idk case 4 (dhf)
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Demam Berdarah
Dengue / DHFMaulidiana Indah
1010211180
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demam berdarah dengue/DBD (dengue
haemorrhagic fever/DHF)
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Etiologi• Demam dengue dan demam berdarah dengue
disebabkan oleh virus dengue, yang termasuk dalamgenus Flavivirus, keluarga Flaviviridae.
• Flavivirus merupakan virus dengan diameter 30nm terdiridari asam ribonukleat rantai tunggal dengan beratmolekul 4 x 106.
• erdapat 4 serotipe virus tipe yaitu D!"#1, D!"#$, D!"#3, dan D!"#4 yang dapat menyebabkan demam dengueatau demam berdarah dengue
• keempat serotype ditemukan di %ndonesia dengan D!"#3 merupakan serotype terbanyak.
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ETIOLOI
• !iru" #amili #la$i$iridae (% "eroti&e'
• 1 2 &ertama ditemu)an di Irian &d *D II+ , %
Fili&ina• Bentu) batang+ termolabil+ "en"iti# ina)ti$a"i dietil
eter -a dio)"ilat+ "tabil &d "uhu .0 0
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ambar 1 !iru" dengue matur dengan &emeri)"aan cryoelectron
microscopy (uhn d))+ 2002'
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E&idemiologi
• Demam berdarah dengue tersebar di &ilayah 'sia enggara, (asi)ik *arat dan +aribia.
• %ndonesia merupakan &ilayah endemis dengan
sebaran di seluruh &ilayah tanah air.• %nsiden D*D di %ndonesia antara 6 hingga 1 per
100.000 penduduk -1/ hingga 1
• pernah meningkat taam saat keadian luar biasahingga 3 per 100.000 penduduk pada tahun1/
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!pidemiologi
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EPIDEMIOLOGI DHF
'2!'" Indonesia menduduki urutan kedua tertinggi kasus DBD
• Vietnam : 234.920 kasus
• Indonesia : 39.405 kasus
• Thailand : 24.82 kasus
• !ili"ina : #2.#2# kasus
• $inga"ura : #.355 kasus• %ala&sia : 05 kasus
• Brunei Darussalam : ' kasus
• ()ro*l Indonesia 2000 : De"kes. +I, 200#-.
• %"D"!2%' $eak "ertama kali ditemukan di /akarta dan $uraa&a thn#98, sam"ai saat ini masih menadi masalah kesehatan mas&arakat. /umlah koran dari tahun ke tahun 1enderung mengalami
• "eningkatan seiring dgn meluasn&a daerah terangkit &g ham"ir
• menangkau seluruh ila&ah (De"kes +I, #999-.
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ANGKA INSIDEN DBD PER PROPINSI
DI INDONESIA TH. 2002
DKI Jaya pada kelompok Merah (IR > 10 per100.000 penduduk)
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Epidemiologi (Lanjutan)
• Data Penderita DBD di Jakarta thn 2000-2007
Tahun Penderita Meninggal CFR
2000 8.729 3 0!
200" 7.37 28 0!
2002 #.7#0 9 0!9
2003 ".07" 9 0!3
200 20.$0 90 0!
200# 23.$$ 80 0!3
200$ 2.932 #" 0!2
2007 % # Fe& 2.##8 8 0!
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ara *enularan• erdapat tiga )aktor yang memegang peranan pada penularan
in)eksi virus dengue, yaitu manusia, virus, dan vektor perantara.
• 5irus dengue ditularkan kepada manusia melalui gigitan nyamuk 'edes aegypti. "yamuk 'edes albopitus, 'edes polynesiensisdan beberapa spesies yang lain dapat uga menularkan virus ini,namun merupakan vektor yang kurang berperan.
• "yamuk 'edes tersebut dapat mengandung virus dengue padasaat menggigit manusia yang sedang mengalami viremia.
• +emudian virus yang berada di kelenar liur berkembang biakdalam &aktu /#10 hari -extrinsi inubation period sebelum
dapat ditularkan kembali kepada manusia pada saat gigitanberikutnya.
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• 5irus dalam tubuh nyamuk betina dapat ditularkan kepada
telurnya -transovanan transmission, namun perannyadalam penularan virus tidak penting.
• 2ekali virus dapat masuk dan berkembangbiak di dalamtubuh nyamuk, nyamuk tersebut akan dapat menularkanvirus selama hidupnya -in)ekti).
• Di tubuh manusia, virus memerlukan &aktu masa tunas 46hari -intrinsi inubation period sebelum menimbulkanpenyakit.
• (enularan dari manusia kepada nyamuk hanya dapat teradibila nyamuk menggigit manusia yang sedang mengalamiviremia, yaitu $ hari sebelum panas sampai hari setelahdemam timbul.
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Patogenesis • Kontroversi Me)ani"me imuno&atologi" ber&eran
&enting
• Hipotesis infeksi sekunder ( "e3ondar4 heterologou"
in#e3tion theor4 ' 5 immune enha3ement
• Infeksi kedua kali dgn virus dengue heterolog 56 re"i)o
77D 66
• AB heterolog 56 $iru" td) dinetrali"a"i 556 beba"
re&li)a"i 556 "e)re"i mediator 56 &ening)atan
&ermeabilita" &emb drh 556 hi&o$olemia "4o)
• Hipotesis 56 !iru" d&t berubah )rn te)anan "ele)"i
a)tu 56 &ening)atan re&li)a"i $iru" dan $iremia +
$irulen"i 56 &oten"i ter9adin4a abah
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•!"g respon infeksi terse"ut
•1 :)ti$a"i "i"tim )om&lemen 56 "hg di)eluar)an ;at
ana#ilato)"in 56 &ening)atan &ermeabilita" )a&iler 56 plasma leakage
•2 :grega"i trombo"it 56 trombo"it menurun )el
#ung"i trombo"it
•, eru"a)an "el endotel556 menga)ti$a"i #a)tor
&embe)uan
•a Peningkatan permea"ilitas kapiler 556"4o)
•b Kelainan Hemostasis 556 *erdarahan hebat
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• %munopatogenesis D*D :#eren
E#e)tor
E#eren
%n)eksi 5irus
7akro)ag2el +upp)er
dan sel
aringan paru
"ekrosis dan
apoptosis
8eseptorF 7onosit
9ati ,:impa,
;sus dan2umsumulang
5iremia
2istem 9umoral-+omplemen
2ubstansi in)lamasi2itokin
tromboplastin
(ermeabilitaskapiler
'kti)asi )aktor
koagulasi
7annosabinding protein
'ntibodi
+omplemenlain
Fagositosis
dan lisis padavirus
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GEJALA & TANDA
• Demam tiba<tiba+ menggigil
• -4eri )e&ala+ mata+ &inggang+ otot+ "endi
• :nore)"ia+ mual+ muntah
• Hi&ere"te"ia )ulit+ gangg &enge3a&an
• E&i"ta)"i"+ &erdarahan gu"i• Eritema+ &ette)ia
• Bradi)ardia relati#
DHF =e)ruden"i demam "etelah 12<2% 9am
He&atomegali+ menometrorhagia+&erdarahan "aluran 3erna+ a"ite"+
e#u"i &leura+en"e#alo&ati
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Laboratorium :
• DBD
Trombo"it > 100000/mm,
?remia+ hi&onatremia+ hi&o&roteinemia+
DI *eman9angan *T+ a*TT
*enurunan #ibrinogen+ #a)tor II+!+!II+@@IIIg M dan Ig :nti Dengue
:ntigen -71 1< A hari
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riteria Diagno"ti) (HO 1C8' riteria Minor
1 Demam mendada)+ &en4ebab ta) di)etahui
2 *erdarahan (terma"u) te" torniuet '
, He&atomegali
% 74o)riteria Ma4or
1 Trombo"ito&enia (> 100000/mm,'
2 Hemo)on"entra"i ( 6 20 G diata" normal'
DBD 2 riteria minor 1 riteria ma4or
Diagno"a *a"ti I"ola"i $iru" atau 7erologi" (IgM '
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+riteria Diagnostik -<9 1=
• Demam atau ri&ayat demam akut, antara $#= hari• erdapat min 1 dari mani) perdarahan berikut ui
bendung ->, petekie, perdarahan mukosa,hematemesis
• rombositopenia
• erdapat min 1 tanda plasma leakage -kebooranplasma 9t ?$0@ dibanding standar
• (enurunan 9t• anda kebooran plasma
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+lasi)ikasi *erat (enyakit
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(eralanan(enyakit
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TO?=-I?ET TE7T
• Te"t =um&le Leede
Inter&reta"i ha"il • *ete)ie 0 10 (20' / in3i2 5 -egati#
• *ete)ie 6 20 / in3i2 5 *o"iti#
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TO?=-I?ET TE7T *O7ITI*TO?=-I?ET TE7T *O7ITI*
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DI:-O7: B:-DI-
1. Demam thyphoid
$. 7alaria
3. 7orbili4. Demam Ahikungunya
. :eptospirosis
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*E-:T:L:7:-::-(engobatan demam berdarah dengue bersi)at simptomatik dan suporti)
yaitu pemberian airan oral untuk menegah dehidrasi. 'pabila airan oraltidak dapat diberikan oleh karena muntah atau nyeri perut yang berlebihanmaka airan intravena perlu diberikan.
7edikamentosa yang bersi)at simptomatis
• ;ntuk hiperpireksia dapat diberikan kompres es dikepala, ketiak,inguinal.
• 'ntipiretik sebaiknya dari asetamino)en, eukinin atau dipiron.• 'ntibiotik diberikan ika ada in)eksi sekunder.
Aairan pengganti
B :arutan )isiologis "aAl B :arutan %sotonis ringer laktat
B 8inger asetat
B Clukosa @
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*=O-O7I7
• +ematian akibat demam berdarah dengueukup tinggi
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*E-E:H:-
7emutuskan rantai penularan dengan ara
1 Mengguna)an in"e)ti"ida
B 7alathion -adultisida dengan pengasapan
B emephos -larvasida dimasukkan ketempat penampungan air bersih.
2 Tan&a In"e)ti"ida
B 7enguras bak mandi dan tempat penampungan air bersih minimal 1xseminggu.
B 7enutup tempat penampungan air rapat rapat.
B 7embersihkan halaman rumah dari kaleng kaleng bekas, botol
botol peah dan benda lain yang memungkinkan nyamuk bersarang.