REFERAT

DENGUE HEMORRHAGIC FEVER

Doctor Receptor
dr. Alfred Siahaan, SpA

Arranged by :
Dora Elysia Octavia Pasaribu
1361050143

Kepaniteraan Klinik Ilmu Kesehatan Anak

Periode 7 Mei 2018 – 21 Juli 2018
Fakultas Kedokteran Universitas Kristen Indonesia Jakarta
 Introduction

 World Health Organization (WHO) states that

Dengue Hemorrhagic Fever (DHF) is the leading
cause of morbidity and mortality in Southeast Asia.

 At least 500,000 DHF patients require hospitalization

every year, where the proportion of patients is
mostly children and 2.5% of whom are reported to
have died.

 In Indonesia, DHF has been a public health problem

since the last 47 years. Since 1968 there has been an
increase in the number of provinces and districts /
cities from 2 provinces and 2 cities, to 34 provinces
and 436 (85%) districts / cities by 2015.
 Writing Purpose
 Knowing the definition, etiology, and pathophysiology of dengue
hemorrhagic fever.
 Provide appropriate therapy selection on dengue hemorrhagic management.
 DEFINITION & ETIOLOGY

Vector: Aedes aegypti, A.

Albopictus, A. polynesiensis

• Dengue hemorrhagic fever is an acute febrile illness caused by

Dengue virus.
• The Dengue Virus that causes Dengue Fever (DD), Dengue
Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) belongs
to the Arthropod Virus group B (Arbovirosis) now known as the genus
Flavivirus.
• Flaviviride family, and has 4 serotypes: Den -1, Den-2, Den-3, Den-4.
Secondary Theory Heterologous Infection / Infection
Enhancing Antibody (Halstead)

Antibody neutralizing = IgM

First Infection (+)
Not necessarily neutralize / DBD (-)
effective against other
dengue virus strains.

Host

Antibody non-neutralizing = IgG

Secondary The viruses easily
(+)
Infection enter the target
cells
Virus DEN 2,3,4
(different type of virus)
Antibody non-neutralizing = IgG
The viruses easily
(+)
enter the target
cells
Attacking mononuclear
cells, macrophages,
monocytes
Stick to the
Fc receptor on corresponding cell
the surface of surface
the infected cell
Virus
Replication
Immune
complex

Titer virus replication

on mononuclear cells
Immune
Complex Spread
 Virus increased Formation of
Replication immune complexes
(virus antibody dependent
enhancement)

Shock

1. Enabling complement system

2. Attached to the platelet surface
3. Damage Endothelial cells drh
vessels (stimulate / activation of
Intravascular
clotting factors)
complement activity
increases
 Release of C3a and
1. Enabling complement system C5a
(Vasculopati) (anaphylactoxine)

The permeability of the

vessel wall increases
Hemostasis disorders

Extra vascular Plasma

Expenditure
(Plasma leak)

2. Attached to the platelet

surface
Decreasing of the
(Thrombocytopenia)
platelet aggregation

3. Damage to endothelial cells of the

drh vessels (stimulating / activating
clotting factors)
(Koagulopathy)
Symptoms and Clinical Characteristics
of Dengue Heorrhagic Fever
Diagnose of Dengue Hemorrhagic
Fever
Clinical :
• sudden high fever
• bleeding (including torniquet test +)
• Hepatomegaly
• Shock

Lab:
• Thrombocytopenia (≤100,000 / μL)
• Hemoconcentration (Ht ≥20% of normal)

2 first clinical symptoms + 2 laboratory symptoms → DHF

DHF Grade According to WHO
 Management & Planning
 Management for DHF patients is divided into 3 (three) groups, which is
:

1. Treatment of group A patients

Treatment of patients without any warning signs, can drink enough and
with normal urine output.

2. Treatment of patient group B

Patients with warning signs or comorbidities (eg diabetes mellitus,
hypertension, heart or renal failure, sickle cell anemia) or in a risk
population (pregnant women, infants, elderly patients with drinking
difficulties).

3. Treatment of group C patients

Patients with severe dengue who require emergency care
Group B: Dengue with warning signs or
dehydration
Group C: Dengue with compensated shock
Group C : Dengue with decompensated
shock
Criteria for repatriating patients :
 No fever for 24 hours without antipyretics
 Appetite improves
 Clinically appears to be improved
 The hematocrit is stable
 Three days after shock resolved
 Platelet count> 50,000 / ml
 No respiratory distress
Prognosis

 Death by dengue fever is almost non-existent, whereas in DHF /

DSS the mortality is quite high. Studies in adults in Surabaya,

Semarang, and Jakarta show that prognosis and disease travel are

generally milder than children.

 Conclusion

 Dengue, a viral disease that is mediated by mosquitoes, often occurs in humans.

 Dengue virus infection in humans results in a spectrum of clinical manifestations

that vary among mild undifferentiated febrile illness, dengue fever, dengue
hemorrhagic fever and dengue shock syndrome.

 Management is to overcome the symptoms / complaints felt by patients to the

provision of replacement volume to overcome the circulation disturbance that
occurred.

 Prevention efforts are to break the chain of transmission and especially the
eradication of vector eradication. The prognosis of the disease is poor in
circumstances with the occurrence of Dengue Shock Syndrome.
 References
1. Pusat Data dan Informasi Kementerian Kesehatan RI. Infodatin: Situasi DBD di
Indonesia. Jakarta selatan. Kementerian Kesehatan RI, 2016.
2. Sudjana P. Buletin jendela epidemiologi demam berdarah dengue. Vol 2. Jakarta :
Pusat Data dan Surveilans Epidemiologi Kementerian Kesehatan RI, 2010. h.21-8.
3. Soedarmo SSS, Garna H, Hadinegoro SRS, Satari HI, penyunting. Buku ajar infeksi &
pediatri tropis. Edisi ke-2. Jakarta : Badan Penerbit IDAI, 2012.h.155-81.
4. Gouzard Veronique, Rigal Jean, Sutton Marianne. Clinical Guidelines diagnosis and
treatment manual. 2016. Ed. Medecins sans frontiers, 2016. 213 P.
5. Handbook for Clinical Management of Dengue. 2012. Ed. World Health Organization,
2012.
6. Roespandi H, Nurhamzah W, et all. Buku saku pelayanan kesehatan anak di rumah
sakit, pedoman bagi rumah sakit rujukan tingkat petama di kabupaten/ kota.
Jakarta : WHO Indonesia, 2008.h.162-6.
7. Kliegman RM, Stanton BMD, et all. Nelson textbook of pediatrics. 19th edition.
Canada : Elsevier Saunders,2011.p.1092-4.
8. Pudijadi AH, et all. Pedoman pelayanan medis ikatan dokter anak Indonesia.
Jakarta : IDAI, 2009.h. 141-9.