Jombang | myclick.net – The change of season occurs practically every year and, as in previous years, the rainy season is synonymous with the breeding season for various types of mosquitoes, one of which is the dengue fever mosquito.
As conveyed in the greeting of Jombang Hospital’s PR session, this time talking about DBD (Dengue Hemorrhagic Fever) with Dr. Dian Novita Kurniawati.
Infectious disease caused by dengue virus with clinical manifestations of fever, muscle aches and/or joint pains accompanied by leucopenia, rash, lymphadenopathy, thrombocytopenia and bleeding diathesis.
Viral etiology, dengue virus (genus flavivirus family Flaviridae), 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4) Cross-reaction between dengue serotype and other flaviviruses such as yellow fever, Japanese encephalitis, viruses of West Nile), transmission by vectors of Aedes dengue mosquitoes, especially Aedes aegypti and Aedes albopictus
thrombosipenia
1. Bone marrow suppression
2. Destruction and shortening of platelet life characteristics of early stage hypocellular bone marrow infection (<5 days) and suppression of megakaryocytes.
Clinical picture
* Asymptomatic/unusual fever
* Dengue
* Dengue hemorrhagic fever
* Dengue shock syndrome
* Expanded dengue syndrome
* Febrile phase 2-7 days followed by critical phase for 2-3 days
* Definitive diagnosis: isolation of dengue virus (cell culture) detection of dengue virus Ag RNA by RT-PCR technique, IGM serological test, anti-dengue IgG
Parameter laboratories
1. Leukocytes are normal or decreased, starting from day 3 there is relative lymphocytosis (> 45% total leukocytes) + lymphocytosis blue plasma > 15% total leukocytes in the shock phase will increase
2. Thrombosis of the penis on days 3-8
3. Increased hematocrit of liver plasma loss > 20% of initial liver, usually on day 3
4. PT/APTT hemostasis, D-dimer fibrinogen, FFP, bleeding is suspected due to blood coagulation disorders.
5. Protein/albumin: Hypotheinemia due to plasma leakage
6. SGOT/SGPT increases
7. Urea/creatinim: in case of impaired renal function
8. Serology
* IgM: from day 3-5 increases until week 3 disappears after 60-90 days
* IgG : primary infection detected on day 14 secondary infection detected on day 2.
9. NS1: detected at the beginning of the first to eighth days of fever
* Sensitivity 63-93.4% specificity 100%
* A negative result does not rule out dengue virus infection
* Radiologists: pleural effusion, especially hemithorax D
Dengue fever (DD) Probable dengue:
* Acute fever for 2-7 days marked 2/ more clinical manifestations
* headache
* retro-orbital nyeri
* Myalgia
* Arthralgia
* Rash
* Hemorrhagic manifestations (petechiae / porta tangle +)
* Leukopenia < 5000
* Platelets < 150,000
* Hctnaik 5-10%
*Positive dengue serology/found confirmed DHF/DHF patients at same location and time
Dengue hemorrhagic fever
* WHO 1997, all of these things are met
1. Fever/history of acute fever between 2-7 days is usually positive
2. There is at least 1 of the following manifestations:
* proof of the barrier
* petechiae, ecchymosis, purpura
* mucosal bleeding (epistaxis / bleeding gums / other places)
*hematemesis/melena
3. Thrombocytopenia <100,000
4. There is at least 1 sign of plasma leukemia -> DD/DD and DBD
* Increase in HCT >20% compared to standard
* HCT increase >20% after prior HCT fluid therapy in Bandung
* DD / typhoid fever, measles, influenza, chikungunya, leptospirosis
Dengue shock syndrome
* criteria: DHF + circulatory failure (fast, weak laughter, decreased blood pressure (<20 mm Hg), hypotension, cold, clammy, restless skin
Clarification of the degree of dengue virus infection
1. DD: fever + 2 /> signs
2. DHF grade I: above symptoms + positive test for containment
3. DHF grade II: above symptoms + spontaneous bleeding
4. DHF grade III: above symptoms + circulatory failure (cold clammy skin and restlessness)
5. DHF grade IV: Severe shock accompanied by TD and therefore not measurable
Therapy
1. Protocol I: Manage suspected (probable) adult DHF without shock
* Complaints of dengue
1. Hb, HCT, thrombosis N
2. Outpatient observation
3. Check Hb, HCT, leukocytes, platelets every 24 hours
2. Hb, hct N
* platelets 100,000 – 150,000
*outpatient observation
* check Hb, hct, leukocytes, platelets in 24 hours
3. Hb, hct N
* platelets < 100,000
* raw
4. Hb, hct, increase
* platelets N or decreased
* raw
2. Protocol 2: Fluid administration to suspected adult DHF under treatment
a. Hb, hct N, thrombosis <100,000 infus kristaloid, Hb, hct, thrombosis for 24 jams
b. Hb, hct N increase crystalloid, Hb, hct platelet infusion by 10-20% every 12 hours
c. Hb, hct increased >20%, platelets < 100.000 % protokol pemberian cairan DBD dengan hct meningkat > 20%
* required daily volume of crystalloid liquid
* formula: 1500 + 20x (BB in kg-20).
Titin Mujiati
