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Sri Rezeki New Clinical Aspect of Dengue in Pediatric UGM 1 PDF
Sri Rezeki New Clinical Aspect of Dengue in Pediatric UGM 1 PDF
25
20
CFR
15
10
5
0 1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Source: DG of CDC & EH, Indonesian MOH, 2012
DHF Cases in Outbreak 2004
in six hospitals in Jakarta, Indonesia
Re assessment by
WHO dengue criteria diagnosis 1997
in source document
DF 232 9 0 241
DHF non shock 850 201 0 1051
DHF w/ shock 2 0 200 202
• Number of DF and DHF w/o shock cases in source document were 241 and
1051, meanwhile in reassessment were 1106 and 189 respectively.
• Reassessment for CFR 1,5% 4,9%
• National data 2004: 1,1%.
Citraresmi E, Hadinegoro SR. Sari Ped 2007;8:8-14.
Important
to differentiate between DF and DHF
• DF and DHF are different disease entity
• DF
• no plasma leakage,
• no hypovolemic shock
• mild bleeding
• good outcome
• Key is monitor at time of early shock phase or
when fever ceased (day 3-5 of illness)
DF vs DHF
Time of fever After time of fever
defervescence
defervescence
(fever ceased)
(fever ceased)
Dengue Fever
• good clinical conditions,
• good appetite
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
Year
1990
40
incidence dengue
30
cases was adult
20
• Children have higher
10 mortality compared to
adult cases
0
Year
Thrombocytopenia is a good
prognostic value, Hct for
guidance the volume
replacement
Source: Comprehensive guideline for prevention and control of dengue and dengue haemorrhagic fever.
Revised and expanded edition. Regional office for South-East Asia, New Delhi, India 2011.
WHO criteria diagnosis guideline
Dengue mortality in Indonesia 1968-2009
WHO
1966
WHO
1975
WHO
1986 WHO
WHO-TDR WHO-SEARO
1997
2009 2011
2013
The dengue case mortality reduced significantly within 40 years
Classification of dengue severity
WHO 1997 vs 2009
50 59 59 56
(38.8 %) (38.8 %) (36.8 %)
40
34
30
(22.4 %)
20
6
10 (3.9 %)
0
Dengue Fever ( DF )/Without Warning Signs DHF 1 and 2 ( DHF )/With Warning Signs DHF 3 and 4 ( DSS )/Severe Dengue
Warning signs
• No clinical improvement at afebrile phase • Bleeding tendency: epistaxis, black stool, hematemesis,
• Refused oral intake menorrhagia, black color urine (haemoglobinuria) or
• Recurrent vomiting hematuria
• Severe abdominal pain • Giddines
• Lethargy, change of behavior • Pale, cold extrimities
• Decreased diuresis within 4-6 hours
No Yes
Profound shock
un-palpable pulse, un-detectable blood pressure
Unusual manifestation, dengue with complication, and
several organ involvement
Six hospitals in Jakarta, dengue outbreak 2004
IVFD 10ml/kg.BW, 1-2 hours Check Ht, blood gas, blood glucose,
calcium, bleeding (ABCS)
Correction soon for acidosis,
Stabile, hypoglycemia, hypocalcaemia
Decreased IVFD gradually
7, 5, 3 , and 1,5 Ht increased Ht decreased
ml/kg.BW/hour
2nd bolus for crystalloid
Or colloid 10-20ml/kg.BW Bleeding
within 10-20 minutes Unclear
Stop IVFD
maximal 48 hours
after shock recover Colloid 10-20ml/kg.BB
within 10-20menit, if shock
Blood transfusion
persist suggested blood
transfusion
Rate infusion in DSS case
Decompensated Dengue Shock Syndrome
• Give oxygen 2-4L/minute
• Examine hematocrite, blood gas, blood glucose, calcium, bleeding (ABCS)
• Crystalloid or colloid 10-20ml/kg.BW within 10-20 minutes
IVFD 10ml/kg.BW, 1-2 hours Evaluated Ht, blood gas, blood glucose,
calcium, bleeding (ABCS)
Correction soon for acidosis,
Stabile, hypoglycemia, hypocalcaemia
Decreased IVFD gradually
7, 5, 3 , and 1,5 Ht increased Ht decreased
ml/kg.BW/hour
2nd bolus for crystalloid
Or colloid 10-20ml/kg.BW Bleeding
within 10-20 minutes Unclear
Stop IVFD
maximal 48 hours
after shock recover Colloid 10-20ml/kg.BB
within 10-20menit, if shock
Blood transfusion
persist suggested blood
transfusion
High Risk Group
• Infants, elderly
• Obese patients
• Prolonged shock
• Significant bleeding
• Encephalopathy
• Underlying diseases
• Pregnancy
Clinical syndrome associated with Flavivirus diseases
Shock Hemorrhage
Dengue Dengue
Yellow fever Yellow fever
CCHF Chikungunya
West Nile fever CCHF
Rift valley fever Rift valley fever
Fever
Hepatitis Encephalitis
Yellow
Yellowfever
fever JE
Congo-crimean
Congo-crimeanhemorrhagic
hemorrhagic
fever Tick borne encephalitis
fever(CCHF)
(CCHF)
West Venezuelan encephalitis
WestNile
Nilefever
fever
Dengue Western equine encephalitis
Dengue
Eastern equine encephalitis
Zinsser Microbiology,1992.p.1020
Expanded dengue syndrome
(unusual or atypical manifestations)
• Unusual manifestations
• uncommon
• neurological (encephalopathy): convulsions,
changes in consciousness, transient paresis
• hepatic, renal, heart, other isolated organ
involvement