Dehydration

-myalgia (TNF α)-generalized body ache

TT +Bruish Purpura Petechiae

Hemorrhagic manfes

Trombocytopenia

Leucopenia Bone marrow

supression

Mual, muntah

-headache-erythema

-facial flushingHigh fever

Abrupt onset

Acute febrile phase (febrile viremia phase)

Meningkatkan set point (fever)

PGE2

Hypothalamus

Systemic circulation

IL 1, TNF α, IL 6, IFN γ

Monocyte & makrofag melepaskan pyrogen

endogen

Complement activationPyrogen exogen

Ag viral + antibody (imun complexes)

Viral infection

Progressive trombocytopenia

Flu like syndrome

SECONDARY HETEROLOGOUS DENGUE INFECTION

Mucosal membran bleed

(nose/gum)

Hepatomegal

Complement activation (C3a, C5a)

Prolonged APTT

Anticoagulant Circulation

Heparan sulfat form integral part

of glycocalyx

Loss of albumin

Damage glycocalyx

Spontaneous bleeding

Progressive/severe hemorrhagic

manfes

Progressive trombocytopenia

Coagulopathy consumptive

Adherence plastelet to

endothelial cell

Plasma leakage, peningkatan

permeabilitas dalam 24-48 jam

Fluid loss to interstitial

Penurunan intravascular oncotic pressure

Movement of albumin

Peningkatan vascular permeability

Immune mediated platelet destruction

NS 1 viral productAb Cytokine release (IFN γ,IL 2, TNF, IL 6, IL 8, IL 10)

Immune complex (Ag+Ab)

Peningkatan viral replikasi

Penurunan suhu tubuh, progresif

leukopeni

Hemokonsentrasi (peningkatan Ht: >20% baseline)

-ascites-pleural effusion

-gall bladder edema

-hepatomegaly

Hepatosplenomegaly

By RES spleen, hepar

Peningkatan vascular permeability