouth

Lips And Buccal

Mucosa

Pink, Soft,

Symmetrical,moist

Pink, Soft,

Symmetrical,dry

Due to fever which

causes dehydration

Teeth And Gums Complete Complete No tooth decay,smooth

shiny tooth enamel,nodentures

Tongue In Midline, Freely

Movable, Pink

In Midline, Freely

Movable, Pink

In Central

position,moist,slightlyrough ;thin whitish

coating,normal,can movefreely

Palates And Uvula,Tonsils

Light Pink, NoDischarges, Present

Gag Reflex

Light Pink, NoDischarges, Present

Gag Reflex

No discoloration, palatesare lighter pink hard

palate

Neck and Musculoskeletal System

Shape And

Symmetry

Symmetrical Symmetrical Positioned in midline

Spinal Deformities Vertically Aligned Vertically Aligned Normal, no deformities

Inspect NeckMuscles

Symmetrical WithHead Centered

Symmetrical With HeadCentered

No swelling or masses,coordinated, smooth

movements with nodiscomfort

Observe Head

Movement

Coordinated,

Smooth, MovementWith No

Discomfort, Equal

Strength

Coordinated, Smooth,

Movement With NoDiscomfort, Equal

Strength

No discomfort, can hyper

extends, laterally flexesand rotates

Muscle Size Is

Symmetrical, NoContracture,

Normally Firm

Size Is Symmetrical, No

Contracture, NormallyFirm

Equal strength,

symmetrical, normal


9/19

Bones No Deformities,

No Swelling OrTenderness

No Deformities,

No Swelling OrTenderness

Normal, can move freely,

no swelling, deformities ortenderness

Joints No Swelling, No

Tenderness

No Swelling, No

Tenderness

Normal, no signs of

swelling in area, no

tendernessRange Of Motion Varies To Some

Degrees

Limited range of

motion in one or morejoints

Can stand and walk, but

limited range of motionsdue to muscular pain

brought by the condition

V. Activities of Daily Living

Functional Health

Pattern

Before her present

condition

During her present

condition

Interpretation

Health Perceptionand Health

Management

Perceives herself as a stronghealthy child.

Reports to mother when she

feels sick

Visits the health center forcheck-up when sick.

Thinks that she isweak and not healthy

Complies with

medications

The patient hadchanged her

perception abouther health because

of the signs andsymptoms

brought by thedisease

Nutritional and

Metabolic

Eats 3 times daily. The

usual food intake would becomposed of meatvegetables

Drinks 5 glasses of water

per day and drinks juice inschool

Same amount of food

is taken. Avoidseating dark coloredfood

Drinks 8 glasses ofwater. Juice is

eliminated in her diet

Dark colored food

was avoided toeasily detectblood in stool

Fluid intake was

increased due toreplace fluid loss.

Juice and other

acidic food wereeliminated toavoid irritation to

gastric mucosa


10/19

Elimination Moves bowel once a day

without difficulty

Soft firm stoolVoids fair amount of urine

without difficulty in normalfrequency

Clear, yellow urine

Same bowel

movement frequency

Same urineelimination frequency

Same amount and

quality of feces andurine

The condition did

not affect herelimination

pattern

Activity Exercise Her usual routine was to go

to school in the morning andwatch television after doing

her homework. Also helpsin household chores

Doesnt go to school

anymore. Cant do anyhousehold chores.

Spends time by talkingto her mother and

playing games in hermothers cellphone

Her usual activity

was affectedbecause she feels

weak due to hercondition.

Sleep-Rest Has 8 hours of sleepeveryday

Deep, uninterrupted sleep

Gets enough energy from

sleepDoesnt need any sleep aids

Has maximum of 7hours of interrupted

sleep

Takes nap in theafternoon to

compensate lostsleeping hours

Inadequate sleepdue to noisy

environment andinterrupted sleep

due to complianceto the medication

Cognitive-Perceptual

Normal hearing acuity anddoes not use hearing aid

Uses eyeglasses

Able to comprehend easily

Normal hearing acuityand does not usehearing aid

Uses eyeglasses

Able to comprehendeasily

The patientscondition has noeffect on

cognition andperception

Self-Perception and

Self-Concept

Pattern

Perceives herself as a good

daughter and student. She

shows interest in music.

Feels that she may get

lower grades in school

because of being

absent. She is

concerned of not being

able to attend her choir

rehearsals.

Being confined in

the hospital made

her unable to go

to school and do

rehearsals


11/19

VI. Development Tasks

Industry vs.Inferiority

At the age of ten, the significant task of the patient is being aware of themselves as

individuals. People at this age work hard at being responsible, being good and doing things right.

Ms. C.T. is starting to recognize her special talents and continue to discover interests as her

education improves. During the assessment, she had verbalized that she is worried of getting

low grades since she cant listen to class discussion anymore. She also mentioned that there is a

choir competition that she should have attended if she were not in the hospital. It is obvious that

the patient is able to perform her task as a school age child. This will surely help her in building

self-confidence which is important to possess as she grows older.

VII. Laboratory/Diagnostic Findings

CBC and Platelet Count

Norms Result Analysis

Hemoglobin 115-155 116 normal

Hematocrit 0.40-0.48 0.41 normal

WBC Count 5.0-10.0 12.8 Due to infection

Lymphocytes 0.2-0.4 0.08 Due to viral infection

Segmenters 0.6-0.7 0.63 normal

Platelets 150-450 110 Due to infection

Torniquet test

10 petichiae per square inch

Interpretation: Positive for Dengue fever syndrome


12/19

VIII. Anatomy and Physiology

BLOOD

Blood is a specialized bodily fluid that delivers necessary substances to the body's cells

such as nutrients and oxygen and transports waste products away from those same cells. It is

composed of blood cells suspended in a liquid called blood plasma. Plasma, which comprises

55% of blood fluid, is mostly water (90% by volume), and contains dissolved proteins, glucose,

mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product

transportation), platelets and blood cells themselves. The blood cells present in blood are mainly

red blood cells (also called RBCs or erythrocytes) and white blood cells, including leukocytes

and platelets. The most abundant cells in vertebrate blood are red blood cells. These contain

hemoglobin, an iron-containing protein, which facilitates transportation of oxygen by reversibly

binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon

dioxide is almost entirely transported extracellularly dissolved in plasma as bicarbonate ion.

Blood is bright-red when its hemoglobin is oxygenated. It is circulated around the body through

blood vessels by the pumping action of the heart.

Blood performs many important functions within the body including: supply of oxygen to

tissues (bound to hemoglobin, which is carried in red cells), supply of nutrients such as glucose,

amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins, removal of

waste such as carbon dioxide, urea, and lactic acid, immunological functions, including

circulation of white blood cells, and detection of foreign material by antibodies, coagulation,

which is one part of the body's self-repair mechanism, messenger functions, including the

transport of hormones and the signaling of tissue damage, regulation of body pH (the normal pH

of blood is in the range of 7.35 - 7.45) (covering only 0.1 pH unit), regulation of core body

temperature

Blood accounts for 7% of the human body weight, with an average density of

approximately 1060 kg/m3, very close to pure water's density of 1000 kg/m3. The average adult

has a blood volume of roughly 5 liters, composed of plasma and several kinds of cells

(occasionally called corpuscles); these formed elements of the blood are erythrocytes (red blood

cells), leukocytes (white blood cells), and thrombocytes (platelets). By volume, the red blood


13/19

cells constitute about 45% of whole blood, the plasma constitutes about 54.3%, and white cells

constitute 0.7%. Whole blood (plasma and cells) exhibits non-Newtonian fluid dynamics; its

flow properties are adapted to flow effectively through tiny capillary blood vessels with less

resistance than plasma by itself. In addition, if all human hemoglobin were free in the plasma

rather than being contained in RBCs, the circulatory fluid would be too viscous for the

cardiovascular system to function effectively.

PLATELETS

Platelets, or thrombocytes, are small, irregularly-shaped anuclear cells, 2-4 m in

diameter, which are derived from fragmentation of precursor megakaryocytes. The average

lifespan of a platelet is between 8 and 12 days. Platelets play a fundamental role in hemostasis

and are a natural source of growth factors. They circulate in the blood of mammals and are

involved in hemostasis, leading to the formation of blood clots. If the number of platelets is too

low, excessive bleeding can occur. However, if the number of platelets is too high, blood clots

can form (thrombosis), which may obstruct blood vessels and result in a stroke and/or a heart

attack. An abnormality or disease of the platelets is called a thrombocytopathy, which could be

either a low number of platelets (thrombocytopenia), a decrease in function (thrombasthenia), or

an increase in the number of (thrombocytosis). There are disorders that reduce the number of

platelets, such as heparin-induced thrombocytopenia (HIT) or thrombotic thrombocytopenic

purpura (TTP) that typically causes thromboses, or clots, instead of bleeding.

A thrombus or blood clot is the final product of blood coagulation, through the

aggregation of platelets and the activation of the humoral coagulation system. Thrombus is

physiologic in cases of injury, but pathologic in case of thrombosis. Some of the conditions in

which blood clots develop include atrial fibrillation (a form of cardiac arrhythmia), heart valve

replacement, a recent heart attack, extended periods of inactivity (see deep venous thrombosis),

and genetic or disease related deficiencies in the blood's clot. Platelet - High and low counts. A

normal platelet count in a healthy person is between 150 and 400 (x 109/L of blood). Both

thrombocytopenia (or thrombopenia) and thrombocytosis may present with coagulation problems


14/19

IX. Pathophysiology

Bite of aedes aegypti mosquito carrying a virus

Virus is deposited in the skin then into the circulation

Infects cells and generate cellular response

Initiates destruction of the platelet

Increased potential for hemorrhage

Stimulates intense inflammatory response

Release of exogenous pyrogens body releases anti inflammatory

mediators (histatin,kinins)

WBC (Neutrophils & Macrophages)

Vascular response

Release of endogenous pyrogens

Redness and heat

Reset of hypothalamic thermostat

Headache, , Epistaxis, Vomiting

Fever Abdominal pain, Circulatory collapse

Muscle contract to Blood vessels constrict

produce more heat to prevent loss of body heat Shock

SHIVERING CHILLS DEATH


15/19

X. Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATI

Subjective:

"Limang araw ngnilalagnat anganak ko," as

verbalized byclient's mother.

Objective:

Flushed skin

Warm to touch

Restlesness

Vital Signs:

Temp: 38.0 C

RR: 38 bpm

Hyperthermia

related to Infectionas evidenced by

increased body

temperature of 38.0

C

Short Term Goal:

After 1 hour of

nursing

intervention, client

will maintain

normal core

temperature of

36.5-37.5.

Independent

y Promote surface cooling bymeans of tepid sponge bath.

y Administer replacementfluids and electrolytes.

y Maintain bed rest.

y Remove excess clothing orblankets.

y Provide air condition/fan ifappropriate.

Dependent

y Administer antipyretics perphysician's order.

y To decreaby meansevaporati

conductio

y To suppovolume aperfusion

y To reducedemands consumpt

y To facilit


16/19

XI. Drug Study

DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SI

EFF

Acetaminophen

Paracetamol

Brand Name:

Tylenol

Analgesic, muscle

relaxant, uricosurics

Decreases

fever byinhibiting the

effects ofpyrogens on

thehypothalamic

heat regulatingcenters and by

a hypothalamicaction leading

to sweating

andvasodilation.Relieves painby inhibiting

prostaglandinsynthesis at the

CNS but doesnot haves anti-

inflammatoryaction because

of its minimal

effect ofperipheralprostaglandin

synthesis.

Relief of mild

to moderatepain, treatment

of fever.

Hypersensitivity:

Intolerance to tartrazine,alcohol, table sugar,

saccharin.

Stimula

drowsinnausea,

vomitinabdomin

hepatoxhepatic

renal faileucope

neutrophemolyt

anemia,

thromboa, pancyrash, urthyperse

cyanosianemia,

jaundicepancyto

CNS stidelirium

followe

vascularcollapseconvuls

coma an


17/19

XII. Discharge Planning

MEDICATION

y Give acetaminophen in case the temperatures increases.y Give oresol to replace fluid in the body.

EXERCISE

y Perform activities of daily living(ADLs) as toleratedy Enough rest

TREATMENT y Increased oral fluid intake.

HEALTH TEACHING

y D - discuss the possible source of infection of the disease.y

E - educate the family/patient on how to eliminate those vectors.

y N - never stocked water in a container without cover.y G - gallon, container and tires must have proper way of disposal.y U - use insecticides at home to kill or reduce mosquito.y E - encourage the family of the patient to clean the surroundings to

destroy the breeding places of mosquito

OPD FOLLOW-UP

yObserve carefully for symptoms

y Give instruction about what symptoms to watch for so she canalert clinician if additional symptoms occur between visits

y Follow-up check upsDIET y Encourage nutritious foods like vegetables, meat and fruits.


18/19

How does Dengue affect the Body?

Dengue infection is caused by 1 of 4 related, but antigenically distinct, viral serotypes:

dengue virus 1 (DENV-1), dengue virus 2 (DENV-2), dengue virus 3 (DENV-3), and dengue

virus 4 (DENV-4). Albert Sabin speciated these in 1944. Each serotype is known to have severaldifferent genotypes. Dengue viruses are small, spherical, single-stranded enveloped RNA viruses

of the family Flaviviridae, genus Flavivirus.

Infection with one dengue serotype confers lifelong homotypic immunity and a very brief

period of partial heterotypic immunity, but each individual can eventually be infected by all 4

serotypes. Several serotypes can be in circulation during an epidemic.

Dengue viruses are transmitted by the bite of an infected Aedes mosquito. Globally, a

aegypti is the predominant highly efficient mosquito vector for dengue infection, but Aalbopictus and other Aedes species can also transmit dengue with varying degrees of efficiency.

Aedes mosquito species have adapted well to human habitation, often breeding around

dwellings in small amounts of stagnant water found in old tires or other small containers

discarded by humans. Female Aedes mosquitoes are daytime feeders. They inflict an innocuous

bite and are easily disturbed during a blood meal, causing them to move on to finish a meal on

another individual, making them efficient vectors. Entire families who develop infection within a

24- to 36-hour period, presumably from the bites of a single infected vector, is not unusual.

Humans serve as the primary reservoir for dengue; however, certain nonhuman primates

in Africa and Asia also serve as hosts. Mosquitoes acquire the virus when they feed on a carrier

of the virus. The mosquito can transmit dengue if it immediately bites another host. In addition,

transmission occurs after 8-12 days of viral replication in the mosquitos salivary glands

(extrinsic incubation period). The mosquito remains infected for the remainder of its 15- to 65-

day lifespan. Vertical transmission of dengue virus in mosquitoes has been documented. The

eggs of Aedes mosquitoes withstand long periods of desiccation, reportedly as long as 1 year, but

are killed by temperatures of less than 10C.

Once inoculated into a human host, dengue has an incubation period of 3-14 days

(average 4-7 d). Following incubation, a 5- to 7-day acute febrile illness ensues. Recovery is

usually complete by 7-10 days. DHF or DSS usually develops around the third to seventh day of

illness, approximately at the time of defervescence. The major pathophysiological abnormalities

that occur in DHF and DSS are plasma leakage and bleeding. Plasma leakage is caused by

increased capillary permeability and may be manifested by hemoconcentration, as well as pleural


19/19

effusion and ascites. Bleeding is caused by capillary fragility and thrombocytopenia and may

present various ways, ranging from petechial skin hemorrhages to life-threatening

gastrointestinal bleeding.

Most patients who develop DHF or DSS have had prior infection with one or moredengue serotypes. In individuals with low levels of neutralizing antibodies, nonneutralizing

antibodies to one dengue serotype, when bound by macrophage and monocyte Fc receptors, have

been proposed to result in increased viral entry and replication, and increased cytokine

production and complement activation. This phenomenon is called antibody-dependent

enhancement. In addition, certain dengue strains, particularly those of DEN-2, have been

proposed to be more virulent, in part because more epidemics of DHF have been associated with

DEN-2 than with the other serotypes.

Classification of Dengue Hemorrhagic Fever

Grade I

There is fever accompanied by non-specific constitutional symptoms and the only

hemorrhagic manifestation is positive tourniquet test

Grade II

All signs of Grade I plus bleeding from the nose, gums, GIT are present.

Grade III

There is presence of circulatory failure as manifested by weak pulse, narrow pulse

pressure, hypotension, cold clammy skin and restlessness

Grade IV

There is profound shock, undetectable blood pressure, and pulse.

Documents

Case Study on Dengue