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DENGUE

DENGUE. DENGUE. an acute infectious disease manifested initially with fever

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DENGUE

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  1. DENGUE

  2. DENGUE • an acute infectious disease manifested initially with fever • It is transmitted by Aedes aegypti, a day-biting mosquito which lays eggs in clear and stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. The adult mosquitoes rest in dark places of the house. http://www.doh.gov.ph/healthadvisories/dengue

  3. Epidemiology DENGUE

  4. Trend • A total of 16,317 dengue cases were admitted to different sentinel hospitals nationwide from January 1 to August 1, 2009. This is 37.2 % lower compared to last year same time period (25,969). National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  5. National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  6. Number of cases were below the alert threshold for morbidity weeks 2-3, 5-8 and 27 to 30. Number of cases reached the epidemic threshold from 19th to 23rd morbidity weeks

  7. Geographic Distribution • Most of the cases were from the following regions: National Capital Region (23%), Region XI (13%),Region IV-A (12%), Region VI (12%), Region XII (9%), and Region III (6%). National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  8. National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  9. Profile of Cases • Ages of cases ranged from less than a month to 96 years old (median = 12 years). • Majority of cases were male (53%). Seventy seven percent of cases belonged to the 1 to 20 years age group • Case fatality ratio greater than 1 were noted among age groups <1, 1 to 10, and 40 years old National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  10. National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  11. There were 165 deaths (CFR 1.0%). Admitted cases with CFR greater than 1 came for Region I, II, CAR, III, VI,VII, VIII, X, & CARAGA(Table 1). National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  12. National Epidemiology Center: http://www.doh.gov.ph/nec/index.php?option=com_content&task=view&id=9

  13. Patient: AJB, 19 y/o, M • Date of Birth: 03 May 1990 • CS: S • Address: Tondo, Manila • Religion: Roman Catholic

  14. Chief Complaint FEVER

  15. PAST MEDICAL HISTORY • Complete vaccine • Fever with convulsion at the age of 3 • (+) Ulcer (high school) • (+) primary complex (5y/o) - took medications for 6 months • (+) dislocation of the 2nd digit of the left foot secondary to trauma s/p cast (2007) • (-) allergies, asthma, HTN, DM, heart disease, CA, thyroid disease

  16. PERSONAL AND SOCIAL HISTORY • a smoker (1 pack year) • occasional alcoholic drinker (6-10 bottles) • denies illicit drug use and not sexually active. • has been living with his maternal aunt since birth. • sedentary lifestyle since. • He’s not fond of eating street food and prefers home cooked meals, particularly meat dishes.

  17. FAMILY HISTORY • (+) Hypertension-maternal grandparents, uncle (2), aunt (2) • (+) COPD-maternal grandmother • (+) DM- maternal grand parents • (+) heart disease - grandfather • (+) stroke - grandfather

  18. FAMILY HISTORY • (-) cancer • (+) myoma - aunt • (+) allergies - aunt • (+) asthma - mother • (+) arthritis - mother, aunt

  19. REVIEW OF SYSTEMS • No jaundice, pruritus • No blurring of vision, photosensitivity, eye itchiness, redness, pain or lacrimation • No deafness, tinnitus, ear discharge • No epistaxis, colds, nasal discharge • No oral lesions, gum bleeding, ulcers

  20. REVIEW OF SYSTEMS • No cough, dyspnea, hemoptysis • No chest pain, palpitations, orthopnea, PND, palpitations, syncope • No urinary frequency, urgency, hesitancy, hematuria, flank pain, nocturia • No polyuria, polydipsia, polyphagia, heat-cold intolerance, tremors • No seizures, dizziness, mental changes

  21. NEUROLOGICAL EXAMINATION On Admission On Interview Conscious, coherent, oriented to time, place and person, follows command, recent and remote memory intact, GCS 15 CN I-XII intact Motor: 5/5 on all extremities Cerebellum: FTNT with ease DTR’s ++ on all extremities No sensory deficit No Babinski, nuchal rigidity • Conscious, coherent, oriented to time, place and person, follows command, recent and remote memory intact, GCS 15 • CN I-XII intact • Motor: grossly graded 5/5 on all extremities • Cerebellar: can do APST and FTNT with ease • Sensory: No sensory deficit • DTRs: ++ • (-) Babinski, (-) nuchal rigidity

  22. PHYSICAL EXAMINATION On Admission On Interview Patient is coherent, oriented as to time and place and ambulatory Pink palpebral conjunctiva, anicteric sclera Tonsils not enlarge, nonhyperemic posterior pharyngeal wall Temperature: 36.5 C PR 64 bpm,regular , +2 RR: 28 cpm BP:120/70 • Conscious, coherent, ambulatory, not in cardiorespiratory distress • Pink palpebral conjunctiva, anicteric sclera • BP 110/60 PR 92bpm regular RR 28cpm, regular, T=39 C

  23. PHYSICAL EXAMINATION On Admission On Interview (-) murmurs, heaves, nor thrills Adynamic precordium, Apex beat at the 5th LICS, midclavicular line S1>s2 at the apex, S2>S1 at the base No cyanosis, edema on the left distal forearm • (-) murmurs no heaves, thrills, • Adynamic precordium, AB 5th LICS MCL, • s1>s2 at apex, s2>s1 base, • ,no cyanosis, no edema

  24. PHYSICAL EXAMINATION On Admission On Interview Not in respiratory distress, Symmetrical chest expansion, no retractions, clear breath sounds, no wheeze nor crackles, symmetrical tactile and vocal fremiti Abdomen is flat, tympanitic, inverted umbilicus, no striae nor scars Pain on the epigastrum on moderate palpation • no alar flaring • (-) use of accessory muscles, (-) supraclavicular retractions, not equal tactile and vocal fremiti, decreased on both lower lung field • Flat abdomen, (-) visible pulsations, (-) striae, NABS, soft, no masses, (+) direct epigastric tenderness

  25. PHYSICAL EXAMINATION On Admission On Interview Liver edge, kidneys, spleen not palpable, trube’s space not obliterated Liver span 9cm,RMCL + Hematoma on R and L antecubitalfossa + petechiae on R lateral arm + Rashes on all extremities with predominance on the distal part

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