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TATA L A K S A N A
D E M A M B E R DA R A H
DENGUE
RUSTAM SIREGAR
DIVISI INFEKSI DAN PENYAKIT TROPIK
BAGIAN ILMU KESEHATAN ANAK
FK UNS/RSUD DR. MOEWARDI
SURAKARTA
2014
DEFINISI
DBD
merupakan
suatu
penyakit
Mempunyai
4 jenis
serotipe
:
Mempunyai
kecenderungan
Den-1,
Den-2,
Den-3,
Den-4,
demam
akut
yang
disebabkan
melalui
perantara
nyamuk aedes
terjadinya
oleh
virus
genus perdarahan
Flavivirus,
famili
aegypti
Flaviviridae
EPIDEMIOLOGI
1953
pertama kali di Asia
Tenggara, di Filipina
EPIDEMIOLOGI
40
MASA
INKUBASI
5 9 HARI
MASA AKUT
1 4 HARI
Hari ke - 1
MASA KRITIS
1 2 HARI
MASA
PENYEMBUHAN
1 2 HARI
39
38
37
36
3
PATOFISIOLOGI
PATOFISIOLOGI
Demam Dengue (Infeksi Primer) dan DBD (Infeksi
Sekunder)
Perembesan plasma
Gangguan hemostasis
PATOGENESIS
PATOGENESIS
SENIN
SELASA
1
12.00
RABU
2
12.00
KAMIS
3
12.00
JUMAT
4
12.00
5
12.00
DENGUE GUIDELINES
Content
Pages
Title
1997
2009
2011
33
160
212
Clinical
manifestation,
diagnosis, case
management
Chapters : (6)
Epidemiology and
burden of disease,
clinical management,
vector management, lab
diagnostic tests,
surveillance and
emergency response,
new avenues
Chapters : (15)
Epidemiology, disease
burden,clinical manifestation
and diagnosis, lab diagnosis,
management, surveillance,
vector, vector management,
IVM, Combi, PHC approach,
case investigation, monitoring,
strategic plan (bi-regional
plan)
2009
2011
Dengue fever
DHF grade I
DHF grade II
DHF grade II
Severe dengue
( severe plasma leakage,
severe hemorrhage,
severe organ involvement)
DHF grade IV
Dengue fever
DHF grade IV
* Expanded dengue
syndrome
Adult management
Adult management
Grade
DF
DHF
Laboratory
II
III
IV
Thrombocytope
nia (platelet
count
100,000/L)
DF
DHF
+/-
+/-
2. Bleeding tendency
3. Thrombocytopaenia
100,000/mm
4. Plasma leakage
SEVERE DENGUE
Asymptomatic
2011
Symptomatic
Expanded Dengue
syndrome/isolated
organophaty (unusual
manifestation)
Undefferentiated
fever
(viral syndrome)
Dengue Fever
(DF)
Without
haemorrhage
With unusual
haemorrhage
Dengue Haemorrhagic
Fever (DHF)
(with plasma leakage)
W H O C L A S S I F I C AT I O N O F D E N G U E I N F E C T I O N S
AND
GRADING OF SEVERITY OF DHF (2011)
DF/
DHF
Grade
DF
Laboratory
DHF
DHF
II
*DHF
III
*DHF
IV
ADMISSION CRITERIA
1997
Signs of significant
dehydration (>10%
normal body weight)
2009
2011
2009
Yes
2011
Yes
2011
Abdominal pain
+ severe
+ or tenderness
Persistent vomiting,
Bleeding
Mucosal
bleed
No clinical improvement or
worsening of the situation
Giddiness
FLUID MANAGEMENT
1997
2009
2011
6-7 ml/kg/hour 5
ml/kg/hour 3
ml/kg/hour stop
after 24-48 hours
CONT
1997
2009
2011
DSS
isotonic crystalloid
solutions at 510
ml/kg/hour over one
hour. reassess
10 ml/kg in children or
300500 ml in adults
over
one hour or by bolus, if
necessary
Further, fluid
administration should
follow the graph
algorithm
Cont
2009
2011
DHF grade IV
2011
10 ml/kg of FWB or 5 ml/kg of freshly
PRC
R AT E O F I N F U S I O N I N D S S
(2011)
1997
IgM
IgG
Interpretation
DISCHARGE CRITERIA
Criteria
1997
2009
2011
Absence of fever
24 hours
without the use
of anti-fever
therapy
48 hours
24 hours
without the
use of antifever
therapy
Clinical improvement
Return of appetite
Stable hematocrit
At least 2 days
At least 2-3
days
No respiratory
distress
Platelet count
> 50,000/L
Increasing trend
> 50,000/L
Summary
SIGNS OF SIGNIFICANT
D E H Y D R AT I O N
-
Tachychardia
Increased capillary refill time (>2 second)
Cool, mottled or pale skin
Diminished peripheral pulses
Changes in mental status
Oliguria
Sudden rise in haematocrit or continously elevated
haematocrit despite administration of fluids
Narrowing of pulse pressure (< 20 mmHg)
Hypotension (a late finding representing uncorrected shock)
back
back
back
Warning signs
Bleeding
Organ impairment
Rising hematocrit
Pleural effusion, ascites or asymptomatic gall bladder thickening
Co-existing conditions
Pregnancy
Co-morbid conditions, such as diabetes mellitus, hypertension peptic
ulcer, hamolitic anemias and others
Overweight or obese (rapid venous access difficult in emergency)
Infancy or old age
Social circumstances
Living alone, living far from healt facility, without reliable means of
transport