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20yo man with fever dx DENGUE - Coggle Diagram
20yo man with fever
dx DENGUE
Differential diagnoses of dengue
• Arboviruses: Chikungunya virus (this has often been mistaken for dengue in South-East Asia).
• Other viral diseases: Measles; rubella and other viral exanthems; Epstein-Barr Virus (EBV);
enteroviruses; influenza; hepatitis A; Hantavirus.
• Bacterial diseases: Meningococcaemia, leptospirosis, typhoid, melioidosis, rickettsial diseases, scarlet fever.
• Parasitic diseases: Malaria
Fever types
remitten
intermittent
septic
continue
cyclic
dengue
definition
dengue fever is a globally important arboviral infection transmitted by mosquitoes of the Aedes genus (primarily Aedes aegypti, but also A albopictus), an insect found in tropical and subtropical regions.
etiology
caused by four antigenically distinct dengue virus serotypes: DENV-1, DENV-2, DENV-3, and DENV-4.
pathogenesis
linked to the host immune response, which is triggered by infection with the virus.Primary infection is usually benign.
Secondary infection with a different serotype or multiple infections with different serotypes may, however, cause severe infection that can be classified as either dengue haemorrhagic fever or dengue shock syndrome, depending on the clinical signs.
epidemiology dengue
Around two fifths of the world’s population (those in tropical and subtropical countries), or up to 2.5 billion people, are at risk of dengue infection.
Transmission of DHF
to occur the female Ae. aegypti must bite an infected human during the viraemic phase of the illness that manifests two days before the onset of fever and lasts 4–5 days after onset of fever.
After ingestion of the infected blood meal the virus replicates in the epithelial cell lining of the midgut
escapes into haemocoele to infect the salivary glands and finally enters the saliva causing infection during probing
Criteria for clinical diagnosis of DHF
Initial laboratory investigations
thrombocytopenia
100 000 cells per mm3 or less
rise of hematocrit
increase of ≥20%
leucopenia
increased of liver function test
Complications
association with underlying disease such as peptic ulcers, severe thrombocytopenia and trauma
prolonged shock leading to metabolic acidosis and severe bleeding as a result of DIC and multiorgan failure such as hepatic and renal dysfunction
Vectors of dengue
Aedes (Stegomyia) aegypti (Ae. aegypti) and Aedes (Stegomyia) albopictus (Ae. albopictus) are the two most important vectors of dengue.
Dengue virus
The dengue viruses are members of the genus Flavivirus and family Flaviviridae. These small (50 nm) viruses contain single-strand RNA as genome. The virion consists of a nucleocapsid with cubic symmetry enclosed in a lipoprotein envelope.
Prognosis
Prognosis depends on
1.Early diagnosis
2.Early recognition of shock
3.Careful clinical observation
4.Simple laboratory test
Management
Catat vital sign tiap 30 menit dan volume urine perjam atau per 4 jam.
Periksa Hb, Ht, Trombosit tiap 4 jam.
Infus Ringer Lactate atau Ringer Acetate (ASERING) cor 1 – 1,5 liter (20 cc/Kg BB/jam), dilanjutkan dengan 40 tetes/menit (50 cc/Kg BB/24 jam)
Vaksinasi
dengvaxia