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Dengue Infection Diagnosis and Treatment dr.

Doni Priambodo Wijisaksono

Global incidence of dengue has grown dramatically in recent decades.


About two fifths of the world's population are now at risk. An estimated 50

million dengue infections occur worldwide annually. An estimated 500 000 people with DHF require hospitalization each year. Dengue is endemic in more than 100 countries. The South-East Asia and Western Pacific regions are the most seriously affected. Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious disease. The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes. (WHO)

In 2008, the annual number of cases was about 2 millions. This is chart of Jogja Province Average of monthly incidence rate / 100,000 (1997-2006) and DHF mortality rate (%) (Wijisaksono et al., 2007).
18 16 14 12 10 8 6 4 2 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

4 3,5 3 2,5 2 1,5 1 0,5 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Total dengue cases in hospital each year is 352 cases in 2009 (179 children, 173 adults), 459 cases in 2010 (284 children, 175 adults), and 78 cases in 2011 (30 children, 48 adults). As you can see below, the chart shows comparison between dengue dengue incidence and dengue shock syndrome incedence. In right side, the graphic shows mortality caused by dengue.

Dengue

infection is

caused

by dengue

virus.

Dengue virus is

an

flavivirus/arbovirus. This dengue virus can be transmitted by mosquitoes, especially Aedes aegypti. It is an single-stranded RNA. It also has 4 serotypes (DEN-1, 2, 3, 4).

This is the picture of aedes aegypti. This insect has role in the transmission of dengue virus. primarily, female aedes aegypti is a day time feeder. It lives around human habitation (its all around you, guys!). It lays eggs and produces larvae preferentially in artificial containers. NOTE : the male aedes aegypti is not the transmit insect for dengue virus, because the one which do blood sucking is the female, and the male just do nectar sucking.

the cycle for dengue transmission. First, female aedes aegypti that contain dengue virus in its saliva, spread it into the healthy human. Then the human get infected. After that another female mosquito suck the blood from the human that already infected by dengue virus. Then the mosquito also containing the dengue virus from that human. After that, it spread it to another human.

Dengue Clinical Syndromes Undifferentiated fever may be the most common manifestation of dengue. Prospective study found that 87% of students infected were either asymptomatic symptomatic. Dengue fever is an acute febrile illness of 2-7 days duration (sometimes with two peaks) with two or more of the following manifestations : headache, retro-orbital pain, myalgia/arthralgia, rash, haemorrhagic manifestation (petechiae and positive tourniquet test) and leukopenia. WHO guidelines for the diagnosis of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). or only mildly

Suggested dengue case classification and levels of severity.

Criteria for severe dengue As you can see, from the confidence, virus isolation is the best way to diagnose dengue infection and serology IgG and IgM is less accurate. But from the accessibility,

serology IgG and IgM is easiest way to diagnose dengue infection.

stepwise

approach

to

the

management of dengue

And, these are the way to manage patient with dengue infection.