DENGUE HEMORRHAGIC FEVER

is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti) DHF was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand. By 1970 nine countries had experienced epidemic DHF and now, the number has increased more than fourfold and continues to rise. Today emerging DHF cases are causing increased dengue epidemics in the Americas, and in Asia, where all four dengue viruses are endemic, DHF has become a leading cause of hospitalization and death among children in several countries. Causative Agent o The causative agent of Dengue Fever (also known as the Devil's Crunch or Breakbone Fever) is the Dengue Fever Virus (DENV) a member of the Flaviviridae family and the Flavivirus species. o However, there are four serotypes of the Dengue fever virus, aptly named DENV-1, DENV-2, DENV-3 and DENV-4 and within these serotypes there are clades and strains that are inherently different in nature. o However, as a conclusion, one would say the DENV virus is the agent of Dengue Fever. Pathophysiology o (Refer to next page) Clinical Manifestations o Classification according to severity ( Halstead & Nimmanitya) Grade I High grade fever (3-5 days) Headache, peri-orbital pain Joint & bone pain Abdominal pain Nausea & vomiting Petechial formation Hermans sign generalized flushing of the skin Grade II signs & symptoms of grade I + bleeding Epistaxis GI bleeding Gum bleeding Grade III grade II + circulatory failure Cold, clammy skin Altered VS decreased BP rapid, weak pulse increased RR Grade IV grade III + hypovolemic shock o Clinical Manifestations by throughout the phases of illness Initial Febrile phase (2-3 days) Fever 38 c 40 c o Accompanied by headache Flushing of palms and soles (+) Tourniquet test Anorexia, vomiting Maculopapular or petechial rash Hermanss sign

Circulatory Phase (starts n the 3rd-5th day) Restless Cool, clammy skin Cyanosis may be notable Profound thrombocytopenia at the onset of shock Rapid and weak pulse Possibility of a narrowed pulse pressure and a drop of BP to an unobtainable level Diagnostic Evaluation o Tourniquet test (Rumpel-Leede test) presumptive test that checks for capillary fragility pediatric: 5-10 mins adults: 10-15 mins o Positive if > 20 petechiae formation in 1 square inch is evident o Platelet countconfirmatory test platelet o Hematocrit () Collaborative Management o Symptomatic and Supportive Oral Fluids and Intravenous fluid replacement Antipyretics as indicated Aspirin containing medications precautions Platelet transfusion as indicated Blood transfusion as indicated if severe bleeding happened Nursing Management o Monitor for presence of bleeding Nosebleed cold compress and application of direct pressure to Melena cold compress over stomach area, avoid eating dark colored foods to avoid false indication of bleeding Gingival bleeding offer ice chips, use of soft bristle toothbrush during oral care Hematemesis Observe for signs of shock Programs of the Government for DHF o 4S Laban sa Dengue Search and Destroy Self-Protection Measures Seek Early Consultation Say no to indiscriminate fogging o Clean Technique C hemically treated mosquito nets L arvae eating fish E nvironmental sanitation (4pm habit) A ntimosquito soaps (basil, citronel) N atural mosquito repellants (neem tree, eucalyptus, oregano)

LEPTOSPIROSIS
is caused by infection with bacteria of the genus Leptospira and affects humans as well as other animals. also known as Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, Rat Catcher's Yellows, Fort Bragg fever, black jaundice, and Pretibial fever Leptospirosis is among the world's most common diseases transmitted to people from animals. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, the eyes, or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most cases occurring in spring and autumn Source of infection: urine of rats Mode of transmission: Skin penetration o Population at risk: Farmers Sewage workers Miners Slaughterhouse workers People living in areas frequented by flood Pathogenesis o Causative Agent Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica o Characteristic of Leptospira spirochete motile both gram-positive and gram-negative characteristics poor staining, therefore, dark-field or phase-contrast microscopy are necessary beta-hemolytic o Wild mammals seem to serve as the primary reservoir of most leptospiral serovars. The organism has been found in more than 160 mammals, including rats, pigs, dogs, cats, raccoons, and cattle. Rats are considered the most important reservoir, as they are the most common source worldwide. Dogs are often carriers of leptospires, which can cause problems because of their close association with people. o Transmission occurs by contamination of water, soil, or vegetation by urine excreted from infected animals. Humans can become infected upon contact of the contaminated material with abraded skin, mucous membranes, or when the contaminated material is ingested. o Humans are considered incidental hosts to the disease because transmission of the disease between people is rare, at best. Humans are the end of the line of the disease, with very rare exceptions. Clinical Manifestations o Septic Stage marked by febrile lasting from four to seven days. There is an abrupt onset of remittent fever, chills, headache, anorexia, abdominal pain and severe prostration. There is also respiratory distress. Fever subsides with lysis. o Immune or toxic stage with or without jaundice and lasts for 4-30 days. Iritis, headache, meningeal manifestations like disorientation, and convulsions, with CSF findings of aseptic meningitis Oliguria and anuria with progressive renal failure Shock, coma, and CHF are also seen in severe cases. Death may occur between the 9th and 16th days. o Convalescence relapse may occur during the 4th to 5th weeks.

Diagnostic Evaluation o Leptospira Agglutination Test A serologic test considered the gold standard on diagnosing leptospirosis. o Leptospira Antigen-Antibody Test o BUN/Creatinine o Enzyme-linked immunosorbent assay (ELISA) o Liver Function Test Aspartate aminotransferase (AST) Alanine aminotransferase (ALT Gamma-glutamyltransferase o Generally, it is not necessary to confirm the diagnosis or wait for the result of the tests before starting treatment. o The clinical assessment and epidemiologic history are more important. o Early recognition and treatment is MORE important to prevent complications of the severe disease and mortality. Medical Management o Antibiotics: Tetracycline (not given to < 8 yrs old and pregnant women) o Doxycycline may be used as a prophylaxis 200250 mg once a week, to prevent infection in high risk areas. o Penicillin and other B- lactam antibiotics o Erythromycin if allergic to Penicillin Nursing Management o Symptomatic and supportive o Eye care (Darken the room) o Monitor urine output (complication kidney failure) o Medication regimen explanation o Promotion of skin integrity to ease pruritus o Health Teachings Provide education to clients telling them to avoid swimming or wading in potentially contaminated water or flood water. Use of proper protection like boots and gloves when work requires exposure to contaminated water. Drain potentially contaminated water when possible. Control rats in the household by using rat traps or rat poison, maintaining cleanliness in the house.

Pathophysiology of Dengue