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    Dengue Haemorrhagic Fever: Case Report

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    mhimi
    This case report describes a 10-year-old boy diagnosed with Dengue Hemorrhagic Fever Grade III. Over the course of his hospitalization, he presented with high fever, vomiting, bloody stool, and petechiae on his skin. Laboratory tests showed decreasing hemoglobin, hematocrit, and platelet counts. He was given IV fluids, antipyretics, and supportive care. By discharge on day 4, his fever had resolved and laboratory values were improving.

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    Dengue Haemorrhagic Fever: Case Report

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    mhimi
    108 views37 pages
    This case report describes a 10-year-old boy diagnosed with Dengue Hemorrhagic Fever Grade III. Over the course of his hospitalization, he presented with high fever, vomiting, bloody stool, and petechiae on his skin. Laboratory tests showed decreasing hemoglobin, hematocrit, and platelet counts. He was given IV fluids, antipyretics, and supportive care. By discharge on day 4, his fever had resolved and laboratory values were improving.

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    presentasi DHF

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    This case report describes a 10-year-old boy diagnosed with Dengue Hemorrhagic Fever Grade III. Over the course of his hospitalization, he presented with high fever, vomiting, bloody stool, and petechiae on his skin. Laboratory tests showed decreasing hemoglobin, hematocrit, and platelet counts. He was given IV fluids, antipyretics, and supportive care. By discharge on day 4, his fever had resolved and laboratory values were improving.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    108 views37 pages

    Dengue Haemorrhagic Fever: Case Report

    Uploaded by

    mhimi
    This case report describes a 10-year-old boy diagnosed with Dengue Hemorrhagic Fever Grade III. Over the course of his hospitalization, he presented with high fever, vomiting, bloody stool, and petechiae on his skin. Laboratory tests showed decreasing hemoglobin, hematocrit, and platelet counts. He was given IV fluids, antipyretics, and supportive care. By discharge on day 4, his fever had resolved and laboratory values were improving.

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    of 37

    CASE REPORT

    Dengue Haemorrhagic Fever

    Presentators :
    Ummi Kaltsum Pulungan
    Rizki Irwansyah

    Supervisor :
    Prof. dr. H. Munar Lubis, Sp. A (K)
    DEFENITION

    • Dengue fever is an acute febril viral


    disease frequently presenting with
    headache, bone, or joint and muscular
    pain, rash and leukopenia as symptoms.
    • Dengue haemorrhagic fever :
     high fever
     haemorrhagic phenomena,
     hepatomegaly
     sign of circulatory failure (severe case)
    EPIDEMIOLOGY
    Aedes aegypti, as vector
    •One distinct physical feature –
    black and white stripes on its
    body and legs.
    •Bites during the day.
    •Lays its eggs in clean, stagnant
    water.
    Female Aedes highly susceptible to
    dengue virus, feeds preferentially on
    human blood, is a daytime feeder,

    On average, a female Aedes


    mosquito can lay about 300 eggs
    during her life span of 14 to 21
    days.
    Life cycle of the Aedes Mosquito

    1-2 days

    Pupae Larvae Eggs

    4-5 days 2-3 days

    Stagnant water
    Dengue Virus

    • single-stranded RNA
    • It is an arbovirus, flavivirus
    genus of the Flaviviridae
    family
    • Has 4 serotypes :
    (DEN-1, DEN-2, DEN-3,
    DEN-4).
    TRANSMISSION
    1. Virus transmitted
    to human in mosquito
    Saliva

    2. Virus replicates
    in target organs

    3. Virus infects white


    blood cells and
    lymphatic tissues

    4. Virus released and


    circulates in blood
    5. Second mosquito
    ingests virus with blood

    6. Virus replicates
    in mosquito midgut
    and other organs,
    infects salivary
    Glands

    7. Virus replicates
    in salivary glands and when the
    mosquito bites another human,
    the cycle continues.
    PATHOGENESIS
    PATHOPHYSIOLOGY
    DIAGNOSIS
    The WHO guidelines propose the
    following classification for symptomatic
    dengue infection :
    Clinical Manifestation
    1. CLASIC DENGUE :
    • High grade fever
    • Severe headache
    • Retroorbital pain
    • Fatigue
    • Severe myalgias
    • Nausea and vomiting
    2. Clinical Characteristics of Dengue
    Haemorrhagic Fever : (WHO)
    3. Dengue Shock Syndrome

    4 criteria for DHF + Evidence of circulatory


    failure

    1. Rapid and weak pulse


    2. Narrow pulse pressure (<20 mmHg)
    3. Hypotension for age (this is defined as systolic
    pressure < 80 mmHg for those less than five years
    of age, or <90 mmHg for those five years of age
    and older.)
    4. Cold clammy skin and restlessness.
    Grading of DHF
    Laboratory tests
    • Clinical laboratory tests
    – CBC WBC, platelets, hematocrit
    – Albumin
    – Liver function tests
    – Urine  check for microscopic hematuria

    • Dengue-specific tests
     Virus isolation (cell culture)
     Serology  IgM, IgG
     NS1 dengue Antigen
     RT-PCR
     HAI-test
    DIFFERENTIAL DIAGNOSE

    • Chikungunya
    • Yellow fever
    • Leptospirosis
    • ITP
    MANAGEMENT of DHF

    • There is no specific treatment for DHF


    • Symptomatic
    Antipyretic : recommend paracetamol. Do not
    use aspirin and ibuprofen.
    • Supportive treatment:
    Replacement of plasma loss is effective and
    proved life saving
    • Efficient medical team/ lab facilities
    COMPLICATION
    • Electrolyte imbalance : Hyponatremia, Hypocalcemia
    • Fluid overload (overhydration
    • Large pleural effusions, ascites
    • Disseminated intravascular coagulation
    PROGNOSIS
    Prognosis Depend on :
    • Early recognition of illness
    • Monitoring and appropriate fluid therapy
    MEDICAL RECORD
    OBJECTIVE

    • The aim of doing this paper is to


    report a case of Dengue
    Hemorrhagic Fever Grade III for
    a 10 years old boy.
    Vital Sign IGD September 16th 2010
    Follow Up September 17th 2010
    S : Fever (+), Vomiting (+) ↓, bloody stool (+) ↓↓
    O: Sens : GCS 15 (E4V5M6) Temp : 37.7C; BW: 44.5 kg; BL: 141 cm;
    BW/BL : 124% (obese); Ideal body weight: 35.4 kg
    Head :
    Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
    Ear/Mouth/Nose : within normal limit
    Neck : Lymph node enlargement (-)
    Thorax : Symmetrical fusiform , retraction (-)
    HR: 120 x/i, regular, murmur (-)
    RR : 24 x/i, regular, ronchi (-)
    Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
    Extremities : Petechie (+), Pulse 120 x/i regular, adequate pressure/volume,
    Blood pressure 110/70

    A : Dengue Hemorrhagic Fever Grade II


    P : 1. O2 1-2 L/I
    2. IVFD RL 5cc/kgBW/hours
    Line I 37 gtt/i macro
    Line II 37 gtt/i macro
    3. Paracetamol 3x500mg
    4. Diet MII 1980 kkal with 80g protein
    Follow Up September 18th 2010

    S : Fever (-), Vomiting (-), Bloody stool (-)


    O: Sens : GCS 15 (E4V5M6) Temp : 37.4C; BW: 44.5 kg; BL: 141 cm;
    BW/BL : 124% (obese); Ideal body weight: 35.4 kg
    Head :
    Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
    Ear/Mouth/Nose : within normal limit
    Neck : Lymph node enlargement (-)
    Thorax : Symmetrical fusiform , retraction (-)
    HR: 90 x/i, regular, murmur (-)
    RR : 30 x/i, regular, ronchi (-)
    Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
    Extremities : Petechie (+), Pulse 90 x/i regular, adequate pressure/volume,
    Blood pressure 100/50
    A : Dengue Hemorrhagic Fever Grade II
    P : 1. O2 1-2 L/I
    2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro
    3. Paracetamol 3x500mg
    Follow Up September 19th 2010
    S : Fever (-)
    O: Sens : GCS 15 (E4V5M6) Temp : 37.1C; BW: 44.5 kg; BL: 141 cm;
    BW/BL : 124% (obese); Ideal body weight: 35.4 kg
    Head :
    Eyes : light reflex (+/+), isochoric pupil, pale inferior conj. palpebra(-/-).
    Ear/Mouth/Nose : within normal limit
    Neck : Lymph node enlargement (-)
    Thorax : Symmetrical fusiform , retraction (-)
    HR: 90 x/i, regular, murmur (-)
    RR : 26 x/i, regular, ronchi (-)
    Abdomen : Soepel, peristaltic (+) normal, Hepar/Spleen : not palpable
    Extremities : Pulse 90 x/i regular, adequate pressure/volume,
    Blood pressure 100/70
    A : Dengue Hemorrhagic Fever Grade II
    P : 1. O2 1-2 L/I
    2. IVFD RL 3cc/kgBW/hours; 45 gtt/i macro
    3. Paracetamol 3x500mg
    Sept16th Sept16th Sept17th Sept17th Sept18th Normal
    Test 2010 2010 2010 2010 2010 Value

    Hb (g%) 15.30 12.00 9.71 9.62 9.30 10.7-17.1

    RBC (/mm3) 6.28 x 106 5.03x 106 4.24x 106 3.81x 106 3.69x 106 3.75-4.95

    WBC (/mm3) 11.80 x 103 5.92x 103 5.85x 103 5.28x 103 5.14x 103 6.0-17.5

    Ht (%) 46.30% 37.00% 31.40% 28.20% 28.10% 38-52

    PLT (/mm3) 48 x 103 24 x 103 40 x 103 81x 103 75x 103 217-497

    MCV (fL) 73.70 73.50 74.10 73.90 76.20 93-115

    MCH (pg) 24.40 23.90 22.90 25.20 25.20 29-35

    MCHC (g%) 33.10 32.50 30.90 34.10 33.10 28-34

    RDW (%) 16.80 15.40 15.10 15.70 14.00 14,9-18,7

    E/B/N/L/M 2/2/49/18/28 0/2/46/25/27 4/1/50/23/22 1/1/46/29/22 1/0/53/33/13


    Laboratory Result (September 16th 2010)

    Electrolyte
    125 mEq (135-155)
    Natrium (Na)
    5.0 mEq (3.6-5.5)
    Kalium (K)
    94 mEq (96-106)
    Chloride (Cl)

    Cabohydrate metabolism
    Blood Glucose ad Random 130 mg/dl <200

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