Review of Related Literature

What is Dengue?

Original Wording:  “Dengue is the most rapidly spreading mosquito-borne viral disease in the world. In the last 50 year, incidence has increased 30-fold with increasing geographic expansion to new countries and, in the present decade, from urban to rural settings.” (p.3)

Source: World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control [E-Reader Version]. Available from https://books.google.com.ph/books?id=dlc0YSIyGYwC&pg=PA23&source=gbs_toc_r&cad=3#v=onepage&q&f=false

Original Wording: “Dengue virus (DENV), a mosquito-borne flavivirus, is the causative agent of dengue fever, currently one of the most significant emerging disease challenges to global public health. In recent decades there has been an unprecedented increase in the geographic range, incidence, and severity of infection.”

Source: Timothy P. Endy, Scott C. Weaver, and Kathryn A. Hanley. (2010). Frontiers in Dengue Virus [E-Reader Version] Available from http://www.horizonpress.com/dengue

Dengue world wide

According to World Health Organization (2009), estimated 50 million dengue cases happen yearly 

and roughly 2.5 billion people populate countries prone to Dengue.

Even the WHO (World Health Organization) wanted its member states to be committed to Dengue disease for it can spread widely even outside a nation’s boarder if not handle or treated well.

Source: World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control [E-Reader Version]. Available from https://books.google.com.ph/books?id=dlc0YSIyGYwC&pg=PA23&source=gbs_toc_r&cad=3#v=onepage&q&f=false

Dengue in Asia

Base on a survey conducted by the world Health Organization (2009), 1.8 billion or more than 70% of the population with Dengue worldwide is widespread at South-East Asia Region or the Pacific Region. Eight countries namely Bangladesh, India, Indonesia, Maldives, Myanmar, Sri Lanka, Thailand and Timor-Leste announce Dengue cases. In 2004, the country’s first dengue outbreak betide at Bhutan and in 2005, Timor-Leste had a “high case-fatality rate” (3.55%).

Source: World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control [E-Reader Version]. Available from https://books.google.com.ph/books?id=dlc0YSIyGYwC&pg=PA23&source=gbs_toc_r&cad=3#v=onepage&q&f=false

Dengue in the Philippines

As stated by the World Health Organization (2009), Philippines is one of the four countries (Cambodia, Malaysia and Vietnam) in the Pacific Region with multiple dengue cases and deaths between 2001 and 2008. The amount of dengue cases in the Philippines together with Cambodia in 2008 existed in its highest peak compared to other nations in the Pacific region.

Source: World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control [E-Reader Version]. Available from https://books.google.com.ph/books?id=dlc0YSIyGYwC&pg=PA23&source=gbs_toc_r&cad=3#v=onepage&q&f=false

The Philippines' Department of Health reported to the World Health Organization a sum of 59,943 dengue cases from January to September of last year (2014) and 10.47% of the overall cases came from Norther Mindanao.

Source: World Health Organization (2015). WHO Representative Office Philippines. Retrieved from
http://www.wpo.who.int/philippines/areas/communicable_disease/dengue/continuation_dengue_area_page/en/

This year (2015), Dengue cases rise by 9.15% higher than 2014 during the same span of time. Notwithstanding the increase number of cases, the DOH (Department of Health) reported 168 deaths or 0.3% from January to August which is lower than 2014 figure (217 deaths).

Source: Geronimo, J, (2015, September 04.)Dengue on the rise: 55,000 reported cases so far in 2015. Rappler. Retrieved from http://www.rappler.com/nation/104736-dengue-cases-january-august-2015

The agent that disseminates the viruses that cause dengue is the Aedes aegypti mosquito. Throught the bites of a contaminated female Aedes mosquito, the viruses are passed. The mosquitoes mainly obtain the virus while feeding on the blood of an affected person.

Source: World Health Organization. (2015). WHO| The Mosquito. Retrieve from http://www.who.int/denguecontrol/mosquito/en/

Dengue in Oroquieta City

In 2014, the Misamis Occidental Provincial Hospital reported 100 dengue cases and by November of 2015 they already handled 135 cases.

Source: Misamis Occidental Provincial Hospital, November 18, 2015.

Three Phases

When you are infected with dengue virus, the illness begins abruptly and in patients with moderate and severe disease is followed by three phases – febrile, critical and recovery.

 Febrile phase

Acute febrile stage usually lasts 2-7 days and patients typically develop a high-grade fever suddenly. In this phrase the patients will experience facial flushing, skin erythema, generalized body ache, myalgia, arthralgia, retro-orbital eye pain, photophobia, rubeliform exanthema and headache. Other patients may have sore thoat, an injected pharynx and conjunctival injection. Anorexia, nausea and vomiting are common.

In this phrase, the liver of the patient may be enlarged and tender after a few days of fever and a progressive decrease in total white cell count will occur.

Medical complications seen in the febrile: Dehydration: high fever may cause neurological disturbances and febrile seizure

       Critical phase

Instead of improving with the subsidence of high fever; patients with increase capillary permeability (the capacity of a blood vessel wall to allow for the flow of small molecules or even whole cells in and out of the vessel) may manifest with warning signs, mostly as a result of plasma leakage. Persistent vomiting and severe abdominal pain are early indications of plasma leakage.

The warning signs mark the beginning of the critical phrase and these patients become worse around this time the fever decrease. When the temperature drops to 37.5-38 degree Celsius or less and remains below this level, usually on days 3-8 of illness, progressive leukopenia followed by a rapid decrease in platelet count and usually precedes plasma leakage.When a critical volume of plasma is lost through leakage, shock could occur. Weakness, dizziness or postural hypotension occurs during a shock state.

Medical complication: Shock from plasma leakage: severe haemorrhage; organ impairment

  Recovery phase

As the patient survives the critical phase, a gradual reabsorption of fluid takes place in the following 48-72 hours. Generally well-being improves and appetite returns. Some patients have round spots that appear on the skin, described as “isles of white in the sea of red” and the white blood cell count usually starts to rise.

Medical complication: Hypervolaemia (only if intravenous fluid therapy has been excessive and has extended into this period) and acute pulmonary oedema

Source: World Health Organization. (2012).Handbook for Clinical Management of Dengue. [E-Reader Version] Available from http://www.who.int/denguecontrol/9789241504713/en/

Complications and intensive care management

Many complications seen in dengue are preventable if clinical team members are alert to the physiological problems of the three different phases. Causes of complications in dengue include:

-Missed diagnosis at the frontime

-Inadequate monitoring and misinterpretation of vital signs

-Inadequate monitoring of fluid intake and urine output

 -Late recognition of shock leading to profound and/ or prolonged shock

 -Late recognition of severe bleeding

 -Too much or too little intravenous fluids i.e not following or understanding the treatment guidelines

These causes of complications can lead to life-threatening situation such as prolonged and profound shock, severe bleeding, fluid overload, respiratory distress and failure, multi-organ dysfunction of liver, kidneys and neurological system and irreversible shock and death.

Source: World Health Organization. (2012).Handbook for Clinical Management of Dengue. [E-Reader Version] Available from http://www.who.int/denguecontrol/9789241504713/en/