Predisposing factors : Age : 13 years old Geographical Area : lives in the mountainous place of Itogon, Benguet

Precipitating factors : Mosquito carrying dengue virus School environment- open spaces with water pots and

Aedes species (flavivirus carrier which includes dengue virus): 8-12 days of viral replication on mosquitos salivary glands

Bite from mosquito (Portal of Entry in the Skin)

Redness and itchiness in the area

Allowing dengue virus to be inoculated towards the circulation/blood (Incubation Period : 3-14 days)

Virus disseminated rapidly into the blood and stimulates WBCs including Blymphocytes that produces and secretes immunoglobulins (antibodies), and monocytes/macrophages, neutrophils

Diagnostic : Hematology: Increased WBC: 13.7x10^g/L (5-10x10^g/L) Lymphocytes : 24.2% (20.0 40.00%) Elevated IgG and IgM

Diagnostic : Hematology : Increased monocytes : 12.6% (0.0012.00%) Neutrophils: 61.9% (45-70%)

Antibodies attach to the viral antigens, and the monocytes/macrophages will perform phagocytosis through Fc receptors (FcR) within the cells and dengue virus replicates in the cells Entry to the bone marrow

Recognition of dengue viral antigen on infected monocyte

Release of cytokines which consist of vasoactive agents such as interleukins, tumor necrosis factor, urokinase and platelet activating factors which stimulates WBCs and pyrogen release Increase number and S/S: size of the pores in the Productive cough but capillaries which leads Diagnostic : unable to expectorate; Cellular direct destruction to a leakage of fluid S/S: Hematology : deep and rapid and infection to the from the blood of red bone Febrile respirations of 30-40 Platelet: : T = 38.4C marrow precursor cells as interstitial fluid Warm,flushed skin 225x10^g/L cpm; (+) crackles DENGU wellThrombocytopenia as immunological (capillary leakage) of Pleural (+) petechiae Dengue Hemorrhagic Body weakness (150-400) shortened platelet E the different parts of effusion

Viruses enter the CNS through a route Hematogenous dissemination/spread S/S: (+) bipedal edema; Bounding pulse

Undergoes local replication in the skin

Ascites

S/S: Abdominal girth of 38 inches; (+) Ascites/Flui d Wave Test

Transient viremia leading to seeding of the reticuloendothelial system and muscles Continuous replication Secondary viremia leading to seeding of other sites, including CNS

Diagnostic: X-ray: Minimal bilateral pleural effusion

Complications : Intense bleeding Pulmonary edema Shock Death

Diagnostic: Ultrasound: Conclusion: Moderate Ascites

Dengue Encephalitis

S/S: Hemorrhage Edema Fever Headache Lethargy