Karakteristik Dengue Berat yang Dirawat di Pediatric Intensive Care Unit

Abstract

Virus dengue dapat menyebabkan infeksi pada semua kelompok usia dengan manifestasi klinis beragam mulai dari asimtomatik, ringan, sampai berat yang biasanya merupakan kasus fatal. Dengue berat ditandai dengan kebocoran plasma, hemokonsentrasi, dan gangguan hemostasis. Penelitian ini bertujuan untuk mengetahui karakteristik penderita dengue berat yang dirawat di ruang Pediatric Intensive Care Unit (PICU) RS Dr. Hasan Sadikin Bandung sejak Januari 2009 sampai Desember 2010. Penelitian dilakukan secara retrospektif deskriptif berdasarkan data dari rekam medis penderita. Sebanyak 21 penderita dengue berat dirawat selama 2 tahun, 15/21 penderita perempuan dan 6/21 laki-laki, serta 5/21 anak meninggal dunia selama dirawat dengan sebab kematian tersering sindrom syok dengue (SSD) dan kogagulopati intravaskular diseminata (KID). Sebagian besar penderita berusia 1−5 tahun dengan status gizi baik. Hepatomegali ditemukan pada semua penderita dengan hematokrit rata-rata 38%. Pada penelitian ini, manifestasi klinis dengue berat berupa SSD (15/21), KID (11/21), ensefalopati (6/21), efusi pleura (5/21), miokarditis (3/21), serta acute respiratory distress syndrome (3/21). Simpulan, dengue berat lebih banyak didapatkan pada anak perempuan, usia 1-5 tahun, serta status gizi baik. Manifestasi klinis dengue berat yang dominan berupa syok, koagulasi intravaskular diseminata, dan ensefalopati. [MKB. 2012;44(3):147-51].

Epidemiology of Children with Severe Dengue Infection in Dr. Soetomo General Hospital

“…A similar report was also found in a previous study conducted at the Central General Hospital of Dr. Sadikin, which reported that almost 60% of children with severe dengue hospitalized for shorter than six days. 24 A cohort study in adult dengue patients found no significant difference in the duration of hospitalization among patients with DF, DHF, and DSS, although there was a trend of increasing duration of hospitalization according to the severity of dengue infection. 27 A fourth-degree DHF patient in this study was hospitalized for fourteen days with complications of sepsis and involvement of the liver, lungs, and systemic.…”

“…18 The frequency of male affected in this study was more than female, similar to studies in India and Mexico, [19][20][21] but contrary to the studies in the following cities in Indonesia: Yogyakarta, Jakarta, and Bandung. [22][23][24] A study from 6 countries in Asia suggested that the males have a habit of being outdoors which provides a greater opportunity of getting dengue infection due to mosquito bites. 25 However, a previous study showed that there is no difference of immune system response to dengue infection in different gender, evidenced by the same amount of cytokines and antibody produced by female and male dengue patients.…”

“…In contrast, studies in Medan and Bandung showed that normal weight was predominant in children with severe dengue infection. 24,31 Nutritional status is often associated with an immune system response that influences the severity of dengue infection. Moderate malnutrition is associated with decreased cell-mediated immunity which is indicated by a decrease in the number of CD4+ cells, complement production, and tumor necrosis factor (TNF).…”

“…The percentage of death was lower than that of previous studies in some cities in Indonesia regarding children with DSS or severe dengue infection, such as 15.4% in Denpasar; 23.8% in Bandung; 25% in Medan; and 34.4% in Yogyakarta. 30,31,22,24 Based on data of patients who died, genetic factor of patient was thought to contribute the most in affecting the severity of dengue infection, indicated by the different vulnerability of individuals against manifestations of severe dengue infection. However, other factors such as community behavior and health services also play a role, 39 as reflected through health-seeking behavior in the community and proper treatment of dengue patients by clinicians.…”