copy of dengue hemorrhagic fever ( kuliah )

7/21/2019 Copy of Dengue Hemorrhagic Fever ( KULIAH )

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DENGUE & DENGUE

HEMORRHAGIC FEVER

Kuliah Blok Kedokteran Tropis



INTRODUCTION

Dengue is a viral infection transmitted by mosquitoes, mainlythe Aedes aegypti species

The virus is contracted from the bite of a striped Aedesaegypti mosquito that has previously bitten an infectedperson One mosquito bite can in!ict the disease

There are four strains or serotypes of dengue virus namelyD"N#$, D"N#%, D"N#& and D"N#' The mosquito !ourishes during rainy seasons but can breed in

(ater#)lled containers, year#round The virus is not contagious and cannot be spread directly from

person to person There must be a person#to#mosquito#to#another#person path(ay

Dengue haemorrhagic fever severe form of dengue *second attac+ by dengue virus of a dierent serotype from the)rst infection

*ppro-imately $. of patients (ith dengueinfection progress to dengue haemorrhagic

fever



Dengue fever

• Main hosts- non humanprimates

• Human-to-humantransmission through

Aedes spp.

• 2.5 billion individuals atrisk

•!-"! million infe#tedea#h $ear %ith thousandsof deaths



&ausative agent of Dengue&ausative agent of Dengue

Dengue is #ause b$ a '() virusDengue is #ause b$ a '() virus

• This virus is a member of the viral famil$This virus is a member of the viral famil$

*laviviridae.*laviviridae.

Dengue virusDengue virus

Bauman+ '.+ ,2!!. Mi#robiolog$ disease b$ s$stems. /an *ran#is#o + &)0 1earsonBenamin &umming 1ublishers



Dengue Virus1. Causes dengue and dengue hemorrhagic e!er

". I# is an ar$o!irus

%. ransmi##ed $' mos(ui#oes

). Com*osed o sing+e,s#randed RNA

-. Has ) sero#'*es DEN,1/ "/ %/ )0



Dengue Virus•Each sero#'*e *ro!ides s*eciic +ie#ime immuni#'/

and shor#,#erm cross,immuni#'•A++ sero#'*es can cause se!ere and a#a+ disease•Gene#ic !aria#ion i#hin sero#'*es•2ome gene#ic !arian#s i#hin each sero#'*e a**ear

#o $e more !iru+en# or ha!e grea#er e*idemic *o#en#ia+



3H4 I2 DENGUE 2UCH A 5IG

6RO57EM ODA48

G+o$a+ *o*u+a#ion

gro#h

Rura+ #o ur$an

migra#ion

Gro#h o ci#iesDe#eriora#ion o

ci#ies

9e# #ra!e+

Hea+#h ser!ices*oor+' organi:ed;

underunded

7ac< o !ec#orcon#ro+

*roessiona+s



3lobal /pread of Dengue

Countries with active dengue + Aedes aegypti

-=,1== mi++ion inec#ions;'ear



/OR0D#/ID" D"N1U"DI2TRI3UTION



3eograph$ distribution of3eograph$ distribution of

DengueDengue

BBB

Blue dot0 3eographi# e4tension of dengue 2!!!-2!!Blue shaded areas0 'isk of dengue transmission6ines0 6ines demar#ate the area %here the ve#tor for dengue e4ists



• 7H* and other

infe#tious diseasestravel 8ui#kl$no%ada$s



Num$er o DHF Cases and Inec#ed Areas

in Indonesia 1>?@ "==%0

9 ' p

e r : !

! + !

! !

( o o

f & i t $ ; D i s t r i # t s 9 n f e # t e d

Incidence Ra#e IR0No o Inec#ed Areas



Dengue DHF0

Ou#$rea< inIndonesia "==)0

Ou#$rea< areas

6o#en#ia+ Ou#$rea< areas



he mos# common e*idemic !ec#or o dengue in #he or+d is

#he Aedes aegypti mos(ui#o. I# can $e iden#iied $' #he hi#e$ands or s#ale patterns on i#s +egs and #horaB.



Aedes aegypti

•Dengue #ransmi##ed $' inec#ed ema+emos(ui#o

•6rimari+' a da'#ime eeder

•7i!es around human ha$i#a#ion

•7a's eggs and *roduces +ar!ae

*reeren#ia++' in ar#iicia+ con#ainers



Aedes aegypti Aedes aegypti life #$#lelife #$#le

2- da$s

< da$s 2 da$s



1.he !irus is inocu+a#ed in#o

humans i#h #he mos(ui#o

sa+i!a.

".he !irus +oca+i:es and

re*+ica#es in !arious #arge#

organs/ or eBam*+e/ +oca+

+'m*h nodes and #he +i!er.

%.he !irus is #hen re+easedrom #hese #issues and

s*reads #hrough #he $+ood #o

inec# hi#e $+ood ce++s and

o#her +'m*ha#ic #issues.

).he !irus is #hen re+eased

rom #hese #issues and

circu+a#es in #he $+ood.



-.he mos(ui#o inges#s $+ood con#aining #he !irus.

?.he !irus re*+ica#es in #he mos(ui#o midgu#/ #he o!aries/

ner!e #issue and a# $od'. I# #hen esca*es in#o #he $od'

ca!i#'/ and +a#er inec#s #he sa+i!ar' g+ands.

.he !irus re*+ica#es in #he sa+i!ar' g+ands and hen #he

mos(ui#o $i#es ano#her human/ #he c'c+e con#inues.



The transmission #$#le of dengue virus b$ the mos8uito Aedes aegypti begins%ith a dengue-infe#ted person. This person %ill have virus #ir#ulating in the blood=a !iremia that lasts for about five da$s. During the viremi# period+ an uninfe#ted

female Aedes aegypti mos8uito bites the person and ingests blood that #ontainsdengue virus. )lthough there is some eviden#e of transovarial transmission ofdengue virus in Aedes aegypti + usuall$ mos8uitoes are onl$ infe#ted b$ biting a!iremic person.Then+ i#hin #he mos(ui#o+ the virus repli#ates during an eB#rinsic in#ubationperiod of eight to t%elve da$s.

The mos8uito then bites a sus#eptible person and transmits the virus to him orher+ as %ell as to ever$ other sus#eptible person the mos8uito bites for the rest ofits lifetime.The virus then repli#ates in the se#ond person and produ#es s$mptoms. Thes$mptoms begin to appear an average of four to seven da$s after the mos8uitobite=this is the in#rinsic in#ubation period+ i#hin humans. >hile the intrinsi#

in#ubation period averages from four to seven da$s+ it #an range from three to :da$s.The !iremia begins slightl$ before the onset of s$mptoms. /$mptoms #aused b$dengue infe#tion ma$ last three to :! da$s+ %ith an average of five da$s+ after theonset of s$mptoms=so the illness persists several da$s after the !iremia hasended.



Population

Infection

Clinical Cases

DHF/DSS

Asymptomatic

Infection

DF(non-DHF)

survive Death

5

!"

#

$%&

'#

"

%!

Fi% * +ates in ,enue mo,el

y Shepar, et al% .accine% !$$" !!0*!'5-*!&$%



Halstea, S1 et al% Am 2 3rop 4e, Hy *# *&0'-*$!*%

Ae-specific DHF/DSS hospitaliation in chil,ren an, infant%



here are ac#ua++' our dengue c+inica+

s'ndromes

1.Undieren#ia#ed e!er

".C+assic dengue e!er

%.Dengue hemorrhagic e!er/ or DHF and

).Dengue shoc< s'ndrome/ or D22.

Dengue shoc< s'ndrome is ac#ua++' a se!ereorm o DHF.



C+inica+ Case Deini#ion or Dengue Fe!er

C+assica+ Dengue e!er or 5rea< $one e!er is an acu#e e$ri+e

!ira+ disease re(uen#+' *resen#ing i#h headaches/ $one or oin#

*ain/ muscu+ar *ains/rash/and +euco*enia

C+inica+ Case Deini#ion or Dengue Hemorrhagic Fe!er

) Necessar' Cri#eria1. Fe!er/ or recen# his#or' o acu#e e!er

". Hemorrhagic manies#a#ions

%. 7o *+a#e+e# coun# 1==/===;mm% or +ess0

). O$ec#i!e e!idence o +ea<' ca*i++aries• e+e!a#ed hema#ocri# "= or more o!er $ase+ine0

• +o a+$umin• *+eura+ or o#her eusions



DENGUE

FEVER

• Incu$a#ion *eriod J - da's• Fe!er J - da's• 7eu<o*enia

• Modera#e #hrom$oc'#o*enia

2immons e# a+ 6hi+ 9 2ci ))1,"-"/ 1>%1



&lini#al Manifestations- D*

• 91 of 2 ? da$s - t$pi#al patient develops

• /udden onset of fever+ #hills+ heada#he

• Ba#k pain %ith severe m$algia+ arthralgia• 'etro-orbital pain ? break bone fever

• Ma#ular rash ? in a4illar$ area

• )denopath$+ palatal vesi#les+ s#leral in.• Ma#ulo-papular rash on trunk ?e4tremities

• @pista4is and s#attered pete#hiae



Ather manifestations- D*

• )nore4ia. (ausea+ vomiting

• 9n apparent illness-to a#ute in#apa#itation

• 9llness is about 2?5 da$s+ biphasi# #ourse• 1ain on e$e movements

• 1ain on palpating abdominal mus#les

• 1rimaril$ not a respirator$ illness• 'are - asepti# meningitis

• &omplete re#over$ is the rule - asthenia



Treatment of D*

• /upportive measures - 7e#tor barrier

• )void )spirin and if possible (/)9Ds

• /teroids should not be used

• *luid repla#ement to avoid hemo#on#.

• &hildren belo% :2 re8uire #areful %at#h

for DH* ; D//

• (o antiviral agents are of proven value



DI2EA2E 26ECRUM

MI7D 2EVERE

DF DHFK hrom$oc'#o*enia KKK hrom$oc'#o*enia

Hidden Vasc. 6erm

1

8 O!er# Vasc. 6erm.

1. 3i++s 5A e# a+ 9 Inec# Dis 1>=@1=,@1@/ "==)



DENGUE HEMORRHAGIC

FEVER;DENGUE 2HOCL24NDROME DHF;D220

Dengue !ascu+o*a#h'



Dengue Haemorrhagi# *ever,DH*

• 7as#ular instabilit$

• De#reased vas#ular integrit$

• )ssault on ma#ro vas#ulature• De#reased platelet fun#tion

• 9n#reased vas#ular permeabilit$

• 7as#ular disruption and lo#al bleeds

• H$potension+ hemo#on#entration- sho#k



&riteria for DH*

• Fever, or recent history of acute fever

• Hemorrhagic manifestations

• Low platelet count (100,000/mm 3 orless)

• !"ective evi#ence of $lea%y capillaries&'

levate# hematocrit *0+ or more

more over !aseline or ≥ 50%

6o% albumin+ pleural effusion



Four Grades o DHF

3rade :*ever and nonspe#ifi# #onstitutional s$mptoms1ositive tourni8uet test is onl$ hemorrhagi#manifestation

3rade 2

3rade : manifestations spontaneous bleeding3rade C

/igns of #ir#ulator$ failure ,rapid;%eak pulse+narro% pulse pressure+ h$potension+

#old;#lamm$ skin3rade

1rofound sho#k ,undete#table pulse and B1



DH* ? &lini#al &riteria

his #hermome#er i++us#ra#es #he de!e+o*men#s in #he i++ness #ha# are



his #hermome#er i++us#ra#es #he de!e+o*men#s in #he i++ness #ha# are

*rogressi!e arning signs #ha# D22 ma' occur.

he ini#ia+ e!a+ua#ion is made $' de#ermining ho man' da's ha!e *assed

since #he onse# o s'm*#oms.

Mos# *a#ien#s ho de!e+o* D22 do so %,? da's a#er onse# o s'm*#oms.

hereore/ i a *a#ien# is se!en da's in#o #he i++ness/ i# is +i<e+' #ha# #he ors#is o!er.

I #he e!er goes $e#een #hree and siB da's a#er #he s'm*#oms $egan/ #his is

a arning signa+ #ha# #he *a#ien# mus# $e c+ose+' o$ser!ed/ as shoc< o#en

occurs a# or around #he disa**earance o e!er.

O#her ear+' arning signs #o $e a+er# or inc+ude a dro* in *+a#e+e#s/ an

increase in hema#ocri#/ or o#her signs o *+asma +ea<age.I 'ou documen# hemoconcen#ra#ion and #hrom$oc'#o*enia and o#her signs

o DHF and #he *a#ien# mee#s #he cri#eria or DHF/ #he *rognosis and #he

*a#ien#s ris< ca#egor' ha!e changed. hough dengue e!er does no# o#en

cause a#a+i#ies/ a grea#er *ro*or#ion o DHF cases are a#a+.

he neB# concern ou+d $e o$ser!a#ion o #he danger signsse!ere

a$domina+ *ain/ change in men#a+ s#a#us/ !omi#ing and a$ru*# change rome!er #o h'*o#hermia. hese o#en hera+d #he onse# o D22.

he goa+ o #rea#men# is #o *re!en# shoc<. he *+asma +ea<age s'ndrome is

se+,+imi#ed. I 'ou can su**or# #he *a#ien# #hrough #he *+asma +ea<age *hase

and *ro!ide suicien# +uids #o *re!en# shoc</ #he i++ness i++ reso+!e i#se+.



Hemorrhagic Manies#a#ions o Dengue•/kin hemorrhages0pete#hiae+ purpura+ e##h$moses•3ingival bleeding

•(asal bleeding•3astrointestinal bleeding0 Hematemesis+ melena+ hemato#heia •Hematuria

•9n#reased menstrual flo%



&lini#al tests for DH*

• 1ete#hiae after tourni8uet test

• Avert bleed from previous 39 lesions

• 1latelet #ount less than :!!+!!!;ul

• 6o% pulse pressure+ #$anosis+ effusions

• H$potension+ /ho#k



Tourni8uet Test

nflate !loo# pressure cuff to a point

mi#way !etween systolic an# #iastolicpressure for - minutes

.ositive test& *0 or more petechiaeper 1 inch (*- cm)



Tourni8uet Test



Hemorrhagi# Manifestations

• 2%in hemorrhages&petechiae, purpura, ecchymoses

• 3ingival !lee#ing

• 4asal !lee#ing• 3astrointestinal !lee#ing&

hematemesis, melena, hematoche5ia

• Haematuria

• ncrease# menstrual flow



1ete#hiae



Danger 2igns in Dengue Hemorrhagic

Fe!er

• )bdominal pain - intense and sustained•1ersistent vomiting• )brupt #hange from fever to h$pothermia+%ith s%eating and prostration

•'estlessness or somnolen#e

)ll of these are signs of impending sho#k andshould alert #lini#ians that the patient needs #loseobservation and fluids.



C+inica+ Case Deini#ion or Dengue 2hoc< 2'ndrome•) cri#eria or DHF

K•E!idence o circu+a#or' ai+ure manies#ed indirec#+' $'

a++ o #he o++oing•Ra*id and ea< *u+se•Narro *u+se *ressure P "= mm Hg0 OR

h'*o#ension or age•Co+d/ c+amm' s<in and a+#ered men#a+ s#a#us

•Fran< shoc< is direc# e!idence o circu+a#or' ai+ure



D22 GRADE III



&riteria for D//

• The four #riteria of DH*

• @viden#e of #ir#ulator$ failure

:. 'apid and %eak pulse

2. (arro% pulse pressue ,less than 2!mm

C. H$potension for the age

. &old #lamm$ skin5. )ltered mental status



*our 3rades of DH*;D//

• 3rade :

*ever+ &onst. /$mptoms+ ve tourni8uet test

• 3rade 23rade : /pontaneous bleeding

• 3rade C

/igns of #ir#ulator$ failure• 3rade

1rofound sho#k - B.1. 1ulse not re#ordable



&apillar$ Damage

@ h i 1 i bit l



@##h$mosis ? 1eriorbital@dema



6arge /ub#utaneous Bleed



PEI = A / B x 100

1leural @ffusion

D22 GRADE IV



D22 GRADE IV

dengue tourni8uet test DH*



dengue tourni8uet test DH*



DH* ; D//

9ntensive &are

A4$gen

'eh$dration

Barrier (ursing

Mos8uito /#reen



DH*- 1oor 1rognosti# /igns

• 3irl #hildren under :2 %ith DH*;D//

• /evere h$potension and sho#k

• Multifo#al bleeding ? abdominal pain• &(/ en#epahlopath$+ fits+ #oma

• >at#h for preorbital edema+ proteinuria

postural or other%ise h$potension• /erot$pe 2 infe#tion after t$pe

• Malnutrition is prote#tive

M t f DH*;D//



Management of DH*;D//

• &lose monitoring of h$potension;sho#k

• A4$gen administration

• 97. 9nfusion of #r$stalloids;#olloids

• 1latelet transfusion

• &lotting fa#tors repla#ement• &ase fatalit$ is 5E in good #enters



*luid Balan#e

• &ontinue monitoring after deferves#en#e

• /erial hemato#rits+ B1+ Frine output

• *luid repla#ement is t%i#e the re8uirement

• :5!! ml 2 4 ,%eight-2! ? for ! kg %t.

@g. G:5!! 2 4 ,!-2! 4 2

I G:5!! ,24 ! 4 2 I ,:5!! "!! 4 2

I 2C!! 4 2 I !! ml I :! pints

Fnusual 1resentations of



Fnusual 1resentations ofDengue

• @n#ephalopath$

• Hepati# damage

• &ardiom$opath$

• /evere 39 bleeding



2igns and 2'm*#oms oEnce*ha+i#is;Ence*ha+o*a#h' Associa#ed i#h

Acu#e Dengue Inec#ion•De#reased level of #ons#iousness0 letharg$+ #onfusion+ #oma•/eiures•(u#hal rigidit$

•1aresis

Diff ti l Di i



Differential Diagnosis

• *M #omple4

:. )ni#teri# leptospirosis

2. 'i#kettsial feversC. 9nfluena+ Measles+ 'ubella

• DH* ; D//

:. Ather hemorrhagi# fevers2. D9& due to septi#emia

C. &ompli#ated Malaria

. Meningo#o##emia



6aborator$ Diagnosis

• &omplete Blood &ounts

• Hemato#rit

• 1latelet &ount

• /erum 3AT+ 31T• /erum )lbumin

• 1roteinuria+ hematuria

• 9mmunologi#al Tests

• &hest /kiagram



6aborator$ Diagnosis

• 6eu#openia. Thrombo#$topenia

• 9n#reased /3AT+ /31T

• 'ising )b titre in paired sera

• )ntigen dete#tion @69/)

• 9gM-#apture @69/) %ithin fe% hours

• 'everse trans#ription 1&' #onfirmator$

• 9g3 @69/) signifi#ant of past infe#tion



7A5ORAOR4 CRIERIA

• I2O7AION OF DENQUE VIRU2

• INCREA2ED IgM OR IgM ANI5ODIE2 IRE2

• DENQUE ANIGEN DEECION 54IMMUNOHI2OCHEMI2R4/IMMUNOF7URO2CENCE/E7I2A

• 6CR

• 7EUCO6ENIA/HROM6OC4O6ENIA



9mmuno Dete#tion Tests

@69/) 1late 9gM-#apture @69/)



&ommon Mis#on#eptions- DH*

• Dengue bleeding I DH*

• DH* is fatal onl$ due to hemorrhage

(o Maorit$ of deaths are due to sho#k

• 1oorl$ managed D* turns into DH*

• 1ositive tourni8uet I DH*

it is not spe#ifi# for DH*+

it indi#ates #apillar$ fragilit$ of an$ origin



More &ommon Mis#on#eptions

• DH* is onl$ a pediatri# illness ?

(o+ )ll ages ma$ be involved

• DH* is a problem of poor families ?

(o+ in fa#t the$ ma$ not have

immune #omple4es to re8uired level

• Tourists %ill get DH* ?

(o+ in fa#t the$ are at lo% risk



9mmuniation

• @a#h serot$pe produ#es life long immunit$

• There is not effi#a#ious va##ine available

• 7a##ine needs to be tetravalent• 6ive attenuated va##ines possible

• /everal #andidate va##ines are on trials

• 9t ma$ be harmful to va##inate in vie%

of the pathogenesis of DH*;D//



3H4 3O 24NDROME2/

5ENIGN and 2EVERE8

O$ser!ed in #o immuno+ogica+se##ings.

1. 6rimar' inec#ions in inan#s.

". 2econdar' inec#ions in chi+drenand adu+#s.

6RIMAR4 INFECION2



6RIMAR4 INFECION2

C+inica+ Fea#ures

4 In chi+dren

DEN 1 & % mi+d i++ness

DEN " & ) no i++ness

4 In adu+#s

DEN 1 & % Disease;Inec#ion 1 g.i. hemorrhages

ma' accom*an' *e*#ic u+cer disease.

DEN " & ) , mi+d , modera#e



o,inec#ions he e*idemio+ogica+ da#a

• DHF documen#ed in chi+dren S 1 'r0

ho circu+a#e inec#ion,ac(uireddengue an#i$od'. Four *ros*ec#i!e

cohor# and ? *ros*ec#i!e

*o*u+a#ion,$ased s#udies.

• In mos# s#udies/ DHF com*rises ",

- o secondar' inec#ions

DHF IN CHI7DREN 6RO26ECIVE



DHF IN CHI7DREN 6RO26ECIVE

COHOR 2UDIE2

References DHF/2o

Den Inf. DHF/10002o Den Inf.

Russell et al, !"#H

1$%&00,1'&(

)/() )&.1

*angawi+ha et al, !

120%&-), 1'(

/112 )-.$

ure et al, !"#H

)(%1$2, 1'((

$/-' 11(.&

raha et al,

!"#H &1%12, 1'''

$/120 -(.)

DHF IN CHI7DREN



DHF IN CHI7DREN

6RO26ECIVE 6O6U7AION,

5A2ED 2UDIE2References DHF/

2o Den Inf

DHF/1000

2o Den Inf

Halstead cad3ress 10$,1'(0 2-2(/12-,$2( 20.1

Russell et al !"#H

1(%&00,1'&(

))/2$00 12.2

*angawi+ha et al! 120%&-),1'(

1(/'20 1'.&

A26

DHF IN CHI7DREN



6RO26ECIVE 6O6U7AION,

5A2ED 2UDIE2References DHF/2o

Den Inf

DHF/1000

2o Den Inf

u4an et al!"#H 2%1$',1''0 121)/ -',($- 20.)

"hein et al !"#H

-&%-&&,1''$

1)(/1(1 )).0

u4an et al !1-2%$'), 2000

202/(10 2.0

Es#a$+ished second inec#ion



Es#a$+ished second inec#ion

se(uences +eading #o DHF

• " 1 hai+and Indonesia• % 1 hai+and• 1 " Cu$a/ 1>@1 Cu$a 1>> hai+and•

% " hai+and• ) " hai+and• 1 % Cu$a/ "==1 hai+and Indonesia• " % hai+and/ DF in Cu$a

• 1 ) hai+and• " ) Indonesia• % ) hai+and

/everal important features of dengue disease



/everal important features of dengue disease

• Dengue virus infe#tion #auses diverse disease spe#trum from

mild D* to severe DH*;D//.• Dengue disease #an o##ur in infant+ #hildren+ and adult.

• /evere DH*;D// is more prevalent in se#ondar$ infe#tion %ithdifferent serot$pe of dengue virus.

• )ntibod$-dependent enhan#ement is h$pothesied to e4plainthe severe DH*;D// in se#ondar$ infe#tion.

• Thrombo#$topenia and plasma leakage are t%o maor#hara#teristi#s of DH*;D//.

• The pathogenesis of DH*;D// is not #learl$ demonstrated. Theprogression from D* to DH*;D// is not predi#table.

• /upportive #are is the onl$ %a$ to treat the DH*;D// patients.

• Dengue va##ine is not #ommer#iall$ available $et.

DI*1NO2I2



Classic symptoms 5 high fever, a petechial rash(ith thrombocytopenia 6 relative leu+openia7decrease in the number of circulating /3C in the

blood8 /9O de)nition of D9: 5 :ever 9aemorrhagic tendency ;positive tourniquet test

7< than %= petechiae per square inch8,

spontaneous bruising, bleeding from mucosa,gingiva, in>ection sites, vomiting blood or bloodydiarrhea?

Thrombocytopaenia ;@$==,=== platelets per mmA? "vidence of plasma lea+age ;rise in hematocrit

level < than %=.?

2erology 7identi)cation of antibodies in the bloodserum8 6 polymerase chain reaction 7BCR8 tocon)rm the diagnosis of dengue if clinicallyindicated

2BTO2



2BTO2 2udden high fever 7&E#'$FGC8

for % to H days 9eadache Bain behind the eyesuscle pain, >oint pain, bone

pain 7brea+#bone fever8

*fter $ to % days of fever, thepatient develops initial rash(ith discoloured spots, oftendescribed as Isles of (hite ina sea of redJ

2econd rash may develop topalms and soles, and s+inmay peel o 7desquamate8 6body temperature drops

TR"*T"NT2



TR"*T"NT2

No speci)c antiviral treatment, only supportivetreatment is given to such patients

If the patient is dehydrating, adequate !uids areto be ta+en

Intravenous !uid is administered if the patient isunable to maintain oral inta+e

:or severe body ache, pain+illers may be needed :or severe headache and for >oint and muscle

pain, acetaminophenKparacetamol and codeinemay be given

If there is signi)cant bleeding, blood or platelettransfusion (ill be carried out

Note : Aspirin should be avoided as this drugmay worsen the bleeding tendency (becauseof its anticoagulant eects & the increasedrisk of developing Reye syndrome)

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Individual roles. Beople are urged toempty stagnant (ater from old tires,

trash cans 6 !o(er pots Mosquito control. Blace larvicide eg*bateM or any other suitable insecticidesinto any e-posed (ater container Usemosquito repellant sprays that containNND3 or D""T

Enforcement. 0ocal authorities froministry of 9ealth conduct on#site chec+ 6destroy larvae at residential premises 6construction sites :ines may be imposedon the o(ner of properties

There is currently no vaccineavailable for the dengue fever.

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Fogging with insecticide. :ogging(ould be carried out by localauthorities in housing area (here % ormore cases of dengue fever arereported (ithin one (ee+

Information. In Nov %==H, theinistry of 9ealth carried out a ma>orcampaign against *edes During thecampaign free pac+ages of *bateM(ere distributed 0ea!ets 6 brochuresto inform the public on (ays toprevent 6 curb *edes breeding aredistributed

Awareness campaign. 2chools 6local communities are encouraged tocarry out communal cleaningactivities Bublic a(arenesscampaigns through strategicallyplaced posters 6 televisionadvertisements are also done

Do the 10-Minute Mozzie Wipe-out everyday.Do the 10-Minute Mozzie Wipe-out everyday.



Remove water from flowerpot plates onalternate days.




Change water in vases on alternate days.




Turn over all pails and waterstorage ontainers.




Cover !am!oo pole holderswhen not in use.




Clear !lo"ages and put #ti insetiide in roofgutters monthly.

$nwanted items$nwanted items



Do not litter. Ru!!ish suh as upsand !ottles an ollet rain water

and !reed mos%uitoes.



J LNO

copy of dengue hemorrhagic fever ( kuliah )

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