Download - presentasi DHF
CASE REPORTDengue Haemorrhagic Fever
Presentators :Ummi Kaltsum Pulungan
Rizki Irwansyah
Supervisor :Prof. dr. H. Munar Lubis, Sp. A (K)
DEFENITION
• Dengue fever is an acute febril viral disease frequently presenting with headache, bone, or joint and muscular pain, rash and leukopenia as symptoms.
• Dengue haemorrhagic fever : high fever haemorrhagic phenomena,hepatomegaly sign of circulatory failure (severe case)
EPIDEMIOLOGY
Aedes aegypti, as vector•One distinct physical feature – black and white stripes on its body and legs.•Bites during the day.•Lays its eggs in clean, stagnant water.
Aedes mosquito
Female Aedes highly susceptible to dengue virus, feeds preferentially on human blood, is a daytime feeder,
On average, a female Aedes mosquito can lay about 300 eggs during her life span of 14 to 21 days.
1-2 days
Stagnant waterStagnant water
Pupae
4-5 days
Life cycle of the Aedes Mosquito
Larvae Eggs
2-3 days
Dengue Virus
• single-stranded RNA• It is an arbovirus, flavivirus
genus of the Flaviviridae family
• Has 4 serotypes :(DEN-1, DEN-2, DEN-3, DEN-4).
1. Virus transmittedto human in mosquitoSaliva
2. Virus replicatesin target organs
3. Virus infects whiteblood cells andlymphatic tissues
4. Virus released andcirculates in blood
TRANSMISSION
5. Second mosquitoingests virus with blood
6. Virus replicatesin mosquito midgutand other organs,infects salivaryGlands
7. Virus replicatesin salivary glands and when the mosquito bites another human, the cycle continues.
PATHOGENESIS
PATHOPHYSIOLOGY
The WHO guidelines propose the following classification for symptomatic dengue infection :
DIAGNOSIS
Clinical Manifestation
1. CLASIC DENGUE :• High grade fever• Severe headache• Retroorbital pain
• Fatigue• Severe myalgias
• Nausea and vomiting
2. Clinical Characteristics of Dengue Haemorrhagic Fever : (WHO)
3. Dengue Shock Syndrome
4 criteria for DHF + Evidence of circulatory failure
1. Rapid and weak pulse2. Narrow pulse pressure (<20 mmHg)3. Hypotension for age (this is defined as systolic
pressure < 80 mmHg for those less than five years of age, or <90 mmHg for those five years of age and older.)
4. Cold clammy skin and restlessness.
1. Rapid and weak pulse2. Narrow pulse pressure (<20 mmHg)3. Hypotension for age (this is defined as systolic
pressure < 80 mmHg for those less than five years of age, or <90 mmHg for those five years of age and older.)
4. Cold clammy skin and restlessness.
Grading of DHF
Laboratory tests• Clinical laboratory tests– CBC WBC, platelets, hematocrit– Albumin– Liver function tests– Urine check for microscopic hematuria
• Dengue-specific tests Virus isolation (cell culture) Serology IgM, IgG NS1 dengue Antigen RT-PCR HAI-test
DIFFERENTIAL DIAGNOSE
• Chikungunya • Yellow fever• Leptospirosis• ITP
MANAGEMENT of DHF
• There is no specific treatment for DHF• Symptomatic
Antipyretic : recommend paracetamol. Do not use aspirin and ibuprofen.
• Supportive treatment:Replacement of plasma loss is effective and proved life saving
• Efficient medical team/ lab facilities
COMPLICATION
• Electrolyte imbalance : Hyponatremia, Hypocalcemia
• Fluid overload (overhydration
• Large pleural effusions, ascites
• Disseminated intravascular coagulation
PROGNOSIS
Prognosis Depend on : • Early recognition of illness• Monitoring and appropriate fluid therapy
MEDICAL RECORD
OBJECTIVE
• The aim of doing this paper is to report a case of Dengue Hemorrhagic Fever Grade III for a 10 years old boy.
• The aim of doing this paper is to report a case of Dengue Hemorrhagic Fever Grade III for a 10 years old boy.
Vital Sign IGD September 16th 2010
Follow Up September 17th 2010
S : Fever (+), Vomiting (+) ↓, bloody stool (+) ↓↓
O: Sens : GCS 15 (E4V5M6) Temp : 37.7C; BW: 44.5 kg; BL: 141 cm;
BW/BL : 124% (obese); Ideal body weight: 35.4 kg
Head :
Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
Ear/Mouth/Nose : within normal limit
Neck : Lymph node enlargement (-)
Thorax : Symmetrical fusiform , retraction (-)
HR: 120 x/i, regular, murmur (-)
RR : 24 x/i, regular, ronchi (-)
Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
Extremities : Petechie (+), Pulse 120 x/i regular, adequate pressure/volume,
Blood pressure 110/70
A : Dengue Hemorrhagic Fever Grade II
P : 1. O2 1-2 L/I
2. IVFD RL 5cc/kgBW/hours
Line I 37 gtt/i macro
Line II 37 gtt/i macro
3. Paracetamol 3x500mg
4. Diet MII 1980 kkal with 80g protein
Follow Up September 18th 2010
S : Fever (-), Vomiting (-), Bloody stool (-)
O: Sens : GCS 15 (E4V5M6) Temp : 37.4C; BW: 44.5 kg; BL: 141 cm;
BW/BL : 124% (obese); Ideal body weight: 35.4 kg
Head :
Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
Ear/Mouth/Nose : within normal limit
Neck : Lymph node enlargement (-)
Thorax : Symmetrical fusiform , retraction (-)
HR: 90 x/i, regular, murmur (-)
RR : 30 x/i, regular, ronchi (-)
Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
Extremities : Petechie (+), Pulse 90 x/i regular, adequate pressure/volume,
Blood pressure 100/50
A : Dengue Hemorrhagic Fever Grade II
P : 1. O2 1-2 L/I
2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro
3. Paracetamol 3x500mg
4. Diet MII 1980 kkal with 80g protein
Follow Up September 19th 2010
S : Fever (-)
O: Sens : GCS 15 (E4V5M6) Temp : 37.1C; BW: 44.5 kg; BL: 141 cm;
BW/BL : 124% (obese); Ideal body weight: 35.4 kg
Head :
Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
Ear/Mouth/Nose : within normal limit
Neck : Lymph node enlargement (-)
Thorax : Symmetrical fusiform , retraction (-)
HR: 90 x/i, regular, murmur (-)
RR : 26 x/i, regular, ronchi (-)
Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
Extremities : Pulse 90 x/i regular, adequate pressure/volume,
Blood pressure 100/70
A : Dengue Hemorrhagic Fever Grade II
P : 1. O2 1-2 L/I
2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro
3. Paracetamol 3x500mg
4. Diet MII 1980 kkal with 80g protein
TestSept16th
2010Sept16th
2010Sept17th
2010Sept17th
2010Sept18th
2010NormalValue
Hb (g%) 15.30 12.00 9.71 9.62 9.30 10.7-17.1
RBC (/mm3) 6.28 x 106 5.03x 106 4.24x 106 3.81x 106 3.69x 106 3.75-4.95
WBC (/mm3) 11.80 x 103 5.92x 103 5.85x 103 5.28x 103 5.14x 103 6.0-17.5
Ht (%) 46.30% 37.00% 31.40% 28.20% 28.10% 38-52
PLT (/mm3) 48 x 103 24 x 103 40 x 103 81x 103 75x 103217-497
MCV (fL) 73.70 73.50 74.10 73.90 76.20 93-115
MCH (pg) 24.40 23.90 22.90 25.20 25.20 29-35
MCHC (g%) 33.10 32.50 30.90 34.10 33.10 28-34
RDW (%) 16.80 15.40 15.10 15.70 14.00 14,9-18,7
E/B/N/L/M 2/2/49/18/28 0/2/46/25/27 4/1/50/23/22 1/1/46/29/22 1/0/53/33/13
Electrolyte
Natrium (Na)
Kalium (K)
Chloride (Cl)
Cabohydrate metabolism
Blood Glucose ad Random
125 mEq
5.0 mEq
94 mEq
130 mg/dl
(135-155)
(3.6-5.5)
(96-106)
<200
Laboratory Result (September 16th 2010)