BackgroundIdentification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. The aim of the study was to determine the predictive diagnostic value of serial ultrasonography for severe dengue.Methodology/Principal FindingsDaily bedside ultrasounds were performed with a handheld ultrasound device in a prospective cohort of adult Indonesians with dengue. Timing, localization and relation to dengue severity of the ultrasonography findings were determined, as well as the relation with serial hematocrit and albumin values. The severity of dengue was retrospectively determined by WHO 2009 criteria. A total of 66 patients with proven dengue infection were included in the study of whom 11 developed severe dengue. Presence of subclinical plasma leakage at enrollment had a positive predictive value of 35% and a negative predictive value of 90% for severe dengue. At enrollment, 55% of severe dengue cases already had subclinical plasma leakage, which increased to 91% during the subsequent days. Gallbladder wall edema was more pronounced in severe than in non-severe dengue patients and often preceded ascites/pleural effusion. Serial hematocrit and albumin measurements failed to identify plasma leakage and patients at risk for severe dengue.Conclusions/SignificanceSerial ultrasonography, in contrast to existing markers such as hematocrit, may better identify patients at risk for development of severe dengue. Patients with evidence of subclinical plasma leakage and/or an edematous gallbladder wall by ultrasonography merit intensive monitoring for development of complications.

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Dengue hemorrhagic fever (DHF) is still a major public health problem in many regions in Indonesia including Bandung City. Community participation in implementing Eradication of Mosquito-Breeding Sites is still needed as it is considered the most effective method in controlling the dengue fever. This study aimed to determine the influence of health education towards community participation to eradicate mosquito-breeding sites, which was measured by knowledge level and larva index conducted in Bandung, specifically in two different locations with the highest and the lowest incidence rates of DHF. This study used quasi-experimental method. Samples were 100 people living in Cijawura and Cisaranten Wetan Subdistricts taken by using purposive sampling technique. Pre-test results showed that knowledge level of respondents in both subdistricts was significantly increasing (p value = 0.000) after health education was given. Container index (CI) and House index (HI) values in Cijawura Subdistrict were 13.2% and 26.7% respectively, then 9.6% and 28.4% respectively in Cisaranten Wetan Subdistrict. After the health education, CI value in Cijawura and Cisaranten Wetan Subdistricts significantly decreased (p value < 0.05), but HI value did not (p value > 0.05). Keywords: Dengue hemorrhagic fever, health education, larva index, knowledge Abstrak Penyakit demam berdarah dengue (DBD) masih menjadi masalah kesehatan utama di beberapa wilayah di Indonesia, termasuk Kota Bandung. Partisipasi masyarakat dalam melaksanakan Pemberantasan Sarang Nyamuk (PSN) sangat diperlukan karena PSN masih menjadi metode pengendalian DBD yang paling efektif. Penelitian ini bertujuan untuk mengetahui pengaruh pendidikan kesehatan terhadap partisipasi masyarakat dalam memberantas sarang nyamuk Aedes aegypti yang diukur dari tingkat pengetahuan dan indikator larva index yang dilakukan di Kota Bandung di dua lokasi berbeda dengan kasus DBD tertinggi dan terendah. Penelitian ini merupakan penelitian quasi experimental. Besar sampel sebanyak 100 orang yang tinggal di Kelurahan Cijawura dan Cisaranten Wetan diperoleh melalui teknik purposive sampling. Hasil pre-test menunjukkan bahwa tingkat pengetahuan responden di dua kelurahan tersebut meningkat secara signifikan (nilai p = 0,000) setelah pendidikan kesehatan diberikan. Nilai container index (CI) dan house index (HI) saat sebelum tes di Kelurahan Cijawura adalah 13.2% dan 26.7% dan Kelurahan Cisaranten Wetan adalah 9.6% dan 28.4%. Setelah dilakukan penyuluhan, nilai CI di Kelurahan Cijawura maupun Cisaranten Wetan dapat menurun secara signifikan (nilai p < 0,05) namun tidak untuk HI (nilai p > 0,05).