Dengue Hemorrhagic Fever

Supervised By : dr. Pulung M. Silalahi, Sp.A

Created : Siti Zulfah (1102014255)

Departement of Pediatric
Raden Said Sukanto Police Center Hospital
Faculty of Medicine YARSI
Rotation Period 28 January- 4 April 2019
LITERATURE REVIEW
 Dengue
infection

Dengue is a mosquito-borne
Dengue fever
(arbovirus) disease caused by
dengue viral infection.

dengue
hemorrhagic
fever (DHF).
 Dengue Hemorrhagic Fever (DHF) is
currently defined by the following four
World Health Organization (WHO) criteria:
• Fever or recent history of fever lasting 2–7
days.
• Any hemorrhagic manifestation.
• Thrombocytopenia (platelet count of
<100,000/ul).
• Evidence of increased vascular
permeability.
Epidemiology
 Etiology

Aegypti mosquito

Dengue virus

Human

Dengue infection
• Dengue virus :
• Dengue fever is a mosquito-borne viral disease caused by 1 of 4
closely related but antigenically distinct serotypes of dengue virus,
from the family Flaviviridae and genus Flavivirus. serotypes
DENV-1, DENV-2, DENV-3, and DENV-4
Transmission
 Pathogenesis

Secondary
Immune
heterologous
enhancement
infection
Risk factor of DHF
 Clinical Diagnosis

• Associated with repeated dengue infection.

• Acute onset of high fever and associated with signs &
symptoms similar to DF.
• Common hemorrhagic diatheses.
• Abnormal haemostasis and plasma leakage.
• Tendency to develop hypovolemic shock.
 Clinical Diagnosis

• Accoring to WHO :
• Fever: acute onset, high and continuous, lasting two
to seven days in most cases.
• Hemorrhagic manifestations (eg, hemoconcentration,
thrombocytopenia, ptechiae, positive tourniquet test)
• Circulatory failure, such as signs of vascular
permeability (eg,hypoproteinemia, effusions)
• Hepatomegaly
 Non-specific constitutional
symptoms observed in
haemorrhagic fever patients with
dengue
Petechiae
 Grading severity of
DHF
DF / DHF Grade Signs & Symptoms Laboratory
DF Fever with 2 following signs : - Leucopenia ( ≤5000 cells/mm3)
- Headache - Thrombocytopenia
- Retro-orbital pain ( ≤150.000 cells/mm3)
- Myalgia - Rising hematocrit (5-10%)
- Arthralgia/bone pain - No evidence of plasma loss
- Rash
- Hemorrhagic manifestations
- No evidence of plasma leakage

DHF I Fever & hemorrhagic manifestations and - Trombocytopenia <100.000

evidence of plasma leakage cells/mm3
- Hematocrit rising ≥20%

DHF II As in grade I plus spontaneous bleeding - Trombocytopenia <100.000 cells/

mm3
- Hematocrit rising ≥20%

DHF/DSS III As in grade I or II plus circulatory failure (weak - Trombocytopenia <100.000

pulse, narrow pulse pressure (≤ 20 mmHg), cells/mm3
hypotensive, restless - Hematocrit rising ≥ 20%

DHF/DSS IV As in grade III plus profound shock with - Trombocytopenia <100.000

undetectable BP & pulse cells/mm3
- Hematocrit rising ≥20%
 Laboratory Findings

• Thrombocytopenia < 100.000 /ul

• Hemoconcentration  rising hematocrite ≥ 20%.
• Hypoproteinemia/albuminemia.
• Hyponatremia, hypocalcemia.
• Prolonged partial thromboplastin time and prothrombin
time.
 Other examination
• Blue plasma lymphocyte (LPB).
• Platelet distribution width (PDW) dan mean platelet volume
(MPV).
• Virus isolation.
• Reverse transcriptionpolymerase chain reaction (RT-PCR).
• IgM and IgG Enzyme-Linked Immunosorbent Assay (ELISA).
• Antigen non structural protein 1 (NS-1) -> for early detection.
Can be use in the first day of fever or fever < 3 day
• Rontgen thorax and USG.
 Diagnosis

Phycical Other
Anamnesis
examination examination
Signs of recovery

• Stable pulse, blood pressure and breathing rate.

• Normal temperature.
• No evidence of external or internal bleeding.
• Return of appetite.
• No vomiting, no abdominal pain.
• Good urinary output.
• Stable hematocrit at baseline level.
• Convalescent confluent petechiae rash or itching,
especially on the extremities.
 Discharging
Criteria
Absence of fever
for at least 24 hours
Return of appetite.
without the use of
anti-fever therapy.

Visible clinical Satisfactory urine

improvement. output.
 Platelet count of more
No respiratory distress than 50 000/mm3. In
from pleural effusion most uncomplicated
and no ascites. cases, platelet rises to
normal within 3–5 days
Differential
Diagnoses
 Treatment

• Supportive care -> analgesics, fluid replacement, and bed

rest
• fluid management and proactive treatment of
hemorrhage
 Vector Control

Mosquito
Focus Fogging and Investigations
eradication nest
Mass Fogging. epidemiology.
(PSN) 4M plus.

Extension Partnership for

individual/groups dissemination of
to raise public dengue
awareness. prevention.
4M
 Complications

• Dengue encephalopathy
• Renal dysfunction
• Lung edema
• Expended dengue syndrom
 Prognosis

If not accompanied by shock

within 24-36 hours, usually
prognosis will be good.

If more than 36 hours there has

been no sign of improvement, the
possibility of recovery becomes
small and poor prognosis Dengue
causes of death is high at 41.5%.
 Prevention

• Wear N,N-diethyl-3-methylbenzamide (DEET)–

containing mosquito repellant
• Wear protective clothing, preferably impregnated with
permethrin insecticide
• The use of mosquito netting is of limited benefit,
as Aedes are day-biting mosquitoes
• Eliminate the mosquito vector
Vaccination
 Reference
• DAFTAR PUSTAKA

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