presentasi DHF

CASE REPORTDengue Haemorrhagic Fever

Presentators :Ummi Kaltsum Pulungan

Rizki Irwansyah

Supervisor :Prof. dr. H. Munar Lubis, Sp. A (K)

DEFENITION

• Dengue fever is an acute febril viral disease frequently presenting with headache, bone, or joint and muscular pain, rash and leukopenia as symptoms.

• Dengue haemorrhagic fever : high fever haemorrhagic phenomena,hepatomegaly sign of circulatory failure (severe case)

EPIDEMIOLOGY

Aedes aegypti, as vector•One distinct physical feature – black and white stripes on its body and legs.•Bites during the day.•Lays its eggs in clean, stagnant water.

Aedes mosquito

Female Aedes highly susceptible to dengue virus, feeds preferentially on human blood, is a daytime feeder,

On average, a female Aedes mosquito can lay about 300 eggs during her life span of 14 to 21 days.

1-2 days

Stagnant waterStagnant water

Pupae

4-5 days

Life cycle of the Aedes Mosquito

Larvae Eggs

2-3 days

Dengue Virus

• single-stranded RNA• It is an arbovirus, flavivirus

genus of the Flaviviridae family

• Has 4 serotypes :(DEN-1, DEN-2, DEN-3, DEN-4).

1. Virus transmittedto human in mosquitoSaliva

2. Virus replicatesin target organs

3. Virus infects whiteblood cells andlymphatic tissues

4. Virus released andcirculates in blood

TRANSMISSION

5. Second mosquitoingests virus with blood

6. Virus replicatesin mosquito midgutand other organs,infects salivaryGlands

7. Virus replicatesin salivary glands and when the mosquito bites another human, the cycle continues.

PATHOGENESIS

PATHOPHYSIOLOGY

The WHO guidelines propose the following classification for symptomatic dengue infection :

DIAGNOSIS

Clinical Manifestation

1. CLASIC DENGUE :• High grade fever• Severe headache• Retroorbital pain

• Fatigue• Severe myalgias

• Nausea and vomiting

2. Clinical Characteristics of Dengue Haemorrhagic Fever : (WHO)

3. Dengue Shock Syndrome

4 criteria for DHF + Evidence of circulatory failure

1. Rapid and weak pulse2. Narrow pulse pressure (<20 mmHg)3. Hypotension for age (this is defined as systolic

pressure < 80 mmHg for those less than five years of age, or <90 mmHg for those five years of age and older.)

4. Cold clammy skin and restlessness.

1. Rapid and weak pulse2. Narrow pulse pressure (<20 mmHg)3. Hypotension for age (this is defined as systolic

pressure < 80 mmHg for those less than five years of age, or <90 mmHg for those five years of age and older.)

4. Cold clammy skin and restlessness.

Grading of DHF

Laboratory tests• Clinical laboratory tests– CBC WBC, platelets, hematocrit– Albumin– Liver function tests– Urine check for microscopic hematuria

• Dengue-specific tests Virus isolation (cell culture) Serology IgM, IgG NS1 dengue Antigen RT-PCR HAI-test

DIFFERENTIAL DIAGNOSE

• Chikungunya • Yellow fever• Leptospirosis• ITP

MANAGEMENT of DHF

• There is no specific treatment for DHF• Symptomatic

Antipyretic : recommend paracetamol. Do not use aspirin and ibuprofen.

• Supportive treatment:Replacement of plasma loss is effective and proved life saving

• Efficient medical team/ lab facilities

COMPLICATION

• Electrolyte imbalance : Hyponatremia, Hypocalcemia

• Fluid overload (overhydration

• Large pleural effusions, ascites

• Disseminated intravascular coagulation

PROGNOSIS

Prognosis Depend on : • Early recognition of illness• Monitoring and appropriate fluid therapy

MEDICAL RECORD

OBJECTIVE

• The aim of doing this paper is to report a case of Dengue Hemorrhagic Fever Grade III for a 10 years old boy.

• The aim of doing this paper is to report a case of Dengue Hemorrhagic Fever Grade III for a 10 years old boy.

Vital Sign IGD September 16th 2010

Follow Up September 17th 2010

S : Fever (+), Vomiting (+) ↓, bloody stool (+) ↓↓

O: Sens : GCS 15 (E4V5M6) Temp : 37.7C; BW: 44.5 kg; BL: 141 cm;

BW/BL : 124% (obese); Ideal body weight: 35.4 kg

Head :

Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).

Ear/Mouth/Nose : within normal limit

Neck : Lymph node enlargement (-)

Thorax : Symmetrical fusiform , retraction (-)

HR: 120 x/i, regular, murmur (-)

RR : 24 x/i, regular, ronchi (-)

Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable

Extremities : Petechie (+), Pulse 120 x/i regular, adequate pressure/volume,

Blood pressure 110/70

A : Dengue Hemorrhagic Fever Grade II

P : 1. O2 1-2 L/I

2. IVFD RL 5cc/kgBW/hours

Line I 37 gtt/i macro

Line II 37 gtt/i macro

3. Paracetamol 3x500mg

4. Diet MII 1980 kkal with 80g protein


S : Fever (-), Vomiting (-), Bloody stool (-)



Head :








Extremities : Petechie (+), Pulse 90 x/i regular, adequate pressure/volume,



P : 1. O2 1-2 L/I

2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro




S : Fever (-)



Head :








Extremities : Pulse 90 x/i regular, adequate pressure/volume,



P : 1. O2 1-2 L/I

2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro



TestSept16th

2010Sept16th

2010Sept17th

2010Sept17th

2010Sept18th

2010NormalValue

Hb (g%) 15.30 12.00 9.71 9.62 9.30 10.7-17.1

RBC (/mm3) 6.28 x 106 5.03x 106 4.24x 106 3.81x 106 3.69x 106 3.75-4.95

WBC (/mm3) 11.80 x 103 5.92x 103 5.85x 103 5.28x 103 5.14x 103 6.0-17.5

Ht (%) 46.30% 37.00% 31.40% 28.20% 28.10% 38-52

PLT (/mm3) 48 x 103 24 x 103 40 x 103 81x 103 75x 103217-497

MCV (fL) 73.70 73.50 74.10 73.90 76.20 93-115

MCH (pg) 24.40 23.90 22.90 25.20 25.20 29-35

MCHC (g%) 33.10 32.50 30.90 34.10 33.10 28-34

RDW (%) 16.80 15.40 15.10 15.70 14.00 14,9-18,7

E/B/N/L/M 2/2/49/18/28 0/2/46/25/27 4/1/50/23/22 1/1/46/29/22 1/0/53/33/13

Electrolyte

Natrium (Na)

Kalium (K)

Chloride (Cl)

Cabohydrate metabolism

Blood Glucose ad Random

125 mEq

5.0 mEq

94 mEq

130 mg/dl

(135-155)

(3.6-5.5)

(96-106)

<200

Laboratory Result (September 16th 2010)

presentasi DHF

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