Dengue Case Presentation Pedia (PCMC)

8/20/2019 Dengue Case Presentation Pedia (PCMC)

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Case Presentation:

DengueBy Michael B. Valderrama


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Objectives To present a case of Dengue Fever with

warning signs

To be able to discuss the dierentials!pathophysiology! clinical manifestations andprognosis of a patient with dengue withwarning signs

To be able to discuss the appropriatemanagement of a patient with dengue feverwith warning signs


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"eneral Data #$D%! &'yo! M

(oman )atholic

FilipinoMontalban! (i*al

+dmitted on, #une - '&/

+ccompanied by the Father! (eliability -0


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)hief )omplaintFever and Vomiting


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1istory of the 2resent

3llnessFive days prior to admission!3ntermittent! undocumented fever

relieved by paracetamol 4'/ mg5%o vomiting! no cough and colds! and no loose

stools.


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3llnessTwo days prior to admission,6till with no cough and colds! no vomiting and no

loose stoolsFever persisted

%ow with accompanying abdominal pain in theepigastric area with no radiation to surrounding areas.

)onsult sought at 7nares 1ospital

)B)41gb, &&'! 1ct, .'8! 9B), :.8! 2latelets, &'/5.Initial Diagnosis: Urinary tract infection

prescribed )efale;in 4unrecalled dose5 andparacetamol '/ mg before discharge.


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3llnessOne day prior to admission!Fever and epigastric pain still persisted

%ow with accompanying vomiting of threeepisodes! &cc


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3llnessOn te day of admission,Fever! epigastric pain and vomiting were

persistent which prompted consult.6till with no coughs and colds! and loose stools.

)B) was ordered at the 2)M) 41gb, &=>! 1ct,=:! 9B), /.'! 2latelets, ?85.

+dvised admission


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Temporal 2ro@le


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!eview of "edications and #abs%o medications! vitamins and herbal

supplements

)B) from 7nares 1ospital, 41gb, &&'! 1ct,.'8! 9B), :.8! 2latelets, &'/5.

)B) from 2)M), 41gb, &=>! 1ct, =:! 9B), /.'!2latelets, ?85.

(ising 1ct! decreasing platelet count.


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(eview of 6ystems


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2ast Medical 1istory%o history of +sthma! allergies! and primary

comple;.

2revious 1ospitali*ations'/ for $cute gastroenteritis

2revious 6urgeries'= for incision and drainage of a %ec&

abscess • There are no Anown allergies to food and

medications.


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Family 1istory There is no 1istory of Malignancies! DM! 1T%!

+topy


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Family "enogram


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%utritional 1istoryBreastfeeding, Birth until &./ years

Formula 4%estogen! Bona5 until > years.

)omplementary feeding at / months.

'= hour diet recall,(ice and adobo for breaAfast

(ice and porA sinigang for lunch

fried @sh and mongo for dinner.

Morning snacA was bread and milA.

• 2reference for chicAen! porA! beef and suash andregularly consumes softdrinAs and junA food forsnacAs.


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Birth and Maternal

1istory2reterm 4unrecalled +O"5 to a '/ year old

":2' 4'&'5

%onCsmoAer! nonCdrinAer! regular prenatalchecACups starting & month

)aesarean 6ection by an OBC"7% in ahospital.

Birth weight and height was unrecalled+2"+(, good cry after delivery.


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Birth and Maternal

1istoryMother tooA unrecalled Multivitamins

Maternal complications, preCecplamptic duringdelivery

Vitamin E and eye care

%ewborn screening done

Baby noted to jaundiced

resolved after one weeA.


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3mmuni*ation 1istoryB)" 4&5! D2T 4:5! O2V 4:5! 1iB 4:5! 1epB 4=5!

MM( 4'5! measles 4&5

(otavirus 45! 2neumococcal 45! 3nuen*a 45Varicella 45! 1ep + 45 and Typhoid 45.

1e has not yet had boosters for 1ep B! DTa2!and MM(


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Developmental 1istory(ross motor: )an stand on his own at &

months! walA up stairs alone at 'yrs

Fine $daptive: MaAes circular stroAes at '

#anguage: Enows name and se;! most ofspeech intelligible to strangers at :yrs.

)ocial: 2arallel play and helps in dressing at

: yrs


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Developmental 1istoryat par with age! with no noted delay in gross

motor! @ne adaptive! social and languagedevelopmental milestones.


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2ersonal! 6ocial and Gnvironmental

1istoryDwelling, one storey! twoCbedroom! concrete

house with adeuate ventilation

6i;Cmember household

+ccess to electricity

2otable water from a re@lling station

%o e;posure to environmental to;ins!

bioha*ards and tobacco."arbage collection, three times a weeA!

unsegregated

%o history of recent travel.


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1GG+D666Home:1ome life is happy

2arents provide for the needs of the family

2atient e;pressed love and respect for theparents and his sibling.

Occasional disciplinary spanAing

(ules are fairly strict especially in academics2arents can be relied upon when having a

problem

%o recent major changes in the family


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1GG+D666Education: The child is in grade >

elementary! a consistent honor student and iscurrently top & of his class. 1e was not bullied

by classmates or other children in thecommunity.


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1GG+D666Education:"rade > elementary

)onsistent honor student

)urrently top & of his class.

Favorite subject, 6cience

"ets along well with teachers and classmates

1e is not bullied by classmates or other childrenin the community.

%o goals


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1GG+D666Eating Behavior 2reference for chicAen! porA! beef and suash

and regularly consumes softdrinAs and junA

food for snacAs*specially li&es fried cic&en and

amburgers

%o diets

)ees self as tin


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1GG+D666 Activity HiAes to play basAetball and tumbang preso

with friends and classmates

6pends about ' hours browsing social mediaduring holidays and weeAends. %one duringschool days

TV, & hour everyday

1as a male bestfriend in his class.


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1GG+D666Drugs1as no friends who smoAe! drinA or tried drugs

1as not tried drugs himself, fears parents


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1GG+D666Sexuality 3nterested in opposite se;! but has no crushes

or girlfriends

%o forced or uncomfortable se;ual e;periences.


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1GG+D666Suicide and Depression1as no suicidal ideations

Does not hurt himself

Financial situation of family maAes him sad

6leeps well

Vents anger or sadness through crying


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1GG+D666Safety %ot a member of a gang or fraternity

+ccompanied by the mother or father going toand from school


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1GG+D666Spirituality (oman )atholic

Believes in "od

2rays at night but does not go to churchregularly


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)ta&eolders+ $nalysis


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2hysical G;amination(eneral $ppearance+waAe! alert! and not in cardiorespiratory

distress. 9eaAClooAing.


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2hysical G;amination9eight, :=Ag

1eight, &=cm

BM3 &8.:1F+, between C& and C' 4%ormal5

BM3F+, between and C& 4%ormal5


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2hysical G;aminationVitals Signs: B2, ? 1(, >? bpm ((, &'

bpm T, :>./ )

Head and Neck : %ormocephalic! ushedface! %o )H+D6! %o necA vein engorgement.%o lesions in scalp

Eyes: +nicteric sclerae! 2inA palpebral

conjunctivae! %o eye discharge! %o periorbitaledema! %o matting of eyelashes! Gyes arebrisAly reactive to light! 4I5 (ed orange ree;.


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2hysical G;aminationEars: Gars are symmetric. Gar canal is nonC

hyperemic and tympanic membrane is notbulging. %o tragal tenderness. Visible cone of

light bilaterally! with brownish retainedcerumen partially occluding the ear canalsbilaterally.

Nose: %asal Bridge is at! no alar aring!nasal septum is midline! and turbinates arepinA with no watery nasal discharge.


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2hysical G;aminationral !avity: Dry lips! moist oral mucosa!

hyperemic buccal mucosa and pharyngealwalls. %o tonsilar enlargement. Dental carries

present. %o gingival and mucosal lesions.

!ardiovascular: +dynamic precordium! %oheaves no thrills! (egular cardiac rate andrhythm! Distinct heart sounds s&Js' at thebase! +pe; beat at the =th 3)6 M)H! %omurmurs appreciated.


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2hysical G;amination!hest and "ungs: 6ymmetric chest

e;pansion! %o retractions! %o lesions ormasses. )lear breath sounds

Back and Spine: %o lesions and obviousspinal deformities.

A#domen: Flat abdomen! no distention! no

scars! no masses! normoactive bowel soundsand tympanitic on all uadrants! withepigastric tenderness 4pain scaleK /


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2hysical G;amination$elvis and %& tract: %


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6alient Features


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2hysical G;amination


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2hysical G;amination


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Primary or&ing ImpressionDengue Fever wit arning signs-vomiting and abdominal pain.'

6ymptom presentation +bsence of hemorrhagic symptoms

3nitial and follow up )B) 4rising haematocrit /C&0! leuAopenia

L/cells


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Patopysiology of

Dengue(ecovery from infection by one provideslifelong immunity against that particularserotype.

)rossCimmunity to the other serotypes afterrecovery is only partial and temporary.

6ubseuent infections by other serotypesincrease the risA of developing severe dengue.


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Patopysiology of

Dengue9arning signs occur :8 days after the @rstsymptoms in conjunction with a decrease intemperature 4below :-P)


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)ourse of 3llness


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DiagnosisVirus isolation serotypic days and ifprocessed without delay

Viral nucleic acid detection

CDengue genome detection using (TC2)(

Viral antigen detection 4%6&5CDeclines to undetectable levels at day /C>.


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Diagnosis3mmunological response based tests 3gM and 3g" antibodyassayssimple and rapid test based on detecting the dengueCspeci@c

3gM antibodies in the test serum using antiChuman 3gM

+nalysis for haematological parametersTrombocytopenia! a drop in platelet count below &

per Ql! is usually found between the third and eighth day ofillness often before or simultaneously with changes in

haematocrit./aemoconcentration with an increase in the haematocrit of

'0 or more is considered to be a de@nitive evidence ofincreased vascular permeability and plasma leaAage.


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Diagnosis


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Therapeutics Treatment of uncomplicated dengue fever is)upportive'

$ntipyretics should be used to Aeep bodytemperature L=P) 4&=PF5.+spirin is contraindicated

Fluid and *lectrolyte !eplacement

reuired for de@cits caused by sweating!fasting! thirsting! vomiting! and diarrhea.


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2rognosis"ood but care should be taAen to avoid use ofdrugs that suppress platelet activity.

3n dengue hemorrhagic fever! Death hasoccurred in =C/0 of patients with shocA! butwith adeuate intensive care! deaths shouldoccur in L&0 of cases.


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2reventive Measures and 2ublic

1ealth 3ssues+voidance of daytime householdCbased

mos0uito bites'3nsecticides! repellents! body covering with

clothing! screening of houses! and destruction of A.aegypti breeding sites.

9ater should not be stored for long periods oftime to prevent it from becoming mosuito

breeding sites.Harvaecides can be used in stored drinAing water.

Vaccines are not yet available but are currentlyunder development.


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2rogress %otes


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2rogress %otes


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(eferences!eferences:Eliegman et. al. 4'&&5 Nelson’s Textbook of

Pediatrics! &?th edition

9orld 1ealth Organi*ation. '&&.Comprehensive guidelines for prevention andcontrol of dengue and dengue haemorrhagicfever. Revised and expanded edition. 91O,(egional ORce for 6outhCGast +sia.


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