Dengue hemorrhagic fever

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of
mosquitoes (Aedes aegypti).

Causes, incidence, and risk factors

Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever
occurs when a person catches a different type dengue virus after being infected by another one sometime
before. Prior immunity to a different dengue virus type plays an important role in this severe disease.
Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these
develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other
countries. It is possible, but uncommon, for a traveler who has returned to the United States to pass the
infection to someone who has not traveled.
Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection
and being younger than 12, female, or Caucasian.

Symptoms
Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days
the patient becomes irritable,restless, and sweaty. These symptoms are followed by a shock -like state.
Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the
skin (ecchymoses). Minor injuries may cause bleeding.
Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.
Early symptoms include:

Decreased appetite

Fever

Headache

Joint aches

Malaise

Muscle aches

Vomiting
Acute phase symptoms include:

Restlessness followed by:

o
Ecchymosis
o
Generalized rash
o
Petechiae
o
Worsening of earlier symptoms

Shock-like state
o
Cold, clammy extremities
o
Sweatiness (diaphoretic)

Signs and tests

A physical examination may reveal:

Enlarged liver (hepatomegaly)

Low blood pressure

Rash

Red eyes

Red throat

Swollen glands

Weak, rapid pulse

Tests may include:

Arterial blood gases

Coagulation studies

Electrolytes

Hematocrit

Liver enzymes

Platelet count
Serologic studies (demonstrate antibodies to Dengue viruses)
Serum studies from samples taken during acute illness and convalescence (increase in titer to
Dengue antigen)
Tourniquet test (causes petechiae to form below the tourniquet)
X-ray of the chest (may demonstrate pleural effusion)

Treatment
Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the
only treatment is to treat the symptoms.

A transfusion of fresh blood or platelets can correct bleeding problems

Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances

Oxygen therapy may be needed to treat abnormally low blood oxygen

Rehydration with intravenous (IV) fluids is often necessary to treat dehydration

Supportive care in an intensive care unit/environment

Expectations (prognosis)
With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of
untreated patients who go into shock do not survive.

Complications

Encephalopathy
Liver damage
Residual brain damage
Seizures
Shock

Dengue fever
Dengue fever is a virus-caused disease that is spread by mosquitoes.

Causes, incidence, and risk factors

Dengue fever is caused by one of four different but related viruses. It is spread by the bite of mosquitoes,
most commonly the mosquito Aedes aegypti, which is found in tropic and subtropic regions. This includes
parts of:

Indonesian archipelago into northeastern Australia

South and Central America

Southeast Asia

Sub-Saharan Africa

Some parts of the Caribbean

Dengue fever is being seen more often in world travelers.
Dengue fever should not be confused with Dengue hemorrhagic fever, which is a separate disease that is
caused by the same type of virus but has much more severe symptoms.

Symptoms
Dengue fever begins with a sudden high fever, often as high as 104 - 105 degrees Fahrenheit, 4 to 7 days
after the infection.
A flat, red rash may appear over most of the body 2 - 5 days after the fever starts. A second rash, which
looks like the measles, appears later in the disease. Infected people may have increased skin sensitivity
and are very uncomfortable.
Other symptoms include:

Fatigue

Headache (especially behind the eyes)

Joint aches

Muscle aches
Nausea
Swollen lymph nodes
Vomiting

Signs and tests

Tests that may be done to diagnose this condition include:

Antibody titer for dengue virus types

Complete blood count (CBC)

Polymerase chain reaction (PCR) test for dengue virus types

Treatment
There is no specific treatment for dengue fever. You will need fluids if there are signs
of dehydration. Acetaminophen (Tylenol) is used to treat a high fever. Avoid taking aspirin.

Expectations (prognosis)
The condition generally lasts a week or more. Although uncomfortable, dengue fever is not deadly. People
with the condition should fully recover.

Complications

Febrile convulsions
Severe dehydration

The febrile phase involves high fever, often over 40 C (104 F), and is associated with generalized pain
and a headache; this usually lasts two to seven days. Vomiting may also occur. A rash occurs in 5080%
of those with symptoms in the first or second day of symptoms as flushed skin, or later in the course of
illness (days 47), as a measles-like rash. Some petechiae (small red spots that do not disappear when
the skin is pressed, which are caused by broken capillaries) can appear at this point, as may some mild
bleeding from the mucous membranes of the mouth and nose. The fever itself is classically biphasic in
nature, breaking and then returning for one or two days, although there is wide variation in how often this
pattern actually happens.

Defenisi Demam Tifoid

Demam tifoid disebut juga dengan Typus abdominalis atau typoid fever.
Demam tipoid ialah penyakit infeksi akut yang biasanya terdapat pada saluran
pencernaan (usus halus) dengan gejala demam satu minggu atau lebih disertai
gangguan pada saluran pencernaan dan dengan atau tanpa gangguan kesadaran .
Infectious Agent
Demam tifoid disebabkan oleh bakteri Salmonella typhi atau Salmonella
paratyphi dari Genus Salmonella. Bakteri ini berbentuk batang, gram negatip, tidak
membentuk spora, motil, berkapsul dan mempunyai flagella (bergerak dengan
rambut
getar).
Salmonella typhi mempunyai 3 macam antigen, yaitu :
1. Antigen O (Antigen somatik), yaitu terletak pada lapisan luar dari tubuh
kuman. Bagian ini mempunyai struktur kimia lipopolisakarida atau disebut
juga endotoksin. Antigen ini tahan terhadap panas dan alkohol tetapi tidak
tahan terhadap formaldehid.
2. Antigen H (Antigen Flagella), yang terletak pada flagella, fimbriae atau pili
dari kuman. Antigen ini mempunyai struktur kimia suatu protein dan tahan
terhadap formaldehid tetapi tidak tahan terhadap panas dan alkohol.
3. Antigen Vi yang terletak pada kapsul (envelope) dari kuman yang dapat

melindungi kuman terhadap fagositosis.

Ketiga macam antigen tersebut di atas di dalam tubuh penderita akan
menimbulkan pula pembentukan 3 macam antibodi yang lazim disebut
aglutinin.
Patogenesis
Salmonella typhi dan Salmonella paratyphi masuk kedalam tubuh manusia
melalui makanan yang terkontaminasi kuman. Sebagian kuman dimusnahkan oleh
asam lambung dan sebagian lagi masuk ke usus halus dan berkembang biak.
Bila respon imunitas humoral mukosa IgA usus kurang baik maka kuman
akan menembus sel-sel epitel terutama sel M dan selanjutnya ke lamina propia.
Di lamina propia kuman berkembang biak dan difagosit oleh sel-sel fagosit terutama
oleh makrofag. Kuman dapat hidup dan berkembang biak di dalam makrofag dan
selanjutnya dibawa ke plaque Peyeri ileum distal dan kemudian ke kelenjar getah
bening mesenterika. Selanjutnya melalui duktus torasikus kuman yang terdapat di
dalam makrofag ini masuk ke dalam sirkulasi darah (mengakibatkan bakterimia
pertama yang asimtomatik) dan menyebar ke seluruh organ retikuloendotelial
tubuh
terutama hati dan limpa. Di organ-organ ini kuman meninggalkan sel-sel fagosit dan
kemudian berkembang biak di luar sel atau ruang sinusoid dan selanjutnya masuk
ke
dalam sirkulasi darah lagi yang mengakibatkan bakterimia yang kedua kalinya
dengan disertai tanda-tanda dan gejala penyakit infeksi sistemik, seperti demam,
malaise, mialgia, sakit kepala dan sakit perut.
Gejala Klinis
Gejala klinis demam tifoid pada anak biasanya lebih ringan jika dibanding
dengan penderita dewasa. Masa inkubasi rata-rata 10 20 hari. Setelah masa
inkubasi
maka ditemukan gejala prodromal, yaitu perasaan tidak enak badan, lesu, nyeri
kepala, pusing dan tidak bersemangat.
Kemudian menyusul gejala klinis yang biasa ditemukan, yaitu :
a. Demam
Pada kasus-kasus yang khas, demam berlangsung 3 minggu. Bersifat febris
remiten dan suhu tidak berapa tinggi. Selama minggu pertama, suhu tubuh
berangsurangsur meningkat setiap hari, biasanya menurun pada pagi hari dan
meningkat lagi
pada sore dan malam hari. Dalam minggu kedua, penderita terus berada dalam
keadaan demam. Dalam minggu ketiga suhu tubuh beraangsur-angsur turun dan
normal kembali pada akhir minggu ketiga.
b. Ganguan pada saluran pencernaan
Pada mulut terdapat nafas berbau tidak sedap. Bibir kering dan pecah-pecah
(ragaden) . Lidah ditutupi selaput putih kotor (coated tongue), ujung dan tepinya
kemerahan, jarang disertai tremor. Pada abdomen mungkin ditemukan keadaan
perut
kembung (meteorismus). Hati dan limpa membesar disertai nyeri pada perabaan.
Biasanya didapatkan konstipasi, akan tetapi mungkin pula normal bahkan dapat
terjadi diare.

c. Gangguan kesadaran
Umumnya kesadaran penderita menurun walaupun tidak berapa dalam,
yaitu
apatis sampai somnolen. Jarang terjadi sopor, koma atau gelisah

Typhoid fever
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Typhoid fever is an infection that causes diarrhea and a rash -- most commonly due to a type of bacteria
calledSalmonella typhi (S. typhi).
Causes
The bacteria that cause typhoid fever -- S. typhi -- spread through contaminated food, drink, or water. If
you eat or drink something that is contaminated, the bacteria enter your body. They travel into your
intestines, and then into your bloodstream, where they can get to your lymph nodes, gallbladder, liver,
spleen, and other parts of your body.
A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years,
spreading the disease.
Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each
year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

Symptoms
Early symptoms include fever, general ill-feeling, and abdominal pain. A high (typically over 103 degrees
Fahrenheit) fever and severe diarrhea occur as the disease gets worse.
Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the
abdomen and chest.
Other symptoms that occur include:

Abdominal tenderness
Agitation

Bloody stools

Chills

Confusion

Difficulty paying attention (attention deficit)

Delirium

Fluctuating mood

Hallucinations

Nosebleeds

Severe fatigue

Slow, sluggish, lethargic feeling

Weakness

Exams and Tests

A complete blood count (CBC) will show a high number of white blood cells.
A blood culture during the first week of the fever can show S. typhi bacteria.
Other tests that can help diagnose this condition include:

ELISA urine test to look for the bacteria that cause Typhoid fever
Fluorescent antibody study to look for substances that are specific to Typhoid bacteria

Platelet count (platelet count will be low)

Stool culture

Treatment
Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink
uncontaminated water with electrolyte packets.
Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance
throughout the world, so your health care provider will check current recommendations before choosing
an antibiotic.

Outlook (Prognosis)
Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early
treatment, but becomes poor if complications develop.
Symptoms may return if the treatment has not completely cured the infection.

Possible Complications

Intestinal hemorrhage (severe GI bleeding)

Intestinal perforation

Kidney failure

Peritonitis

PNEUMONIA
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up
of small sacs called alveoli, which fill with air when a healthy person breathes. When an
individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing
painful and limits oxygen intake.
Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an
estimated 1.2 million children under the age of five years, accounting for 18% of all deaths of
children under five years old worldwide. Pneumonia affects children and families everywhere,
but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from
pneumonia, it can be preventedwith simple interventions, and treated with low-cost, low-tech
medication and care.
Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The
most common are:
Streptococcus pneumoniae the most common cause of bacterial pneumonia in children;

Haemophilus influenzae type b (Hib) the second most common cause of bacterial pneumonia;
respiratory syncytial virus is the most common viral cause of pneumonia;
in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of
pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Transmission
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly
found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread
via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood,
especially during and shortly after birth. More research needs to be done on the different
pathogens causing pneumonia and the ways they are transmitted, as this has critical importance
for treatment and prevention.
Symptoms

The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral
pneumonia may be more numerous than the symptoms of bacterial pneumonia.
The symptoms of pneumonia include:
rapid or difficult breathing
cough
fever
chills
loss of appetite
wheezing (more common in viral infections).
When pneumonia becomes severe, children may experience lower chest wall indrawing, where
their chests move in or retract during inhalation (in a healthy person, the chest expands during
inhalation). Very severely ill infants may be unable to feed or drink and may also experience
unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose
immune systems are compromised are at higher risk of developing pneumonia. A child's immune
system may be weakened by malnutrition or undernourishment, especially in infants who are not
exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's
risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
living in crowded homes
parental smoking.
Treatment
Pneumonia caused by bacteria can be treated with antibiotics. These are usually prescribed at a
health centre or hospital, but the vast majority of cases of childhood pneumonia can be
administered managed effectively within the home with inexpensive oral antibiotics.
Hospitalization is recommended in infants aged two months and younger, and also in very severe
cases.
Prevention

Preventing pneumonia in children is an essential component of a strategy to reduce child

mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is
the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive
breastfeeding for the first six months of life. In addition to being effective in preventing
pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean
indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the
number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of
contracting pneumonia.
What are the symptoms?
Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged
with blood.
Fever.

Fast breathing and feeling short of breath.

Shaking and "teeth-chattering" chills. You may have this only one time or many times.

Chest pain that often feels worse when you cough or breathe in.

Fast heartbeat.

Feeling very tired or feeling very weak.

Nausea and vomiting.

Diarrhea.
When you have mild symptoms, your doctor may call this "walking pneumonia."
Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may
have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in
how well they think. Confusion ordelirium is common. Or, if they already have a lung disease, that disease
may get worse.
Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly
and often are not as obvious or as bad.

MEASLES
Measles is a highly contagious, serious disease caused by a virus. In 1980, before
widespread vaccination, measles caused an estimated 2.6 million deaths each year.

It remains one of the leading causes of death among young children globally, despite the
availability of a safe and effective vaccine. An estimated 139 300 people died from measles in
2010 mostly children under the age of five.
Measles is caused by a virus in the paramyxovirus family. The measles virus normally
grows in the cells that line the back of the throat and lungs. Measles is a human disease and is
not known to occur in animals.
Accelerated immunization activities have had a major impact on reducing measles deaths.
From 2001 to 2011 more than one billion children aged 9 months to 14 years who live in high
risk countries were vaccinated against the disease. Global measles deaths have decreased by 74%
from 535 300 in 2000 to 139 300 in 2010.
Signs and symptoms
The first sign of measles is usually a high fever, which begins about 10 to 12 days after
exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes,
and small white spots inside the cheeks can develop in the initial stage. After several days, a rash
erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually
reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the
rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).
Severe measles is more likely among poorly nourished young children, especially those
with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or
other diseases.
Most measles-related deaths are caused by complications associated with the disease.
Complications are more common in children under the age of five, or adults over the age of 20.
The most serious complications include blindness, encephalitis (an infection that causes brain
swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory
infections such as pneumonia. As high as 10% of measles cases result in death among
populations with high levels of malnutrition and a lack of adequate health care. People who
recover from measles are immune for the rest of their lives.
Who is at risk?
Unvaccinated young children are at highest risk of measles and its complications,
including death. Any non-immune person (who has not been vaccinated or was vaccinated but
did not develop immunity) can become infected.
Measles is still common in many developing countries particularly in parts of Africa and Asia.
More than 20 million people are affected by measles each year. The overwhelming majority
(more than 95%) of measles deaths occur in countries with low per capita incomes and weak
health infrastructures.
Measles outbreaks can be particularly deadly in countries experiencing or recovering
from a natural disaster or conflict. Damage to health infrastructure and health services interrupts
routine immunization, and overcrowding in residential camps greatly increases the risk of
infection.
Transmission
The highly contagious virus is spread by coughing and sneezing, close personal contact
or direct contact with infected nasal or throat secretions.
The virus remains active and contagious in the air or on infected surfaces for up to two hours. It
can be transmitted by an infected person from four days prior to the onset of the rash to four days
after the rash erupts.

Measles outbreaks can result in epidemics that cause many deaths, especially among
young, malnourished children. In countries where measles has been largely eliminated, cases
imported from other countries remain an important source of infection.
Treatment
Severe complications from measles can be avoided though supportive care that ensures
good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral
rehydration solution. This solution replaces fluids and other essential elements that are lost
through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections,
and pneumonia.
All children in developing countries diagnosed with measles should receive two doses of
vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness.
Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.
Prevention
Routine measles vaccination for children, combined with mass immunization campaigns
in countries with high case and death rates, are key public health strategies to reduce global
measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and
inexpensive. It costs less than one US dollar to immunize a child against measles.
The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries
where these illnesses are problems. It is equally effective in the single or combined form.
In 2010, about 85% of the world's children received one dose of measles vaccine by their first
birthday through routine health services up from 72% in 2000. Two doses of the vaccine are
recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity
from the first dose.

Measles
Measles is a very contagious (easily spread) illness caused by a virus.

Causes, incidence, and risk factors

The infection is spread by contact with droplets from the nose, mouth, or throat of an infected person.
Sneezing and coughing can put contaminated droplets into the air.
Those who have had an active measles infection or who have been vaccinated against the measles
have immunity to the disease. Before widespread vaccination, measles was so common during childhood
that most people became sick with the disease by age 20. The number of measles cases dropped over
the last several decades to almost none in the U.S. and Canada. However, rates have started to rise
again recently.
Some parents do not let their children get vaccinated because of unfounded fears that the MMR vaccine,
which protects against measles, mumps, and rubella, can cause autism. Large studies of thousands of
children have found no connection between this vaccine and autism. Not vaccinating children can lead to
outbreaks of a measles, mumps, and rubella -- all of which are potentially serious diseases of childhood.

Symptoms

Symptoms usually begin 8 - 12 days after you are exposed to the virus. This is called the incubation
period.
Symptoms may include:

Bloodshot eyes
Cough
Fever
Light sensitivity (photophobia)
Muscle pain

Rash
o

Usually appears 3 - 5 days after the first signs of being sick

May last 4 - 7 days

Usually starts on the head and spreads to other areas, moving down the body
Rash may appear as flat, discolored areas (macules) and solid, red, raised areas
(papules) that later join together

Itchy

Redness and irritation of the eyes (conjunctivitis)

Runny nose

Sore throat

Tiny white spots inside the mouth (Koplik's spots)

Signs and tests

Measles serology

Viral culture (rarely done)

Treatment
There is no specific treatment for the measles.
The following may relieve symptoms:

Acetaminophen (Tylenol)

Bed rest

Humidified air

Some children may need vitamin A supplements. Vitamin A reduces the risk of death and complications in
children in less developed countries, where children may not be getting enough vitamin A. People who
don't get enough vitamin A are more likely to get infections, including measles. It is not clear whether
children in more developed countries would benefit from supplements.

Expectations (prognosis)

Those who do not have complications such as pneumonia do very well.

Complications
Complications of measles infection may include:

Bronchitis
Encephalitis (about 1 out of 1,000 measles cases)
Ear infection (otitis media)
Pneumonia

Patofisiologi
Virus campak ditularkan lewat infeksi droplet lewat udara, menempel dan berkembang biak
pada epitel nasofaring. Tiga hari setelah invasi, replikasi dan kolonisasi berlanjut pada kelenjar
limfe regional dan terjadi viremia yang pertama. Virus menyebar pada semua sistem
retikuloendotelial dan menyusul viremia kedua setelah 5-7 hari dari infeksi awal. Adanya giant
cells dan proses keradangan merupakan dasar patologik ruam dan infiltrat peribronchial paru.
Juga terdapat udema, bendungan dan perdarahan yang tersebar pada otak. Kolonisasi dan
penyebaran pada epitel dan kulit menyebabkan batuk, pilek, mata merah (3 C : coryza, cough
and conjuctivitis) dan demam yang makin lama makin tinggi. Gejala panas, batuk, pilek makin
lama makin berat dan pada hari ke 10 sejak awal infeksi (pada hari penderita kontak dengan
sumber infeksi) mulai timbul ruam makulopapuler warna kemerahan.Virus dapat berbiak
juga pada susunan saraf pusat dan menimbulkan gejala klinik encefalitis. Setelah masa
konvelesen pada turun dan hipervaskularisasi mereda dan menyebabkan ruam menjadi makin
gelap, berubah menjadi desquamasi dan hiperpigmentasi. Proses ini disebabkan karena pada
awalnya terdapat perdarahan perivaskuler dan infiltrasi limfosit