DHF

Dengue Haemoragic Fever

 Serotipe → genotipe
 DEN-1 : 3-5 genotypes
 DEN-2 : 5-6 genotypes
 DEN-3 : 4-5 genotypes
 DEN-4 : 2 genotypes
Genotipe (varian strain)  virulent strain
untuk DBD
 Gejala/Tanda DBD
Klinis
– Demam 2 – 7 hari
– Perdarahan: uji RL(+)/spontan
– Pembesaran hati
– Syok
2 gejala
klinis
Laboratorium
– Trombositopenia (<100.000 /ul) +lab
– Hemokonsentrasi (≥20%)
• Atau tanda kebocoran plasma
(efusi pleura, ascites, hipoproteinemia)
• Penurunan hematokrit setelah resusitasi
 Diagnosis DBD
Tersangka DBD
Demam tinggi mendadak, tanpa sebab yang jelas, selama 2-7 hari
disertai manifestasi perdarahan (sekurang-kurangnya uji Tourniquet
positif) dengan atau tanpa trombositopenia (jumlah trombosit ≤100.000/μl)

DBD
Demam tinggi mendadak, tanpa sebab yang jelas,
selama 2-7 hari disertai satu atau lebih tanda klinis: 1) manifestasi
perdarahan (sekurang-kurangnya uji Tourniquet positif), 2) hepatomegali,
dan 3) syok, dengan trombositopenia (≤100.000/μl),
dan hemokonsentrasi (≥20%) (Diagnosis Klinis).

Atau
Hasil pemeriksaan serologis pada Tersangka DBD:
Menunjukkan hasil positif (infeksi sekunder) pada pemeriksaan HI test
atau positif RDT (rapid diagnostic test): Positif IgG saja atau IgM dan IgG
(Diagnosis Laboratoris).
 Standard Case Definitions

DF/DHF Grade Symptoms Laboratory

DF Fever with two or more of the Leukopenia

following signs: headache, retro- occationally,
orbital pain, myalgia, arthralgia Thrombocytopenia
may be present, No
evidence of plasma loss

DHF I Above signs plus positive tourniquet Thrombocytopenia

test <100.000,Hct rise ≥20%

DHF II Above signs plus spontaneous Thrombocytopenia

bleeding <100.000,Hct rise ≥20%

DHF (=DSS) III Above signs plus circulatory failure Thrombocytopenia

(week pulse, hypotention, <100.000,Hct rise ≥20%
restlessness)

DHF (=DSS) IV Profound shock with undetectable Thrombocytopenia

blood pressure and pulse <100.000,Hct rise ≥20%

WHO, 1999
 Sekilas tentang infeksi Dengue
Gejala pada berbagai kondisi infeksi virus dengue

Demam Dengue Demam Berdarah Dengue Sindrom Syok Dengue

(Dengue Fever) (Dengue Haemorrhagic Fever) (Dengue Shock Syndrome)
Ordinary Fatal Fatal

 High fever;  Possibly more frequently seen in children  Often develops from DHF;
 Rash; and young adults:  Similar onset as DF;
 Severe headache;  Similar onset as DF and the complications  Patients deteriorate after a few
 Pain behind the eyes; usually starts when fever subsides; days of fever;
 Muscle and joint pain;  Facial flush;  Cold clammy skin;
 Nausea;  Haemorrhagic phenomena, such as bruises,  Low pulse pressure;
 Loss of appetite. blood in stools, gingival bleeding and the  Repeated fainting;
like;  Encephalopathy;
 Hepatomegaly;  Coma.
 Signs of circulatory failure.
Positive Tourniquet Test
 Pemeriksaan Laboratorium pada
infeksi virus dengue
 Parameter umum
 CBC/Darah lengkap  WBC(leukosit), platelets(trombosit),
PCV/hematokrit
 (Limfosit plasma biru)
 Liver function tests/LFT  SGOT, SGPT
 Albumin
 Urine  cek hematuria mikroskopik
 PT, APTT, Fibrinogen , D-dimer
 Pemeriksaan spesifik Dengue
 Isolasi virus
 Serologi : anti-dengue IgM dan IgG, antigen NS1
 Deteksi molekuler antigen RNA dengue dengan metode
PCR
1. Memahami respon imun infeksi
dengue
 Larvasiding

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