“I am tired…I want to lie down, Papa,” Nimfa, a new registered nurse, told her father one morning. She never woke up from that sleep. The diagnosis was dengue hemorrhagic fever (DHF).{{more}}
What a tragedy! She had just passed the Nurse Licensure Exam which was released that year, and they were all informed to come back for the oathtaking and pinning ceremony two weeks before she died.
Unlike her other classmates, Nimfa was immediately hired as a staff nurse in a hospital in their hometown after she took the NLE. The medical history revealed that she had been having on-and -off fever for more than a week, and not wanting to incur absences from her work, she kept on reporting even if she had fever until that day when she felt she could not go on anymore.
Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti and A. albopictus) . The mosquito vectors breed in small collections of water such as storage tanks, cisterns, flower vases, and backyard litter.
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.
The Department of Health claims that factors which favor the spread of the disease are: poor environmental sanitation, water stored within the house or standing water in the premises, high population density or overcrowding. The disease affects all ages but almost all cases are among children 0—15 years old. Both sexes are equally affected. Cases are more frequent during the rainy season, and the incidence is higher in urban communities.
Dengue became a notifiable disease in 1958. Since then, cases have been reported to occur sporadically in urban centers, and steadily increased to a point when it is now an endemic disease in all provinces and cities in the country. In recent years, more epidemics have been reported in urban centers. However, rural areas are not spared.
The World Health Organization reports that : “Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. It is possible for a traveler who has returned to the United States to pass the infection to someone who has not traveled.”
Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or Caucasian.
Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state.
Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding.
Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.
Early symptoms include: Decreased appetite, fever, headache, joint pains, malaise, muscle aches, vomiting.
Acute phase symptoms include: restlessness followed by: ecchymosis, general rash, petechiae, and worsening of earlier symptoms. Shock-like state may follow manifested by cold, clammy extremities and sweatiness (diaphoretic).
Exams and Tests: A physical examination may reveal: enlarged liver (hepatomegaly), low blood pressure, rash, red eyes, red throat, swollen glands and weak rapid pulse.
Tests may include: arterial blood gases, coagulation studies, electrolytes , hematocrit, liver enzymes, platelet count, serologic studies (demonstrate antibodies to Dengue viruses),serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen), tourniquet test (causes petechiae to form below the tourniquet), X-ray of the chest (may demonstrate pleural effusion).
Treatment: Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms.
* A transfusion of fresh blood or platelets can correct bleeding problems
* Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances
* Oxygen therapy may be needed to treat abnormally low blood oxygen
* Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
* Supportive care in an intensive care unit/environment
Outlook (Prognosis): With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.
Possible Complications: encephalopathy, liver damage, residual brain damage, seizures and shock.
In most instances, the client survives just like a nurse who came home to visit her parents, one summer, a few years ago. She had fever for several days. One of the blood exams revealed leukopenia or a platelet count below normal (normal platelet count is: 150,000 — 450,000 per cu mm) which was suggestive of DHF. Since there was no available private room in the hospital, she opted to stay home but she was given intravenous fluids and was closely monitored by a niece who is a physician. A few days later she was transferred to the hospital where she was given more attention and additional medicines. She recovered and was able to return to the U.S.A.
The rainy season is here and the threat of DHF is back (two of our friends got sick with it last May and recovered). So let’s clean our premises, change the water in flower vases inside the house daily, check the backyard and other areas for possible breeding places of mosquitoes, and don’t take fever for granted…for you may have been bitten by the daybiting, Aedes Aegypti mosquito and may get sick with the deadly DHF.
By: Nenita P. Tayko
Foundation University College of Nursing
