dengue fever

UNIT I

INTRODUCTION

1.1  Background

Dengue, the most common arboviral illness transmitted worldwide, is caused by infection with 1 of the 4 serotypes of dengue virus, family Flaviviridae, genus Flavivirus (single-stranded nonsegmented RNA viruses). Dengue is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical areas of the world, and is classified as a major global health threat by the World Health Organization (WHO) (Wikipedia, 2010).

Initial dengue infection may be asymptomatic (50%-90%),may result in a nonspecific febrile illness, or may produce the symptom complex of classic dengue fever (DF). A small percentage of persons who have previously been infected by one dengue serotype develop bleeding and endothelial leak upon infection with another dengue serotype. This syndrome is termed dengue hemorrhagic fever (DHF), although dengue vasculopathy has been proposed as a better term, as fluid loss into tissue spaces can lead to prolonged shock and complications, including gastrointestinal bleeding, a greater fatality risk than bleeding per se. Some patients with dengue hemorrhagic fever develop shock (dengue shock syndrome [DSS]), which may cause death (Moore, 2010).

Dengue virus transmission follows two general patterns—epidemic dengue and hyperendemic dengue. Epidemic dengue transmission occurs when dengue virus is introduced into a region as an isolated event that involves a single viral strain. If the number of vectors and susceptible pediatric and adult hosts is sufficient, explosive transmission can occur, with an infection incidence of 25%-50%. Mosquito-control efforts, changes in weather, and herd immunity contribute to the control of these epidemics. Transmission appears to begin in urban centers and then spreads to the rest of a country. This is the current pattern of transmission in parts of Africa and South America, areas of Asia where the virus has reemerged, and small island nations. Travelers to these areas are at increased risk of acquiring dengue during these periods of epidemic transmission (WHO, 2010).

Hyperendemic dengue transmission is characterized by the continuous circulation of multiple viral serotypes in an area where a large pool of susceptible hosts and a competent vector (with or without seasonal variation) are constantly present. This is the predominant pattern of global transmission. In these populations, antibody prevalence increases with age and most adults are immune. Hyperendemic transmission appears to be a major risk for dengue hemorrhagic fever. Travelers to these areas are more likely to be infected than are travelers to areas that experience only epidemic transmission (Moore, 2010).

Currently, dengue hemorrhagic fever is one of the leading causes of hospitalization and death in children in many Southeast Asian countries, with Indonesia reporting the majority of dengue hemorrhagic fever cases. Of interest and significance in prevention and control, 3 surveillance studies in Asia report an increasing age among infected patients and increasing mortality rate. Since 2009 in Singapore, more than 50% of deaths have occurred in individuals older than 15 years. In Indonesia, young adults in Jakarta and provincial areas make up a larger percentage of infected patients. During the 2009 epidemic in indonesia up to 82% of hospitalized patients were adults, and all deaths occurred in patients older than 5 years (Moore, 2010).

More than 58,000 new cases of dengue fever, a virus transmitted to humans through bites from infected mosquitoes, were discovered in Indonesia in 2004, while some 2.5 billion people worldwide are estimated to be at risk for the disease (Moore, 2010).

An outbreak of dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) in the city of Palembang, south Sumatra. In the 2 hospitals surveyed, the monthly mean number of outbreak-related dengue cases over 4 months was 833 (range 650-995 cases/month); the mean monthly value for the previous 72 months was 107 (range 14-779 cases/month). An apparent trend in epidemic transmission was observed, evolving from a 5-year cyclic phenomenon to an annual occurrence, often indistinguishable from one year to the next. The proportional distribution of clinical outbreak cases into DF, DHF and DSS diagnostic categories was 24%, 66%, and 10%, respectively. The population aged 10-19 years accounted for the largest (35%) proportion of hospitalized DHF cases, followed by children aged 5-9 years (25%) and children aged 4 years (16%) (Potter, 2005).

In the Hospital Medical Staff must Professional in patient suffer hemoragic dengue fever disease such as, medication and health promotion. And then The central public health, have function  solve disease hemoragic dengue fever with give information and counseling prevention disease hemoragic dengue fever.

1.2. Theological problem

The based description in text, The writer make a question :

1. What is Disease Hemoragic Dengue Fever ?

2. How the Sign and symptom Disease Hemoragic Dengue Fever ?

3. What the Cause disease Hemoragic Dengue Fever ?

4. What the Problem Disease Hemoragic Dengue Fever ?

5. How The Solution disease Hemoragic dengue fever ?

1.3. Purpose

Purpose is the student can be understand this making of the task.

1.4. Method

Method that use with take a references from the library and searching internet.

UNIT II

DISCUSSION

2.1 Definition

Dengue fever (pronounced UK: /ˈdɛŋɡeɪ/, US: /ˈdɛŋɡiː/) and dengue hemorrhagic fever (DHF) are acute febrile diseases which occur in the tropics, can be life-threatening, and are caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. It is also known as breakbone fever. It occurs widely in the tropics, including northern Argentina, northern Australia, Indonesia. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur (Wikipedia, 2010).

 Dengue is transmitted to humans by the Aedes aegypti or more rarely the Aedes albopictus mosquito, both of which feed exclusively during daylight hours. The WHO says some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. The disease is now endemic in more than 100 countries  (Wikipedia, 2010).

2.2 Signs and symptoms

The disease manifests as fever of sudden onset associated with headache, muscle and joint pains (myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or bonecrusher disease), and rash. The classic dengue rash is a generalised macular-papular rash with islands of sparing. A hemorrhagic rash of characteristically bright red pinpoint spots, known as petechiae can occur later during the illness and is associated with thrombocytopenia. It usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting, or diarrhea. Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash is present. Thus travelers from tropical areas may pass on dengue inadvertently, having not been properly diagnosed at the height of their illness. Patients with dengue can pass on the infection only via Aedes mosquitoes or much more unusually, blood products and only while they are still febrile. The classic dengue fever lasts about two to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called "biphasic pattern"). Clinically, the platelet count will drop until after the patient's temperature is normal. Cases of DHF also show higher fever, variable hemorrhagic phenomena, thrombocytopenia, and hemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate (Moore, 2010).

2.3 Cause

Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunity to a different dengue virus type plays an important role in this severe disease (Anonym, 2008).

More than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections hemoragic dengue fever catches people indonesia, because low immunity system until risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or male indonesia (Anonym, 2008).

2.4 Problem

The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a rash with thrombocytopenia and relative leukopenia - low platelet and white blood cell count. Dengue infection can affect many organs and thus may present unusually as liver dysfunction, renal impairment, meningo-encephalitis or gastroenteritis.

1. Fever, headaches, eye pain, severe dizziness and loss of appetite.
2. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
3. Thrombocytopenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in hematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinemia)
5. Encephalitic occurrences.

Dengue shock syndrome is defined as dengue hemorrhagic fever plus:

• Weak rapid pulse,
• Narrow pulse pressure (less than 20 mm Hg)
• Cold, clammy skin and restlessness (Wikipedia, 2010).

Dependable, immediate diagnosis of dengue can be performed in rural areas by the use of Rapid Diagnostic Test kits, which also differentiate between primary and secondary dengue infections. Serology and polymerase chain reaction (PCR) studies are available to confirm the diagnosis of dengue if clinically indicated. Dengue can be a life threating fever (Wikipedia, 2010).

2.5 Solution 

Intervention nursing care  is necessary teratment also in patients with dengue fever, dengue hemorrhagic fever, or dengue shock syndrome.

NURSING CARE

• Dengue fever is usually a self-limited illness, and only supportive care is required. Acetaminophen may be used to medication   patients with symptomatic fever. Such as : Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and Corticosteroids should be avoided. And nurse give medicine  every three time days and then giving injection IC boluse 2X1/ days.
• Nurse must known with patient about suspected dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after defervescence. Patients with a rising hematocrit level or falling platelet count should have intravascular volume deficits replaced. Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for continued hydration.
• Nurse must known condition and monitoring the patient  about develop checking vital signs of dengue hemorrhagic fever warrant closer observation. Patients who develop signs of dehydration, such as tachycardia, prolonged capillary refill time, cool or mottled skin, diminished pulse amplitude, altered mental status, decreased urine output, rise in hematocrit levels, narrowed pulse pressure, or hypotension, require admission for intravenous fluid administration.
• Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. If this fails to correct the deficit, the hematocrit value should be determined, and, if it is rising, limited clinical information suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One recent study has suggested that starch may be preferable because of hypersensitivity reactions to dextran.If the patient does not improve after this, blood loss should be considered. Patients with internal or gastrointestinal bleeding may require transfusion. Patients with coagulopathy may require fresh frozen plasma.
• After patients with dehydration are stabilized, nurse usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.
• Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. A recent case report demonstrated good improvement following intravenous anti-D globulin administration in two patients. The authors proposed that, similarly to nondengue forms of immune thrombocytopenic purpura, intravenous anti-D produces Fcγ receptor blockade to raise platelet counts.
• And then nurse known the patient are resuscitated from shock rapidly recover. Patients with dengue hemorrhagic fever or dengue shock syndrome may be discharged from the hospital when they meet the following criteria:
• Afebrile for 24 hours without antipyretics
• Good appetite, clinically improved condition
• Adequate urine output
• Stable hematocrit level
• At least 48 hours since recovery from shock
• Absence of respiratory distress
• Platelet count greater than 50,000 cells/μL (Potter, 2005).

MEDICAL CARE 

Intervention medical care  is necessary teratment  in patients with dengue fever, dengue hemorrhagic fever, or dengue shock syndrome usually used by the doctor.

Consultations

ü      Consultation with an infectious diseases specialist may be helpful in guiding decisions regarding diagnosis and treatment.

ü       Consultation with a critical care medicine specialist may be helpful when treating patients with dengue hemorrhagic fever or dengue shock syndrome and severe hemorrhagic manifestations or shock.

Diet

ü       No specific diet is necessary for patients with dengue fever.

ü       Patients may become dehydrated from fever, lack of oral intake, or vomiting. Patients who are able to tolerate oral fluids should be encouraged to drink oral rehydration solution, fruit juice, or water to prevent dehydration.

ü      Return of appetite after dengue hemorrhagic fever or dengue shock syndrome is a sign of recovery.

Activity

Bedrest is recommended for patients with symptomatic dengue fever, dengue hemorrhagic fever, or dengue shock syndrome.

Medication

Intervention medical care give treatment of dengue shock syndrome (dengue shock syndrome) in a prospective, randomized, double-blind, placebo-controlled trial. Acetaminophen (paracetamol) is recommended for treatment of pain and fever. Aspirin, other salicylates, and NSAIDs should be avoided.

ü      Analgesics/antipyretics

The treatment of dengue fever is symptomatic and supportive in nature. Bedrest and mild analgesic-antipyretic therapy are often helpful in relieving lethargy, malaise, and fever associated with the disease.

ü      Acetaminophen (Tylenol, Feverall)

Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating. Used in dengue infections to relieve pain and lower temperature when fever is thought to contribute to patient discomfort (Potter, 2005).

Volume expanders

Plasma volume expanders are used in the treatment of intravascular volume deficits or shock to restore intravascular volume, blood pressure, and tissue perfusion the patient hemoragic dengue fever (Potter, 2005).

ü      Dextran 40 (Macrodex, LMD)

Polymer of glucose. When infused, it increases intravascular volume, blood pressure, and capillary perfusion. Used to restore intravascular volume when isotonic crystalloid use fails.

ü      Albumin (Albuminar-5, Buminate)

Human albumin is a sterile solution of albumin (major plasma protein responsible for colloid oncotic pressure of blood). Pooled from blood, serum, plasma, or placenta from healthy donors. Infusion of albumin results in a shift of fluid from extracellular space into circulation, thereby decreasing hemoconcentration and blood viscosity.May be administered wide open when treating shock. Patient response must be assessed before repeating dose.

ü      Starch (hetastarch, 6% hydroxyethyl starch)

Hydroxyethyl starch is a sterile solution of starch responsible for colloid oncotic pressure of blood. Infusion of albumin results in a shift of fluid from extracellular space into circulation, thereby decreasing hemoconcentration and blood viscosity (Potter, 2005).

UNIT III

CONCLUSION

Dengue is transmitted to humans by the Aedes aegypti or more rarely the Aedes albopictus mosquito, both of which feed exclusively during daylight hours. The WHO says some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. The disease is now endemic in more than 100 countries .

Most infections hemoragic dengue fever catches people indonesia, because low immunity system until risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or male indonesia.

The disease manifests as fever of sudden onset associated with headache, muscle and joint pains (myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or bonecrusher disease), and rash. The classic dengue rash is a generalised macular-papular rash with islands of sparing. A hemorrhagic rash of characteristically bright red pinpoint spots, known as petechiae can occur later during the illness and is associated with thrombocytopenia.

Medical care and Nursing care are used in the Medication, and Health Promotion for in solving Hemoragic Dengue Fever Disease.

REFERENCE

Wikipedia. 2010. Event Hemoragic Dengue Fever.  http://en.wikipedia.org/wiki/Dengue_fever, up date 20 juny 2010

Anonym. 2008.Hemoragic dengue fever http://www.nlm.nih.gov/medlineplus/ency/article/001373.htm,up date 20 juny 2010

Moore. 2010. disease hemoragic fever.http://www.jevuska.com/topic/makalah+dhf.html, up date 20 juny

Potter, Patricia. 2005. Fundamental Of Nursing 6 th Edition. United States Of America : Elsevier Mosby