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Dengue Hany
Dengue Hany
Presenters: - Okmaronab Febriza (080100375) - Hanidya fazwat (080100381) Supervisor : dr. Lily Irsa, SpA (K)
DEPARTMENT OF PEDIATRICS HAJI ADAM MALIK GENERAL HOSPITAL FACULTY OF MEDICINE UNIVERSITAS SUMATERA UTARA
2012
CASE REPORT
Dengue fever is disease that cause by one of the four serotype of dengue virus (den-1, den-2, den-3, den-4). - Family: flaviviridae - Genus: flavivirus - = 50 nm Dengue fever is transmitted from human to human by the mosquito aedes aegypti.
1980
EPIDEMIOLOGY
CLINICAL MANIFESTATIONS
FEBRILE PHASE
Increasing hemoconcentration, hypoprotein, pleural effusion, ascites Skin bleeding, mucosal bleeding (gastrointestinal or vaginal)
RECOVERY PHASE
Dengue fever
Acute febrile illnes with two or more of the following manifestation
Headache, Retro-orbital, manifestation, leukopenia Myalgia, Rash, Haemorrhagic
Complete Blood Count Haematrocrit Haemoglobin Thrombocyte Leucocyte Bleeding time aPTT PTT
Virus Isolation
RT-PCR
Detection of antigens IgM/IgG ratio
IgA
DF/DHF Grade DF
Thrombocytopenia, may be
present,no evidence of plasma loss
DHF
DHF
II
DHF
III
Thrombocytopenia < 100.000, Hct rise 20% Thrombocytopenia < 100.000, Hct rise 20%
DHF
IV
Differential Diagnose
chinkungunya Scarlet fever
malaria
leptospirosis Thypoid and typhus Influenza measles
Bed rest
Adequate Nutrition
Symptomatic :
Oral fluids sent home Intravena fluids Paracetamol
Negative
Inpatient
Normal leucocyte
One day observation Observe for 24 hours Symptoms & lab+ Thrombocyte <
Fever persist > 3 days Check Hb, Ht, leucocyte & thrombocyte
18
Fluid Drink 2 litre/day to prevent dehydration Mineral water, juice, oralit Symptomatic Give antipiretic if high fever or history of febrile seizure occured. Suggestion is paracetamol. Asetosal & ibuprofen are contraindicated Diazepam Domperidon 1 mg/kgBB, 3 dose, 1-2 days H2 blocker (ranitidine, cimetidine) Antibiotic is not given Steroid is not effective
19
Able to drink
Discharge
Improve
Worsen
Change to RL D5%
20
No Improvement
Monitor the vital signs Hb, Ht, thrombocyte every 6-12 hours Agitated Respiratory distress HR increase Ht increase Pulse pressure < 20mmHg Diuresis <1 ml/kg/hr
Fluid increase to 10-15 ml/kg/hour Evaluate in 12-24 hours Treatment of DSS Unable vital signs
21
SHOC K
O2 2-4 L/min Isotonic fluid 20 ml/kg/hour RL/RA/NS in 30 min Evaluate in 30 minute, has the shock resolved? Yes No Continue the RL + Kolloid + Correct acidosis Evaluate in 1 hour Ht Not resolved Increase Kolloid No improvement
22
Stable
Stop the fluid not more than 48 hours after the shock has resolved
23
Environment
-drain the tub or water reservoirs at least once a week -replace or drain the vase -bury the cans Biological -use of larvae-eating fish Chemical -fogging using malathion and fenthion or abate powder in water reservoirs
encephalopat hy
Intracranial bleeding
Adam Malik Hospital at the Infection Unit Pediatric Department on May 28th 2012 with the main complaint fever. This occurred since 2 days ago, high fever tipical, temperature get lower after the medicine given but fever still remain, seizure (-), freezing (-). While the first time get fever, followed by swollen eyes, fever get worst at night. Cough(+), flu (-), dypsneu (-), disfagia (). vomit (+) 2 times this morning, volume of vomit is glass of water. Spontantly bleeding history : epistaksis(+), bleeding gum (-), black feaces (-), rash found on the hand and foot, BAK and BAB (+) N.
History of previous illness History of previous medication
: cough : Paracetamol
Physical Examination :
Presence Status :
Compos Mentis, Temperature : 38,2C, Body Weight : 17kg, Dyspnea (-), Edema (-), Cyanosis (-), Icteric (-), Anemic (-) Head : Eye : light reflexes (+/+), isochoric pupil, pale inferior conj. palpebra (-/-). Ear/Nose/Mouth: normal. Neck : Lymph node enlargement (-). Thorax : Symmetrical fusiform , retraction (-)
Physical Examination : HR: 90 bpm, regular, murmur (-) RR : 24 bpm, regular, rales (-)
Abdominal :
Soepel, peristaltic (+) N, liver and spleen not palpable, maculopapular erythematous rash (-) Extremities : Pulse = 90 bpm, regular, adequate pressure/volume, warm acral, maculopapular erythematous rash (-) in superior and inferior dextra and sinistra extremities. Urogenital : Male, within normal limit
Differential Diagnosis: typhus measles, chinkungunya, malaria, leptospirosis, thypoid, Working Diagnosis: Dengue Fever
Management : - IVFD RL 50 gtt/ minute micro - Paracetamol 3x250 mg - Diet MB 1350 kkal with 35 gram protein
Laboratorium
Test (28-05-2012)
Results 11.60 g% 4.40 x 106/mm3 2.27 x 103/mm3 42.90 % 90 x 103/mm3 70.30 fL 20.00 pg 33.20 g% 14.10 % 9.20 Fl 0.19 % 10.5 fL
Normal Value 11.3 14.1 4.40 4.48 4.5 13.5 37 41 217 497 81 95 25 29 29 31 11.6 14.6 7.2 10.0
Results
Normal Value
37 80 20 40 28 16 01
Neutrophil absolute
Limfosit absolute Monosit absolute Eosinophil absolute Basophil absolute
3.21x 103/L
0.00 x 103/L 0.40 x 103/L 0.10 x 103/L 0.00x 103/L
2.4 7.3
1.7 5.1 0.2 0.5 0.10 0.30 0 0,1
Carbohydrate Metabolism
105,09 mg/dl
134 mEq/L 4.4 mEq/L 101 mEq/L
<200
135-155 3.5-5.5 96-106
Virus Anti DHF IgM Anti DHF IgG Positive Negative Negative Negative
Follow Up
Follow Up May 29th 2012 S : Fever (-)
Head
Neck : Lymph node enlargement (-). Thorax : Symmetrical fusiform, retraction epigastrium (-) HR:86 bpm, reguler, murmur (-) RR: 28 bpm, reguler, ronchi (-/-)
Abdominal
Extremities
Genitalia
A : Dengue Fever
P: - IVFD RL 50 gtt/ minute micro - Paracetamol 3x250 mg - Diet MB 1350 kkal with 35 gram protein
Test (29-05-2012) Complete Blood Count : Hemoglobin (Hb) Erytrocyte (RBC) Leukocyte (WBC)
Hematocrite
Trombocyte (PLT) MCV
38.50 %
152 x 103/mm3 88.70 fL
37 41
217 497 81 95
MCH
MCHC RDW MPV PCT PDW LED
27.20 pg
30.20 g% 14.10 % 9.10 Fl 0.19 % 10.5 fL 45
25 29
29 31 11.6 14.6 7.2 10.0
<15
Results
Normal Value
37 80 20 40 28 16 01
Neutrophil absolute
Limfosit absolute Monosit absolute Eosinophil absolute Basophil absolute
3.21x 103/L
0.00 x 103/L 0.40 x 103/L 0.00 x 103/L 0.00x 103/L
2.4 7.3
1.7 5.1 0.2 0.5 0.10 0.30 0 0,1
Carbohydrate Metabolism
<200
135-155 3.5-5.5 96-106
Follow Up
Follow Up May 30th 2012
S : Fever (-) O: Sensorium : Compos Mentis, Temperature = 36.5 0C, BP: 120/80 mmHg
Body Weight: 17 kg, BB/TB: 80,75% Head : Face : macula Eritematous (-) Eye : Light reflexes (+/+), isochoric pupillary, palpebra inferior conjunctival pallor (-/-), Ear/Nose/Mouth: within normal limit
Neck : Lymph node enlargement (-). Thorax : Symmetrical fusiform, retraction epigastrial (-),
Follow Up May 30th 2012 Abdominal : Soepel, peristaltic (+) Normal, Liver and Lien were not
palpable,
Extremities : Pulse = 84 bpm, regular, adequate pressure/volume, warm acral,
Fever
P: - IVFD RL 50 gtt/ minute micro - Paracetamol 3x250 mg - Diet MB 1350 kkal with 35 gram protein
Test (30-05-2012)
Complete Blood Count : Hemoglobin (Hb) Erytrocyte (RBC) Leukocyte (WBC) Hematocrite Trombocyte (PLT) MCV MCH MCHC RDW MPV PCT
Results
12.60 g% 4.43 x 106/mm3 8.5 x 103/mm3 38.70 % 207 x 103/mm3 79.30 fL 23.00 pg 33.80 g% 12.10 % 8.20 Fl 0.19 %
Normal Value
11.3 14.1 4.40 4.48 4.5 13.5 37 41 217 497 81 95 25 29 29 31 11.6 14.6 7.2 10.0
PDW
LED
10.5 fL
45 <15
Results
Normal Value
37 80 20 40 28 16 01
Neutrophil absolute
Limfosit absolute Monosit absolute Eosinophil absolute Basophil absolute
3.21 x 103/L
2.00 x 103/L 0.40 x 103/L 0.00 x 103/L 0.00 x 103/L
2.4 7.3
1.7 5.1 0.2 0.5 0.10 0.30 0 0,1
Theory
Cases
Epidemic dengue is a major Indonesia is a country located public health problem in on the equatorial zone. Indonesia, Myanmar, Sri Lanka, Thailand and TimorLeste which are in the tropical monsoon and equatorial zone where Aedes aegypti is widespread in both urban and rural areas.
The initial phase is typically characterized by high temperature ( 38,50 C) accompanied by headache, vomiting, myalgia, and joint pain, sometimes with a transient macular rash. Children have high fever but are generally less symptomatic than adults during this phase of the illness. Mild hemorrhagic manifestation such as petechiae and bruising, particularly at venipuncture sites and palpable liver are commonly noted. Laboratory finding mild-tomoderate thrombocytopenia and leucopenia, often with a moderate elevation of hepatic aminotransferase levels. This pahse last for 3 to 7 days, after which most patient recover without complication
main complaint of this patient is fever. This occurred since 4 days ago, high fever tipical, temperature get lower after the medicine was given but fever still remain until now. While the first time get fever. vomitting (+) 2 times this morning, volume of vomit is glass of water. Leucocytes of this patient 2.27 x 103/mm3 and thrombocyte 90x 103
dengue fever. A symptomatic treatment to has been conducted to this patient. He has been stabilized, and sent home.