Case 01 Dengue Hemorrhagic Fever COMMON TROPICAL INFECTION — TROPICAL MEDICINE SYSTEM FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARAN 2016 - 2017Block title Tropical Medicine Week theme ‘Common Tropical Infection case ttle + Dengue Hemorrhagic Fever (DHF) case pages General Learning Objective _: The purpose of this week is to discuss etiology, the signs and symptoms, epidemiology, pathophysiology, diagnosis, complication, management, prevention, and control of DHF Case objective for the student: By the end of the week the students will be able to explain the: Characteristics of dengue virus Epidemiology Pathophysiology Signs and symptoms Diagnosis Laboratory examination for diagnosis Complication Management Prevention and control of DHF PEN OTA wN > (case synopsis: Denny, a 10-year-old boy was presents to emergency department with high fever that last for 5| days with abrupt onset. The symptom was accompanied by headache, myalgia, arthralgia, and| hemorrhagic manifestations. Physical examination revealed high fever, hepatomegaly, petechiae, land positive tourniquet test. Laboratory findings revealed thrombocytopenia. During) hospitalization he experienced shock, pleural effusion, a drop in platelet count, and @ rise of] lhematocrit level more than 20%. Prompt and appropriate volume replacement result in| luneventful recovery. HI test showed a secondary infection of Dengue virus infection. The final diagnosis is DHF secondary infection with Dengue Shock Syndrome as complication. The patient] lwas fully recovered and discharged, The case was reported to district health authority. Reference for the student: 1. WHO. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded edition. World Health Organization 2011 2. Halstead S.B. Dengue Fever and Dengue Hemorrhagic Fever. In : Behrman, R.E; Kliegman R.M. and Jenson H.B (eds.). Nelson textbook of Pediatrics, 17 ed., Saunders, International ed., Philadelphia, Pennsylvania, 2004: 1092 - 1093 3. Woodward, T. F. The Fever Pattern as a Diagnostic Aid. In : Mackowiak, P.A (ed.), Fever : Basic ‘Mechanism and Management, 2" ed., Lippincott-Raven, Philadelphia-New York, 1997 : 215 ~ 236 4, Jawetz, Melnick & Adelberg's Medical Microbiology, 27" Edition, Geo F Brooks, Karen C Carroll, Janet $ Butel, Stephen A Morse, Timothy A Mietzner, A Lange Medical Book, Mc Graw Hill, International Edition, 2016 Reference for the tutor: 1. WHO. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded edition. World Health Organization 2011 2. Halstead S.8, Dengue Fever and Dengue Hemorrhagic Fever. In : Behrman, R.E; Kliegman R.M. and Jenson H.B (eds). Nelson textbook of Pediatrics, 17 ed., Saunders, International ed., Philadelphia, Pennsylvania, 2004: 1092 - 1093 ‘Woodward, T. F. The Fever Pattern as a Diagnostic Aid. In : Mackowiak, P.A (ed.), Fever : Basic Mechanism and Management, 2” ed., Lippincott-Raven, Philadelphia-New York, 1997 : 215 — 236 4, Jawetz, Melnick & Adelberg’s Medical Microbiology, 27" Edition, Geo F Brooks, Karen C Carroll, Janet $ Butel, Stephen A Morse, Timothy A Mietzner, A Lange Medical Book, Mc Graw Hil, International Edition, 2016 5. Gubler DJ, Kuno G, Dengue Hemorrhagic Fever. CAB International, New York, 1997Tutorial 1 Page 1 [You are a fourth year of medical student in ER department in RS Ujung Berung. Denny, a 10-year, lold boy, presents to you with high fever last for 5 days with abrupt in onset, the body itemperature range from 38.9 to 39.5°C, it’s occurs all day and night. On the 3" day the body Itemperature decreased to 37.5-38°C. But on the next day elevated again as it was occurred cn] the previous days. Identify the patient's problem! Generate a hypothesis for the problem! What further information/investigations maybe helpful for the management of Denny illness? Identify the patient's problem a. The students are supposed to discuss at least problems of: b. Fever: high, last for 3 days, abrupt in onset, high, biphasic in pattern Generate hypothesis for the problem Guiding question: what is the cause of the problem? Fever, 2 change in the normal regulation of body temperature set point, literally a resetting of the thermostat, is one of the changes in homeostatic setting that occurs during the acute phase response to inflammatory stimuli, To figure out the cause of the illness, for many centuries, clinical diagnosis has been made or strongly suggested by the history, the present helpful physical findings, and observation of the patient. In respect of fever, helpful clues come from the type of onset (abrupt or slow), the duration, the pattern of fever, and the febrile curve following institution of specific treatment. Even not absolutely correct, a specific infection tends to associate with the characteristic pattern of fever. The type of febrile patterns traditionally grouped according to the definition listed below. 1. Continuous (sustained) fever with slight remissions not exceeding 2.0°F/ 1°C in remittance. Within this group fall fevers caused by lobar and gram-negative types of pneumonia, rickettsial diseases, typhoid fever, central nervous system disorders, tularemia, and falciparum (malignant tertian) malaria, Intermittent (hectic, quotidian, “picket fence") fever with wide fluctuations, usually normal or low in the morning with a peak at 4:00 to 8:00 pm. This group includes fever caused by localized pyrogenic infections and bacterial endocarditis; chills and leucocytosis are usually present. Malaria (commonly with leucopenia) may present as quotidian (daily spike), tertian, (spike every third day), or quartan (spike every fourth day) types. in acute brucellosis, fever is often intermittent, with sweating associated with leukopenia or @ normal leukocyte count, A double quotidian pattern with two dally spikes occurs sufficiently often to be helpful in salmonellosis, miliary tuberculosis, double ‘malarial infections, and gonococcal and meningococcal endocarditis. Tertian and quartan intermittent febrile pattern occur in malaria, these cyclic patterns occur regularly and are consistent with the parasites’ repetitive cycles of multiplication. 3. Remittent fever, the fluctuation of body temperature is also wide, more than 1°C, the difference between remittent and intermittent fever, is that in the former, the lowest temperature never reach normal body temperature. The fever usually low in the morning and higher in the late evening. This pattern can be found in the first week of typhoid fever. 4, Saddleback (biphasic) fever, with several days of fever, a gap of reduced fever fof about 1 day, and then several additional days of fever. This type characterizes dengue and yellow fever, Colorado tick fever, Rift Valley fever, and viral infections such as influenza, poliomyelitis, and lymphocytic choriomeningitis.