Group 6 gcp

Acute fever, body
malaise and rashes
in a 25 year old male
Group case presentation
6A
Joya, Jeb Reinard
Kalaw, Maria Natalia
Kho, Beatriz Barbara
Kimura, Akemi
King, Emmanuel
Koa, Daryl
Lacuna, Dan Paulo
Lalusis, John Kelvin
Lao, Nicole Mae
Laxamana, Jack Rene

Module 4

Group 6 3B Med

6B
Laxamana, Michael
Laygo, Richard Joseph
Lee, Andria
Lee, Nica Kristine
Lerma, Joshua Dave
Libiran, Jonika Maris
Lim, Janine Abigail
Lim, Jerald Garvin
Lim, Joseph Michael

GCP: Acute fever, body malaise & rashes in a 25 year old male

Objectives
• To present a case of a patient with acute fever
• To discuss differential diagnoses
• To discuss Dengue infection
–
–
–
–
–

Epidemiology
Pathophysiology
Clinical manifestations
Treatment & management
Updates on diagnosis & treatment


History
6A Kalaw, Maria Natalia & Kimura, Akemi
6B Laxamana, Michael & Laygo, Richard Joseph


General Information
Name of Patient: J.R.P
Address: R. Papa, Manila

Age: 25 years old
Birthday: July 01, 1988
Sex: Male
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: College level (2nd yr. B.S. in Nursing)
Occupation: unemployed
Date Admitted: November 3, 2013

Bed No. 210 C

Date of Interview: November 8, 2013 (Hospital Day 6)
Informant: Patient
Informant Reliability: 90%


A 25 year old male

Chief complaint: Fever
•
•
•

chills, fever (39oC), body malaise
Self medicated Paracetamol (Biogesic) 500mg/tab 1tab PO
q4h
Amoxicillin 500mg/cap 1cap PO

13 hours PTA

•
•
•
•

fever (39.1 - 39.9oC), sore throat,
vomiting after meals, anorexia,
headache 5/10, myalgia on upper extremities 6/10,
knee arthralgia 4/10

2 hours PTA

• fever 39.8oC, flushed face, red eyes, dry lips

2 days PTA

Admission November 03, 2013


Past Medical History
A 25 year old male
• BIRTH AND DEVELOPMENTAL HISTORY: unrecalled
• CHILDHOOD ILLNESS/HOSPITALIZATIONS: none
• ADULT ILLNESS/HOSPITALIZATIONS: none
• SURGERIES: none
• INJURIES/ACCIDENTS: none
• TRANSFUSIONS/REACTIONS: none
• ALLERGIES: none
• IMMUNIZATION: unrecalled


Family History
(+) Asthma: Father, brother
(-) Thyroid problems, DM
(-) Hypertension & cardiovascular diseases
(-) Cancer

Personal and Social History
•
•
•
•

•

Smoking: 0.75 pack years (5 sticks per day since 2010)
Occasional social alcoholic beverage drinker (wine, beer, hard drinks)
No illicit drug use
Nutrition
– No eating difficulties, has good appetite
– High salt diet
– Usually eats a generous serving of vegetables & fruits
Sleep Pattern
– No difficulty in sleeping
– Sleeps for about 9-10 hours a day, no naps in between


Personal and Social History
•
•

•

•

•
•

Marital status
Single
Living arrangement/ Family structure
Has 2 older brothers and sister; youngest among siblings
Lives alone, rents an apartment unit beside older brother’s unit
Support/secondary gains
Mother, older brother and sister-in-law are the primary caregivers.
Older brother supports patient financially
Employment history/Job satisfaction
2010 Crew at McDonald’s UAE
2011 Promoted to Supervisor in McDonald’s UAE
2013 February – finished contract
Sexual history
Had 1 sexual partner (Filipina OFW, UAE, 2012)
Significant life events, deaths, hardships
2007 death of father due to car accident
denied having financial hardship thereafter


REVIEW OF SYSTEMS
General

Conscious, coherent, not in respiratory distress

Skin

(-) pigmentation, (-) pruritus, (-) jaundice, (-) pallor

HEENT

(+) blurring of vision, (-) ear discharge, (-) ear pain, (-) epistaxis, (-) gum
bleeding, (-) hoarseness, (-) ulcers

Cardiovascular

(-) palpitations, (-) cyanosis, (-) chest pain, (-) PND, (-) orthopnea, (-)
easy fatigability

Respiratory

(-) cough, (-) colds, (-) exertional dyspnea

Gastrointestinal

(-) constipation, (-) diarrhea, (-) melena

Genitourinary

(-) urgency, (-) hematuria, (-) oliguria, (-) dysuria, (-) nocturia,

Musculoskeletal

(-) swelling, (-) Inflammation

Neurologic

(-) seizures, (-) tremors, (-) sleep disturbance, (-) alterations of mood

Hematologic

(-) easy bruisability, (-) anemia

Endocrine/Metabolic

(-) polyphagia, (-) polyuria, (-) polydipsia, (-) heat/cold intolerance

Psychiatric

(-) depression, (-) hallucinations


Physical Examination
6A Kalaw, Maria Natalia & Kimura, Akemi
6B Laxamana, Michael & Laygo, Richard Joseph


General survey
On Admission (November 3, 2013)

Upon PE (November 8, 2013)

•Conscious, coherent, awake


•GCS 15

•GCS 15

•Ambulatory

•Ambulatory

•not in respiratory nor cardiac distress

•not in respiratory nor cardiac distress

•oriented to time, place and person

•oriented to time, place and person

• cooperative, neutral mood, broad affect

• cooperative, neutral mood, broad affect

• no agitation

• no agitation

• judgment and insight intact

• judgment and insight intact

• intact memory for recent and remote events

• intact memory for recent and remote events


Vital Signs & Anthropometrics


•BP = 110/80 mmHg (Sitting)

•BP = 100/80 mmHg (Sitting)

• PR = 107 bpm, regular

• PR = 65 bpm, regular

• RR = 20 breaths per min, regular

• RR =19 breaths per min, regular

• Temp 38.7 °C (Axillary)

• Temp 36.0 °C (Axillary)

•Height = 165 cm

•Height = 165 cm

•Weight = Kg

•Weight = 53 Kg

•BMI = 18.5 (Normal)

•BMI = 18.5 (Normal)


Skin


•(-) petechiae

•(+) petechiae on both lower extremities

• Warm, moist

• Warm, moist

• no facial flushing

• no facial flushing

• no palmar erythema

• no palmar erythema

• pink nail beds, no clubbing

• pink nail beds, no clubbing


HEENT


• Head : round, symmetrical & no deformities, no
lesions or masses

• Head : round, symmetrical & no deformities, no lesions or masses
hair is black, ample in volume & with smooth texture

Eyes : no ptosis & exophthalmos
pink palpebral conjunctiva
anicteric sclera
pupils 2-3mm equally reactive to light, (+)
ROR

Eyes : no ptosis & exophthalmos
pink palpebral conjunctiva
anicteric sclera
pupils 2-3mm equally reactive to light, (+) ROR

•Ears : no ear deformities and tenderness, gross hearing
intact, intact tympanic membranes, nonhyperemic
external auditory canals
•Nose: no alar flaring, no nasal discharge

•Ears : no ear deformities and tenderness, gross hearing intact, intact
tympanic membranes, nonhyperemic external auditory canals
•Nose: no alar flaring, no nasal discharge

• Mouth: pinkish lips, moist buccal mucosa, no cyanosis
•no oral ulcers

•septum at midline
•non-congested nasal turbinates

•Throat: non hyperemic posterior pharyngeal wall

•moist nasal mucosa

•tonsils not enlarged

• Mouth: pinkish lips, moist buccal mucosa, no cyanosis

•Tongue not deviated

•no oral ulcers

•uvula in midline

•Throat: non hyperemic posterior pharyngeal wall

•Supple neck, no limitation in motion

•tonsils not enlarged

•no palpable cervical masses and lymph nodes

•Tongue not deviated
•uvula in midline
•Supple neck, no limitation in motion
•no palpable cervical masses and lymph nodes


Thorax/Lungs


•Symmetrical chest expansion
•Not in respiratory distress
•no tenderness upon palpation of chest
•normal tactile and vocal fremiti on all lung fields
•no adventitious breath sounds on all lung fields
•symmetrically resonant on all fields

•Symmetrical chest expansion
•no chest deformities
•trachea midline
•regular pattern of breathing
•no use of accessory muscles, SCM not prominent
•no tenderness upon palpation of chest
•normal tactile and vocal fremiti on all lung fields
•no adventitious breath sounds on all lung fields
•symmetrically resonant on all fields


Chest/Heart


•JVP 3 cm at 30 degrees

•JVP 3 cm at 30 degrees

•carotid artery pulse with rapid upstroke
and gradual downstroke

•carotid artery pulse with rapid upstroke
and gradual downstroke,

•adynamic precordium

•adynamic precordium

•no murmurs, no thrills, heaves or lifts

•no murmurs, no thrills, heaves or lifts

•S1 > S2 at apex, S2 > S1 at base, no S3 or S4 • apex beat 11.5 cm from sternum at 6th
ICS, on the Left, 1 fingerbreadth soft in
•(+)2 on radial, dorsalis pedis, posterior
characteristic
tibialis, brachial and popliteal pulses
• S1 > S2 at apex, S2 > S1 at base, no S3 or
S4
•(+)2 on radial, dorsalis pedis, posterior
tibialis, brachial and popliteal pulses


Abdomen/Gastrointestinal


•abdomen is flat and symmetrical

•abdomen is flat and symmetrical

•umbilicus in midline

•no visible pulsations and peristalsis

•normoactive bowel sounds

•umbilicus in midline and inverted

•tympanitic at all quadrants

•normoactive bowel sounds, no
borborygmi

•No tenderness on light & deep palpation

•tympanitic at all quadrants
•No tenderness on light & deep palpation
•Liver span = 9 cm Right MCL
•Traube’s space is not obliterated


Genitourinary
•(-) CVA tenderness

•(-) CVA tenderness
•non palpable kidneys


Neurologic exam
Cranial Nerves
CN I No anosmia
•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual
light reflex on both eyes, corneal reflex intact, (+)
accommodation, (-) visual field defect, (-) ptosis
•CN 3 4 6: EOMs full & equal
•
No nystagmus, no drooping of eyelids
•CN 5: no sensory deficit on the left of face
•CN 7: Can clench teeth, can smile, can frown
•CN8 : Gross hearing intact
•CN 9 10: (+) gag reflex, Uvula midline on phonation
•CN 11: Can shrug both shoulders
•CN 12: No deviation of the tongue on protrusion

Cerebrum:
•GCS 15 (E4 V5 M6)
•Oriented to time, place & person
•Follows commands
Cerebellum
•
Able to do finger-to-nose test & alternate
pronation-supination test
Cranial Nerves
CN I No anosmia
•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual
light reflex on both eyes, corneal reflex intact, (+)
accommodation, (-) visual field defect, (-) ptosis
•CN 3 4 6: EOMs full & equal
•
No nystagmus, no drooping of eyelids
•CN 5: no sensory deficit on the left of face
•CN 7: Can clench teeth, can smile, can frown
•CN8 : Gross hearing intact
•CN 9 10: (+) gag reflex, Uvula midline on phonation
•CN 11: Can shrug both shoulders
•CN 12: No deviation of the tongue on protrusion


Salient Features
25 y.o. Male
Subjective
• Fever, chills
• body malaise
• sore throat, vomiting after
meals, anorexia
• headache 5/10
• myalgia on upper extremities
6/10,
• knee arthralgia 4/10

Objective
• Vital signs
BP: 100/80
PR: 65 bpm
RR: 19 cpm
Temp: 36 oC


Initial Impression
Acute Viral Infection


Differential Diagnosis
6A King, Emmanuel & Lao, Nicole Mae
6B Lee, Andria & Lee, Nica Kristine

Patient
Fever 39oC
Chills
body malaise
Sore throat
Vomiting after
meals
anorexia
headache
myalgia,
arthralgia
Rashes on both
lower extremities

Chikungunya Virus
Infection
Fever(38oC-39oC)
Chills
Myalgias
Arthralgias
Headache
Photophobia
Cough
Coryza
Pharyngitis
Anorexia
Nausea
Vomiting
Fatigue
Malaise
Splenomegaly
Dark urine/clay-colored
stools before the onset
of jaundice
Exposure to endemic
areas/ contaminated
food/water

Influenza
Acute Fever not
responding to antibiotic
therapy
Headache
Physical Findings:
Conjunctival Suffusion
Pharyngeal erythema
w/o exudate
Muscle tenderness
Dullness on lung
percussion
Rales on lung
auscultation
Rash (maculopapular,
erythematous, petechial
or ecchymotic)
Exposure history

Rocky Mountain
Spotted Fever
Fever
Abdominal pain
Headache
Photophobia
Vomitting
Vertigo
Sore throat
Meningeal signs
Lethargy
Somnolence
Disoriented/Intellectual
deficit
Tremors
Loss of abdominal
reflexes
Cranial nerve palsies
Hemiparesis
Difficulty in swallowing
Tick borne

Source: Harrison’s Principles of Internal Medicine 18th edition

Patient

Hepatitis A Infection

Leptospirosis

Dengue Fever

Fever 39oC
Chills
body malaise
Sore throat
Vomiting after
meals
anorexia
headache
myalgia,
arthralgia

Fever(38oC-39oC)
Chills
Myalgias
Arthralgias
Headache
Photophobia
Cough
Coryza
Pharyngitis
Anorexia
Nausea
Vomiting
Fatigue
Malaise
Splenomegaly
Dark urine/claycolored stools before
the onset of jaundice
Exposure to endemic
areas/ contaminated
food/water

Acute Fever not
responding to antibiotic
therapy
Headache

Fever
Headache
Weakness
Anorexia
General body pain
(arthralgias, myalgias)
Abdominal pain
Vomiting
Maculopapular rash
Sore throat
Mild hemorrhagic
manifestations (eg,

Rashes on both
lower
extremities

Physical Findings:
Conjunctival Suffusion
Pharyngeal erythema
w/o exudate
Muscle tenderness
Dullness on lung
percussion
Rales on lung
auscultation
Rash (maculopapular,
erythematous, petechial
or ecchymotic)
Exposure history

petechiae, bleeding
gums, epistaxis,
hematuria)

Lymphadenopathy
Mosquito vector

Source: Harrison’s Principles of Internal Medicine 18th edition


Course in the ward
6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin
6B Lim, Janine Abigail & Lim, Jerald Garvin

Day 1 (11/03)

Day 2 (11/04)

Day 3 (11/05)

Day 4 (11/06)

Sx

Fever, sore throat, Abd.
Pain

Fever

Fever

Fever

Hgb

132g/L

129g/L

130g/L

141g/L

140g/L

Hct

0.38

0.38

0.37

0.40

0.40

WBC

3.10x109/L
(N:0.62, L:0.36, Eo:0.02)

2.50x109/L
(N:0.69, L:0.31)

1.90x109/L
(N:0.46, L:0.51, Mo:0.03)

3.40x109/L
(N:0.19, L:0.78, Mo:0.02,
Eo:0.01)

5.00x109/L
(N:0.17, L:0.79,
Mo:0.02,
Eo:0.02)

PLT

185x109/L

180x109/L

90x109/L

33x109/L

51x109/L

Na

135mmol/L

141mmol/L

K

3.72mmol/L

3.98mmol/L

Crea: 0.93mg/dL
ALT: 39.42U/L

Other

AST: 51.37 U/L
ALT: 37.26 U/L
Fecalysis: No significant
findings

Dengue NS1: (+)
Rx

0.4

Paracetamol 500mg Tablet
IV Fluid (LRS)
Esomeprazole 40mg/tab

1

Paracetamol 500mg Tablet prn

Paracetamol 500mg Tablet
PRN

2

Paracetamol 500mg
Tablet
PRN

3

Paracetamol 500mg Tablet PRN

4

4
200

0.3

150

0.2

100

0.1

50

0

0

Day 5 (11/07)

Day 6 (11/08)

Rashes

Rashes

Sx
Hgb

137g/L

140g/L

130g/L

Hct

0.40

0.39

0.37

WBC

4.80x109/L
(N:0.14, L:0.83, Eo:0.03)

4.10/x109/L
(N:0.19, L: 0.75,Mo:0.02,
Eo:0.04)

4.30x109/L
(N:0.16, L:0.77,
Mo:0.02,Eo:0.05)

PLT

39x109/L

73x109/L

80x109/L

Rx

1
0.4

2

3

4

4

Paracetamol 500mg Tablet PRN
Cetirizine 10mg Tablet OD

5

6

None

200
6
150

0.3
0.2

100

0.1

50

0

0


Final Clinical Diagnosis
Dengue Infection
(with warning signs of abdominal pain, vomiting, lethargy,
increased Hct & rapid increase in platelet count)


Pathophysiology
6A Kho, Beatriz Barbara & Laxamana, Jack Rene
6B Lerma, Joshua Dave & Libiran, Jonika Maris


Types of Patient
Group A

Group B

Group C

• are able to tolerate
adequate volumes of
oral fluids
• pass urine at least
once every six hours
• do not have any of
the warning signs,
particularly when
fever subsides

• with warning signs
OR
• Without warning
signs but with:
• co-existing medical
conditions
• certain social
circumstances

• severe plasma
leakage leading to
dengue shock and/or
fluid accumulation
with respiratory
distress
• severe hemorrhages
• severe organ
impairment

DOH Revised Dengue Clinical Management Guidelines, 2011


WHO. Dengue Guidelines for Diagnosis,
Treatment, Prevention and Control, 2009


FEBRILE PHASE

CRITICAL PHASE

RECOVERY PHASE

Fever
Headache
Body malaise
Myalgia
Arthralgia
Retro-orbital pain
Anorexia
Nausea
Vomiting
Diarrhea
Flushed skin
Rash

Defervescence

Resorption of
extravasated fluid
Hemodynamic status
stabilizes

Abdominal pain or
tenderness
Persistent vomiting
Clinical signs of fluid
accumulation
Mucosal bleeding
Lethargy; restlessness
Liver enlargement

DOH Revised Dengue Clinical Management Guidelines, 2011


“The incidence of dengue has increased 30-fold over
the last 50 years. Up to 50-100 million infections
are now estimated to occur annually in over 100
endemic countries, putting almost half of the
world’s population at risk.”

Philippines: 7th

WHO Global Strategy For Dengue Prevention and Control .2012


Dengue in the Philippines
• 1953- first epidemic of severe dengue
• Dengue cases: 110,611(2012) vs 102,192(2013)

Source: Department of Health (DOH)


Pathophysiology
Human
Aedes aegypti

DENGUE
Mosquito

-breed indoors and are capable of biting anyone
throughout the day
-less susceptible to climatic variations
Virus
→increases the mosquitoes’ longevity.
Source: WHO. Programmes and Projects: Dengue Control.
http://www.who.int/denguecontrol/en/


Viral replication in white blood cells: Cytokine production= IL-1, IL-6, TNF, IFN → Inflammatory response
Fever: ↑PGE2 in hypothalamus→↑cAMP→ altered thermoregulatory set point
Myalgia: Perivascular mononuclear infiltrates + Lipid accumulation Microbiology
Nausea and vomiting: bloodborne emetic stimuli (H1 and 5-HT)
Increased endothelial permeability

• Rashes/petechiae (pinpoint hemorrhages)
• Induced vasodilatation = dopamine and 5-HT release → headache
Ashley, L. et.al. Barriers to preclinical investigations of anti-dengue immunity and
dengue pathogenesis. Nature Reviews 11, 420–426 (2013)


Goals of Therapy,
Treatment & Management


Treatment and Management
• Revised Dengue Clinical
Case Management
Guidelines
• DOH
• 2011


Monitoring
–
–
–
–
–

Temperature pattern
Volume of fluid intake and losses
Urine output – volume and frequency
Warning signs
Hematocrit, WBC and Platelets counts

Discharge Criteria
• ALL of the following must be
present
 No fever for 48 hours
 Improvement in clinical status







Urine output
No respiratory distress

 Increasing trend of platelet count
 Stable hematocrit without IV fluids

General well-being
Appetite
Hemodynamic status
Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical
Management Guidelines 2011


Home Care for Dengue
•

Adequate bed rest

•

Adequate fluid intake (>5 glasses for average-sized adult or accordingly in children)

– Milk, fruit juice (caution with diabetes patient) and isotonic electrolyte
solution (ORS) and barley/rice water
– Plain water alone may cause electrolyte imbalance
•

Take paracetamol (not more than 4 grams per day for adults and accordingly in
children)

•

Tepid sponging

•

Look for mosquito breeding places in and around the home and eliminate them

•

AVOID: NSAIDs, Acetylsalycylic acid (aspirin), Mefenamic acid, Steroids (If
already taking, consult physician)

•

Antibiotics are not necessary


D.E.N.G.U.E.
D aily monitor the patient’s status
E ncourage intake of oral fluids like oresol (oral
rehydration solution), water and juices

N ote any warning signs of dengue like persistent
vomiting and bleeding

G ive paracetamol to the patient, NOT aspirin as it
induces bleeding

U se mosquito nets/repellants

E

arly consultation with doctors for any warning signs


•“Although there were small38.9 ± 9.6% phenolic
Platelet count increasedof the anti- of hirta
by amount
Euphorbia
• To determine the validity
Thrombocytopenia
• compound in tawa-tawa, E.59.38in animalmg/kg to
Bleeding time improvedof this decoction (100 models
± sufficient
was 6.44%
thrombocytopenic effect by hirta by oral gavage)
induction by ethanol
• exertsubnormal platelet counts due Administration of
Clotting time improved quality and ethanol.
with effect promoting by 46.6 ± 11.3%
to quantity
• The platelet count (Micros Raynes said.
Histopathological Exam Counter), bleeding time
platelets,” Mr.
– Less method), and clotting ethanol + determined
(Duke’s dilated liver sinusoids in time was E. hirta
decoction group it won the
Because
findings,
•during theof6the study’s significantHealthanalysisfirst(PNHRS) theliver at GruppoManila last 10 August
Histopathological Research System prize in Week held –and spleen held
of the PCHRD Sofitel Medica Award
Philippine National

– No notable difference in spleen
Platelet Count
2012. PCHRD – Gruppo Medica Award is given to undergraduate students engaged in herbal medicine research
th

that have potential
• ThisBleeding Time fordue toor commercial applications. (1 week) of
was most likely practical the short duration
Blood Collection on Day
induction of thrombocytopenia may have7caused liver
and 14
Clotting
Euphorbia hirtaTime insufficient to cause any significant changes
Linn. (Euphorbiaceae) “Tawa-tawa”
damage but was
Histopathological Exam
to the spleen.


Updates on Diagnosis


Appraisalresults applicable for your patient?
Whatthe results also showed that the sensitivity
Are were the results?
The

Are the results of combined diagnostic kitlaboratories and a
- Inofcomparison between hospital did not vary
a the the study valid?

-

Given our patient’s presentation and history,

Patients were all selected during a Dengue outbreak in 2011
national reference laboratory, the sensitivity, the
significantly between the serotypes of
performing presented with a history of fever within
Selected patients a diagnostic test capableand was
Clinical Question least one ofof theimmune status or
specificity, PPV the patient’s NS1/IgM/IgG
past 7 days with byand NPV theof Dengue early will
unaffected at diagnosis following : rash, severe
confirming the pain,
headache, retro-orbitalwere myalgia, jointearly detection of
combination testsof time confirm management
capable
• -What test cantoutilize to betweenpains, bleeding of
by the interval selected, clinical a
onset
contribute I an optimal with aof fever of 10
Patients were randomly
maximum
Dengue infection sample collection
diagnosis of Denguehospital per week use of
hospitalized patients per in my patient?
the patient,and avoid unnecessary
and
patients were
- AllWords: Dengue, twice (early and late), with early
the Diagnosis
• -Keyoptimal performanceRapid tests require adequate
antibioticsbysampled of drugs/ancillaries, limiting
and otherisolation, HIA and MAC-ELISA,
samples tested PCR, viral
training and quality assurance as HIA and MAC-ELISA
while late samples were tested with onlythere was a
patient expenses in the process.

significant difference in the values between hospital
laboratories and the national reference laboratory.


Updates on Prevention


The graphic will identify the type of pest the product is expected to
repel & the amount of time the repellent will be effective.
Source: United States Environmental
Protection Agency http://www.epa.gov


Technological Initiatives


• Dengue Vaccine
– Final stage of clinical development
– Sanofi Pasteur dengue vaccine
• Only vaccine entered Phase III clinical study
• Mexico, Colombia, Honduras, Puerto
Rico, Peru, Vietnam, Singapore, Australia, Thailand and the
Philippines
• Initial data showed very satisfactory results in terms of
safety profile and balance immune system response to the
four dengue serotypes (serotype 1,2,3 and 4) among
children, adolescents and adults tested
Source: http://www.pchrd.dost.gov.ph


• Ovicidal Larvicidal
Trap
– Ordinary tin can
painted black
– Strip of lawanit
board
– Solution

Source: http://www.pchrd.dost.gov.ph



Dengue Vector Surveillance websites
– Mosquito population nationwide
– Dengue incidence, other mosquito-related facts
Source: www.cdc.gov; www.dost.gov.ph


Biologic Agents
– Larvivorous fishes
• Gumbusia affinis, a fresh water fish species, commonly known as “gambusia”, “kataba”,
“bubundat” or “mosquito fish,”
• Poecilia reticulate, commonly known as “guppy fish,” can also consume about 80 to 100 mosquito
larvae per day

– Predatory copepods like water bugs
• Diplonychus indicus

– Sterile male mosquito
Source: http://www.dost.gov.ph

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