Dengue Hemorrhagic Fever Management

Dengue Hemorrhagic Fever (DHF) is a form of dengue infection accompanied by bleeding manifestation from mild to severe. DHF becomes a health problem both in tropical and sub-tropical areas (as "imported cases", cases under the tropics).

Since the advent of the disease several decades ago, to date there has practically no decrease in both incidence and prevalence. Dengue fever is a fever caused by Dengue virus infection.

Known 4 different types of Dengue Virus namely: Den-1, Den-2.Den-3, and Den-4.

Clinical signs and symptoms

Usually asymptomatic (no symptoms). Patients taken to the hospital are usually in severe condition. Symptoms and signs-clinicnya syndrome (collection of symptoms) from mild form of mild fever to shock due to severe bleeding.

Bleeding and plasma leakage (leakage of blood vessels) that occur usually because the patient gets an infection attack by one type of Dengue virus. In endemic areas (like Indonesia) we should suspect any fever that occurs as dengue fever until further examination proves that it is not dengue fever.

Specialist surgeons (who suspect there is appendicitis) and obstetricians (who suspect there is an out-of-date pregnancy) should be vigilant when confronted with patients from endemic areas or recently returned from endemic areas with high fever accompanied by abdominal pain (abdomen ).

Do not rush into surgery, before being sure that the stomach pain is not due to dengue fever. Because the symptoms are similar between dengue fever with appendicitis, and pregnancy outside the womb (ectopic pregnancy is disrupted).

Laboratory examination is characterized by decreased platelets and signs of plasma Leakage (inflammation of the plasma due to leakage of blood vessels) is the occurrence of hemokonsentrasi (increased hematocrit levels). Clinical and laboratory changes of DHF patients Very quickly, requiring strict vital monitoring and serial laboratory (every 12 hours or 24 hours).

WHO criteria are still used for the diagnosis of DHF. But in certain circumstances we should not only hold on to one kind of examination. Platelet value less than 100,000 (only) can not be used as a handle to insert the patient to the hospital, because platelets that are still above 100,000 / mm3 can suddenly drop drastically. So if the patient is still at home would be very dangerous to the soul of the patient.

Diagnosis of DHF with serological examination of ELISA and rapid test (rapid test) with Dengue blot. For Dengue Blot usually new positive on fifth day of fever. There are other checks: NS1 antigen, recommended for patients with fever less than 3 days, if positive supports Dengue Fever, But if negative results should be confirmed again with Dengue Blot after fever day 5.

Management

Dengue Hemorrhagic Therapy is supportive (boosting the immune system) and symptomatic (relieving symptoms). No specific drugs have been found to kill the Dengue virus.

Need to replace fluid loss due to plasma leakage (Dengue virus attacks blood vessel walls) and provide substitution therapy (replacement) of blood components when needed. If platelet counts are very low and bleeding occurs, platelet transfusions are given.

In the administration of fluid therapy, the need for fluid monitoring. Take care of patients both clinically and laboratories (see Hemoglobin, Hematocrit, and platelet levels). The process of plasma leakage and the occurrence of thrombocytopenia (decreased thrombocyte) generally occur days 4 to 6 since the fever. Thus, it is necessary to be careful when treating DHF on days 4 to 6. On that day patients often do not complain of heat and tend to ask for outpatient care.

Day 7 fever, the process of plasma leakage will decrease and the fluid returns from the interstitial space (around blood vessels) to the intravascular (into the blood vessels). Liquid therapy in such circumstances should be gradually reduced. Because, will cause a lot of fluid buildup in the blood vessels.

It is necessary to monitor the possibility of fluid overload and the occurrence of pleural effusion (accumulation of fluid in the lung layer) or ascites (fluid accumulation in the abdominal cavity). Can be seen from clinical symptoms: shortness of breath, heavy breathing, and feelings of discomfort.

Need nonfarmakologis Therapy (without drugs) which includes bed rest (on platelets openia = severe platelet count). Normal platelet levels: 150 thousand to 450 thousand. If dropped below 100 thousand, should be hospitalized. Because it is feared there will be bleeding and possible Shock (Shock Syndrome in Dengue).

Provision of food with nutritional content: regular rice or soft rice according to the taste of the patient. Needed a meal Does not contain substances or spices that irritate the digestibility (spicy, sour).

 Symptomatic therapy, given antipyretics (paracetamol), overcomes dyspepsia (discomfort in the pit of the stomach, nausea, vomiting, sebah, easily satiated, bloated, often belching).

The fluid administration protocol as a major component of adult DHF management follows 5 protocols, which refer to the WHO protocol.

The protocol is divided into 5 categories, as follows:

1. Handling suspect dengue without shock.

2. Giving fluids to adult DHF suspects in the care room.

3. Management of DHF with increased hematocrit (blood viscosity)> 20%

4. Management of spontaneous bleeding in adult dengue

5. Management of dengue shock syndrome in adults

Dengue Hemorrhagic Fever will always be there throughout the year. We can prevent transmission of this disease by jointly seeking the breaking of the transmission chain by eradicating mosquito nests.

By: Dr. Muchlis Achsan Udji Sofro SpPD-KPTI

SMF Disease In RSUP Dr Kariadi Semarang