Demam Berdarah Dengue

Dengue: Penyakit Arboviral yang Paling Cepat Menyebar

Jumlah insiden DD dan DBD yg

dilaporkan ke WHO (WHO, 2011)

30x incidence increase in

50 yrs
Daerah penyebaran dengue 2008 (WHO, 2009)
Surabaya (2000 - 2009):
↑ insiden: 12.04  48.9
WHO 2009: Perlu upaya yg lebih intensif untuk penelitian
per 100000
tentang patogenesis, perbaikan tata laksana, dan upaya
penemuan obat/vaksin
Belum ada obat/ vaksin
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Infeksi virus dengue (DENV)
Merupakan penyakit
demam akut yang
disebabkan oleh virus
dengue dan ditularkan
melalui gigitan nyamuk
Aedes aegypty dan
Aedes albopictus serta
memenuhi kriteria
WHO untuk Demam
Berdarah Dengue (DBD)

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 Manifestation of dengue virus infection
Dengue virus infection

Asymtomatic Symtomatic

Undifferentiated Dengue Fever Dengue haemorrhaegic Expanded dengue

Fever (DF) fever (DHF) syndrome / isolated
(viral syndrome) (with plasma leakage) organopathy
(unusual manifestation)

Without With unusual DHF DHF with shock

haemorrhage haemorrhage Non-shock DSS
Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever, WHO-SEARO 2011 4
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 Manifestasi/perubahan patofisiologis utama pada DBD
Infeksi Dengue

Demam Hepatomegali Trombositopeni Derajat

Manifestasi
Anoreksia perdarahan ; paling keparahan
Muntah sering uji torniquet DBD
Peningkatan permeabilitas
(+), petekie vaskular

Hemokonsentrasi
Dehidrasi
Hipoproteinemia Kebocoran Plasma I

Efusi Pleura/Ascites Koagulopati

II
Hipovolemia
Koagulasi
Intravaskular III
Syok Diseminata
(KID)

Perdarahan masif : IV
perdarahan saluran
cerna (tersembunyi),
Kematian perdarahan otak, dll
DBD/SSD
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Demam Dengue
Course of dengue illness

Shock/Bleeding

Dengue: Guidelines for diagnosis, treatment, prevention and control, TDR-WH0 2009
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Pemeriksaan penunjang
• Pemeriksaan darah serta serologi
• DL, LFT, RFT, BG, Coagulation profile, BGA, Electrolyte, lactate, NS1,
Igm/IgG anti-dengue
• EKG
• Pemeriksaan Radiologis
• Foto Thoraks
• USG
• Penunjang lainnya sesuai indikasi

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Classifications
1997 2009 2011
Dengue Fever Dengue without warning signs Dengue Fever
DHF grade I
DHF grade I
Dengue with warning signs
DHF grade II
DHF grade II

DHF grade III

Severe dengue: DHF grade III
With compensated shock
DHF grade IV With hypotensive shock DHF grade IV

EXPANDED DENGUE
SYNDROME
 WHO 2011 Classification of Dengue Infections
and Grading of Severity of DHF
DF/DHF Grade Symptoms Laboratory
DF Fever with two of the following: Leucopenia (wbc ≤5000
Headache, etro-orbital pain, Myalgia, cells/mm 3 ), Thrombocytopenia
Arthtralgia/bone pain, (Platelet count <150 000
Rash,Haemorrhagic manifestations, No cells/mm 3 ), Rising haematocrit
evidence of plasma leakage. (5% – 10% ),
No evidence of plasma loss
DHF I Fever and haemorrhagic manifestation Thrombocytopenia
(positive tourniquet test) and evidence of <100,000, Hct rise >20%
plasma leakage
DHF II As in Grade I plus Thrombocytopenia
Spontaneous bleeding. <100,000, Hct rise >20%
DHF III As in Grade I or II plus Thrombocytopenia
Circulatory Failure (weak pulse, narrow <100,000, Hct rise >20%
pulse pressure(≤20 mmHg),
hypotension,restlessness).
DHF IV As in Grade III plus profound shock Thrombocytopenia
with undetectable BP and pulse <100,000, Hct rise >20%
10 10
 Expanded dengue syndrome
NEUROLOGICAL
Febrile seizures in young children. CARDIAC
Encephalopathy. Conduction abnormalities.
Encephalitis/aseptic meningitis. Myocarditis.
Intracranial haemorrhages/thrombosis. Pericarditis.
Subdural effusions.
Mononeuropathies/polyneuropathies/GBS
Transverse myelitis.
RESPIRATORY
GASTROINTESTINAL/HEPATIC Acute respiratory distress
Hepatitis/fulminant hepatic failure. syndrome.
Acalculous cholecystitis. Pulmonary haemorrhage.
Acute pancreatitis.
Hyperplasia of Peyer’s patches.
OTHERS
Acute parotitis.

MUSCULOSKELETAL
RENAL Myositis with raise CPK
Acute renal failure. Rabdomyolysis
Hemolytic uremic syndrome.

Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health. 2007 Sep.; 12(9):1087 – 95 11
Warning signs (2009)
• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation
• Mucosal bleed
• Lethargy, restlessness
• Liver enlargment >2 cm
• Laboratory: increase in HCT concurrent with rapid
decrease in platelet count

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Dengue shock sydrome
Kriteria DHF dengan tanda tanda syok
• Takikardia, ekstremitas dingin, waktu pengisian kapiler
memanjang, nadi lemah, lesu atau gelisah, yang mungkin
merupakan tanda dari penurunan perfusi otak

• Tekanan nadi ≤20 mmHg dengan peningkatan tekanan

diastolik , misalnya 100/80 mmHg

• Hipotensi yang disesuaikan dengan usia, yakni tekanan

sistolik < 80 mmHg untuk mereka yang berusia < 5 tahun
atau 80 - 90 mmHg untuk anak-anak dan orang dewasa

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