DENGUE HEMORRHAGIC FEVER
1
,3.1. Dengue Fever
3.1.1. Definition
Dengue fever is the most common fever in the age group of children, adolescents
and adults. In general, dengue fever is an acute febrile condition, which sometimes has a
biphasic pattern and is accompanied by severe headaches, myalgias, arthralgias, skin
rashes, leukopenia and thrombocytopenia. Even though dengue fever is actually a harmless
condition, it can cause sufferers to be unable to do activities due to severe headaches,
muscle, joint and bone pain (break-bone fever), especially in adults. Sometimes atypical
bleeding occurs, such as gastrointestinal bleeding, hypermenorrhea, and massive epistaxis.
In areas experiencing dengue fever epidemics, transmission of dengue fever rarely occurs
between local residents
Dengue hemorrhagic fever (DHF) is more common in children under 15 years of
age in hyperendemic areas, and it is associated with recurrent dengue infection. However,
its incidence in adults is also increasing. DHF is characterized by a high fever with an
acute onset with symptoms and signs similar to the symptoms and signs of dengue fever in
the initial phase. In DHF, abnormalities in bleeding can be found, for example, a positive
tourniquet (rumple leed) test, petechiae, bruises and gastrointestinal bleeding in more
severe cases.
At the end of the febrile phase, there is a threat of hypovolemic shock (dengue
shock syndrome) due to plasma leakage. The emergence of warning signs such as
persistent vomiting, abdominal pain, lethargy, restlessness, irritability, and oliguria is an
important thing to be followed up immediately in order to prevent shock. Hemostatic
disorders and plasma leakage are the main pathophysiological processes in DHF.
Thrombocytopenia and increased hematocrit/hemoconcentration are features that are
invariably encountered before a reduction in fever/onset of shock. DHF mostly occurs in
children who get a second infection with the dengue virus. There are also reports of DHF
cases occurring in the first infections with DENV-1 and DENV-3 viruses as well as
infections in infants. 6
2
, Expanded dengue syndrome is an unusual manifestation that is increasingly being
reported in cases of dengue hemorrhagic fever and dengue fever where there is
involvement of organs such as the liver, kidneys, brain and heart which are related to
dengue infection, but there is no evidence of plasma leakage. This may be caused by co-
infection, co-morbidity, or complications from prolonged shock. A more in-depth study
needs to be done for this case. Most patients with dengue hemorrhagic fever who
experience this unusual manifestation are caused by prolonged shock accompanied by
organ failure
Undifferentiated fever Undifferentiated fever is a fever in infants, children and adults
caused by dengue virus infection, especially if the infection is the first time it occurs
(primary dengue infection) where this fever cannot be distinguished from fever due to
other viral infections. A maculopapular rash may accompany fever or as the fever returns
to normal. Other symptoms that often accompany are symptoms involving the respiratory
and gastrointestinal systems
3.1.2. Etiology
Dengue virus types 1, 2, 3 and 4 (group Arthropod borne virus group B) are
transmitted through the bite of many Aedes mosquito species (among others Aedes aegypti
and Aedes albopi. Four different dengue viruses are known to cause dengue fever. Dengue
fever occurs when a person is bitten by a mosquito infected with the virus. The Aedes
aegypti mosquito is the main species that spreads the disease. There are over 100 million
new cases of dengue fever every year worldwide. A small number of these develop into
dengue fever.7
3
, Most infections in the United States are brought in from other countries. Risk
factors for dengue include having antibodies to the dengue virus from a previous infection
(Vyas, et al, 2014). Dengue virus belongs to the genus Flavirus, family flaviridae, there are
4 serotypes of the virus with DEN-1, DEN-2, DEN-3 and DEN-4, all four of which are
found in Indonesia with the most den-3 serotypes. Infection with one serotype will produce
antibodies against the serotype in question, while the antibodies formed against the other
serotypes are very lacking, so they cannot provide adequate protection against other
serotypes. A person living in the epidermal area of dengue can be infected by 3 or 4
serotypes during his life. The four serotypes of dengue virus can be found in various
regions in Indonesia.6
3.1.3. Symptom
Clinical features Dengue fever After an incubation period of an average of 4-6
days (range, 3-16 days), various non-specific constitutional symptoms as well as
headache, back pain and malaise begin to appear. The uniqueness of the onset of dengue
fever is fever that rises suddenly with a sharp increase in temperature and is often
accompanied by facial flushing and headache. Occasionally, chills accompany a sudden
rise in temperature. After that, retro-orbital pain can appear which is especially felt when
moving the eyeball or if pressure is applied to the eyeball, photophobia, back pain,
muscle pain and bone/joint pain. Other symptoms that often appear are anorexia and
changes in tongue taste sensation, constipation, colicky abdominal pain. groin area pain,
sore throat and depression. These symptoms usually persist for several days to several
weeks. It is important to note that the symptoms of dengue fever vary widely in terms of
frequency and severity
Fever: body temperature usually ranges from 39 oC - 40 oC, fever has a biphasic
pattern, and lasts 5-7 days in most cases.
Skin rash: a diffuse rash of short duration appearing on the face, neck and chest in
the first 2 to 3 days; later, a marked rash appears as maculopapular or rubelliform lesions
on the 3rd and 4th day. At the end of the feverish period, or as soon as the temperature
begins to drop, the diffuse rash will disappear, and clusters of localized petechiae will
appear in such locations as the soles of the feet, feet, palms and arms. This healing rash has
4
1
,3.1. Dengue Fever
3.1.1. Definition
Dengue fever is the most common fever in the age group of children, adolescents
and adults. In general, dengue fever is an acute febrile condition, which sometimes has a
biphasic pattern and is accompanied by severe headaches, myalgias, arthralgias, skin
rashes, leukopenia and thrombocytopenia. Even though dengue fever is actually a harmless
condition, it can cause sufferers to be unable to do activities due to severe headaches,
muscle, joint and bone pain (break-bone fever), especially in adults. Sometimes atypical
bleeding occurs, such as gastrointestinal bleeding, hypermenorrhea, and massive epistaxis.
In areas experiencing dengue fever epidemics, transmission of dengue fever rarely occurs
between local residents
Dengue hemorrhagic fever (DHF) is more common in children under 15 years of
age in hyperendemic areas, and it is associated with recurrent dengue infection. However,
its incidence in adults is also increasing. DHF is characterized by a high fever with an
acute onset with symptoms and signs similar to the symptoms and signs of dengue fever in
the initial phase. In DHF, abnormalities in bleeding can be found, for example, a positive
tourniquet (rumple leed) test, petechiae, bruises and gastrointestinal bleeding in more
severe cases.
At the end of the febrile phase, there is a threat of hypovolemic shock (dengue
shock syndrome) due to plasma leakage. The emergence of warning signs such as
persistent vomiting, abdominal pain, lethargy, restlessness, irritability, and oliguria is an
important thing to be followed up immediately in order to prevent shock. Hemostatic
disorders and plasma leakage are the main pathophysiological processes in DHF.
Thrombocytopenia and increased hematocrit/hemoconcentration are features that are
invariably encountered before a reduction in fever/onset of shock. DHF mostly occurs in
children who get a second infection with the dengue virus. There are also reports of DHF
cases occurring in the first infections with DENV-1 and DENV-3 viruses as well as
infections in infants. 6
2
, Expanded dengue syndrome is an unusual manifestation that is increasingly being
reported in cases of dengue hemorrhagic fever and dengue fever where there is
involvement of organs such as the liver, kidneys, brain and heart which are related to
dengue infection, but there is no evidence of plasma leakage. This may be caused by co-
infection, co-morbidity, or complications from prolonged shock. A more in-depth study
needs to be done for this case. Most patients with dengue hemorrhagic fever who
experience this unusual manifestation are caused by prolonged shock accompanied by
organ failure
Undifferentiated fever Undifferentiated fever is a fever in infants, children and adults
caused by dengue virus infection, especially if the infection is the first time it occurs
(primary dengue infection) where this fever cannot be distinguished from fever due to
other viral infections. A maculopapular rash may accompany fever or as the fever returns
to normal. Other symptoms that often accompany are symptoms involving the respiratory
and gastrointestinal systems
3.1.2. Etiology
Dengue virus types 1, 2, 3 and 4 (group Arthropod borne virus group B) are
transmitted through the bite of many Aedes mosquito species (among others Aedes aegypti
and Aedes albopi. Four different dengue viruses are known to cause dengue fever. Dengue
fever occurs when a person is bitten by a mosquito infected with the virus. The Aedes
aegypti mosquito is the main species that spreads the disease. There are over 100 million
new cases of dengue fever every year worldwide. A small number of these develop into
dengue fever.7
3
, Most infections in the United States are brought in from other countries. Risk
factors for dengue include having antibodies to the dengue virus from a previous infection
(Vyas, et al, 2014). Dengue virus belongs to the genus Flavirus, family flaviridae, there are
4 serotypes of the virus with DEN-1, DEN-2, DEN-3 and DEN-4, all four of which are
found in Indonesia with the most den-3 serotypes. Infection with one serotype will produce
antibodies against the serotype in question, while the antibodies formed against the other
serotypes are very lacking, so they cannot provide adequate protection against other
serotypes. A person living in the epidermal area of dengue can be infected by 3 or 4
serotypes during his life. The four serotypes of dengue virus can be found in various
regions in Indonesia.6
3.1.3. Symptom
Clinical features Dengue fever After an incubation period of an average of 4-6
days (range, 3-16 days), various non-specific constitutional symptoms as well as
headache, back pain and malaise begin to appear. The uniqueness of the onset of dengue
fever is fever that rises suddenly with a sharp increase in temperature and is often
accompanied by facial flushing and headache. Occasionally, chills accompany a sudden
rise in temperature. After that, retro-orbital pain can appear which is especially felt when
moving the eyeball or if pressure is applied to the eyeball, photophobia, back pain,
muscle pain and bone/joint pain. Other symptoms that often appear are anorexia and
changes in tongue taste sensation, constipation, colicky abdominal pain. groin area pain,
sore throat and depression. These symptoms usually persist for several days to several
weeks. It is important to note that the symptoms of dengue fever vary widely in terms of
frequency and severity
Fever: body temperature usually ranges from 39 oC - 40 oC, fever has a biphasic
pattern, and lasts 5-7 days in most cases.
Skin rash: a diffuse rash of short duration appearing on the face, neck and chest in
the first 2 to 3 days; later, a marked rash appears as maculopapular or rubelliform lesions
on the 3rd and 4th day. At the end of the feverish period, or as soon as the temperature
begins to drop, the diffuse rash will disappear, and clusters of localized petechiae will
appear in such locations as the soles of the feet, feet, palms and arms. This healing rash has
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