Clinical features of dengue hemorrhagic fever and risk factors of shock event
Keywords:
Dengue hemorrhagic fever in children, clinical features, risk factor, dengue shock syndrome
Abstract
Background Dengue hemorrhagic fever (DHF) can lead to highmorbidity and mortality. Its clinical features vary from time to time.
Many studies were performed to determine the risk factors of se-
vere dengue infection.
Objective To find out clinical features and risk factors for predict-
ing the likelihood of shock in DHF.
Methods A retrospective cohort study was conducted in all con-
firmed DHF children who were hospitalized at the Department of
Child Health, Cipto Mangunkusumo Hospital within the period of
January 1, 2003 until June 30, 2004. Risk factors for development
of shock were analyzed using chi-square test and multiple logistic
regressions with a level of significance of <0.05.
Results A total of 101 patients, consisted of 47 males and 54
females were enrolled in this study. Mean age was 6.5 (SD 3.6)
years, ranged from 5 months to 15 years. About 31.7% patients
had grade III DHF, 30.7% grade II, and 26.7% grade IV (including
1 patient with encephalopathy). Shock was more frequent among
patients aged between 6-10 years, female, under-nourished, body
temperature <38°C, hematocrit level 46-50 vol%, and platelet count
<20 000/ml. During year 2003-2004, there was increased number
of patients who developed shock. Based on univariate analysis,
hepatomegaly, high hematocrit value, and thrombocytopenia were
considered significantly different. Among those variables analyzed
with multiple logistic regression method, only hepatomegaly and
thrombocytopenia were identified as predictors of shock.
Conclusion There was an alteration on clinical features of DHF
in our hospital in 2003-2004 period compared to the previous years.
Hepatomegaly and platelet count <50 000/ml are independent risk
factors of shock among DHF patients
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Tamil Nadu India. J Clin Microbiol 2003;41:3919-21.
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penyakit demam berdarah dengue, perhatian khusus
pada syok, produksi TNF-a, interleukin-6, dan sebagai
faktor prediktor demam berdarah dengue berat [dis-
sertation]. Jakarta: University of Indonesia; 1996.
23. Bachtar E. Status gizi anak penderita demam berdarah
dengue [thesis]. Jakarta: University of Indonesia; 1990.
24. Horvath R, McBride WJH, Hanna JN. Clinical features of
hospitalized patients during dengue-3 epidemic in Far North
Queensland 1997-1998. Dengue Bull 1999;23:20-24.
25. Sutaryo. Dengue. 1st ed. Yogyakarta: Penerbit Medika
FK-UGM; 2004.
26. Lei HY, Yeh TM, Liu HS, Lin YS, Chen SH, Liu CC.
Immunopathogenesis of dengue virus infection. J
Biomed Sci 2001;8:377-88.
27. Juffrie M, Haasnoot K, Thijs LG. Dengue virus infec-
tion and dengue hemorrhagic shock. Crit Care &
Shock 2000;3:139-45.
28. Gomber S, Ramachandran VG, Kumar S, Agarwal KN,
Gupta P, Dewan DK. Hematological observation as
diagnostic markers in dengue hemorrhagic fever: A re-
appraisal. Indian Pediatrics 2001;38:477-81.
29. Shivbalan S, Anandnathan K, Balasubramanian S,
Datta M, Amalraj E. Predictors of spontaneous bleed-
ing in dengue. Indian Pediatrics 2004;71:33-6.
ver: Diagnosis, treatment, prevention, and control.
Geneva: WHO; 1997. p. 1-83.
2. Kautner I, Robinson MJ, Kuhnle U. Dengue virus in-
fection: Epidemiology, pathogenesis, clinical presen-
tation, diagnosis, and prevention. J Pediatr 1997;
131:515-24.
3. Gibbons R, Vaughn DW. Dengue: An escalating prob-
lem. BMJ 2002;324:1563-6.
4. Shepherd S, Hinfey P. Dengue fever. Available from:
URL: http://www.emedicine.com/emerg/topic124.htm.
5. Suroso T, Achmad H, Imran A. Dengue hemorrhagic
fever outbreaks in Indonesia 1997-1998. Dengue Bull
1998;22:38-44.
6. Tumbelaka AR. Diagnosis demam dengue/demam
berdarah dengue. In: Harun SR, Satari HI, editors.
Demam berdarah dengue. Naskah lengkap pelatihan
bagi dokter spesialis anak dan dokter spesialis penyakit
dalam dalam tatalaksana kasus demam berdarah den-
gue. Jakarta: Balai Pustaka FKUI; 1999. p. 73-9.
7. Suroso T, Harun SR, Wuryadi S, Simanjuntak C, Umar
AI, Pitoyo PD, et al. Pencegahan dan penanggulangan
penyakit demam dengue dan demam berdarah den-
gue. Jakarta: Depkes RI; 2000. p. 105-14.
8. Harun SR, Soegijanto S, Suroso T. Tatalaksana demam
dengue/demam berdarah dengue pada anak. In: Harun
SR, Satari HI, editors. Demam berdarah dengue. Naskah
lengkap pelatihan bagi dokter spesialis anak dan dokter
spesialis penyakit dalam dalam tatalaksana kasus demam
berdarah dengue. Jakarta: Balai Pustaka FKUI; 1999. p.
82-137.
9. Harun SR, Purwanto SH, Chatab F. Dengue shock syn-
drome, clinical manifestations, management, and the out-
come. In: Soegijanto S, Poernomo B, Hargono R,
Notosudirjo I, Probohoesodo S, Rantam FA, et al, editors.
Proceeding of International seminar on dengue fever/den-
gue hemorrhagic fever. New strategy in controlling and
prevention of dengue fever/dengue hemorrhagic fever in
South-East Asia; Surabaya: October 28-29, 1999. p. 43-9.
10. Juffrie M, Meer Vande GM, Haasnoot K, Groen J, Sutaryo,
Hack CE, et al. Early clinical and laboratory indicators for
development of shock in children with dengue virus in-
fection. Crit Care & Shock 1999;4:201-7.
11. Cam BV, Fonsmark L, Hue NB, Phuong NT, Poulsen
A, Heegaard ED. Prospective case control study of
encephalopathy in children with dengue hemorrhagic
fever. Am J Trop Med Hyg 2001;65:848-51.
12. Vaughn DW, Green S, Kalayanarooj S, Innis BL,
Nimmannitya S, Suntayakorn S, et al. Dengue viremia
titer, antibody response pattern, and virus serotype cor-
relate with disease severity. J Infect Dis 2000;181:2-9.
13. Narayanan M, Aravind MA, Thilothammal N, Prema
R, Rex CS, Sargunam, et al. Dengue fever epidemic in
Chennai: A study of clinical profile and outcome. In-
dian Pediatrics 2002;39:1027-33.
14. Guzman MG, Kouri G. Advances in dengue diagnosis.
Clin Diagn Lab Immunol 1996;3:621-27.
15. Harris E, Videa E, Perez L, Sandoval E, Tellez Y, Perez
MA, et al. Clinical, epidemiologic and virologic fea-
tures of dengue in the 1998 epidemic in Nicaragua.
Am J Trop Med Hyg 2000;63:5-11.
16. Triono A. Faktor prognostik memberatnya demam
dengue dan demam berdarah dengue di instalasi
kesehatan anak RS dr. Sardjito [thesis]. Yogyakarta:
Gadjah Mada University; 2004.
17. Suparyatha IBG. Faktor-faktor prediktor renjatan pada
demam berdarah dengue [preliminary report].
Denpasar: Udayana University; 2002.
18. Gayatri P. Faktor-faktor prognosis pada demam berdarah
dengue [thesis]. Jakarta: University of Indonesia; 1997.
19. Guzman MG, Kouri G. Dengue: An update. Lancet
Infect Dis 2002;2:33-42.
20. Sukri NC, Laras K, Wandra T, Didi S, Larasati RP,
Rachdyatmaka JR, et al. Transmission of epidemic den-
gue hemorrhagic fever in easternmost Indonesia. Am
J Trop Med Hyg 2003;68:529-35.
21. Kabilan L, Balasubramanian S, Keshava M, Thenmozhi
V, Sekar G, Tewari SC, et al. Dengue disease spectrum
among infants in the 2001 dengue epidemic in Chennai,
Tamil Nadu India. J Clin Microbiol 2003;41:3919-21.
22. Harun SR. Telaah endotoksemia pada perjalanan
penyakit demam berdarah dengue, perhatian khusus
pada syok, produksi TNF-a, interleukin-6, dan sebagai
faktor prediktor demam berdarah dengue berat [dis-
sertation]. Jakarta: University of Indonesia; 1996.
23. Bachtar E. Status gizi anak penderita demam berdarah
dengue [thesis]. Jakarta: University of Indonesia; 1990.
24. Horvath R, McBride WJH, Hanna JN. Clinical features of
hospitalized patients during dengue-3 epidemic in Far North
Queensland 1997-1998. Dengue Bull 1999;23:20-24.
25. Sutaryo. Dengue. 1st ed. Yogyakarta: Penerbit Medika
FK-UGM; 2004.
26. Lei HY, Yeh TM, Liu HS, Lin YS, Chen SH, Liu CC.
Immunopathogenesis of dengue virus infection. J
Biomed Sci 2001;8:377-88.
27. Juffrie M, Haasnoot K, Thijs LG. Dengue virus infec-
tion and dengue hemorrhagic shock. Crit Care &
Shock 2000;3:139-45.
28. Gomber S, Ramachandran VG, Kumar S, Agarwal KN,
Gupta P, Dewan DK. Hematological observation as
diagnostic markers in dengue hemorrhagic fever: A re-
appraisal. Indian Pediatrics 2001;38:477-81.
29. Shivbalan S, Anandnathan K, Balasubramanian S,
Datta M, Amalraj E. Predictors of spontaneous bleed-
ing in dengue. Indian Pediatrics 2004;71:33-6.
Published
2016-10-18
How to Cite
1.
Dewi R, Tumbelaka A, Sjarif D. Clinical features of dengue hemorrhagic fever and risk factors of shock event. PI [Internet]. 18Oct.2016 [cited 27Apr.2024];46(3):144-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/918
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Received 2016-10-14
Accepted 2016-10-14
Published 2016-10-18
Accepted 2016-10-14
Published 2016-10-18
