Pathophysiology and management of dengue hemorrhagic fever

Abstract

SUMMARY Dengue infection is caused by any of four dengue virus serotypes. The clinical manifestations range from asymptomatic infection to undifferentiated fever, dengue fever and dengue hemorrhagic fever (DHF). DHF is characterized by sustained high fever for 2–7 days; bleeding diathesis such as positive tourniquet test, petechiae, epistaxis and hematemesis; thrombocytopenia with platelet counts ≤ 100 × 109/L and plasma leakage due to increased vascular permeability evidenced by hemoconcentration, pleural effusion and ascites. Bleeding diathesis is caused by vasculopathy, thrombocytopenia, platelet dysfunction and coagulopathy. The three stages of clinical presentations are classified as febrile, toxic and convalescent. The toxic stage, which lasts 24–48 hours, is the most critical period, with rapid plasma leakage leading to circulatory disturbance. The severity of DHF varies from mild (World Health Organization grades I and II), with minimal and transient change in vital signs, to severe (World Health Organization grades III and IV), with threatened shock (e.g. blood pressure 100/90 mmHg) or profound shock. There is no specific treatment for DHF. Intensive supportive care is the most important aspect of management. Early recognition of the disease and careful monitoring for circulatory disturbance are essential. Optimal fluid therapy to maintain the functions of the vital organs during the critical period and effective control of bleeding episodes will lead to favorable outcomes. Administration of recombinant activated factor VII is suggested whenever massive bleeding does not respond to blood component therapy.

Comparison of Platelet Indices with Platelet Count to Predict Bleeding Tendency in Seropositive Dengue Cases

“…Plateletcrit were low on the day of bleeding (mean:0.07) than values on the day of recovery (Mean:0.13). 4 This will result in large size platelet production by bonemarrow which increase MPV and PDW compared to control samples. However our study did not show any significant difference irrespective of thrombocytopenia.…”

“…The platelet count has also been used as a predictor of bleeding, a marker of severity and a criteria for patient recovery. 4 To compensate these loss, bone marrow produces young large volume platelets which leads to high MPV. Platelets with high MPV and high PDW were found to be the markers of platelet activation thus enabling a high hemostatic property irrespective of the degree of thrombocytopenia.…”

Unusual yet isolated oral manifestations of persistent thrombocytopenia: a rare case report

“…The SouthEast Asian countries such as India, Indonesia, Myanmar and Thailand are at the highest risk of DF/DHF, accounting for nearly half the global risk. Criteria for diagnosis of dengue hemorrhagic fever include a probable or confirmed case of dengue infection while hemorrhagic tendencies are evidenced by one or more of the following: a positive result from tourniquet test; petechiae, ecchymoses or purpura; bleeding from mucosa, gastrointestinal tract, injection sites; hematemesis or melena; and thrombocytopenia (<100,000/mm 3 ) with an evidence of plasma leakage due to increased vascular permeability 8 . In the present case, history of previously confirmed diagnosis of dengue infection along with oral mucosal lesions exhibiting bleeding tendency, in association with platelet count <40000/mm 3 pointed toward dengue hemorrhagic fever.…”

Faktor Prognosis Kematian Sindrom Syok Dengue

“…17 Pasien dengan perdarahan masif atau perdarahan tersembunyi yang tidak dapat diketahui, terutama perdarahan saluran cerna dapat mengakibatkan syok, gagal hati dan ginjal, dan gagal banyak organ sampai kematian. 18 Anak dengan SSD yang mengalami syok berkepanjangan mempunyai prognosis meninggal 16 kali lebih besar atau 88% lebih tinggi dibanding anak dengan SSD yang tidak mengalami prolonged shock. Disfungsi sirkulasi atau syok pada DBD disebabkan karena peningkatan…”

“…Syok berkepanjangan diikuti dengan asidosis metabolik, hipoksemia dan dapat menimbulkan DIC sehingga menyebabkan terjadinya perdarahan berat yang berakhir dengan kematian. 7,18,20 Pada penelitian kami manajemen cairan sebelum masuk RSUP Dr. Sardjito yang tidak adekuat merupakan faktor prognosis kematian pada SSD. Hal tersebut juga sama pada penelitian yang dilakukan di India oleh Kamath 7 mendapatkan hasil bahwa penye bab kematian pada anak dengan dengue berat adalah syok refrakter berat, DIC, ARDS, gagal hati dan manifestasi neurologi.…”