Predisposing Geographical area tropical islands in thePacific (Philippines) and Asia

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

Aedes aegypti (dengue virus carrier): 8-12 days of viral replication on mosquito's s a l i v a r y glands

Bite from mosquito (Portal of Entry in the Skin)

Redness & itchiness in the area

Allowing dengue virus to be inoculated towards the circulation/blood (Incubation Period: 3-14 days) Diagnostic: Hematology: Increased WBC:12,900/cumm(5,00010,000/cumm), Increased Lymphocytes: 49% (20-40%)

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

Diagnostic: Hematology: Decreased Monocytes: 4 %( 814%) Decreased Neutrophils: 49 %( 5070%)

Antibodies attach to the viralantigens, and thenmonocytes/macrophages willperform phagocytosis through Fcreceptor (FcR) within the cells and dengue virus replicates in the cells Entry to the spleen, and Recognition of dengue viral antigen on infected monocyte 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: 38.6C, Diaphoresis, warm skin, flushed; headache of 3/10 pain scale; whitish spots; body weakness

Dengue

Virus ultimately targets liver and spleen parenchymal cells where infection produces Diagnostic: Ultrasound: minimal hepatosplenom egaly Blood Chemistry: SGOT: 558.0U/L (Up to 46)

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

Hepatosplenomegaly

Thrombocytopenia Increase number and size of the pores in the capillaries which leads to a leakage of fluid from the blood to the Dengue Hemorrhagic interstitial fluid (capillary leakage) Fever

Diagnostic: Hematology: Decreased Platelet: 68,000/cumm Signs/symptoms: +1 Bipedaledema; weak Signs/symptoms: Red sclera bounding pulse in both eyes Petechiae

Signs/ symptoms :> Abdominal pain with 5/10 pain scale as verbalized. Signs/ symptoms: Profuse nonproductive cough with white sputum with bloodspots noted; shallow &rapid respirations of 35cpm; crackles/rales

Pleural effusion

Ascite

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

Recovery

Diagnostic: Ultrasound: Conclusion: Minimal bilateral pleural effusion.

Complications: Intense bleeding; Pulmonary Edema; Shock; Very low blood pressure; Liver cirrhosis; Death

Diagnostic: Ultrasound: Conclusion: Moderate ascites