Professional Documents
Culture Documents
/DENGUE
HEMORRHAGIC FEVER
CURRICULUM VITAE
Nama
: Dr. H. Harun Hudari, SpPD, FINASIM
TTL
: Palembang, 3 Mei 1970
Pendidikan :
- Dokter FK Universitas Sriwijaya 1996
- Spesialis Penyakit Dalam FK Universitas Sriwijaya 2008
Riwayat Pekerjaan :
1. Dokter PTT Puskesmas Muara Rupit 1997 2000
2. Dokter PNS RSUD Dr. MM Dunda Gorontalo 2001 2004
3. Dokter Spesialis Penyakit Dalam RSUD Banyuasin
2008 sekarang
4. Dokter Spesialis Penyakit Dalam FK UNSRI/RSMH
Palembang 2009 sekarang
HP : 081271621966 / 0711 7301744
About Dengue
Dengue is one of the most important mosquito-born
viral diseases affecting humans.
Viral life cycle involves humans and the mosquito
vector Aedes aegypti.
In the U.S. it has been found that the mosquito Aedes
albopictus also transmits the DEN virus.
992- Chinese
Encyclopedia
1780- Philadelphia
break-bone
fever
Benjamin Rush
Dengue virus
Infection
Asymptomatic
Symptomatic
Undifferentiated
fever
Dengue Fever
No
hemorrhage
Unusual
hemorrhage
DHF 1& 2
DHF 3&4
DSS
Flaviviridae
(dengue, yellow fever,
TBE encephalitides)
Enveloped
RNA viruses
Filoviridae
(Ebola, Marburg)
Bunyaviridae
(CCHF, RVF,
Hantaviruses)
Geographic distribution:
Southeast Asia, the Caribbean,
the Western Pacific Regions.
Other epidemiological features:
High incidence in rainy season;
Spread rapidly;
High mobidity;
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Dengue Virus
Family: Flaviviridae
ss +RNA
genome: 10
proteins
3 Structural
Coat, deliver
RNA to target
cells
7 Nonstructural
Enveloped
4 serotypes:
DEN-1, 2, 3, 4
Goodsell, David. "Dengue Virus." RCSB PDB-101. N.p., n.d.
Web. 23 Oct. 2012.
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18
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Immune Response
Ag/Ab level
Symptom
Antibody
NS1 Ag
Bite
DAY -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12
ACUTE
PHASE
CRITICAL
PHASE
CONVALESENC
E PHASE
IgG
IgM
NS1
Ag
23
Day
Dengue Fever
Febrile Phase
Critical Phase
Recovery
Phase
Critical
Phase
Recovery
Phase
25
Febrile Phase
Usually lasts for 2 7 days
Fever is often accompanied by
Facial flushing, skin erythema, generalised body
ache, myalgia, arthalgia and headache
Anorexia, nausea and vomiting are common
Critical Phase - 1
Occurs either
Towards the late febrile phase
Often after 3rd day of fever
or
Around defervescence
Usually between 3rd day to 5th day of fever;
but may go up to the 7th day of fever.
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Critical Phase - 2
During this phase if,
Minimal or no plasma
leakage occurs
Patient feels better as
the temperature
subsides
Dengue fever
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Critical Phase -3
In more severe form of plasma
leakage
Patients may sweat, become restless,
have cool extremities and prolonged
capillary filling time
The pulse rate increases, diastolic BP
increases and the pulse pressure
narrows
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Time
Critical Phase - 3
Clinical warning signs of severe dengue or
high possibility of rapid progression to shock
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Critical phase - 4
Thrombocytopenia and
hemoconcentration are usually
detectable before the onset of shock
HCT level correlates well with plasma
volume loss and disease severity.
However HCT values may be equivocal
and hence unhelpful when there is
frank hemorrhage or with untimely
HCT determinations
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Recovery Phase
Plasma leakage stops after 24-48 hours of
defervescence
This followed by reabsorption of
extravascular fluid
Patients general well being improves,
appetite returns, gastrointestinal
symptoms abate, hemodynamic status
stabilises and diuresis ensues.
Recovery of platelet count is typically
preceded by the recovery of WCC count
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Grade 2
spontaneous bleeding in addition to the manifestation from
Grade 1
Grade 3*
circulatory failure rapid, week pulse and narrowing of pulse
pressure or hypotension with the presence of cold,
clammy skin and restlessness.
Grade 4*
profound shock with undetectable blood pressure or pulse.
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Pathophysiology of DHF - 1
Primary pathophysiological abnormality
in DHF and DSS is an acute increase in
vascular permeability
Plasma leakage results in
hemoconcentration and hypovolemia
or shock
Hypovolemia leads to reflex
tachycardia and generalised
vasoconstriction
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Pathophysiology of DHF - 2
Clinical manifestations of
vasoconstriction in various systems
are;
Skin
coolness, pallor and delayed capillary refill time
Cardiovascular system
raised diastolic blood pressure and a narrowing pulse
pressure
Renal system
reducing urine output
Gastrointestinal system
vomiting and abdominal pain
Respiratory system
tachypnoea (respiratory rate >20/min)
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Kasus DBD
1.Demam akut 2-7 hari, bersifat bifasik.
2. Manifestasi perdarahan
uji tourniquet positif
petekia, ekimosis, atau purpura
Perdarahan mukosa, saluran cerna, dan tempat bekas
suntikan
Hematemesis atau melena
3. Trombositopenia < 100.00/pl
4. Kebocoran plasma yang ditandai dengan
Peningkatan nilai hematrokrit >_ 20 % dari nilai baku sesuai
umur dan jenis kelamin.
Penurunan nilai hematokrit >_ 20 % setelah pemberian cairan
yang adekuat
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Efusi pleura, asites, hipoproteinemi
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TATALAKSANA
1. Demam dengue
Pasien DD dapat berobat jalan, tidak perlu dirawat.
Pada fase demam pasien dianjurkan
Tirah baring, selama demam.
Obat antipiretik atau kompres hangat
Asetosal tidak dianjurkan gastritis, perdarahan,
/asidosis.
cairan dan elektrolit per oral, jus buah, sirop, susu,
disamping air putih, paling sedikit diberikan selama 2 hari.
Monitor suhu, jumlah trombosit dan hematokrit sampai fase
konvalesen.
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2. DBD
Jenis Cairan (rekomendasi WHO)
Kristaloid.
Larutan ringer laktat (RL) ,
Larutan ringer asetat (RA), Larutan garam faali (GF)
Dekstrosa 5% dalam larutan ringer laktat (D5/RL)
Dekstrosa 5% dalam larutan ringer asetat (D5/RA)
Dekstrosa 5% dalam 1/2 larutan garam faali (D5/1/2LGF)
(Catatan:Untuk resusitasi syok dipergunakan larutan RL atau
RA tidak boleh larutan yang mengandung dekstran)
Koloid.
Dekstran 40
Plasma
Albumin
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Volume Therapy
fluid replacement
Kristaloid
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Terapi kasus
hypovolemia
penggantian kehilangan
cairan di ruang intravascular
(= kehilangan darah)
volume replacement
Koloid
KEBOCORA
N SEL
DEMAM
PERDARAHA
N
MUAL &
MUNTAH
Cairan tubuh
(air + ION)
berkurang.
POTENSI
DEHIDRASI
Groups A
may be sent
home
tolerate
adequate
volumes of
oral fluids
and pass
urine at
least once
every 6
hours
Groups B
referred for
in-hospital
managemen
t
with
warning
signs, coexisting
conditions,
with certain
social
Groups C
require
emergency
treatment
and urgent
referral
severe
dengue (in
critical
phase)
monitor:
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Thank
you
Arigatou
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Terima
kasih
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