Dengue Hemorrhagic Fever Pathophysiology 36246o

23

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

Definition Dengue Hemorrhagic Fever - is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes 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’ salivary glands Bite from mosquito (Portal of Entry in the Skin) Allowing dengue virus to be inoculated towards the 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 monocytes/macrophges, neutrophils Diagnostic: Hematology : Decreased Monocytes: 4%(8-14%) Decreased Neutrophils: 49%(50-70%)

Antibodies attach to the viral antigens, and then 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 by cytotoxic T cells 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, warm skin, flushed; headache of 3/10 pain scale; whitish spots; body weakness

Dengue Fever

24

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

Entry to the spleen, and liver

Entry to the bone marrow

25

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 apoptosis/cell death

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

Hepatosplenomeg aly 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 35m; crackles/rales Diagnostic: Ultrasound: Conclusion: Minimal bilateral pleural effusion.

Thrombocytop enia

Signs/ symptoms: Red sclera in both eyes Petechiae

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

Pleural effusion

Recovery

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

Signs/ symptoms: +1 Bipedal edema; weak bounding pulse

Ascite s

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

Signs/ symptoms: Abdominal distention with abdominal girth of 93cm (36.6 inches); hypoactive bowel sounds of 2/min Diagnostic: Ultrasound: Conclusion: Moderate ascites

26

Legend: - Pathophsiology

- Medications

- Signs and symptoms

- Diagnostic exams

- Complications

- Interventions

- Early signs