EMERGENCY ROOM NIGHT SHIFT CASE REPORT Dengue with vasculopathy On Wednesday, 2 ND SEPTEMBER 2015 GP on duty: dr. Wulan dr. Nita Supervisior : dr Soroy Lardo SpPD FINASIM (Divisi Tropik dan Infeksi Departemen Penyakit Dalam) Coass on duty: Ardian Ajeng Universitas Kristen Jakarta (UKRIDA) Indonesia Army Central Hospital Gatot Soebroto
23
Embed
Case report dengue with vasculopathy and the role of innate immunity
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
EMERGENCY ROOM NIGHT SHIFTCASE REPORT
Dengue with vasculopathy On Wednesday, 2ND SEPTEMBER 2015
GP on duty: dr. Wulan
dr. NitaSupervisior : dr Soroy Lardo SpPD FINASIM (Divisi Tropik dan Infeksi
Departemen Penyakit Dalam)Coass on duty:
Ardian Ajeng
Universitas Kristen Jakarta (UKRIDA)Indonesia Army Central Hospital Gatot Soebroto
PATIENT RECAPITULATION
Mr. B , 22 y.o , dengue hemorrhage feverMs. T , 24 y.o , dyspepsia Mrs. E , 45 y.o , GERDMr. P , 78 y.o , susp. Hepatitis BMrs. S , 57 y.o, ca mammaeMr. P, 67 y.o , GEA +low intakeMrs. V , 55 y.o, gastritisMrs W, 44 y.o, SIDA + low intake
Patient’s Identity
• Name : BP• MR no : 81 30 39• Sex : male• Age : 22 years old• Religion : Christian• Marital status : single• Ethnic : Javanese• Occupation : Army Soldier
History of Present IllnessPatient came to the ER with the complain of the fever he had since 2 days ago. Fever that he had occurred all day long, even with the anti fever medication. The complaint also came with the headache that occurred from behind his eye balls. He also had muscles and joints pain and loss of eating appetite. Patient often felt nausea, but never vomitted. Patient once came to the 24 hours clinic, but didn’t feel better and decided to go to the ER for a check up.
History of Past Illness
- Patient has never been hospitalized before- Patient has neither hypertention, diabetes,
PULMOInspection : chest within normal shape, symmetries
on static and dynamic statePalpation : tactile vocal fremitus in both of lungs were symmetries.Percussion : sonor in both of lungsAuscultation : Vesicular Breath Sound +/+, rhonki -/-, wheezing -/-
Abdomen : convex (+), intestinal motility (n), tenderness on epigastric regio.Extremities: no edema , petechiae (+) rumple leed (+)
RESUMEPatient came to the ER with the complain of the fever he had since 2 days ago. Fever that he had occurred all day long, even with the anti fever medication. The complaint also came with the headache that occurred from behind his eye balls. He also had muscles and joints pain and loss of eating appetite. Patient often felt nausea, but never vomitted. Patient once came to the 24 hours clinic, but didn’t feel better and decided to go to the ER for a check up. Blood pressure: 120/80 mmHg, Heart rate:90x/minute, Respiratory rate :22x/minute, Temperature:38,8 o C, petechiae (+), leukocyte : 5.620.
List of problems
• Dengue hemorrhage fever Grade 2
Problem Analysis
• 2 days fever with retroorbital pain, arthralgia, myalgia, tenderness in epigastric
Quo ad Vitam = bonamQuo ad functionam = bonamQuo ad sanationam = bonam
THANK YOU
Vasculopathy in DHF
Viral infection
Endotelial cell
CD4/8 ratio
inversion, IL-6 and
cytocine overproduction
Trombocyte
dysfunction and vascular damage
Innate immunity in DHF
Innate Imunity in DHF
• Interstitial dendritic cells (DCs) are believed to constitute the first line of the innate host defense against invading DV
• Early activation of natural killer (NK) cells and type-I interferon-dependent immunity may be also important in limiting viral replication at the early times of dengue infection