DENGUE HEMORRHAGIC FEVER PATHOPHYSIOLOGY

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XI. PATHOPHYSIOLOGY Medical Diagnosis  T/C Dengue Hemorrhagic Fever/ Pleural Effusion, T/C Liver Pathology

Definition ( Aedes Dengue Hemorrhagic Fever - is a severe, potentially deadly infection spread by certain species of mosquitoes ( Aedes aegypti). aegypti).

Pleural Effusion - is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation. Liver Pathology – a condition characterized by any liver diseases or condition

Schematic Diagram Predisposing Geographical area – tropical islands in the Pacific (Philippines) and Asia

Precipitating Environmental conditions (open spaces with water  pots, and plants) Immunocompromise Mosquito carrying dengue virus Soldier  Sweaty skin

Aedes aegypti (dengue virus carrier): 812 days of viral replication on mosquitos’ sali saliva varr land lands s

Bite from mosquito (Portal of Entry in

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

Redness & itchiness in the area

Virus disseminated rapidly into the blood and stimulates WBCs including B lymphocytes that produces and secretes immunoglobulins (antibodies), and monoc onoc tes/m s/macro acro h es, es, neu neutro hils ils Diagnostic: Hematology : Decreased Monocytes: 4%(8-14%) Decreased Neutrophils: 49%(50-70%)

Antibodies attach to the viral antigens, and then monocytes/macrophages monocytes/macrophages will perform phagocytosis through Fc receptor (FcR) within the cells and dengue virus replicates in the cells 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 Signs/ symptoms: Febrile: 38.6C Diaphoresis, Diaphoresis, warm skin, flushed; headache of  3/10 pain scale; whitish spots; body weakness

Dengue

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Diagnostic: Hematology : Increased WBC: 12,900/cumm (5,000- 10,000/cumm) Increased Lymphocytes: 49% (2040%)

Entry to the spleen, and

Entry to the bone marrow

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Diagnostic: Ultrasound: minimal hepatospleno megaly Blood Chemistry: SGOT: 558.0 U/L(Up to 46)

Virus ultimately targets liver and spleen parenchymal cells where infection produces

Cellular direct destruction and infection of red bone marrow precursor cells as well as immunological shortened platelet

Hepatosplenomeg

Signs/ symptoms: >Abdominal pain with 5/10 pain scale as verbalized.

Signs/ symptoms: Profuse non-productive cough with white sputum with blood spots noted; shallow & rapid respirations of  35cpm; crackles/rales

Diagnostic: Ultrasound: Conclusion: Minimal bilateral pleural effusion.

 Thrombocytop

Signs/ symptoms: Red sclera in both eyes Petechiae

Dengue Hemorrhagic

Increase number and size of  the pores in the capillaries which leads to a leakage of  fluid from the blood to the interstitial interstitial fluid (capillary

Pleural

Recovery

Diagnostic: Hematology : Decreased Platelet: 68,000/cumm

Ascite

Complications: Intense bleeding Pulmonary Edema Shock Very low blood pressure Liver cirrhosis Death

Signs/ symptoms: +1 Bipedal edema; weak boun boundi din n ulse ulse

Signs/ symptoms: Abdominal distention with abdominal girth of  93cm (36.6 inches); hypoactive bowel Diagnostic: Ultrasound: Conclusion: Moderate ascites

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Legend: - Pathophsiology

- Medications

- Signs and symptoms

- Diagnostic exams

- Complications

- Interventions

- Early signs