referat DHF
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REFERATDEMAM DENGUE DAN DEMAM BERDARAH
DENGUEOleh :
Ajeng Tri Septiani2008730048
Pembimbing : Dr. Heka Mayasari, SpA
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Definisi
Demam berdarah dengue (DBD) → Penyakit demam akut yang disebabkan o/ virus Dengue→ Memenuhi kriteria WHO untuk DBD
DBD → manifestasi simptomatik dari infeksi virus dengue
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Klasifikasi Who 1997
Infeksi virus
dengue
Asimptomatik
Simptomatik
Demam tidak
spesifik
Demam dengue
Perdarahan (-)
Perdarahan (+)
Demam berdarah dengue
Syok (-) DSS
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Klasifikasi WHO 2009
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Epidemiologi
Masalah kesehatan masyarakat selama 41 tahun terakhir
Endemis pada 2 provinsi dan 2 kota (1968) → 32 provinsi dan 382 kabupaten/kota (2009)
Peningkatan jumlah kasus DBD, 58 kasus (1968) →158.912 (2009)
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Angka Insiden DBD per 100.000 Penduduk Menurut Provinsi di
Indonesia Tahun 2009
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Dengue virus
Genus Flavivirus Family flaviridae 4 serotipe virus → DEN-1, DEN-2, DEN-3
dan DEN-4 Ditularkan kepada manusia → Aedes
aegypti, Nyamuk Aedes albopictus, Aedes polynesiensis
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Patofisiologi
DF
DHF
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Demam dengue
Manifestasi klinis
• Demam • Ruam • Manifestasi
perdarahan
Laboratorium
• WBC ≤ 5000 sel/m3
• PLT 100000 – 150000 sel/m3
• Ht ↑ 10%• ALT, AST ↑
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Kriteria diagnosis DBD
Manifestasi klinis
• Demam• Manifestasi
perdarahan• Hepatomegali• Warning sign• shock
Pemeriksaan lab
• Trombositopenia (100.000 sel/mm3 atau kurang)
• Haemokonsentrasi (ht ≥ 20%)
• Efusi pleura pd Ro thorax
• Hipoalbumin, hiponatremia
• PT & PTT memanjang• ALT, AST ↑• Asidosis metabolik,
BUN ↑
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Tes dengue
Virus isolasi Karakterisasi serotypic / genotipik
Deteksi asam nukleat virus Deteksi virus antigen Tes respon imunologi
IgM dan IgG antibodi tes Analisis untuk parameter hematologis
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Pasien dengan risiko tinggi
Bayi dan orang tua Obesitas Wanita hamil Penyakit ulkus peptikum Wanita yang mengalami perdarahan vagina atau menstruasi
tidak normal Penyakit hemolitik seperti defisiensi glukosa-6-fosfatase
dehidrogenase (G-6PD), thalassemia dan haemoglobinopathies lain
Penyakit jantung bawaan Penyakit kronis seperti diabetes mellitus, hipertensi, asma,
penyakit jantung iskemik, gagal ginjal kronis, sirosis hati Pasien pada pengobatan steroid atau NSAID, dan Lain-lain
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MANAJEMEN
Suspek DBD, perdarahan spontan dan masif (-), syok (-)
Hb, Ht (n), tromb < 100.000; Infus kristaloid*; Hb, Ht,
tromb tiap24 jam
Hb, Ht 10-20%, tromb < 100.000; Infus kristaloid*; Hb, Ht, tromb tiap
24 jam
Hb, Ht > 20%, tromb < 100.000
Protokol pemberian cairan pada kasus DBD dengan
Ht ≥ 20%
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Note Childre rate (ml/kg/hour)
Adult rate (ml/hour)
Half the maintenance M/2
1.5 40–50
Maintenance (M)
3 80–100
M + 5% deficit 5 100–120
M + 7% deficit 7 120–150
M + 10% deficit
10 300–500
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PERBAIKAN
Kasus DBD dengan Ht > 20%
5% defisit cairan
Terapi awal cairan intravena, kristaloid 6-7 ml/kgBB/jam
Evaluasi 3-4 jam
PERBAIKAN Ht, frek. nadi , tensi membaik, prod.urin
TIDAK MEMBAIK Ht, frek.nadi , tensi < 20mmHg, prod.urin
Kurangi infus kristaloid 5ml/kgBB/jam
TANDA VITAL & HEMATOKRIT MEMBURUK
Infus kristaloid 10ml/kgBB/jam
PERBAIKAN
PERBAIKAN
PERBAIKAN
Kurangi infus kristaloid 3ml/kgBB/jam
Terapi cairan dihentikan 24-48jam
TIDAK MEMBAIK
Infus kristaloid 15ml/kgBB/jam
KONDISI MEMBURUK tanda syok (+)
Protokol 5
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Monitoring
KU, nafsu makan, muntah, perdarahan, dll
TTV Non syok 2-4 jam Syok 1-2 jam
Ht (sebelum resusitasi) 4 – 6 jam Urin output 8 – 12 jam (normalnya 0,5 ml
/ kgBB ideal / jam)
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Komplikasi
Perdarahan Asidosis metabolik Kegagalan multi organ Udem paru Gagal jantung
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TERIMA KASIH