View
222
Download
0
Category
Preview:
DESCRIPTION
Copy of Dengue Hemorrhagic Fever ( KULIAH )
Citation preview
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 1/90
DENGUE & DENGUE
HEMORRHAGIC FEVER
Kuliah Blok Kedokteran Tropis
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 2/90
INTRODUCTION
Dengue is a viral infection transmitted by mosquitoes, mainlythe Aedes aegypti species
The virus is contracted from the bite of a striped Aedesaegypti mosquito that has previously bitten an infectedperson One mosquito bite can in!ict the disease
There are four strains or serotypes of dengue virus namelyD"N#$, D"N#%, D"N#& and D"N#' The mosquito !ourishes during rainy seasons but can breed in
(ater#)lled containers, year#round The virus is not contagious and cannot be spread directly from
person to person There must be a person#to#mosquito#to#another#person path(ay
Dengue haemorrhagic fever severe form of dengue *second attac+ by dengue virus of a dierent serotype from the)rst infection
*ppro-imately $. of patients (ith dengueinfection progress to dengue haemorrhagic
fever
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 3/90
Dengue fever
• Main hosts- non humanprimates
• Human-to-humantransmission through
Aedes spp.
• 2.5 billion individuals atrisk
•!-"! million infe#tedea#h $ear %ith thousandsof deaths
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 4/90
&ausative agent of Dengue&ausative agent of Dengue
Dengue is #ause b$ a '() virusDengue is #ause b$ a '() virus
• This virus is a member of the viral famil$This virus is a member of the viral famil$
*laviviridae.*laviviridae.
Dengue virusDengue virus
Bauman+ '.+ ,2!!. Mi#robiolog$ disease b$ s$stems. /an *ran#is#o + &)0 1earsonBenamin &umming 1ublishers
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 5/90
Dengue Virus1. Causes dengue and dengue hemorrhagic e!er
". I# is an ar$o!irus
%. ransmi##ed $' mos(ui#oes
). Com*osed o sing+e,s#randed RNA
-. Has ) sero#'*es DEN,1/ "/ %/ )0
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 6/90
Dengue Virus•Each sero#'*e *ro!ides s*eciic +ie#ime immuni#'/
and shor#,#erm cross,immuni#'•A++ sero#'*es can cause se!ere and a#a+ disease•Gene#ic !aria#ion i#hin sero#'*es•2ome gene#ic !arian#s i#hin each sero#'*e a**ear
#o $e more !iru+en# or ha!e grea#er e*idemic *o#en#ia+
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 7/90
3H4 I2 DENGUE 2UCH A 5IG
6RO57EM ODA48
G+o$a+ *o*u+a#ion
gro#h
Rura+ #o ur$an
migra#ion
Gro#h o ci#iesDe#eriora#ion o
ci#ies
9e# #ra!e+
Hea+#h ser!ices*oor+' organi:ed;
underunded
7ac< o !ec#orcon#ro+
*roessiona+s
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 8/90
3lobal /pread of Dengue
Countries with active dengue + Aedes aegypti
-=,1== mi++ion inec#ions;'ear
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 9/90
/OR0D#/ID" D"N1U"DI2TRI3UTION
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 10/90
3eograph$ distribution of3eograph$ distribution of
DengueDengue
BBB
Blue dot0 3eographi# e4tension of dengue 2!!!-2!!Blue shaded areas0 'isk of dengue transmission6ines0 6ines demar#ate the area %here the ve#tor for dengue e4ists
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 11/90
• 7H* and other
infe#tious diseasestravel 8ui#kl$no%ada$s
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 12/90
Num$er o DHF Cases and Inec#ed Areas
in Indonesia 1>?@ "==%0
9 ' p
e r : !
! + !
! !
( o o
f & i t $ ; D i s t r i # t s 9 n f e # t e d
Incidence Ra#e IR0No o Inec#ed Areas
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 13/90
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 14/90
Dengue DHF0
Ou#$rea< inIndonesia "==)0
Ou#$rea< areas
6o#en#ia+ Ou#$rea< areas
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 15/90
he mos# common e*idemic !ec#or o dengue in #he or+d is
#he Aedes aegypti mos(ui#o. I# can $e iden#iied $' #he hi#e$ands or s#ale patterns on i#s +egs and #horaB.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 16/90
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 17/90
Aedes aegypti
•Dengue #ransmi##ed $' inec#ed ema+emos(ui#o
•6rimari+' a da'#ime eeder
•7i!es around human ha$i#a#ion
•7a's eggs and *roduces +ar!ae
*reeren#ia++' in ar#iicia+ con#ainers
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 18/90
Aedes aegypti Aedes aegypti life #$#lelife #$#le
2- da$s
< da$s 2 da$s
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 19/90
1.he !irus is inocu+a#ed in#o
humans i#h #he mos(ui#o
sa+i!a.
".he !irus +oca+i:es and
re*+ica#es in !arious #arge#
organs/ or eBam*+e/ +oca+
+'m*h nodes and #he +i!er.
%.he !irus is #hen re+easedrom #hese #issues and
s*reads #hrough #he $+ood #o
inec# hi#e $+ood ce++s and
o#her +'m*ha#ic #issues.
).he !irus is #hen re+eased
rom #hese #issues and
circu+a#es in #he $+ood.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 20/90
-.he mos(ui#o inges#s $+ood con#aining #he !irus.
?.he !irus re*+ica#es in #he mos(ui#o midgu#/ #he o!aries/
ner!e #issue and a# $od'. I# #hen esca*es in#o #he $od'
ca!i#'/ and +a#er inec#s #he sa+i!ar' g+ands.
.he !irus re*+ica#es in #he sa+i!ar' g+ands and hen #he
mos(ui#o $i#es ano#her human/ #he c'c+e con#inues.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 21/90
The transmission #$#le of dengue virus b$ the mos8uito Aedes aegypti begins%ith a dengue-infe#ted person. This person %ill have virus #ir#ulating in the blood=a !iremia that lasts for about five da$s. During the viremi# period+ an uninfe#ted
female Aedes aegypti mos8uito bites the person and ingests blood that #ontainsdengue virus. )lthough there is some eviden#e of transovarial transmission ofdengue virus in Aedes aegypti + usuall$ mos8uitoes are onl$ infe#ted b$ biting a!iremic person.Then+ i#hin #he mos(ui#o+ the virus repli#ates during an eB#rinsic in#ubationperiod of eight to t%elve da$s.
The mos8uito then bites a sus#eptible person and transmits the virus to him orher+ as %ell as to ever$ other sus#eptible person the mos8uito bites for the rest ofits lifetime.The virus then repli#ates in the se#ond person and produ#es s$mptoms. Thes$mptoms begin to appear an average of four to seven da$s after the mos8uitobite=this is the in#rinsic in#ubation period+ i#hin humans. >hile the intrinsi#
in#ubation period averages from four to seven da$s+ it #an range from three to :da$s.The !iremia begins slightl$ before the onset of s$mptoms. /$mptoms #aused b$dengue infe#tion ma$ last three to :! da$s+ %ith an average of five da$s+ after theonset of s$mptoms=so the illness persists several da$s after the !iremia hasended.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 22/90
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 23/90
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 24/90
Population
Infection
Clinical Cases
DHF/DSS
Asymptomatic
Infection
DF(non-DHF)
survive Death
5
!"
#
$%&
'#
"
%!
Fi% * +ates in ,enue mo,el
y Shepar, et al% .accine% !$$" !!0*!'5-*!&$%
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 25/90
Halstea, S1 et al% Am 2 3rop 4e, Hy *# *&0'-*$!*%
Ae-specific DHF/DSS hospitaliation in chil,ren an, infant%
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 26/90
here are ac#ua++' our dengue c+inica+
s'ndromes
1.Undieren#ia#ed e!er
".C+assic dengue e!er
%.Dengue hemorrhagic e!er/ or DHF and
).Dengue shoc< s'ndrome/ or D22.
Dengue shoc< s'ndrome is ac#ua++' a se!ereorm o DHF.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 27/90
C+inica+ Case Deini#ion or Dengue Fe!er
C+assica+ Dengue e!er or 5rea< $one e!er is an acu#e e$ri+e
!ira+ disease re(uen#+' *resen#ing i#h headaches/ $one or oin#
*ain/ muscu+ar *ains/rash/and +euco*enia
C+inica+ Case Deini#ion or Dengue Hemorrhagic Fe!er
) Necessar' Cri#eria1. Fe!er/ or recen# his#or' o acu#e e!er
". Hemorrhagic manies#a#ions
%. 7o *+a#e+e# coun# 1==/===;mm% or +ess0
). O$ec#i!e e!idence o +ea<' ca*i++aries• e+e!a#ed hema#ocri# "= or more o!er $ase+ine0
• +o a+$umin• *+eura+ or o#her eusions
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 28/90
DENGUE
FEVER
• Incu$a#ion *eriod J - da's• Fe!er J - da's• 7eu<o*enia
• Modera#e #hrom$oc'#o*enia
2immons e# a+ 6hi+ 9 2ci ))1,"-"/ 1>%1
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 29/90
&lini#al Manifestations- D*
• 91 of 2 ? da$s - t$pi#al patient develops
• /udden onset of fever+ #hills+ heada#he
• Ba#k pain %ith severe m$algia+ arthralgia• 'etro-orbital pain ? break bone fever
• Ma#ular rash ? in a4illar$ area
• )denopath$+ palatal vesi#les+ s#leral in.• Ma#ulo-papular rash on trunk ?e4tremities
• @pista4is and s#attered pete#hiae
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 30/90
Ather manifestations- D*
• )nore4ia. (ausea+ vomiting
• 9n apparent illness-to a#ute in#apa#itation
• 9llness is about 2?5 da$s+ biphasi# #ourse• 1ain on e$e movements
• 1ain on palpating abdominal mus#les
• 1rimaril$ not a respirator$ illness• 'are - asepti# meningitis
• &omplete re#over$ is the rule - asthenia
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 31/90
Treatment of D*
• /upportive measures - 7e#tor barrier
• )void )spirin and if possible (/)9Ds
• /teroids should not be used
• *luid repla#ement to avoid hemo#on#.
• &hildren belo% :2 re8uire #areful %at#h
for DH* ; D//
• (o antiviral agents are of proven value
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 32/90
DI2EA2E 26ECRUM
MI7D 2EVERE
DF DHFK hrom$oc'#o*enia KKK hrom$oc'#o*enia
Hidden Vasc. 6erm
1
8 O!er# Vasc. 6erm.
1. 3i++s 5A e# a+ 9 Inec# Dis 1>=@1=,@1@/ "==)
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 33/90
DENGUE HEMORRHAGIC
FEVER;DENGUE 2HOCL24NDROME DHF;D220
Dengue !ascu+o*a#h'
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 34/90
Dengue Haemorrhagi# *ever,DH*
• 7as#ular instabilit$
• De#reased vas#ular integrit$
• )ssault on ma#ro vas#ulature• De#reased platelet fun#tion
• 9n#reased vas#ular permeabilit$
• 7as#ular disruption and lo#al bleeds
• H$potension+ hemo#on#entration- sho#k
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 35/90
&riteria for DH*
• Fever, or recent history of acute fever
• Hemorrhagic manifestations
• Low platelet count (100,000/mm 3 orless)
• !"ective evi#ence of $lea%y capillaries&'
levate# hematocrit *0+ or more
more over !aseline or ≥ 50%
6o% albumin+ pleural effusion
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 36/90
Four Grades o DHF
3rade :*ever and nonspe#ifi# #onstitutional s$mptoms1ositive tourni8uet test is onl$ hemorrhagi#manifestation
3rade 2
3rade : manifestations spontaneous bleeding3rade C
/igns of #ir#ulator$ failure ,rapid;%eak pulse+narro% pulse pressure+ h$potension+
#old;#lamm$ skin3rade
1rofound sho#k ,undete#table pulse and B1
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 37/90
DH* ? &lini#al &riteria
his #hermome#er i++us#ra#es #he de!e+o*men#s in #he i++ness #ha# are
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 38/90
his #hermome#er i++us#ra#es #he de!e+o*men#s in #he i++ness #ha# are
*rogressi!e arning signs #ha# D22 ma' occur.
he ini#ia+ e!a+ua#ion is made $' de#ermining ho man' da's ha!e *assed
since #he onse# o s'm*#oms.
Mos# *a#ien#s ho de!e+o* D22 do so %,? da's a#er onse# o s'm*#oms.
hereore/ i a *a#ien# is se!en da's in#o #he i++ness/ i# is +i<e+' #ha# #he ors#is o!er.
I #he e!er goes $e#een #hree and siB da's a#er #he s'm*#oms $egan/ #his is
a arning signa+ #ha# #he *a#ien# mus# $e c+ose+' o$ser!ed/ as shoc< o#en
occurs a# or around #he disa**earance o e!er.
O#her ear+' arning signs #o $e a+er# or inc+ude a dro* in *+a#e+e#s/ an
increase in hema#ocri#/ or o#her signs o *+asma +ea<age.I 'ou documen# hemoconcen#ra#ion and #hrom$oc'#o*enia and o#her signs
o DHF and #he *a#ien# mee#s #he cri#eria or DHF/ #he *rognosis and #he
*a#ien#s ris< ca#egor' ha!e changed. hough dengue e!er does no# o#en
cause a#a+i#ies/ a grea#er *ro*or#ion o DHF cases are a#a+.
he neB# concern ou+d $e o$ser!a#ion o #he danger signsse!ere
a$domina+ *ain/ change in men#a+ s#a#us/ !omi#ing and a$ru*# change rome!er #o h'*o#hermia. hese o#en hera+d #he onse# o D22.
he goa+ o #rea#men# is #o *re!en# shoc<. he *+asma +ea<age s'ndrome is
se+,+imi#ed. I 'ou can su**or# #he *a#ien# #hrough #he *+asma +ea<age *hase
and *ro!ide suicien# +uids #o *re!en# shoc</ #he i++ness i++ reso+!e i#se+.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 39/90
Hemorrhagic Manies#a#ions o Dengue•/kin hemorrhages0pete#hiae+ purpura+ e##h$moses•3ingival bleeding
•(asal bleeding•3astrointestinal bleeding0 Hematemesis+ melena+ hemato#heia •Hematuria
•9n#reased menstrual flo%
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 40/90
&lini#al tests for DH*
• 1ete#hiae after tourni8uet test
• Avert bleed from previous 39 lesions
• 1latelet #ount less than :!!+!!!;ul
• 6o% pulse pressure+ #$anosis+ effusions
• H$potension+ /ho#k
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 41/90
Tourni8uet Test
nflate !loo# pressure cuff to a point
mi#way !etween systolic an# #iastolicpressure for - minutes
.ositive test& *0 or more petechiaeper 1 inch (*- cm)
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 42/90
Tourni8uet Test
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 43/90
Hemorrhagi# Manifestations
• 2%in hemorrhages&petechiae, purpura, ecchymoses
• 3ingival !lee#ing
• 4asal !lee#ing• 3astrointestinal !lee#ing&
hematemesis, melena, hematoche5ia
• Haematuria
• ncrease# menstrual flow
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 44/90
1ete#hiae
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 45/90
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 46/90
Danger 2igns in Dengue Hemorrhagic
Fe!er
• )bdominal pain - intense and sustained•1ersistent vomiting• )brupt #hange from fever to h$pothermia+%ith s%eating and prostration
•'estlessness or somnolen#e
)ll of these are signs of impending sho#k andshould alert #lini#ians that the patient needs #loseobservation and fluids.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 47/90
C+inica+ Case Deini#ion or Dengue 2hoc< 2'ndrome•) cri#eria or DHF
K•E!idence o circu+a#or' ai+ure manies#ed indirec#+' $'
a++ o #he o++oing•Ra*id and ea< *u+se•Narro *u+se *ressure P "= mm Hg0 OR
h'*o#ension or age•Co+d/ c+amm' s<in and a+#ered men#a+ s#a#us
•Fran< shoc< is direc# e!idence o circu+a#or' ai+ure
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 48/90
D22 GRADE III
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 49/90
&riteria for D//
• The four #riteria of DH*
• @viden#e of #ir#ulator$ failure
:. 'apid and %eak pulse
2. (arro% pulse pressue ,less than 2!mm
C. H$potension for the age
. &old #lamm$ skin5. )ltered mental status
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 50/90
*our 3rades of DH*;D//
• 3rade :
*ever+ &onst. /$mptoms+ ve tourni8uet test
• 3rade 23rade : /pontaneous bleeding
• 3rade C
/igns of #ir#ulator$ failure• 3rade
1rofound sho#k - B.1. 1ulse not re#ordable
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 51/90
&apillar$ Damage
@ h i 1 i bit l
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 52/90
@##h$mosis ? 1eriorbital@dema
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 53/90
6arge /ub#utaneous Bleed
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 54/90
PEI = A / B x 100
1leural @ffusion
D22 GRADE IV
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 55/90
D22 GRADE IV
dengue tourni8uet test DH*
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 56/90
dengue tourni8uet test DH*
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 57/90
DH* ; D//
9ntensive &are
A4$gen
'eh$dration
Barrier (ursing
Mos8uito /#reen
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 58/90
DH*- 1oor 1rognosti# /igns
• 3irl #hildren under :2 %ith DH*;D//
• /evere h$potension and sho#k
• Multifo#al bleeding ? abdominal pain• &(/ en#epahlopath$+ fits+ #oma
• >at#h for preorbital edema+ proteinuria
postural or other%ise h$potension• /erot$pe 2 infe#tion after t$pe
• Malnutrition is prote#tive
M t f DH*;D//
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 59/90
Management of DH*;D//
• &lose monitoring of h$potension;sho#k
• A4$gen administration
• 97. 9nfusion of #r$stalloids;#olloids
• 1latelet transfusion
• &lotting fa#tors repla#ement• &ase fatalit$ is 5E in good #enters
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 60/90
*luid Balan#e
• &ontinue monitoring after deferves#en#e
• /erial hemato#rits+ B1+ Frine output
• *luid repla#ement is t%i#e the re8uirement
• :5!! ml 2 4 ,%eight-2! ? for ! kg %t.
@g. G:5!! 2 4 ,!-2! 4 2
I G:5!! ,24 ! 4 2 I ,:5!! "!! 4 2
I 2C!! 4 2 I !! ml I :! pints
Fnusual 1resentations of
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 61/90
Fnusual 1resentations ofDengue
• @n#ephalopath$
• Hepati# damage
• &ardiom$opath$
• /evere 39 bleeding
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 62/90
2igns and 2'm*#oms oEnce*ha+i#is;Ence*ha+o*a#h' Associa#ed i#h
Acu#e Dengue Inec#ion•De#reased level of #ons#iousness0 letharg$+ #onfusion+ #oma•/eiures•(u#hal rigidit$
•1aresis
Diff ti l Di i
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 63/90
Differential Diagnosis
• *M #omple4
:. )ni#teri# leptospirosis
2. 'i#kettsial feversC. 9nfluena+ Measles+ 'ubella
• DH* ; D//
:. Ather hemorrhagi# fevers2. D9& due to septi#emia
C. &ompli#ated Malaria
. Meningo#o##emia
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 64/90
6aborator$ Diagnosis
• &omplete Blood &ounts
• Hemato#rit
• 1latelet &ount
• /erum 3AT+ 31T• /erum )lbumin
• 1roteinuria+ hematuria
• 9mmunologi#al Tests
• &hest /kiagram
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 65/90
6aborator$ Diagnosis
• 6eu#openia. Thrombo#$topenia
• 9n#reased /3AT+ /31T
• 'ising )b titre in paired sera
• )ntigen dete#tion @69/)
• 9gM-#apture @69/) %ithin fe% hours
• 'everse trans#ription 1&' #onfirmator$
• 9g3 @69/) signifi#ant of past infe#tion
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 66/90
7A5ORAOR4 CRIERIA
• I2O7AION OF DENQUE VIRU2
• INCREA2ED IgM OR IgM ANI5ODIE2 IRE2
• DENQUE ANIGEN DEECION 54IMMUNOHI2OCHEMI2R4/IMMUNOF7URO2CENCE/E7I2A
• 6CR
• 7EUCO6ENIA/HROM6OC4O6ENIA
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 67/90
9mmuno Dete#tion Tests
@69/) 1late 9gM-#apture @69/)
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 68/90
&ommon Mis#on#eptions- DH*
• Dengue bleeding I DH*
• DH* is fatal onl$ due to hemorrhage
(o Maorit$ of deaths are due to sho#k
• 1oorl$ managed D* turns into DH*
• 1ositive tourni8uet I DH*
it is not spe#ifi# for DH*+
it indi#ates #apillar$ fragilit$ of an$ origin
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 69/90
More &ommon Mis#on#eptions
• DH* is onl$ a pediatri# illness ?
(o+ )ll ages ma$ be involved
• DH* is a problem of poor families ?
(o+ in fa#t the$ ma$ not have
immune #omple4es to re8uired level
• Tourists %ill get DH* ?
(o+ in fa#t the$ are at lo% risk
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 70/90
9mmuniation
• @a#h serot$pe produ#es life long immunit$
• There is not effi#a#ious va##ine available
• 7a##ine needs to be tetravalent• 6ive attenuated va##ines possible
• /everal #andidate va##ines are on trials
• 9t ma$ be harmful to va##inate in vie%
of the pathogenesis of DH*;D//
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 71/90
3H4 3O 24NDROME2/
5ENIGN and 2EVERE8
O$ser!ed in #o immuno+ogica+se##ings.
1. 6rimar' inec#ions in inan#s.
". 2econdar' inec#ions in chi+drenand adu+#s.
6RIMAR4 INFECION2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 72/90
6RIMAR4 INFECION2
C+inica+ Fea#ures
4 In chi+dren
DEN 1 & % mi+d i++ness
DEN " & ) no i++ness
4 In adu+#s
DEN 1 & % Disease;Inec#ion 1 g.i. hemorrhages
ma' accom*an' *e*#ic u+cer disease.
DEN " & ) , mi+d , modera#e
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 73/90
o,inec#ions he e*idemio+ogica+ da#a
• DHF documen#ed in chi+dren S 1 'r0
ho circu+a#e inec#ion,ac(uireddengue an#i$od'. Four *ros*ec#i!e
cohor# and ? *ros*ec#i!e
*o*u+a#ion,$ased s#udies.
• In mos# s#udies/ DHF com*rises ",
- o secondar' inec#ions
DHF IN CHI7DREN 6RO26ECIVE
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 74/90
DHF IN CHI7DREN 6RO26ECIVE
COHOR 2UDIE2
References DHF/2o
Den Inf. DHF/10002o Den Inf.
Russell et al, !"#H
1$%&00,1'&(
)/() )&.1
*angawi+ha et al, !
120%&-), 1'(
/112 )-.$
ure et al, !"#H
)(%1$2, 1'((
$/-' 11(.&
raha et al,
!"#H &1%12, 1'''
$/120 -(.)
DHF IN CHI7DREN
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 75/90
DHF IN CHI7DREN
6RO26ECIVE 6O6U7AION,
5A2ED 2UDIE2References DHF/
2o Den Inf
DHF/1000
2o Den Inf
Halstead cad3ress 10$,1'(0 2-2(/12-,$2( 20.1
Russell et al !"#H
1(%&00,1'&(
))/2$00 12.2
*angawi+ha et al! 120%&-),1'(
1(/'20 1'.&
A26
DHF IN CHI7DREN
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 76/90
6RO26ECIVE 6O6U7AION,
5A2ED 2UDIE2References DHF/2o
Den Inf
DHF/1000
2o Den Inf
u4an et al!"#H 2%1$',1''0 121)/ -',($- 20.)
"hein et al !"#H
-&%-&&,1''$
1)(/1(1 )).0
u4an et al !1-2%$'), 2000
202/(10 2.0
Es#a$+ished second inec#ion
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 77/90
Es#a$+ished second inec#ion
se(uences +eading #o DHF
• " 1 hai+and Indonesia• % 1 hai+and• 1 " Cu$a/ 1>@1 Cu$a 1>> hai+and•
% " hai+and• ) " hai+and• 1 % Cu$a/ "==1 hai+and Indonesia• " % hai+and/ DF in Cu$a
• 1 ) hai+and• " ) Indonesia• % ) hai+and
/everal important features of dengue disease
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 78/90
/everal important features of dengue disease
• Dengue virus infe#tion #auses diverse disease spe#trum from
mild D* to severe DH*;D//.• Dengue disease #an o##ur in infant+ #hildren+ and adult.
• /evere DH*;D// is more prevalent in se#ondar$ infe#tion %ithdifferent serot$pe of dengue virus.
• )ntibod$-dependent enhan#ement is h$pothesied to e4plainthe severe DH*;D// in se#ondar$ infe#tion.
• Thrombo#$topenia and plasma leakage are t%o maor#hara#teristi#s of DH*;D//.
• The pathogenesis of DH*;D// is not #learl$ demonstrated. Theprogression from D* to DH*;D// is not predi#table.
• /upportive #are is the onl$ %a$ to treat the DH*;D// patients.
• Dengue va##ine is not #ommer#iall$ available $et.
DI*1NO2I2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 79/90
Classic symptoms 5 high fever, a petechial rash(ith thrombocytopenia 6 relative leu+openia7decrease in the number of circulating /3C in the
blood8 /9O de)nition of D9: 5 :ever 9aemorrhagic tendency ;positive tourniquet test
7< than %= petechiae per square inch8,
spontaneous bruising, bleeding from mucosa,gingiva, in>ection sites, vomiting blood or bloodydiarrhea?
Thrombocytopaenia ;@$==,=== platelets per mmA? "vidence of plasma lea+age ;rise in hematocrit
level < than %=.?
2erology 7identi)cation of antibodies in the bloodserum8 6 polymerase chain reaction 7BCR8 tocon)rm the diagnosis of dengue if clinicallyindicated
2BTO2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 80/90
2BTO2 2udden high fever 7&E#'$FGC8
for % to H days 9eadache Bain behind the eyesuscle pain, >oint pain, bone
pain 7brea+#bone fever8
*fter $ to % days of fever, thepatient develops initial rash(ith discoloured spots, oftendescribed as Isles of (hite ina sea of redJ
2econd rash may develop topalms and soles, and s+inmay peel o 7desquamate8 6body temperature drops
TR"*T"NT2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 81/90
TR"*T"NT2
No speci)c antiviral treatment, only supportivetreatment is given to such patients
If the patient is dehydrating, adequate !uids areto be ta+en
Intravenous !uid is administered if the patient isunable to maintain oral inta+e
:or severe body ache, pain+illers may be needed :or severe headache and for >oint and muscle
pain, acetaminophenKparacetamol and codeinemay be given
If there is signi)cant bleeding, blood or platelettransfusion (ill be carried out
Note : Aspirin should be avoided as this drugmay worsen the bleeding tendency (becauseof its anticoagulant eects & the increasedrisk of developing Reye syndrome)
BR"L"NTION2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 82/90
BR"L"NTION2
2TR*T"1I"2
Individual roles. Beople are urged toempty stagnant (ater from old tires,
trash cans 6 !o(er pots Mosquito control. Blace larvicide eg*bateM or any other suitable insecticidesinto any e-posed (ater container Usemosquito repellant sprays that containNND3 or D""T
Enforcement. 0ocal authorities froministry of 9ealth conduct on#site chec+ 6destroy larvae at residential premises 6construction sites :ines may be imposedon the o(ner of properties
There is currently no vaccineavailable for the dengue fever.
BR"L"NTION2
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 83/90
BR"L"NTION2
Fogging with insecticide. :ogging(ould be carried out by localauthorities in housing area (here % ormore cases of dengue fever arereported (ithin one (ee+
Information. In Nov %==H, theinistry of 9ealth carried out a ma>orcampaign against *edes During thecampaign free pac+ages of *bateM(ere distributed 0ea!ets 6 brochuresto inform the public on (ays toprevent 6 curb *edes breeding aredistributed
Awareness campaign. 2chools 6local communities are encouraged tocarry out communal cleaningactivities Bublic a(arenesscampaigns through strategicallyplaced posters 6 televisionadvertisements are also done
Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 84/90
Remove water from flowerpot plates onalternate days.
Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 85/90
Change water in vases on alternate days.
Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 86/90
Turn over all pails and waterstorage ontainers.
Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 87/90
Cover !am!oo pole holderswhen not in use.
Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 88/90
Clear !lo"ages and put #ti insetiide in roofgutters monthly.
$nwanted items$nwanted items
7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )
http://slidepdf.com/reader/full/copy-of-dengue-hemorrhagic-fever-kuliah- 89/90
Do not litter. Ru!!ish suh as upsand !ottles an ollet rain water
and !reed mos%uitoes.
Recommended