Pathophysiology of Dhf

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  • Topic: Dengue fever, Fever, Mosquito
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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

Legend:

- Pathophsiology

- Medications- Signs and symptoms

- Diagnostic exams- Complications

- Interventions- Early signs

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Precipitating
Environmental conditions (open spaces with water pots, and plants) Immunocompromise
Mosquito carrying dengue virus
Soldier
Sweaty skin

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

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)

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

Diagnostic:
Ultrasound:
minimal hepatospleno megaly
Blood 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)

Dengue Fever

Entry to the spleen, and liver

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

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

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

Redness & itchiness in the area

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

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

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

Signs/ symptoms:
Febrile: 38.6C
Diaphoresis, warm skin, flushed; headache of 3/10 pain scale; whitish spots; body weakness

Entry to the bone marrow

Hepatosplenomegaly

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

Ascites

Pleural effusion

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%)

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

Signs/ symptoms:
Red sclera in both eyes
Petechiae

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 bleeding
Pulmonary Edema
Shock
Very low blood pressure
Liver cirrhosis
Death

Recovery
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