1. DENGUE
HEMORRHAGIC FEVER
By:
Dave Jay Sibi. Manriquez BSN, RN
DR Muhammad TUSEEF JAVED

2. What is Dengue
Hemorrhagic Fever?
DR Muhammad TUSEEF JAVED
IPH LAHORE
DR Muhammad TUSEEF JAVED

3. IINTRODUCTION:
Philippine Hemorrhagic Fever was first reported in 1953. In
1958, hemorrhagic became a notifiable disease in the
country and was later reclassified as Dengue Hemorrhagic
Fever.
What is Dengue
Hemorrhagic Fever?
• A severe mosquito transmitted viral illness endemic
in the tropics.
• It is characterized by increased vascular
permeability, hypovolemia and abnormal blood
DR Muhammad TUSEEF JAVED
clotting mechanisms.

4. WHO case definition for DHF:
• fever or history of recent fever
• thrombocytopenia (platelet count equal to or less than 100 x 10 /
cu mm)
• hemorrhagic manifestations such as petechiae or overt bleeding
phenomena, and
• evidence of plasma leakage due to increase vascular permeability
Infectious Agent / Etiologic Agent:
Flaviviruses; Dengue Virus Types 1, 2, 3, and 4
DR Muhammad TUSEEF JAVED

5. Occurrence:
Dengue occurrence is sporadic throughout the year.
Epidemic usually occurs during the rainy seasons June
– November.
Peak months are September and October.
DHF are observed most exclusively among children of
the indigenous population under 15 years of age.
Occurrence is greatest in the areas of high Aedis
Aegypti prevalence.
DR Muhammad TUSEEF JAVED

6. Notifiable Diseases and Deaths by Cause in
the Philippines (2001 – 2004)
2001 2002 2003 2004
Notifiable
Diseases Reported Reported Reported Reported
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
Dengue
Fever 23,235 13,187 18,039 15,838
Source: National Statistics Office
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7. INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN
CEBU CITY (YEAR 2007)
Selected Number of New Cases Number of Deaths Year
Communicable
Disease: total male female total male female
Dengue / DHF 43, 350 … … 416 … … 2007
Source: Department of Health Region VII
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8. Reservoir / Source of Infection:
• Some source is a vector mosquito, the Aedes
Aegypti or the common household mosquito
• The infected person
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9. Mode of Transmission: Mosquito bite (Aedis Aegypti)
Incubation Period: Probably 6 days to one week
Period of Presumed to be on the 1st week
of illness – when virus is still
Communicability:
present in the blood
Susceptibility and All persons are susceptible. Both
sexes are equally affected. The age
resistance: groups predominantly affected are
the preschool age and school age.
Adults and infants are not
exempted. Peak age affected 5-9
years. Susceptibility is universal.
DR Muhammad TUSEEF JAVED immunity may be
Acquired
temporary but usually permanent.

10. Diagnostic Test:
1.) Tourniquet Test (Rumpel Leads Tests)
• Inflate the blood pressure cuff on the upper arm to
a point midway between the systolic and diastolic
pressure for 5 minutes
• Release cuff and make an imaginary 2.5 cm
square or 1 inch just below the cuff, at the
antecubital fossa
• Count the number of petechiae inside the box
• A test is (+) when 2 or more petechiae per 2.5 cm
square or 1 inch square are observed
2.) A con firmed diagnosis is established by
culture of the virus, polymerase-chain-reaction
(PCR) tests, or serologic assays.
DR Muhammad TUSEEF JAVED

11. Clinical Manifestations (Public Health Nursing in
the Philippines, 2007):
An acute febrile infection of sudden onset with 3 stages:
• 1st-4th day (febrile or invasive stage)
-high fever, abdominal pain and headache; later flushing which
may be accompanied by vomiting, conjunctiva infection and
epistaxis.
• 4th-7th day (toxic or hemorrhagic stage)
-lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the form of
hematemesis or melena. Unstable blood pressure, narrow pulse
pressure and shock. Death may occur. Tourniquet test which may be
positive may become negative dueTUSEEFlow or vasomotor collapse.
DR Muhammad
to JAVED

12. • 7th-10th day (convalescent or recovery
stage)
-generalized flushing with intervening areas of
blanching, appetite regained and blood
pressure already stable.
• Dengue shock syndrome is defined as dengue
hemorrhagic fever plus:
*Weak rapid pulse,
*Narrow pulse pressure (less than 20 mm Hg) or,
*Cold, clammy skin and restlessness
DR Muhammad TUSEEF JAVED

13. Grading of Dengue Fever:
The severity of DHF is categorized into four grades:
• grade I, without overt bleeding but positive for tourniquet test
• grade II, with clinical bleeding diathesis such as petechiae, epistaxis and
hematemesis
• grade III, circulatory failure manifested by a rapid and weak pulse with
narrowing pulse pressure (20 mmHg) or hypotension, with the presence of
cold clammy skin and restlessness; and
• Grade IV, profound shock in which pulse and blood pressure are not
detectable. It is note-worthy that patients who are in threatened shock or
shock stage, also known as dengue shock syndrome, usually remain
conscious.
DR Muhammad TUSEEF JAVED
* Grade III and IV are considered to be Dengue Shock Syndrome

14. MANAGEMENT
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15.  Promote rest
 Medication
 Paracetamol – for
fever and muscle
pains.
 Analgesic – for
headache
 DON’T GIVE ASPIRIN
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16.  Rapid replacement of body
fluids is the most important
treatment
 Give ORESOL to replace
fluid as in moderate
dehydration at 75ml/kg in
4-6 hours or up to 2-3L in
adults. Continue ORS
intake until paient’s
condition improves.
 Intravenous fluid
DR Muhammad TUSEEF JAVED

17.  For hemorrhage
 Keep patient at rest during
bleeding periods
 For epistaxis – maintain an
elevated position of trunk
and promote
vasoconstriction in nasal
mucosa membrane through
an ice bag over the
forehead.
 For melena – ice bag over
the abdomen.
DR Muhammad TUSEEF JAVED

18.  Provide support during the
transfusion therapy
 Diet
 Low fat, low fiber, non-
irritating, non-carbonated
 Noodle soup may be given
 Observe signs of
deterioration (shock) such as
low pulse, cold clammy
perspiration, prostration.
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19. PREVENTION
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20. • Eliminate vector by:
– Changing water and scrubbing
sides of lower vases once a
week
– Destroy breeding places of
mosquito by cleaning
surroundings
– Proper disposal of rubber
tires, empty bottles and cans
– Keep water containers covered
DR Muhammad TUSEEF JAVED

21. OTHER PRECAUTIONS:
• When outdoors in an area where
dengue fever has been found
– Use a mosquito repellant
– Dress in protective clothing-
long-sleeved shirts, long
pants, socks, and shoes
DR Muhammad TUSEEF JAVED

22. • Keeping unscreened windows and
doors closed
• Keeping window and door screens
repaired
• Use of mosquito nets
DR Muhammad TUSEEF JAVED

23. DR Muhammad TUSEEF JAVED