Paediatrica Indonesiana

November 

VOLUME 49

NUMBER 6

Original Article

Serum zinc levels and clinical severity of dengue

infection in children
Nuke Yuliana, RM Ryadi Fadil, Alex Chairulfatah

Abstract
Background,PPXQRSDWKRJHQHVLVRIGHQJXHLQIHFWLRQUHYHDOV
the aberrant immune response. Zinc deficiency alters immune
UHVSRQVHDQGWKHUHIRUHPD\DVVRFLDWHGZLWKFOLQLFDOVHYHULW\RI
dengue infection.
Objective 7RLQGHQWLI\WKHUHODWLRQVKLSEHWZHHQVHUXP]LQFOHYHOV
and clinical severity of dengue infection in children.
Methods $FRPSDUDWLYHVWXG\ZDVFRQGXFWHGDWWKH'HSDUWPHQW
of Child Health Hasan Sadikin Hospital Bandung, from February
to March :HLQFOXGHGFKLOGUHQDJHG\HDUVIXOILOOHGWKH
FOLQLFDOFULWHULDIRUGHQJXHIHYHU')GHQJXHKHPRUUKDJLFIHYHU
'+)DQGGHQJXHVKRFNV\QGURPH'66DFFRUGLQJWR:+2
 FRQILUPHG ZLWK VHURORJLF WHVW 6XEMHFWV ZHUH VHOHFWHG
consecutively until met the sample size for each group. Serum
]LQF OHYHO ZHUH PHDVXUHG ZLWK DWRPLF DEVRUSWLRQ VSHFWURVFRS\
$$6RQDGPLVVLRQ'DWDZHUHDQDO\]HGXVLQJ.UXVNDO:DOOLVDQG
3HDUVRQFKLVTXDUHWHVW6LJQLILFDQFHZDVFRQVLGHUHGLI3
Results 7KHVHUXP]LQFOHYHOVZHUHORZLQFKLOGUHQ
7KHVHUXP]LQFOHYHOLQ')'+)DQG'66VXEMHFWVZHUH;
6' JG/;6' JG/
DQG;6' JG/UHVSHFWLYHO\3<0.001
7KHSUHYDOHQFHUDWLRRI')WR'+)DQG'+)WR'66ZHUH
3 DQG3 UHVSHFWLYHO\
Conclusion /RZVHUXP]LQFOHYHOZHUHVLJQLILFDQWO\GLIIHUHQWLQ
HDFKFOLQLFDOVHYHULW\RIGHQJXHLQIHFWLRQ+RZHYHUORZVHUXP]LQF
OHYHOZDVQRWDULVNIDFWRUIRUWKHGHYHORSPHQWRIVHYHUHGHQJXH
infection in children. [Paediatr Indones. 2009;49:309-14].
Keywords: serum zinc levels, dengue infection,
clinical severity

engue infection is an immediate problem

and it has become a leading cause of child
mortality in South and Southeast Asia and
Central and South America.7KH:RUOG
+HDOWK 2UJDQL]DWLRQ :+2 HVWLPDWHV WKDW PRUH
WKDQELOOLRQSHRSOHDUHDWULVNRIGHQJXHLQIHFWLRQ
2IDQHVWLPDWHGFDVHVRI'+)'66UHTXLULQJ
KRVSLWDOL]DWLRQHDFK\HDUURXJKO\GLHDFFRUGLQJWR
:+2VWDWLVWLFVDOWKRXJKFDVHIDWDOLW\FRXOGEHWZLFH
as high.7KHGLVHDVHPRVWO\DIIHFWHGFKLOGUHQDQG
SHUFHQWRIFDVHVRFFXUHGLQWKHDJHJURXSEHORZ
\HDUV
7KHSDWKRJHQHVLVRIVHYHUHGHQJXHLVQRWZHOO
understood. Various mechanisms have been suggested
to explain the pathogenesis of severe dengue,
LQFOXGLQJDQWLERG\GHSHQGHQWHQKDQFHPHQWRU$'(
FRPSOHPHQWDFWLYDWLRQE\YLUXVDQWLERG\FRPSOH[HV
7FHOOPHGLDWHGLPPXQRSDWKRORJ\DQGGLIIHUHQFHVLQ
virulence of viral genotypes.
Serum zinc levels have been studied more
UHFHQWO\ WR EH FRUUHODWHG ZLWK VHYHULW\ RI GHQJXH
LQIHFWLRQ :LGDJGR found the mean serum zinc

From the Departement of Child Health, Medical School, Padjajaran

University, Hasan Sadikin Hospital.
Reprint requests to: Nuke Yuliana, MD, Department of Child Health,
Medical School, Padjadjaran University, Hasan Sadikin General Hospital,
-O3DVWHXU1R%DQGXQJ,QGRQHVLD7HO
)D[(PDLOQXNHPXO\D#JPDLOFRP

Paediatr Indones, Vol. 49, No. 6, November 2009309

Nuke Yuliana et al : Serum zinc level and clinical severity of dengue infection

OHYHOV ZDV ORZHU WKDQ QRUPDO EXW WKHUH ZDV QR

DVVRFLDWLRQEHWZHHQVHUXP]LQFOHYHOVDQGVHYHULW\RI
WKHGLVHDVH+RZHYHULQWKDWVWXG\WKHQXPEHUVRI
VXEMHFWVIRUHDFKJURXSZHUHQRWSURSRUWLRQDO=LQF
LVHVVHQWLDOIRUOLIHZLWKLWVLQYROYHPHQWLQLPPXQH
function, including the skin barrier, gene regulation
ZLWKLQ O\PSKRF\WHV DQG QRUPDO GHYHORSPHQW DQG
function of cells mediating nonspecific immunity, such
as neutrophils and natural killer cells. Zinc deficiency
can result in impairment of the immune system and
may increase the risk of morbidity and mortality due
to infection.
7KH DLP RI WKLV VWXG\ ZDV WR LQGHQWLI\ WKH
UHODWLRQVKLS EHWZHHQ VHUXP ]LQF OHYHOV DQG FOLQLFDO
severity of dengue infection in children.

Methods
:HFRQGXFWHGDFRPSDUDWLYHVWXG\DWWKH'HSDUWPHQW
of Child Health Hasan Sadikin Hospital Bandung,
from February to March  7KH VXEMHFWV LQ WKH
VWXG\ ZHUH FKLOGUHQ DJHG   \HDUV DGPLWWHG WR
the Department of Child Health Hasan Sadikin
+RVSLWDO %DQGXQJ ZKR IXOILOOHG WKH FOLQLFDO FULWHULD
IRU ') '+) RU '66 DFFRUGLQJ WR :+2 
FRQILUPHGZLWKVHURORJLFWHVW6XEMHFWVZHUHVHOHFWHG
consecutively until met the sample size for each group
 VXEMHFWV 7KH H[FOXVLRQ FULWHULD ZHUH VHYHUH
malnutrition or obesity, had been diagnosed of other
illness besides dengue infection during hospitalisation,
had been taking immunosuppresion therapy or zinc
VXSOHPHQWDWLRQIRUWZRZHHNVEHIRUHDGPLVVLRQ
7KH VHURORJLF WHVW ZDV WDNHQ ZLWK UDSLG WHVW
dengue blot using Panbio dengue duo cassette kit.
3ULPDU\LQIHFWLRQLIWKHUHVXOWZDVQHJDWLYH,J0DQG
,J* VHFRQGDU\ LQIHFWLRQ LI WKH UHVXOW ZDV SRVLWLYH
,J*ZLWKSRVLWLYHRUQHJDWLYH,J06HUXP]LQFOHYHO
ZHUHPHDVXUHGZLWKDWRPLFDEVRUSWLRQVSHFWURVFRS\
$$6RQDGPLVVLRQZLWKQRUPDOOHYHOZDV
JG/
7KH SDWLHQWV ZHUH FDWHJRUL]HG LQWR ') DQG
VHYHUH GHQJXH LQIHFWLRQ '+)'66 'DWD ZDV
DQDO\]HGXVLQJ.UXVNDO:DOOLVDQG3HDUVRQFKLVTXDUH
WHVW 6LJQLILFDQFH ZHUH FRQVLGHUHG LI 3<0.05. All
VWDWLVWLFDQDO\VHZDVSHUIRUPHGXVLQJ6366YHUVLRQ
IRU:LQGRZV6366,QF&KLFDJR,OOLQRLV
USA.

310Paediatr Indones, Vol. 49, No. 6, November 2009

7KLVVWXG\ZDVDSSURYHGE\(WKLFV&RPPLWWHH
of Medical Faculty of Padjadjaran University, Hasan
6DGLNLQ +RVSLWDO %DQGXQJ :ULWWHQ FRQVHQW ZDV
obtained from the parents for each patient before
enrolling in the study.

Results
7KH FKDUDFWHULVWLFV RI WKH VXEMHFWV DQG FOLQLFDO
PDQLIHVWDWLRQVRIERWKJURXSVDUHVKRZQLQTable 1
and Table 2, respectively.
Table 3 VKRZVWKDWFKLOGUHQZKRVXIIHUHG
VHYHUH GHQJXH LQIHFWLRQ '+)'66 UHYHDOHG
VHFRQGDU\LQIHFWLRQFRPSDUHGWRFKLOGUHQZKR
VXIIHUHGPLOGGHQJXHLQIHFWLRQ')3<0.057KH
HOHYDWHGKHPRJORELQDQGKHPDWRFULWZHUHIRXQGLQ
DHF and DSS (P<0.05/HXNRSHQLDZDVIRXQGLQ
FKLOGUHQ7KHVHUXP]LQFOHYHOVZDVORZLQ
FKLOGUHQ7KHVHUXP]LQFOHYHOLQ')'+)
DQG'66VXEMHFWVZHUH;6' 
JG/  ;  6'     JG/ DQG
 ;  6'     JG/ UHVSHFWLYHO\
(P<0.001
0DQQ:KLWQH\ DQDO\VLV DV VHHQ LQ Table 4
revealed the comparison of serum zinc level for each
FOLQLFDOVHYHULW\ZDVVLJQLILFDQWO\GLIIHUHQW+RZHYHU
the prevalence ratio of DF to DHF and DHF to DSS
(Table 5 and Table 6) ZHUH  P  DQG
P UHVSHFWLYHO\

Discussion
:HIRXQGQRGLIIHUHQFHVLQDJHGLVWULEXWLRQVVH[DQG
length of fever among the clinical severity of dengue
infection (P<0.05+XQJHWDODQG7DZHHSRQJDQG
SupapanIRXQGQRDVVRFLDWLRQEHWZHHQVH[RUDJH
DQGWKHVHYHULW\RIWKHGLVHDVH+RZHYHU+DPPRQG
et al and Junia et alIRXQGWKDWFKLOGUHQEHWZHHQ
five and nine year old have higher risk for severe
GHQJXHLQIHFWLRQ,QWKLVVWXG\ILIWHHQFKLOGUHQ
LQ '+) KDG QRUPDO QXWULWLRQ 7KLV\DNRUQ DQG
NimmannityaIRXQGWKDWPRVWSDWLHQWVZLWK'+)
ZHUHQRWXQGHUQRXULVKHG
Upper respiratory symptoms such as cough and
LQMHFWHGSKDU\Q[ZDVIRXQGLQVXEMHFWV$OWKRXJK
XSSHU UHVSLUDWRU\ V\PSWRPV ZHUH QRW LQFOXGHG LQ

Nuke Yuliana et al : Serum zinc level and clinical severity of dengue infection

the diagnostic criteria of dengue infection, but some

DHF patients may complain of sore throat, and an
injected pharynx may be found in examination.
+HSDWRPHJDO\ ZDV PRVWO\ IRXQG LQ '66 DQG '+)
Narayanan et alLQDVWXG\RI'+)FDVHVIRXQG
KHSDWRPHJDO\LQFDVHVDQGHOHYDWHGOLYHU
HQ]\PHV LQ PRUH WKDQ  RI FDVHV 7KH HOHYDWHG
KHPRJORELQDQGKHPDWRFULWZHUHIRXQGLQ'+)DQG
DSS (P<0.057DZHHSRQJDQG6XSDSDQ found the
ULVNIRU'+)ZDVDQLQFUHDVHLQKHPRFRQFHQWUDWLRQ
RIPRUHWKDQIURPEDVHOLQH

 :H IRXQG WKDW FKLOGUHQ ZKR VXIIHUHG VHYHUH

GHQJXH LQIHFWLRQ '+)'66 UHYHDOHG VHFRQGDU\
LQIHFWLRQ FRPSDUHG WR FKLOGUHQ ZKR VXIIHUHG PLOG
GHQJXH LQIHFWLRQ ') 7DQWUDFKHHZDWKRUQ DQG
7DQWUDFKHHZDWKRUQ and Hammond et al found
VHFRQGDU\LQIHFWLRQZDVDULVNIDFWRUIRUVHYHUHGHQJXH
LQIHFWLRQ 6HFRQGDU\ LQIHFWLRQV KDYH EHHQ VKRZQ
to lead to higher viral loads and the manifestations
of severe dengue are believed to be due to virus
UHSOLFDWLRQ ZKLFK LQGXFHV LQIHFWHG PRQRF\WHV WR
release vasoactive mediators.7KLVREVHUYDWLRQFDQ

Table 1. Characteristics of the subjects

Clinical severity

Sex
Male
Female
Age (years)
0-4
5-9
10-14
Nutritional status
Normal nutrition
Under nutrition
Length of fever (day)
2-3
4-5
6-7
Note: * = Pearsons chi square test (C2)

DF (n=20)

DHF (n=20)

DSS (n=20)

13
7

9
11

11
9

9
6
5

7
7
6

5
10
5

7
13

15
5

8
12

1
14
5

0
12
8

0
6
14

Table 2. Clinical manifestations of the subjects

Clinical severity

URTI
Negative
Positive
Spontaneous Bleeding
Negative
Positive
Epigastric pain
Negative
Positive
Hepatomegaly
Negative
Positive
Rumple Leede
Negative
Positive
Notes: * = Pearsons chi square test (C2)
URTI = Upper respiratory tract infection

DF (n=20)

DHF (n=20)

DSS (n=20)

18
2

15
5

18
2

17
3

17
3

14
6

5
15

4
16

0
20

11
9

6
14

6
14

8
12

10
10

Paediatr Indones, Vol. 49, No. 6, November 2009311

Nuke Yuliana et al : Serum zinc level and clinical severity of dengue infection

Table 3.CDQTCVQT[PFKPIUQHVJGUWDLGEVU
Clinical Severity
P value
Type of Infection (IgG/IgM)
Secondary / IgG(+)
Primary / IgG(-)
Hemoglobin
Mean (SD)
Median
Interval
Hematocrit
Mean (SD)
Median
Interval
Leukocyte count
Decrease
Normal
Increase
Serum zinc level (g/dL)
Mean (SD)
Median
Interval

DF (n=20)

DHF (n=20)

DSS (n=20)

13
7 (35%)

17
3 (15%)

20
0

12 (1.5)
11.7
9.5 14.8

13.9 (2.2)
14.1
9.8 17.7

14.4 (1.4)
14.5
11.7 17.1

<0.001***

35.4 (4.2)
34
30 43

40.9 (5.1)
42
30 49

43 (4.8)
43
34 52

<0.001**

17
3
0

14
5
1

10
10
0

0.088**

68.2 (8.3)
68
56-81

61.6 (8.7)
59
50-77

42.7 (5.4)
41
35-52

<0.001**

0.012*

Notes:
*= Pearsons chi square test (F2)
**= Kruskal-Wallis chi square test (F2KW)
*** = analysis of variance/ANOVA (F test)
SD=Standard deviation

Table 4. Comparison of serum zinc level for each clinical

spectrum
Clinical Severity
Comparing
Compared
DF
DF
DHF

Differentiation of
Serum Zinc level

5KIPKECPE[

6.95
23.65
16.7

0.009
0.000
0.000

DHF
DSS
DSS

Table 5. The prevalence ratio of serum zinc level for DHF

Serum zinc level Clinical Severity Prevalence ratio P value*
(95% CI)
DF
DHF
Decrease
Normal

12
8

15
5

1.444
(0.672-3.107)

0.311

Note: *= Pearson chi square test (F2)

Table 6. The prevalence ratio of serum zinc level for DSS

Serum zinc level

Clinical Severity
DHF

Decrease
Normal

15
5

DSS
19
1

Prevalence
P value*
ratio
(95% CI)
3.353
0.077
(0.547-20.569)

Note: *= Pearson chi square test (F2)

312Paediatr Indones, Vol. 49, No. 6, November 2009

be explained by the theory of immune enhancement.

&URVVUHDFWLYH QRQQHXWUDOL]LQJ DQWLERGLHV IURP D
previous heterologous dengue virus infection bind to
WKHQHZLQIHFWLQJVHURW\SHDQGIDFLOLWDWHYLUXVHQWU\
YLD )FUHFHSWRUEHDULQJ FHOOV 7KLV PHFKDQLVP FDQ
VHUYHWRLQFUHDVHWKHQXPEHURIDQWLJHQSUHVHQWLQJ
FHOOV LQIHFWHG GXULQJ VHFRQGDU\ GHQJXH ZKLFK FDQ
OHDG WR WKH DFWLYDWLRQ RI SUHH[LVWLQJ FURVVUHDFWLYH
GHQJXHYLUXVVSHFLILF7O\PSKRF\WHVIURPWKHSULPDU\
IODYLYLUXVLQIHFWLRQ7KLVVHOIDPSOLI\LQJFDVFDGHFDQ
then lead to the release of cytokines and chemical
mediators that may cause plasma leakage.
Zinc is crucial for normal development and
function of cells mediating nonspecific immunity
such as neutrophils and natural killer cells. Zinc
GHILFLHQF\DOVRDIIHFWVWKHGHYHORSPHQWRIDFTXLUHG
LPPXQLW\ E\ SUHYHQWLQJ ERWK WKH RXWJURZWK DQG
FHUWDLQIXQFWLRQVRI7O\PSKRF\WHVVXFKDVDFWLYDWLRQ
7KF\WRNLQHSURGXFWLRQDQG%O\PSKRF\WHKHOS
7KHPDFURSKDJHDSLYRWDOFHOOLQPDQ\LPPXQRORJLF
functions, is adversely affected by zinc deficiency,
ZKLFKFDQG\VUHJXODWHLQWUDFHOOXODUNLOOLQJF\WRNLQH
SURGXFWLRQDQGSKDJRF\WRVLV7KHHIIHFWVRI]LQFRQ

Nuke Yuliana et al : Serum zinc level and clinical severity of dengue infection

these key immunologic mediators is rooted in the

myriad roles for zinc in basic cellular functions such
as DNA replication, RNA transcription, cell division,
and cell activation. Apoptosis is potentiated by zinc
GHILFLHQF\'HFUHDVHG&'&'FHOOUDWLRVDUH
also seen. Recent studies in an experimental human
PRGHOVKRZHGWKDWWKHSHUFHQWDJHRI&'&'7
O\PSKRF\WHVSUHFXUVRUVWRF\WRWR[LF7O\PSKRF\WHV
WKDWUHTXLUHGIRUDQWLJHQUHFRJQLWLRQSUROLIHUDWLRQ
DQGF\WRO\VLVZDVGHFUHDVHGLQ]LQFGHILFLHQF\=LQF
deficiency may be accompanied by an imbalance
RI 7K FHOO DQG 7K FHOO IXQFWLRQ UHVXOWLQJ LQ
dysregulated resistance to infection.
7KLV VWXG\ UHYHDOHG WKDW VHUXP ]LQF OHYHOV
ZHUHVLJQLILFDQWO\GLIIHUHQWLQHDFKFOLQLFDOVHYHULW\
+RZHYHUVHUXP]LQFOHYHOZDVQRWDULVNIDFWRUIRU
the development of severe dengue infection.
,W ZDV FRQFOXGHG WKDW ORZ VHUXP ]LQF OHYHO
ZHUH VLJQLILFDQWO\ GLIIHUHQW LQ HDFK FOLQLFDO VHYHULW\
RIGHQJXHLQIHFWLRQ+RZHYHUORZVHUXP]LQFOHYHO
ZDVQRWDULVNIDFWRUIRUWKHGHYHORSPHQWRIVHYHUH
dengue infection in children. Furthermore, the results
of our analysis emphasize the need for additional
data collection pertaining to zinc in larger studies,
HVSHFLDOO\WKRVHLQZKLFKVWXG\VXEMHFWVDUHVWUDWLILHG
according to baseline nutritional status.

References
 *XKD6DSLU'6FKLPPHU%'HQJXHIHYHUQHZSDUDGLJPV
IRUDFKDQJLQJHSLGHPLRORJ\(PHUJLQJ7KHPHVLQ(SLGHPLRO

 7KRQJFKDURHQ3-DWDQDVHQ6(SLGHPLRORJ\RIGHQJXHDQG
GHQJXH KDHPRUUKDJLF IHYHU ,Q 7KRQJFKDURHQ 3 HGLWRU
0RQRJUDSKRQGHQJXHGHQJXHKDHPRUUKDJLFIHYHU5HJLRQDO
3XEOLFDWLRQ6($521RS
3. Malavige GN, Fernando S, Seneviratne SL. Dengue viral
LQIHFWLRQV3RVWJUDG0HG-
 :RUOG+HDOWK2UJDQL]DWLRQ'HQJXHGHQJXHKDHPRUUKDJLF
fever and dengue shock syndrome in the context of the
LQWHJUDWHGPDQDJHPHQWRIFKLOGKRRGLOOQHVV*HQHYD:RUOG
+HDOWK2UJDQL]DWLRQ
 +DGLQHJRUR 65 3XUZDQWR 6+ &KDWDE ) '66 FOLQLFDO
manifestation, management and outcome. A hospital based
VWXG\LQ-DNDUWD,QGRQHVLD'HQJXH%XOO
6. Rothman AL. Dengue: defining protective versus pathologic
LPPXQLW\-&OLQ,QYHVW

 +DOVWHDG6%$QWLERG\PDFURSKDJHVGHQJXHYLUXVLQIHFWLRQ
VKRFNDQGKHPRUUKDJH$SDWKRJHQLFFDVFDGH5HY,QIHFW
'LVVXSSO6
 .XUDQH,5RWKPDQ$//LYLQJVWRQ3*,PPXQRSDWKRORJLF
mechanisms of dengue hemorrhagic fever and dengue shock
V\QGURPH$UFK9LURO
 0RQJNROVDSD\D-'HMQLUDWWLVDL:;X;19DVDQDZDWKDQD
6 7DQJWKDZRUQFKDLNXO 1 &KDLUXQVUL $ HW DO 2ULJLQDO
antigenic sin and apoptosis in the pathogenesis of dengue
KHPRUUKDJLFIHYHU1DWXUH0HG
 /HL +< +XDQJ .- /LQ <6 <HK 70 /LX +6 /LX &&
,PPXQRSDWKRJHQHVLV RI GHQJXH KHPRUUKDJLF IHYHU $P -
,QIHFW'LV
 :LGDJGR%ORRG]LQFOHYHOVDQGFOLQLFDOVHYHULW\RIGHQJXH
KHPRUUKDJLFIHYHULQFKLOGUHQ6RXWKHDVW$VLDQ-7URS0HG
3XE+HDOWK
 %ODFN5(=LQFGHILFLHQF\LQIHFWLRXVGLVHDVHDQGPRUWDOLW\
LQWKHGHYHORSLQJFRXQWU\-1XWU6
 )LVFKHU:&%ODFN5(=LQFDQGWKHULVNIRULQIHFWLRXVGLVHDVH
$QQX5HY1XWU
 6KDQNDU $+ 3UDVDG $6 =LQF DQG LPPXQH IXQFWLRQ WKH
biological basis of altered resistance to infection. Am J Clin
1XWU
 +XQJ17/DQ17/HL+</LQ<6/LHQ/%$VVRFLDWLRQ
EHWZHHQ VH[ QXWULWLRQDO VWDWXV VHYHULW\ RI GHQJXH
hemorrhagic fever, and immune status in infants
ZLWK GHQJXH KHPRUUKDJLF IHYHU $P - 7URS 0HG +\J

 7DZHHSRQJ 7 6XSDSDQ 7 5LVN IDFWRUV RI GHQJXH VKRFN
V\QGURPHLQFKLOGUHQ-0HG$VVRF7KDL
 +DPPRQG61%DOPDVHGD$3HUH]/7HOOH]<6DERULR6,
Differences in dengue severity in infants, children, and adults
LQD\HDUVKRVSLWDOEDVHVWXG\LQ1LFDUDJXD$P-7URS0HG
+\J
 -XQLD - *DUQD + 6HWLDEXGL ' &OLQLFDO ULVN IDFWRUV IRU
GHQJXH VKRFN V\QGURPH LQ FKLOGUHQ 3DHGLDWU ,QGRQHV

 7KLV\DNRUQ 8 1LPPDQQLW\D 6 1XWULWLRQDO VWDWXV RI
FKLOGUHQ ZLWK GHQJXH KHPRUUKDJLF IHYHU &OLQ ,QIHFW 'LV

 1DUD\DQDQ 0 $UDILQG 0$ 7KLORWKDPPDO 1 3UHPD 5
Sargunam CSR, Ramamurty N. Dengue fever epidemic in
&KHQQDL$ VWXG\ RI FOLQLFDO SURILOH DQG RXWFRPH ,QGLDQ
3HGLDWU
 7DQWUDFKHHZDWKRUQ 7 7DQWUDFKHHZDWKRUQ 6 5LVN IDFWRUV
RI GHQJXH V\RN V\QGURPH LQ FKLOGUHQ - 0HG $VVRF 7KDL

 9DXJKQ':*UHHQ6.DOD\DQDURRM6,QQLV%/1LPPDQQLW\D

Paediatr Indones, Vol. 49, No. 6, November 2009313

Nuke Yuliana et al : Serum zinc level and clinical severity of dengue infection
S, Suntayakhon S, et al. Dengue viremia titer, antibody
UHVSRQVH SDWWHUQ DQG YLUXV VHURW\SH FRUUHODWH ZLWK GLVHDVH
VHYHULW\-,'
 .LQJ /( )UDNHU 3- 9DULDWLRQV LQ WKH FHOO F\FOH VWDWXV
of lymphopoietic and myelopoietic cells created by zinc
GHILFLHQF\-,QIHFW'LV6XSSO6

314Paediatr Indones, Vol. 49, No. 6, November 2009

 .LQJ/()UDNHU3-=LQFGHILFLHQF\LQPLFHDOWHUVP\HORSRLHVLV
DQGKHPDWRSRLHVLV-1XWU
 3UDVDG $6 'LVFRYHU\ RI KXPDQ ]LQF GHILFLHQF\ RI ]LQF
,Q 7RPLWD + HGLWRU 7UDFH HOHPHQWV LQ FOLQLFDO PHGLFLQH
7RN\R6SULQJHU9HUODJS
 %HUJHU$:KDWGRHV]LQFGR"%0-