virus dengue
TRANSCRIPT
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Dengue InfectionMost important arthropod-borne viral diseaseVektor utama Aedes aegyptiAda 4 serotipe (DEN-1, DEN-2, DEN-3, DEN-
4)Menyebabkan :
Dengue Fever (DF)Dengue Haemorrhagic Fever (DHF) / DSS
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cont50-100 juta kasus pertahun500.000 DHF/DSS30.000 meninggal (1-5% kasus)Endemik > 100 negara
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VIROLOGIVirus SS-RNA, 10,6 kb, FlavivirusSferik ukuran 50 nm, berenvelopGenom tdr 3 protein struktural (C, prM, E)7 protein non struktural (NS-1, NS-2A, NS-
2B, NS3, NS4A, NS4B, NS5)Yang lain : Yellow Fever Virus (YFV),
Japanese encephalitis (JEV), West Nile (WNV), Tick-borne encephalitis (TBE)
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Gambaran KlinikMasa inkubasi 3-7 hari (3-14)Pada Dengue Fever :
Onset demam, sakit kepalaNyeri retro-orbitalBody-aches (myalgia, arthralgia, abdominal pain)Anorexia, nausea, vomiting, weakness Flushing of the faceViremia : 100 rb- 1jt infectious unit/ml saat demam
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Gambaran Hasil Lab DF
LeukopeniaTrombositopeniaPeningkatan serum transaminase
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Gambaran Klinik DHF / DSSMore severe form of DENV infectionFever, trombocytopenia, haemorrhagic
manifestation and evidence of increased vascular permeability with leakage of intra- vascular fluid into interstitial spaces
Viremia 10-100 kali DFSering pd usia < 15 th
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Manifestasi HemoragikCapillary fragilityPetechiae, ecchymoses or purpuraBleeding from mucosa, gastrointestinal tract
or other sitesHaematemesis or melena
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Cont ..DENGUE SHOCK SYNDROME
Disertai kegagalan sirkulasi, nadi cepat dan lemah
Tekanan darah turunKulit dingin, lembabPasien gelisah
Perjalanan penyakit sulit diramalkan, fase demam 2-7 hari diikuti fase kritis 2-3 hari
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Diagnosis BandingDemam tifoidCampakInfluenzaeLeptospirosis
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Pem. LabLeukopenia dan limfositosis relatifTrombositopenia :
Supresi SST (sitokin hematodepresif : TNF-a, IL-2, IL-6, IL-8, INF-a, INF-g)
Meningkat kerusakan kapilerBerkorelasi dg berat klinik DHF
Hemokonsentrasi .> 20%Limfosit plasma biru > 15% : fase syok
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Diagnosis LabIsolasi virus pd kultur sel merupakan gold
standard ( lebih 1 minggu)Deteksi antibodi thd virus (IgM dan IgG
dengan ELISA) ; low sensitivity (4 hr feverRT-PCR :
Pem 4 jamKuantitatif viral load in blood sample
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contIsolasi virus:
Live miceLive mosquitoesCell culture
Tes serologi : dengan ELISAIgM : terdeteksi 3-5 hari setelah infeksi, men-
capai puncak +/- 2 minggu stl itu menurun dan tdk terdeteksi setelah 2-3 bulan
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contIgG, terdeteksi 9-10 hari dan bertahan for lifePada infeksi sekunder, IgG meningkat cepat dg
kadar tinggi dlm 1-2 hari stl infeksiPemeriksaan antigen NS-1 dengan ELISA utk
deteksi awal DV. Sensitivitas 97,3 %Molekuler :
Mendeteksi kuantitas virus dlm serumTes RNA virus, mendeteksi material virus 5
hari pertama sakit
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TERAPITidak spesifik (terapi suportif)Pemeliharaan cairan sirkulasi ; mencegah
dehidrasi dan hemokonsentrasiFase demam :
Antipiretik, kompres hangatLar oralit, jus buah
Fase kritis :Pada hai ke-5 (tdk makan dan minum)IV, bila syok – O2
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Pemberian komponen darahTrombosit : bila ada perdarahan nyata dan
berat, diberikan sampai perdarahan berhentiKriopresipitat ; bila fibrinogen di bawah 100
mg/dl
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