Dengue hemorrhagic fever (DHF)
Caused by infection with the dengue virus. Originally, as the name suggests. Dengue fever was a tropical disease that had spread throughout the world. Due to very rapid population mobilization, Its spread is widespread, such as urbanization migration between countries, and tourism.
There are One example of the spread through tourism is a tourist from Australia Queensland who reported said that to have contracted dengue fever while on vacation in Bali. Cases of dengue fever in Australia are imported from other countries and then lead to local transmission. Australia is not an endemic country for dengue fever.
Dengue Hemorrhagic Fever In Indonesia-
Indonesia is the most comfortable area for breeding Aedes aegypti mosquitoes Because it is crossed by an equator, the mosquito that spreads the dengue virus that causes dengue fever. An area can be selected in 2022, there were 131,265 cases of dengue fever, with 1,183 deaths. Based on data from the Ministry of Health (Kemenkes), 73 percent of the fatalities were children. Compared to 2022 In 2023, there were 114,435 cases of Dengue Hemorrhagic Fever , with 894 deaths., the number of cases and deaths due to dengue fever has reduced.
According to records from the Ministry of Health, there has been an outbreak with a total of 60,296 infection cases and 455 deaths due to dengue infection. this year, up to the 14th week or mid-April 2024,. Compared to 2023, based on data from the Ministry of Health, during the same period there were 20,502 cases, indicating an increase in the number of cases and deaths up to three times the number of dengue infection cases.
But 2024 is still a long way to go. All participants must work together to overcome this dengue problem. Don’t let the victims stay to fall.
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Blood examination
When a patient is infected with dengue fever, the normal examination carried out is a blood examination, including immunology examinations and hematology. For monitoring dengue infection is mainly the hematocrit and platelet count, for this hematological examination used, while the immunological examination that needs to be carried out to confirm the diagnosis is the examination of dengue NS1 and/or dengue IgG/IgM.
The increase in hematocrit, known as hemoconcentration, In cases of dengue infection, and the decrease in platelet count, known as thrombocytopenia, are the main worries. Usually, the laboratory results that patients and their families pay attention to and remember are the decreased platelet count.
For the general public Platelets have become a standard measurement to scale the severity of dengue fever. especially for those who associate the death of dengue-infected patients with a decrease in platelet count. Platelets have become a myth.
The spread of information by word of mouth makes platelets the suspected main cause of death of patients infected with dengue fever so patients and families will try hard to increase platelets as soon as possible. They will give milk, foods containing iron, eat nuts, or eat bone marrow.
Based on research, the main problem with dengue infection is plasma leakage which can cause shock and death. Plasma leakage is a condition of increased permeability of the blood vessel walls due to spacing of the interendothelial junction and focal adhesions which are the host’s response to infectious pathogens. Plasma leakage and the extent of the leakage can only be identified by its secondary effects on plasma volume and body fluid distribution, such as pleural effusion, hemoconcentration, and ascites.
Currently, the common method to monitor plasma leakage in patients with dengue shock syndrome (DSS) and dengue fever (DBD) is through serial hematocrit and albumin measurements that can identify plasma leakage. However, this method is still considered inadequate as basic data on patients hematocrit.
Serial USG examinations can identify plasma leakage during the defervescence phase this is another method used for this purpose is ultrasonography (USG). In laboratory tests need to be carried out in cases of suspected or confirmed dengue infection?
There are primarily two tests-
Hematocrit-
Dengue Hemorrhagic Fever in the blood Hematocrit is the percentage of the volume of all red blood cells, its value is expressed in percentage with reference values for adult women being 34-45.1 percent for adult men being 39.9-51.1 percent. Hematocrit testing is carried out using an automatic hematology tool.
Hematocrit values increase due to plasma leakage or the release of body fluids from intravascular to extravascular spaces, For patients with dengue fever. Blood vessels can be likened to water pipes, if the walls of the pipes have holes, then plasma leakage can be described as the flow of water from those holes.
One of the diagnostic criteria for dengue fever is an increase in hematocrit levels by more than 20 percent. The release of bodily fluids or plasma from the surrounding tissues causes the patient to appear swollen and can also “flood” into body cavities, such as the pleura which is called pleural effusion, or into the abdominal cavity which is known as ascites.
If plasma leakage is not addressed, just like a leaking pipe, Plasma leakage is a fatal event for patients. The amount of water in the pipe will decrease, and the bucket will only be filled with a small amount of water.
Based on research, the main problem with dengue infection is plasma leakage which can cause shock and death.
Platelets
Platelets which have become a myth in society when talking about dengue fever. To slow or stop bleeding, help heal wounds, and “patch” leaks that occur due to stretched interendothelial junctions in vascular walls. This is the job of platelets in the body.
The decreased number of thrombocytopenia or platelets is influenced by three factors, namely increased consumption, increased destruction factors, and decreased production.
If decrease in the number of platelets, a patient doesn’t panic. patient can be given a platelet component transfusion to increase the number of platelets in the body With the current advances in blood transfusion techniques, if needed,
In cases of thrombocytopenia patients, they need to be guided they should be prevented from falling, such as when they need to get out of bed to use the bathroom. patients experience unsteady walking and dizziness. If the patient is injured, it will be difficult to stop bleeding, the patient needs to eat soft food to prevent bleeding in the digestive tract, which is indicated by melena.
Important message
if you have a high fever, immediately consult a doctor Don’t ignore it. Don’t be sarcastic if the doctor orders you to be hospitalized. If your family, neighbors, friends, or colleagues are sick with dengue fever, don’t just focus on asking about their platelet count. It is also important to ask what the hematocrit value is.