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Fever
Dr. Dwi Lingga Utama, SpA(K)
1
DEFINITION
Dengue fever, a benign syndrome
caused by several arthropod-borne
viruses, is characterized by biphasic
fever, myalgia or arthralgia, rash,
leukopenia, and lymphadenopathy.
Dengue hemorrhagic fever (DHF)
Dengue shock syndrome (DSS)
Etiology
There are at least 4 antigenic types
of dengue virus.
Viruses are transmitted by
mosquitoes of the Stegomyia family.
Aedes aegypti, a daytime biting
mosquito, is the principal vector.
Pathogenesis
The pathogenesis is incompletely
understood, but epidemiologic
studies suggest that it is usually
associated with second infections
with dengue types 14 (the
secondary heterologous infections).
Homologous Antibodies Form
Non-infectious Complexes
1
1
1
1 Dengue 1 virus
Neutralizing antibody to Dengue 1 virus
Non-neutralizing antibody
1 Complex formed by neutralizing antibody and virus
Heterologous Complexes Enter
More Monocytes, Where Virus
Replicates
2
2
2
2
2
2 2
2
2
2 Dengue 2 virus
Non-neutralizing antibody
Complex virus-antibody
Complemen activation
Complemen
Plasma leakage
50DF, 50 DHF
Non-shock Shock
DHF DSS
(Dengue shock syndrome)
48 1-2
DHF
Grading of Illness
Grade I
Unspecified febrile, Tourniquet test
positive
Grade II
Grade I + spontaneous bleeding
Grade III
Circulatory failure (restless, fast &
small pulse, pulse pressure < 20mmHg,
hypotension, cyanosis, cold & moist
extremities)
Grade IV
Shock, undetected pulse and blood 11
Criteria from WHO (1999)
Clinical :
Fever 2 7 days
Bleeding : RL test (+)/spontaneous bleeding
Hepatomegaly
Shock 2 clinical + lab
Laboratories :
Low platelet count (<100.000 /ul)
Hemoconcentrate (>20%)
12
Dengue Classification 2009
DENGUE Warning SEVERE
Signs DENGUE
With
Without 1.Severe plasma
Warnin leakage
g 2.Severe haemorrhage
3.Severe organ
Signs impairment
Systolic + Diastolic
2
= 5 menit
INTERPRETASI HASIL
PEMERIKSAAN IgM dan IgG
Fever Shock
Pleural effusion,
Ascites
20
Temperature curve for dengue infection
Temp
Time of defervescence
Days of illness
21
Temperature Curve for
Dengue Hemoragic Fever
Clinilcal getting worse, faint,
restless, cold hands and feet,
increase RR, low urine output,
loss of appetite
Shock
Days of illness 22
Protokol 1
Tersangka infeksi Virus
Dengue Demam tinggi mendadak, terus <7
hari tanpa sebab yang jelas
Parasetamol
Rawat Inap Rawat Jalan Kontrol @ hari sampai
Lihat Protokol 2 demam hilang
Minum banyak
Parasetamol k/p Kontrol @
hari sampai demam turun Nilai tanda klinis & Jml
Bila demam menetap Trombosit, Ht bila msh
px: Hb, Ht, Tromb demam hari sakit ke 3
Perbaikan Perburukan
Tidak gelisah, Nadi kuat, Tanpa Tanda syok
TD stabil, Diuresis cukup Gelisah, Distres
Ht tetap tinggi/naik
(1 cc/kg/jam,Ht turun pernafasan, Frek Nadi
(2x pemerksaan) naik, Ht tetap tinggi/naik,
Tek. Nadi<20 mmHg,
Tetesan Dikurangi Diuresis kurang/tidak ada
Rumatan atau sesuai
kebutuhan
Tetesan
dipertahankan Masuk ke protokol Syok
Evaluasi
Ht tetap tinggi/naik
Tidak ada tanda kelebihan cairan
Jika syok Ht turun
berulang lagi
koloid 10-20 ml/kgbb/jam
Tranfusi PRC sesuai dosis maksimal
10 ml/kg.
Kembali ke awal
protokol 4 ini
Teratasi Tidak Teratasi