Fatal Febrile Syndrome

OverviewConcern at St CarolusUnusual increase in number of deaths at hospitalUsually, approximately 50 60 per monthNov 2006, number increased to approximately 120

OverviewAs of 30 Nov 200628 suspected cases that meet case definition4 Hospitals reporting suspected since 1 NovSt Carolus: 25 cases, 22 deathsRS Cipto: 1 case, 1 deathRS Mitra Kemayoran: 1 case, 1 deathRS Atmajaya: 1 case, 1 death25 deaths (CFR 89%)Crude canvasing of 7 other Jakarta hospitals2 hospitals report 2-3 possible suspected cases in the last 90 days, but data not available or reliable (recall)

OverviewCase definition developed based on case similarities:On presentation:Fever (>39C) DeliriumHyponatremia ( 110-126 meq/L )Present with symptoms since 1 Nov 2006

Time to DeathOnset to Death 3.5 days (2-8), n=22Onset to Admission 2 days (1-5.5), n=24Admission to Death 1 day (1-3), n=23Median (IQR)

Demographic Data of CasesNumber of casesAge groupAge: Median 56.5 years (IQR: 38-62), n=28

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Cases

Demographic DataMale Predominance22 Males, 6 FemalesNo religious preferenceSuspected cases have no familial or contact relationshipOne case reported contact with someone who died cause ?No occupation dataNo recognized geographic relationship

Household Mapping of Cases

Co-MorbiditiesHypertension (8)Diabetes Mellitus (7)Stroke (3)Asthma (2)Hypercholesterolemia (1)Parkinson (1)MI (1)

Admission: Vital Signs & Laboratory FindingsAdmission:TemperatureMedian: 39.8 (IQR: 39.3 40.2), n=23Normotensive, some hypertensiveNormal oxygen saturation, room airHyponatremiaMedian: 120.5 (IQR: 117.5-128.5), n=20+/- LeukocytosisMedian: 10,300 (IQR: 8700-15600), n=15 elevated CK and CK-MB, normal Trop I

Analisa Gas DarahCorakan bronkhovaskular sedikit kasar.Jantung normal.Sinus dan diafragma baik.Foto Rontgen Thorax

Pemeriksaan6/11 pH7,44pCO213,4pO245,9O2 Saturasi85,3

Analisa Gas Darah- Tidak tersedia -Foto Rontgen Thorax

Pemeriksaan26/11 (jam 12.47)26/11 (jam 21.21)28/11 (jam 08.49)28/11 (jam 22.52)pH7,387,387,417,43pCO236,128,330,017,0pO252,3170,5104,086,0O2 Saturasi80,399,495,094,0

Analisa Gas DarahTidak tampak kelainan di paru-paruCor tidak membesarSinus-sinus dan diafragma baikFoto Rontgen Thorax

Pemeriksaan19/11 pH7,53pCO216,0pO2148,0O2 Saturasi97,0

OverviewFirst Clinical Suspicion20 November 20066 cases: fever (>39C), delirium, hyponatremia+/- leukocytosisRespiratory distress > failureTreated with antibiotics: cephalosporins, quinolones6/6 died

Analisa Gas DarahKesan : Corakan vaskular paru agak kasar di kedua perihilerFoto Rontgen Thorax

Pemeriksaan17/1118/11 pH7,517,59pCO226,022,0pO2110,075,0O2 Saturasi99,097,0

Analisa Gas DarahTak tampak kelainan di paruJantung : CTR tak dapat dinilai (Os supine)Ada elongasi aortaSinus dan diafragma baikFoto Rontgen Thorax- Tidak tersedia -

Analisa Gas DarahTidak tampak kelainan di paruJantung : CTR tak dapat dinilai (Os supine)Sinus dan diafragma kanan baikSinus kostofrenikus kig)ri suram (superposisi bayangan janguFoto Rontgen Thorax

Pemeriksaan23/11pH7,41pCO229,5pO2129,0O2 Saturasi98,8

Analisa Gas DarahKesan : kesuraman tipis di lapangan atas paru kanan suspek infiltratFoto Rontgen Thorax- Tidak tersedia -

Analisa Gas Darah22/11 : Tak tampak kelainan di paruJanutng : CTR tak dapat dinilai Os supine)Sinus dan diafragma baik

23/11 : Cor tidak jelas membesar, paracardialKanan agak suram; bronhopneumonia?Paru kiri baikSinus-sinus dan diafragma baikFoto Rontgen Thorax

Pemeriksaan22/1123/11pH7,477,43pCO221,825,3pO2126,575,0O2 Saturasi99,195,7

Analisa Gas Darah- Tidak tersedia -Foto Rontgen Thorax

Pemeriksaan11/1113/11 pH7,507,39pCO228,034,0pO282,069,0O2 Saturasi97,088,0

Analisa Gas DarahTidak tampak kelainan di paru-paruAda kesan cor agak membesarSinus-sinus dan diafragma baikFoto Rontgen Thorax

Pemeriksaan11/1114/11 pH7,477,46pCO225,124,3pO288,670,5O2 Saturasi97,595,3

At Death: Vital Signs & Laboratory FindingsTemperatureMedian: 41.9 (IQR: 41.3 42), n=17 +/- LeukocytosisMedian: 14450 (IQR: 7850-25000), n=4

Diagnostic radiologyChest X-Ray:Initially normal, progress in some cases to infiltratesEchocardiogram:No wall motion abnormalities (n=1)Head CTPeriventricular ischemic changes

DISTRIBUSI KASUS MENURUT TEMPAT TINGGALES/HMS 9/06

WILAYAHJUMLAH%JAK. PUSAT1150JAK. TIMUR522JAK. BARAT210LUAR JKT418

DISTRIBUSI KASUS MENURUT TANGGAL MASUKES/HMS 9/06

TANGGALJUMLAH1 NOV13 NOV14 NOV15 NOV111 NOV417 NOV118 NOV419 NOV121 NOV222 NOV123 NOV1

26 NOV327 NOV1

ANGKA KEMATIAN SUSPECT KASUS

Jumlah kasus suspect : 35 Jumlah kematian : 22 Angka kematian : 62,8 %ES/HMS 9/06

DISTRIBUSI KASUS MENINGGAL MENURUT USIAES/HMS 9/06

USIA/J.KLLAKI-LAKIPEREMPUANJUMLAH< 40 21341-502-251-6041561-709110>712-2

JUMLAH19322

LAMA HARI RAWAT KASUS MENINGGALES/HMS 9/06

HARI RAWATJUMLAH%1 HR12542 HR4183 HR2104 HR210>4 HR210

DISTRIBUSI SUHU BADAN WAKTU MRSES/HMS 9/06

SUHU JUMLAH%< 38 21038 - 40837