Case Report

DENGUE FEVER
Compiled by :
CATERINE A. MANURUNG
SOFYA AZHARNI

Supervisor :
dr. Pertin Sianturi, M.Ked (Ped), Sp.A(K)
INTRODUCTION
 DENGUE FEVER

Definition
• Classic dengue fever, or “break bone fever,” is characterized by acute
onset of high fever 3–14 days after the bite of an infected mosquit

Epidemiology
• In 2012, SEAR countries reported approximately 0.29 million cases, of
which Thailand contributed almost 30%, Indonesia 29% and India 20%

Etiology
• These viruses contain single stranded RNA. There are four dengue virus
serotypes which are designated as DENV-1, DENV-2, DENV-3 and DENV-
4
Pathogenesis
Clinical Manifestation
Treatment
Treatment
Treatment
 CASE REPORT

• ASS, a 17 year 2 months old boy, who had a body weight of

75 kg and body height of 158 cm, came to RSUP HAM on
August 16th at 12.30 pm. His main complaint was fever. It
has happened since 4 days ago before entered the hospital.
It was characterized by high and continious fever with the
highest fever was 41ºC, and the fever was reduce with drug
but it never reach normal.

• Abdominal pain has been found 2 days before entered the

hospital. Bleeding has been found, the patient said that
black stool was found once with volume ± ½ cup in 1 day
before entered the hospital. History of supplement to
increase blood is not found.Gingival bleeding (-), epistaksis (-
).
 CASE REPORT

• Nausea and vomiting has been occured once per

daily before entered the hospital, containing what he
consumed before. Headache and retroorbital pain
has been happened since 1 day before entered the
hospital. Cough and cold was not found.
• The patient said that he had been treated in clinic on
the second day of fever and given medications such
as paracetamol,amoxycillin,CTM and vitamin C.
• History of family and neighbor with the same
condition was nothing.
 Physical Examination

• Present Status
Sensorium : CM (GCS 15 = E4V5M6) Temp : 38,3°C
HR : 91 x/i regular, murmur(-) RR : x/i
BW : 75 kg BL : 158 cm
BW/A: 116%
BH/A : 90%
BW/BH: 115%
anemic (-), icteric (-), dispnea (-), cyanosis (-), edema
(-/-)
 Physical Examination

• Localized Status
–Head :
• Eye :Light Reflex(+/+), Isochoric Pupil (3mm/3mm), Pale
Conjungtival Palpebra (-/-), Palpebral Edema (-/-)
• Ear : Normal
• Nose : Epistaksis (-)
• Mouth : Gingival Bleeding (-)

―Thorax : Symmetrical Fuciform, Retraction (-) rash (-)

• HR : 91 x/i, regular, murmur (-)
• RR : 22 x/i, regular, ronchi (-/-)
 Physical Examination

• Localized Status
– Abdomen: Soepel, Rash (-), Normal Peristaltic,Distension (-),
Shifting Dullness(-), Liver & Spleen wasn’t
palpable

– Extremities: Rash (-) Pulse 91 x/i,Regular, BP: 100/80 mmHg,

P/V adequate, Warm Extremities, CRT<3”, Pale
Plantarand Palmar (-/-), Edema (-)

– Anogenital : Normal
Laboratory Finding
 Working Diagnosis :
Dengue Hemorrhagic Fever without Shock

Differensial Diagnosis :
Dengue Hemorrhagic Fever without shock
Dengue Fever
Tyfoid Fever
Chikungunya Fever

Therapy :
IVFD Ringer Lactate 6cc/KGBW/Hour = 450cc/hour= 150 gtt/i
macro for 1-2 hour
Paracetamol 4 x 750mg
MII 2600 kkal + 150 gram protein
 Patient Follow Up

Sens: CM
Fever (-) (D4)
Temp: 37,4⁰C, BP: 110/80 mmgHg,
abdominal pain (-)
HR: 96bpm, RR : 24 perminute
loss of appetite (+)
UOP: 600cc/6 hour

16/10/2016

-IVFD Ringer Lactate

3cc/KGBW/Hour = 225cc/hour= 75
Dengue Hemorrhagic Fever gtt/i macro
Without Shock
-Paracetamol 4 x 750mg
-MII 2600 kkal + 150 gram protein
 Patient Follow Up

Fever (+) (D5)
abdominal pain (-)
loss of appetite (+)
Sens: CM
Temp: 38,3⁰C, BP: 110/870
mmgHg, HR: 89bpm, RR : 20
perminute
OUP: ±1,5 L/ 24 hour

17/10/2016

-IVFD Ringer Lactate 36 gtt/i macro

Dengue Hemorrhagic Fever
Without Shock
-Paracetamol 4 x 750mg
-MII 2600 kkal + 150 gram protein
R: Complete Blood , Ig M, IgG
dengue
 Patient Follow Up

Fever (-) (D6) Sens: CM

abdominal pain (-) Temp: 36,6⁰C, BP: 110/70 mmgHg,
loss of appetite (+) HR: 68bpm, RR : 20 perminute
Nause and vomiting (+) OUP: ±1,75 L/ 24 hour

18/10/2016

-IVFD Ringer Lactate 36 gtt/i macro

Dengue Hemorrhagic Fever -Paracetamol 4 x 750mg
Without Shock -MII 2600 kkal + 150 gram protein
R: Complete Blood
 Patient Follow Up

Fever (-) (D7) Sens: CM

abdominal pain (-) Temp: 36,0⁰C, BP: 110/70 mmgHg,
loss of appetite (+) HR: 80bpm, RR : 20 perminute
Nause (+) OUP: ±1,5 L/ 24 hour

19/10/2016

-IVFD Ringer Lactate 36 gtt/i macro

Dengue Hemorrhagic Fever -Paracetamol 4 x 750mg
Without Shock -MII 2600 kkal + 150 gram protein
R: Complete Blood
 Patient Follow Up

Fever (-) (D7) Sens: CM

abdominal pain (-) Temp: 36,3⁰C, BP: 110/70 mmgHg,
loss of appetite (+) HR: 86bpm, RR : 20 perminute
Nause (-) OUP: ±2 L/ 24 hour

20/10/2016

Dengue Hemorrhagic Fever -IVFD Ringer Lactate 36 gtt/i macro

Without Shock -MII 2600 kkal + 150 gram protein
 Patient Follow Up

Fever (-) (D8) Sens: CM

abdominal pain (-) Temp: 36,6⁰C, BP: 110/70 mmgHg,
loss of appetite (-) HR: 83bpm, RR : 20 perminute
Nause (-) OUP: ±2 L/ 24 hour

21/10/2016

Dengue Fever Patient go home

 Laboratory Finding

Date Of Analysis

Test 16/10/16 18/10/16 19/10/16 20/10/16 Unit Reference

13.08 11.20 10.54 11.17

Hemoglobin 14.5 14,6 14,4 14,3 g/dL 13-18

Leukocyte 2.170 1.760 4.680 5.790 /µL 4.000-11.000

150.000-
Platelet 119.000 79.000 182.000 318.000 / µL
450.000

Hematocryte 47 48 46 44 % 39-54

Limfosit 25,30 51,10 54,90 54,80 % 20-40

 Clinical Manifestation

Dengue Case

• Symptoms: acute onset • The main complain was

of high fever 3–14 days, fever. Fever was
frontal headache, retro- suddenly high in the
orbital pain, myalgias, first day. Patient also felt
arthralgias, hemorrhagic nausea and vomiting.
manifestations, rash, The patient also
and low white blood cell complained Headache
count, anorexia and and retro orbital pain.
nausea Loss of appetite (+)
 Hemorragic Manifestations
Dengue Case

• The most common • In this patient, there was

hemorrhagic
manifestations are mild
and include a positive
tourniquet test, skin
hemorrhages, epistaxis,
gingival bleeding, and
microscopic hematuria,
vaginal bleeding,
hematemesis, melena,
and intracranial bleeding.
no history of bleeding,
epistaxis, gingival
bleeding, and seizure, but
history of defecation was
found black tarry stools
since 1 day before hospital
admission. There was no
history of eating iron pills
or bismuth.
 Grading Dengue

DF

DHF
DHF I
IV
Dengue

DHF DHF
III II
 Grading Dengue
Dengue
• The difference in making
diagnosis of DF and DHF is the
plasma leakage. In DHF it was
found with plasma leakage
marked by an elevated
hematocrit ≥20% above the
population mean hematocrit for
age and sex, a decline in
hematocrit after volume-
replacement treatment of ≥20%
of the baseline hematocrit,
presence of pleural effusion or
ascites Hypoproteinemia or
hypoalbuminemia.
Case
• Based on the laboratory results
obtained from the patients with
no increasing hematocrit of
20%from the normal value.
Normal hematocrit in these
patients is 44% and were
determined based on the lowest
hematocrit of patients during
care and still in the normal
range. The final diagnoses after
patients were admitted is
dengue fever.
 CONCLUSION

The management of patient with dengue fever or

dengue hemoragic fever needs to be done as soon
as possible by early diagnosis and intervention by
IV fluid replacement therapy and medication.