PredisposingGeographical area – tropical islands in the Pacific (Philippines) and Asia

PrecipitatingEnvironmental conditions (open spaces with water pots, and plants)Immunocompromise Mosquito carrying dengue virusSoldier Sweaty skin

Aedes aegypti (dengue virus carrier): 8-12 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

Recognition of dengue viral antigen on infected monocyte by cytotoxic T cells

Entry to the spleen, and liver

Virus disseminated rapidly into the blood and stimulates WBCs including B lymphocytes that produces and secretes immunoglobulins (antibodies), and monocytes/macrophges, neutrophils

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 of monocytes/macrophages

Diagnostic:Hematology :Increased WBC: 12,900/cumm(5,000- 10,000/cumm)Increased Lymphocytes: 49% (20-40%)

Diagnostic:Hematology :Decreased Monocytes: 4%(8-14%)Decreased Neutrophils: 49%(50-70%) Entry to the bone

marrow

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: 38.6CDiaphoresis, warm skin, flushed; headache of 3/10 pain scale; whitish spots; body weakness

Dengue Fever

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

causing platelet lyses

Virus ultimately targets liver and spleen parenchymal cells where infection produces apoptosis/cell

death

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 organs and skin

Thrombocytopenia

Pleural effusion Ascites

Diagnostic:Hematology :Decreased Platelet: 68,000/cumm (150,000-400,000)

Signs/ symptoms:Red sclera in both eyesPetechiae

Diagnostic:Ultrasound:Conclusion:Minimal bilateral pleural effusion.

Diagnostic:Ultrasound: Conclusion:Moderate ascites

Dengue Hemorrhagic Fever

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

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

Signs/ symptoms:+1 Bipedal edema; weak bounding pulse of 79bpm

Complications: Intense bleedingPulmonary EdemaShockVery low blood pressureLiver cirrhosisDeath

Hepatosplenomegaly

Recovery

Diagnostic:Ultrasound:minimal hepatospleno megalyBlood Chemistry:SGOT: 558.0 U/L(Up to 46)SGPT:433.3 U/L(Up to 40)Protein: 5.2g/dL (6.6-8.7)Albumin:2.3g/dL (3.5-5.5)

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