Professional Documents
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Dengue
By Michael B. Valderrama
Objectives
To present a case of Dengue Fever with
warning signs
To be able to discuss the differentials,
pathophysiology, clinical manifestations and
prognosis of a patient with dengue with
warning signs
To be able to discuss the appropriate
management of a patient with dengue fever
with warning signs
General Data
JXDN, 12yo, M
Roman Catholic
Filipino
Montalban, Rizal
Admitted on: June 8 2015
Accompanied by the Father, Reliability 80%
Chief Complaint
Fever and Vomiting
stools.
loose stools
Fever persisted
Now with accompanying abdominal pain in the
epigastric area with no radiation to surrounding areas.
Consult sought at Ynares Hospital
CBC(Hgb: 112, Hct: 0.27, WBC: 3.7, Platelets: 125).
Initial Diagnosis: Urinary tract infection
prescribed Cefalexin (unrecalled dose) and
paracetamol 250 mg before discharge.
episodes,
1cc/episode.
Temporal Profile
supplements
CBC from Ynares Hospital: (Hgb: 112, Hct:
0.27, WBC: 3.7, Platelets: 125).
CBC from PCMC: (Hgb: 146, Hct: 43, WBC: 5.2,
Platelets: 97).
Rising Hct, decreasing platelet count.
Review of Systems
complex.
Previous Hospitalizations
2005 for Acute gastroenteritis
Previous Surgeries
2004 for incision and drainage of a Neck
abscess
There are no known allergies to food and
medications.
Family History
There is no History of Malignancies, DM, HTN,
Family Genogram
Nutritional History
Breastfeeding: Birth until 1.5 years
Formula (Nestogen, Bona) until 6 years.
Complementary feeding at 5 months.
24 hour diet recall:
Rice and adobo for breakfast
Rice and pork sinigang for lunch
fried fish and mongo for dinner.
Morning snack was bread and milk.
Preference for chicken, pork, beef and squash and
G3P2 (0212)
Non-smoker, non-drinker, regular prenatal
check-ups starting 1 month
Caesarean Section by an OB-GYN in a
hospital.
Birth weight and height was unrecalled
APGAR: good cry after delivery.
delivery
Vitamin K and eye care
Newborn screening done
Baby noted to jaundiced
resolved after one week.
Immunization History
BCG (1), DPT (3), OPV (3), HiB (3), HepB (4),
Developmental History
Gross motor: Can stand on his own at 10
Developmental History
at par with age, with no noted delay in gross
HEEADSSS
Home:
Home life is happy
Parents provide for the needs of the family
Patient expressed love and respect for the
HEEADSSS
Education: The child is in grade 6
HEEADSSS
Education:
Grade 6 elementary
Consistent honor student
Currently top 1 of his class.
Favorite subject: Science
Gets along well with teachers and classmates
He is not bullied by classmates or other children
in the community.
No goals/plans yet for future career
HEEADSSS
Eating Behavior
Preference for chicken, pork, beef and squash
and regularly consumes softdrinks and junk
food for snacks
Especially likes fried chicken and
hamburgers
No diets
Sees self as thin
HEEADSSS
Activity
Likes to play basketball and tumbang preso
with friends and classmates
Spends about 2 hours browsing social media
during holidays and weekends. None during
school days
TV: 1 hour everyday
Has a male bestfriend in his class.
HEEADSSS
Drugs
Has no friends who smoke, drink or tried drugs
Has not tried drugs himself: fears parents
HEEADSSS
Sexuality
Interested in opposite sex, but has no crushes
or girlfriends
No forced or uncomfortable sexual experiences.
HEEADSSS
Suicide and Depression
Has no suicidal ideations
Does not hurt himself
Financial situation of family makes him sad
Sleeps well
Vents anger or sadness through crying
HEEADSSS
Safety
Not a member of a gang or fraternity
Accompanied by the mother or father going to
and from school
HEEADSSS
Spirituality
Roman Catholic
Believes in God
Prays at night but does not go to church
regularly
Stakeholders Analysis
Physical Examination
General Appearance
Awake, alert, and not in cardiorespiratory
distress. Weak-looking.
Physical Examination
Weight: 34kg
Height: 140cm
BMI 17.3
HFA: between -1 and -2 (Normal)
BMIFA: between 0 and -1 (Normal)
Physical Examination
Vitals Signs: BP: 90/60 HR: 69 bpm RR: 12
bpm T: 36.5 C
Head and Neck: Normocephalic, flushed
face, No CLADS, No neck vein engorgement.
No lesions in scalp
Eyes: Anicteric sclerae, Pink palpebral
conjunctivae, No eye discharge, No periorbital
edema, No matting of eyelashes, Eyes are
briskly reactive to light, (+) Red orange reflex.
Physical Examination
Ears: Ears are symmetric. Ear canal is non-
Physical Examination
Oral Cavity: Dry lips, moist oral mucosa,
Physical Examination
Chest and Lungs: Symmetric chest
Physical Examination
Pelvis and GU tract: N/A
Rectal: N/A
Upper and Lower Extremities: Negative
Salient Features
Physical Examination
Physical Examination
Pathophysiology of Dengue
Mosquito-borne viral disease
Transmission: female mosquitoesAedes
Pathophysiology of
Dengue
Recovery from infection by one provides
Pathophysiology of
Dengue
The immune system is implicated early in the
Pathophysiology of
Dengue
Warning signs occur 37 days after the first
Course of Illness
Diagnosis
Virus isolation serotypic/genotypic
characterization
-Only useful in the first 6 days and if
processed without delay
Viral nucleic acid detection
-Dengue genome detection using RT-PCR
Viral antigen detection (NS1)
-Declines to undetectable levels at day 5-6.
Diagnosis
Immunological response based tests IgM and IgG antibody
assays
simple and rapid test based on detecting the dengue-specific
Diagnosis
Therapeutics
Treatment of uncomplicated dengue fever is
Supportive.
Antipyretics should be used to keep body
temperature <40C (104F).
Aspirin is contraindicated
Therapeutics
Monitoring of dengue/DHF patients during the critical
period
General condition, appetite, vomiting, bleeding and
cases.
Prognosis
Good but care should be taken to avoid use of
mosquito bites.
Insecticides, repellents, body covering with
Progress Notes
Progress Notes
References
References:
Kliegman et. al. (2011) Nelsons Textbook of
Pediatrics, 19th edition
World Health Organization. 2011.
Comprehensive guidelines for prevention and
control of dengue and dengue haemorrhagic
fever. Revised and expanded edition. WHO:
Regional Office for South-East Asia.
Thank you!