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LAPORAN KASUS:

INFEKSI DENGUE KONGENITAL

Case Report: Congenital Dengue Infection

Yudi Rakhmadi, Yulia Iriani, Herman Bermawi, Julniar M.Tasli,


Afifa Ramadanti, Indrayady
Departemen Kesehatan Anak RSUP Dr. Mohammad Hoesin Palembang

Abstrak
Latar Belakang: Infeksi dengue merupakan infeksi arbovirus yang tersebar di negara tropik termasuk
Indonesia. Virus dengue dapat ditransmisikan secara vertical. Neonatus tidak segera membentuk
antibodi protektif dan antibodi IgM maternal tidak ditransmisi transplasental menyebabkan kondisi
yang rentan. Kematian neonatus dapat dicegah dengan diagnosis dini dan penatalaksanaan adekuat.

Kasus: Bayi perempuan dari ibu usia 21 tahun G1P0A0 hamil 33 minggu dengan anhidramnion tanpa
pecah ketuban dan demam berdarah dengue (NS1+) lahir secara SC pasca pematangan paru 2 hari atas
indikasi anhidramnion dan trombositopenia (trombosit 39.000u/L). Ibu riwayat demam 5 hari
prepartum dan tidak memiliki riwayat penyakit lain. Laboratorium ibu lainnya dalam batas nomal

Investigasi: Bayi lahir menangis setelah rangsangan taktil, Apgar 8/9, BBL 2.000gram, PL 45cm,
lingkar kepala 30cm, meconeum (-), urin (-). Gerak aktif, refleks isap dan tangis kuat, tanda vital,
keadaan spesifik, dan reflek primitif normal. Kesan: pertumbuhan dan perkembangan sesuai usia gestasi
(Ballard 20). Demam muncul pada hari ke-4 dan terdiagnosis sepsis neonatorum dengan CRP 12mg/L,
LED 17mm/jam, sementara pemeriksaan LP normal. Diagnosis infeksi dengue tegak hari ke-7 dengan
NS1Ag(+) dan Dengue IgG(+) hari ke-8. Kadar trombosit menurun hingga 52.000/uL pada hari ke-8
dan meningkat mencapai kadar normal pada hari ke-10.

Tatalaksana dan luaran: Sejak lahir, bayi diinjeksi Vitamin K dan diberi ASI/2 jam lamanya 45-
60menit, diteruskan ASI on demand. Bayi menerima IVFD D10%1/5NS kecepatan 10cc/jam hingga 6
hari dan injeksi Ceftazidim 3x120 mg selama 14 hari sejak terdiagnosis sepsis neonatorum. Kondisi
bayi menurun postpartum hingga mencapai kovalesens pada hari ke 6 untuk seterusnya membaik dan
dipulangkan pada hari ke-14.

Kesimpulan: Tatalaksana bayi dengue kongenital serupa dengue anak. Pasien diberi cairan adekuat
dan dimonitor tiap 1-4 jam sampai melewati fase kritis, lalu cairan diperlambat dan distop saat tanda
vital stabil. Sepsis dapat disebabkan karena infeksi nosokomial, sehingga bayi diberi antibiotik
maksimal 14 hari.

Kata kunci:.dengue kongenital, diagnosis, tatalaksana


CASE REPORT:
CONGENITAL DENGUE INFECTION

Laporan Kasus: Infeksi Dengue Kongenital

Yudi Rakhmadi, Yulia Iriani, Herman Bermawi, Julniar M.Tasli,


Afifa Ramadanti, Indrayady
Pediatric Departement Dr. Mohammad. Hoesin Hospital Palembang

Abstract
Background: Dengue infection is arbovirus infection spread in tropical countries including Indonesia.
Dengue virus can be transmitted vertically. Neonates protective antibody are not formed immediately
and maternal IgM antibodies not transmitted transplasentally, leading to a vulnerable conditions.
Neonatal mortality can be prevented by early diagnosis and adequate management.

Case: A female baby was born by CS from 21-year-old mother G1P0A0 33 weeks gestational age
complicated with anhydramnios without rupture of membranes, dengue hemorrhagic fever (NS1+), and
thrombocytopenia (platelets 39,000u/L) after 2 days of fetal lung maturation. Mother had history of 5
days prepartum fever and no other diseases history. Other maternal laboratories were within nomal
limits

Investigation: Newborn baby crying after tactile stimulation, Apgar 8/9, BW 2000gram, BL 45cm, and
head circumference of 30cm, meconeum (-), urine (-). Active motion, strong suction reflex and cries,
normal vital signs, specific conditions, and primitive reflexes. Impression: growth and development
were according to gestational age (Ballard 20). Fever appeared on the 4th day and was diagnosed with
neonatal sepsis by CRP 12mg/L, LED 17mm/hour, while normal LP examination. Dengue infection
was diagnosed on the 7th day by NS1Ag(+) and Dengue IgG(+) on the 8th day. Platelet levels decreased
to 52000u/L on day 8 and increased to normal levels on the 10th day.

Management and outcome: Immediately postpartum, infants injected with Vitamin K and given breast
milk/2 hours of 45-60 minutes, followed by breast milk on demand. Babies receive IVFD D10% 1/5NS
at speeds of 10cc/hour to 6 days and injection of Ceftazidim 3x120 mg for 14 days since the diagnosis
of neonatal sepsis. Baby condition were decreases postpartum until it reaches covalesence on the 6th
day then improved and discharged on the 14th day.

Conclusion: Management of congenital dengue infants similar to children dengue. Babies are given
adequate fluids and monitored every 1-4 hours until they pass the critical phase, then the fluid is slowed
and stopped when vital signs are stable. Sepsis can be caused due to nosocomial infections, so babies
best given antibiotics up to 14 days.

Keywords: congenital dengue, diagnosis, treatment