Dengue Hemorragic Fever

8/11/2019 Dengue Hemorragic Fever

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Update on

Management of

PediatricDengue

YuliaIriani


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Disease burden

Indonesia:

- Maor public healthproblem.

- eading cause ofhospitali&a! on and

death amongchildren.

- 0$perendemicit$ with all1 serot$pes circula!ng in

urban areas.

- preading to rural areas.
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3auses of D04 Death

Dela$ed diagnosis

6PD prolonged shoc"

7PD 8uid o9erload b$ h$potonic

solu!ons :5( D/ ;/2 at M rate


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Prolonged shoc" grade

7=

>ithout proper treatment

+ 1

hours

o 0epa!c failure prognosis 5#(

sur9i9al o ? @enal failure

prognosis ,#( sur9i9al o ? A

organ

failure

prognosis

Miracle

+ ,#

hours

Death
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Coals of dengue

management

@ecogni&e dengue

infec!on at an

earl$

stage

Detect the earl$ onset of plasmalea"age

in

these pa!ents

and

Eppropriatel$ manage

deh$dra!on

and

h$po9olemia.

@educe

mortalit$

and

morbidit$
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=irusF =ector and

Gransmission


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*thiological agent


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Aedes aegyp*


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Dengue transmission


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Disease

Pathogenesis


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3urrent 0$pothesis

D*;= tropism 3ells of the immune s$stem 6rgan patholog$ *ndothelial cells

=irus 9irulence

En!bod$HIDependent *nhancement

3omplement s$stem ac!9a!on Eutoimmunit$ 0ost gene!c factors 3rossHI@eac!9eGHI3ell response
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Proposed model of heterologous immunit$ in secondar$ dengue 9irus infec!ons and its implica!ons for the

pathogenesis of dengue hemorrhagic fe9er. Primar$ D*;=HI2 infec!on and se%uen!al D*;=HI, and D*;=HI2 infec!onsare

compared

for

illustra!on

purposes.

Ghe

nai9e

G

cell

repertoire

:pale

colors06/GD@

2##'

SDengue is

one

disease

en!t$

with

diJerent clinical

presenta! ons and

osen with unpredictable clinical

e9olu!on

and

outcomeT
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3@7G*@7E 46@ D*;CU* U>E@;7;C 7C;

ProbableDengue

- li9e in /tra9el to dengueendemic

area.4e9er and 2 of the followingcriteria- ;auseaF 9omi!ng

- @ash- Eches and pains- Gourni%uet test posi!9e

- eu"openia- En$ warning signaborator$HIconLrmed dengue :important when nosign of plasma lea"age<

>arning ignsV

- Ebdominal pain ortenderness- Persistent 9omi!ng

- 3linical 8uid accumula!on- Mucosal bleed- etharg$F restlessness

- i9er enlargment +2 cm

- aborator$ increase in03G concurrent withrapid decrease in platelet

count

V:re%uiring strict obser9a!onand

medicalinter9en!on


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aborator$HIconLrmed

dengue

:important when no sign of plasma lea"age<


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3@7G*@7E 46@ *=*@*

D*;CU*

e9ere

plasmalea"ageleading

to

- hoc" :D06 ,''

>06 *E@6

2#,,
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3linical 3ase DeLni!on

Probable Dengue4e9er

3onLrmed Dengue4e9er

- 4e9er of 2 to da$sdura!onF with two ormore of the following

- 0eadacheF retroorbitalpainF m$algiaF arthralgiaF rashFhemorrhagic

manifesta! onsFleu"openiaF andsuppor!9e serolog$ oroccurrence at the sameloca!on and !me asother conLrmed cases

ofdengue.
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-Probable case and at least one of thefollowing

- 7sola!on of dengue 9irus from serumF34 orautops$ samples.

- 4ourfold or greater increase inserum 7gC :b$ 07 test


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3linical 3ase DeLni!on
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>06 Crading of D04


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3linical Management ofD04


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Principle of D04

Management Primar$ abnormali!es

in

D04

=asculopath$

Ghromboc$topeniaGhrombopath$

3oagulopath$ e9ere D73
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trateg$ of D04

Management uppor!9e therap$

Drug as

indicated

Plasma lea"age olume replacement 0ow to choose 8uid solu!on

25( need colloid

3linical course of D04 unpredictable monitoring

*arl$ detec!on and prompt treatment of

circulator$ disturbance clinicall$ Z P3=

bleeding manifesta! on clinicall$ and lab
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51/93

6utpa!ent management ofpa!ents

withdengue

-arly

dengue Q#( of pa!ents ma"e the Lrst 9isit to amedical

doctor within the Lrst 2 da$s of fe9er

followHIup card diagnosis of

suspected

dengueF

serial

fullHIbloodHIcount results :to includeF at leastFhaematocrit

[er$throc$te

9olume

frac!on\

Documents

Dengue Hemorragic Fever