Journal Reading

ADE CAHYO ISLAMI

DEWINTA PUTRI UTAMI
 Introduction
Dengue fever is caused by the dengue virus and is transmitted by the
bite of an infective female Aedes mosquito. The diagnosis is based on
history, physical findings, and laboratory markers.
According to the World Health Organization, about 50 million dengue
infections and 25,000 deaths occur worldwide annually, making
dengue one of the most important arthropod-borne viral diseases in
humans.
There are four major clinical syndromes: 1) undifferentiated fever, 2)
dengue fever, 3) dengue hemorrhagic fever (DHF), and 4) dengue
shock syndrome (DSS).
 Pathogenesis
Dengue virus is an arbovirus of the flavivirus family that has four
different serotypes (DEN-1, -2, -3, and -4). Its classification is based
on biologic and immunologic characteristics.

Because there is no cross-protection between the different

serotypes, lifetime immunity is obtained only after infection by each
type.
Pathogenesis
1. Faktor virus
2. Faktor penjamu
3. Faktor lingkungan

1. Respon imun humoral

2. Respon imun seluler
3. Mekanisme autoimun
4. Peran sitokin dan mediator inflamasi lain
5. Peran komplemen
Pathogenesis
 Mosquito Cycle
A aegypti is the primary vector responsible for transmission; other
vectors include A albopictus, A polynesiensis, and A niveus.
The life cycle begins when an uninfected female mosquito takes
blood from an infected person during the viremic phase of illness.
Within the mosquito’s digestive system, the virus replicates for 8 to
12 days (extrinsic incubation period).
When this infective mosquito bites again, it transmits the virus to
another person by injecting its salivary fluid. Once the virus is in the
body, it replicates in target organs and is released into the blood
(intrinsic incubation period)
Mosquito Cycle
WHO and CDC Definitions of Dengue Clinical Syndrome
 Clinical Presentation
Undifferentiated fever Dengue fever

 Patients are mildly  Onset of high-grade fever (38.9 – 40.6 oC)

symptomatic  Associated with headache (retroorbital pain), severe
 Occurs during a myalgia, arthralgia, nausea/vomiting, altered taste sensation,
primary infection with and sometimes a rash
dengue viruses  Infants and young children usually present with nonspecific
symptoms such as fever, runny nose, rash, and diarrhea
 Older children and adults have the classic break bone fever
 Dengue Hemorrhagic Fever
 DHF is a potentially fatal illness marked by high fever, hemorrhagic
manifestations, and evidence of plasma leakage
 Features of plasma leakage include ascites, pleural effusion (right-
sided in most cases), and rarely, pericardial effusion associated with
a high mortality
 The hemorrhagic manifestations of DHF include skin hemorrhages
such as petechiae, purpura, and ecchymoses; bleeding from mucous
membranes (epistaxis, gingival bleeding); and bleeding from the
gastrointestinal, vaginal, and urinary tracts
 The gastrointestinal tract being the most common site of bleeding.
Grade
DHF
 Dengue Shock Syndrome
 DSS occurs during defervescence 3 to 6 days after the onset of
symptoms and has a high mortality rate of 10% to 47%.
Warning signs of DSS :
1. severe abdominal pain;
2. persistent vomiting (with or without blood);
3. abrupt change of temperature from fever to hypothermia; and
4. altered mental status, including irritability, somnolence, or
obtundation
 Complication of Dengue Infection
 Severe dengue complications : liver dysfunction, encephalitis,
cardiomyopathy (usually reversible), pancreatitis, acalculous
cholecystitis, peripheral neuropathy, and acute renal failure.
 Liver involvement is one of the most important gastrointestinal
manifestations,
 can present as acute hepatitis with elevated liver enzyme values
(aspartate aminotransferase being more significantly elevated than
alanine aminotransferase), jaundice, altered mental status, seizures,
and severe hypoglycemia.
Methods of Laboratory Diagnosis of
Dengue Infection
Differential
Diagnosis
of Dengue
Fever
 Treatment
 Fever is controlled with acetaminophen.
Nonsteroidal anti-inflammatory agents should be avoided due to their
anticoagulant properties and risk of Reye syndrome in children.
 Patients do not have to be admitted to the hospital or receive intravenous
fluids unless they present with severe vomiting, dehydration, bleeding,
altered mental status, clinical deterioration, or evidence of DHF or DSS
 DHF and those who are in shock should be treated in an intensive care
setting.
Hematologic, cardiovascular, and fluid and electrolyte status should be
observed and supported
 Prevention / Infection Control
 Using repellants containing N,Ndiethyl- 3-methylbenzamide (DEET)
 Wearing protective clothing (long-sleeved shirts and pants) during the
mosquito-biting period (morning and afternoon), and using bed nets can
minimize mosquito bites.
 Insect repellants can be used safely in children older than 2 months of age.
 Travelers also can reduce their risk by staying in screened or air-conditioned
areas when possible and avoiding potential mosquito breeding sites.
Eliminating mosquito breeding by covering water containers and eliminating
standing water can prevent the transmission of dengue virus.