Dengue fever is a disease caused by a family of viruses transmitted by mosquitoes.

Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with
compromised immune systems. Because it is caused by one of five serotypes of the dengue
virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces
immunity for a lifetime to that particular viral serotype to which the patient was exposed.

Dengue goes by other names, including "breakbone fever" or "dandy fever." Victims of dengue
often have contortions due to the intense pain in the joints, muscles, and bones, hence the
name breakbone fever. Slaves in the West Indies who contracted dengue were said to have
dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include
headache, fever, rash, and evidence of bleeding (hemorrhage) in the body. Dengue is prevalent
throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean,
including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been
imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore,
the South Pacific, including the Philippines, Southeast Asia, the West Indies, India, and the
Middle East

Dengue is now the leading cause of acute febrile illness in U.S. travelers returning
from the Caribbean, South America, and Asia. Center for Disease Control
Globally, According to the World Health Organization (WHO), there are about 390 million
cases of dengue fever worldwide, and 96 million require medical treatment. Five hundred
thousand cases of dengue hemorrhagic fever, the most severe form of dengue, require
hospitalization each year. Nearly 40% of the world's population lives in an area endemic with
dengue. The World Health Organization (WHO) estimates 22,000 deaths occur yearly, mostly
among children.

The virus is contracted from the bite of a striped Aedes aegypt mosquito that has previously
bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-
filled flower pots, plastic bags, and cans year-round. One mosquito bite can cause the disease.

The virus is not contagious and cannot be spread directly from person to person. It is mosquito-
borne, so there must be a person-to-mosquito-to-another-person pathway. The full life cycle of
the virus involves the mosquito as the vector (transmitter) and the human as the source of
infection. After being bitten by a mosquito carrying the virus, the incubation period for dengue
fever ranges from three to 15 (usually five to eight) days before the signs and symptoms of
dengue appear in stages.
In the Philippines, the number of dengue fever cases in the country has grown to nearly 36,000
in the first five months of this year, but lower than the same period last year, Health Secretary
Paulyn Ubial said Thursday.(Sunstar Manila, June 2017) In a statement for the commemoration
of Asean Dengue Day, Ubial said that from January 1 to May 20 the DOH has recorded 35, 973
dengue cases. The number, she said, Is actually 31.8% lower compared to the 52,780 cases
recorded during the same time period last year.

There is a decreasing trend of reported dengue cases to the Epidemiology

Bureau DOH Sec. Paulyn Ubial.
We chose this case as this case is never dying even though with the presence of the Dengue
Vaccine in our country number of cases here are still very high, and our question is why?
PERSONAL DATA

Patient's Name : Nugas, Bryx Agdon

Religion: Roman Catholic

Nationality: Filipino

Address: Mangingisda, Puerto Princesa City

Birthday: July 2, 1999

Age: 18

Contact Person: Sally Nugas(Mother)

Physician: Dr. Varona

Date of Admission: September 5, 2017

Chief Complaint: High Grade Fever, Severe Headache

Final Diagnosis: Dengue

Present Medical History

Patient B is a 18 year old who lives in Mangingisda, Puerto Princesa City with the complain of 4
days prior the admission he experienced high grade fever and consulted @ Satellite Health
Center and was given Paracetamol 500mg 1 tab, He is also complaining of severe headache with
a pain scale of 10/10 and has experienced dizziness during the height of the fever, client also
mentioned of experiencing abdominal pain and was having flushed skin.
Past Medical History

Patient B stated the he has already experienced having Mumps, cough, colds, and fever when
he was young and stated that he has completed his Vaccines namely BCG, DPT, Hepa B, and
Measles Vaccine, has undergone only a minor surgery Circumcision , No known allergies on
food and drugs as stated.

Integument

Skin: The clients skin is flushed and warm to touch.

Hair: The hair of the client is thin and curly and evenly distributed.

Nails: The client has a light brown nails and has the shape of convex curve and slightly longer

than the normal height . When nails pressed between the fingers (Blanch Test), the nails return

to usual color in more than 3 seconds.

Head

Head: The head of the client is round in shape

Skull: There are no nodules or masses and depressions when palpated.

Face: The face of the client appeared smooth but saggy and has uniform consistency and with

no presence of nodules or masses.

EENT

Eyebrows: Hair is evenly distributed..

Eyelashes: Eyelashes appeared to be equally distributed and curled slightly outward.

Eyelids: There were no presence of discharges, no discoloration and lids close symmetrically

with involuntary blinks approximately 10-12 times per minute.

Eyes: The pupils of the eyes are black and equal in size. The iris is flat and round. PERRLA (pupils

equally round respond to light accommodation), sclera is in jaundice

Ears: The Auricles are symmetrical and has the same color with his facial skin. The client is able

to hear clearly

Nose: The nose appeared symmetric, straight and uniform in color. There was no presence of

discharge or flaring. When lightly palpated, there were no tenderness and lesions

Mouth: The lips of the client are uniformly pink; moist, symmetric and have a smooth texture.

Teeth and Gums: enamels light yellow in color, no retraction of gums, pinkish in color of gums.

The buccal mucosa of the client appeared as uniformly pink; moist, soft, glistening and with

elastic texture. The tongue of the client is centrally positioned. It is yellowish in color, moist and

slightly rough. There is a presence of thin whitish coating.

7| P a g e
Neck: The neck muscles are equal in size. The client showed coordinated, smooth head

movement with no discomfort. The lymph nodes of the client are not palpable. The trachea is

placed in the midline of the neck. The thyroid gland is not visible on inspection and the glands

ascend during swallowing but are not visible.

Thorax, Lungs, and Abdomen

Lungs / Chest: The chest wall is intact with no tenderness and masses. Theres a full and

symmetric expansion and the thumbs separate 2-3 cm during deep inspiration when assessing

for the respiratory excursion. The client manifested crackles during respiration. Heart: There

were no visible pulsations on the aortic and pulmonic areas. There is no presence of heaves or

lifts.

Abdomen: The abdomen of the client has a saggy skin and is uniform in color. The abdomen has

a symmetric contour. There were symmetric movements caused associated with clients

respiration. There is presence of Intra Jugular Catheter Attached to (R) Intra-Jugular Vein.

The extremities are symmetrical in size and length. After Aug. 19 2017, S/P BKA on (R) Leg the

extremities are non-symmetrical in size and length.

Muscles: The muscles are not palpable with the absence of tremors. (R) Lower leg is exhibiting

necrosis with dark, dry and shiny in appearance. After Aug. 19 2017, S/P BKA on (R) Leg

exhibited tremors when trying to lift the leg for wound dressing.
Bones: There were no presence of bone deformities before BKA procedure.