Dengue Hemorrhagic Fever

Presented by:
Ivan Nugraha

Supervisor:
dr. Pulung M. Silallahi, SpA

Department of Pediatrics
Bhayangkara Tk. I R. Said Sukanto Hospital
YARSI University Jakarta
2017
 Dengue
Dengue Fever
is an infectious disease caused by dengue
virus with clinical manifestations of fever,
muscle pain and / or joint pain that is
accompanied by leukopenia, rash,
lymphadenopathy, and thrombocytopenia.
Dengue Hemorrhagic Fever
Plasma leakage occurs characterized by
hemoconcentration (increased
hematocrit) or accumulation of fluid in
the body cavity
 Epidemiology

1968, Surabaya: Suspected Case 1970 Virological

Confirmation.

Sex: Female = Male

Age <15 years old (86-95%)

Penyebaran global Demam Berdarah Dengue (WHO,2011) .
 Etiology

Dengue virus, which is included in group B

arthropod borne viruses (arboviruses) Genus
Flavivirus, family Flaviviridae.
4 serotypes DEN-1, DEN-2, DEN-3 and DEN-4
Replication in sitoplasma and passage in RES
Etiology

Aedes aegypti Aedes albopictus

Pathogenesis
The Course of Dengue Illness

WHO. Handbook for Clinical Management of Dengue. World Health Organization 2012.
Demam dengue

The incubation period of 1-2 mg

Chills, fever up to 40 C
Headache, joint and muscle
Fever decreased after 7
daysmacula exanthema

DHF
Bleeding in the skin and organs
Petechiae, nose bleeding, bloody
stool, hematuria.
 Diagnosis
Supporting
Investigation
A. Laboratory examination

Thrombocytopenia (<100,000/ul)
Hemoconcentration
Leukopenia / leukocytosis
Relative lymphocytosis with atypical
lymphocytes
Hypoproteinemia
Reduction of fibrinogen, prothrombin, factor
VIII, factor XII, and antithrombin III.
Prolonged PTT and aPTT
 Diagnosis
Supporting
Investigation

B. Imaging: USG, ECHO, CT SCAN, X RAY

Dilation of the blood vessels of the lungs,

Pleural effusion,
Cardiomegaly and pericardial effusion,
Hepatomegaly,
Ascites
 Diagnosis
Supporting
Investigation

Rumpel Leed Test / Tourniquet Test

The resistance of blood capillaries by

imposing the damming of the veins, allowing
blood to suppress the capillary walls.
Fragile Capillary petechiae
The test is positive if there are 10 or more
petechia per square inch.
 Diagnosis
Criteria Diagnosis

WHO 2011 Dengue Hemorrhagic Fever

Clinical Criteria
Laboratory Criteria

DIAGNOSIS = 2 Clinical Criteria +

trombositopenia + hemoconcentration.
 Diagnosis
Criteria Diagnosis

CLINICAL CRITERIA
Fever
Bleeding manifestations, (1):
Test tourniquets (+)
Petechie, ekhimosis or purpura
Gastrointestinal tract mucosal bleeding,
epistaxis
Hematemesis and melena
Hepatomegaly
Failure circulation (signs of shock): cold
extremities, systolic less than 90 mmHg, moist
skin, narrowing of pulse pressure (<20 mmHg)
 Diagnosis
Criteria Diagnosis

LABORATORY CRITERIA

Thrombocytopenia (platelet count

<100,000 / ul)
Hemoconcentration (Increased hematocrit
of 20% or 20% decrease in hematocrit after
receiving fluid therapy).
DHF CLASSIFICATION
 Diff erential
Diagnosis
Viral infections Arbovirus group

Chikungunya

Other viral diseases

Measles, Rubella, and a variety of other viruses, such as Epstein Barr

virus, enterovirus, Influenza, Hepatitis A, hantavirus

Bacterial disease

Leptospirosis, typhoid, Meliodosis, Rackettsial disease

Parasitic disease

Malaria
Diff erential
Diagnosis
 Management

DHF treatment according to WHO (2011) is

SUPPORTIVE symptomatic in order to improve
circulation and prevent the onset of shock and
disseminated intravascular coagulation (DIC).
Oral rehydration
Paracetamol is recommended to maintain the
temperature below 39 0C at a dose of 10-15 mg /
kg / times
Anticonvulsant (Ptx with febrile seizure history)
 Management

Key to the success of the treatment of DHF is the

accuracy of volume replacement , so as to
prevent shock
Criteria repatriate patients :

1. There is no fever for 24 hours without antipyretics

2. Appetite improved

3. Looks clinical improvement

4. Hematocrit stable

5. Three days after the shock is resolved

6. Platelet counts above 50,000 / ml and is likely to increase

7. Not found any respiratory distress (due to pleural effusion or acidosis)

 Complication

Dengue encephalopathy
Kidney disorder
Pulmonary edema
 Prognosis
If not accompanied by shock within 24-36 hours Good
> 36 hours there has been no sign of improvement, the
possibility of recovery becomes small and poor prognosis
Causes of death include:
Shock
Overhydration
Massive Bleeding
Dengue shock accompanied by manifestations of
shock
 Prevention

1. VECTOR CONTROL

GOVERNMENT
SOCIETY (PHBS)

2. EPIDEMIOLOGY INVESTIGATION

Focus Foging
Abatisasi
 Prevention
1) Preventive efforts, fogging mass before the
transmission of the disease in the village / sub
endemic

2) Promote community to join participation in

the activities of mosquito nest eradication
(PSN)

3) Conduct prevention focus in patient home

and around in order to prevent the occurrence
of extraordinary events (KLB)

4) Conducting outreach to the community

through various media.
 Vaccine

http://www.mims.com/philippines/drug/info/dengvaxia%20md
http://www.mims.com/philippines/drug/info/dengvaxia
 References
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WHO. Global Strategy for Dengue Prevention and Control 2012-2020. World Health
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WHO. Weekly Epidemiological Record Dengue Vaccine: WHO Position Paper July 2016. No
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CDC. Dengue and Dengue Hemorrhagic Fever: Information for Health Care Practitioners. U.S.
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WHO. Handbook for Clinical Management of Dengue. World Health Organization 2012.
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