Viral Infection Dengue Haemorrhagic Fever and Acquired Immuno Defficiency Syndrome (AIDS)

VIRAL INFECTION;
Dengue Haemorrhagic Fever and

Acquired Immuno Defficiency
Syndrome ( AIDS )
PRESENTED BY:
Joze Rizal ( 030.02.118 )

Kartika Lestari ( 030.02.121 )
Dengue Haemorrhagic
Fever ( DHF )
• Definition
• Etiology
• Epidemiology
• Pathogenesis
• Clinical Manifestation
• Diagnosis & Treatment
• Complication
• Prognosis
• Prevention
• DHF in Pediatri aspect
Definition & Etiology
• Is a severe, often
fatal febrile
disease caused by
dengue viruses.
It's caracterized
by abnormality of v
ascular
permeability and
hemostatic
disturbance
Epidemiology
• Dengue Viruses are

transmitted by Aedes
aegyptie and Aedes
albopictus
• DHF in Indonesia is an
annual disease
• The onset of DHF is
occur in rainy season
with the peak in the
mid/end of the season
Epidemiology ( 2 )
• Considered that mostly DHF patients

are children, To minimalize DHF
patient being a “big project” in
pediatric world
• The first action that supposed to be
done is to break the vector cycle
Epidemiology ( 3 )
• Aedes aegepytie is
a daybitting
mosquito
• 5M is an
instruction from
our government
due to breaking the
vector cycle by
destroy their
breeding place
( clean water )
5M
Pathogenesis
• The pathogenesis of DHF is Vascular
leakage due to rapid activation of the
complement system.
• This condition will be followed by
Haemostatic disturbance due to
problem in bleeding factor
( Depression of XII factor )
Clinical Manifestation
• Are variable and influenced by the age oh the
patient
• In infants and young children, the disease maybe
undiferrentiated by fever 1-5 days, pharyngeal
inflammation, mild cough and rhinitis
• In older children, the onset marked by
temperature rapidly increasing to 39,4- 41.1
grade Celcius usually accompanied by frontal or
retro-orbital pain
• Nausea and 100
vomitting usually
90
80
followed the fever 70 Fever
60
• Myalgia and 50 Headache
Arthalgia
40
30 Gastro
Intestinal
• Headache 20
10
complain
• Taste aberrations 0
1st
Qtr
2nd
Qtr
3rd
Qtr
4th
Qtr
Establish the diagnosis
• SUSPECTED DHF:
• Fever for 2-7 days
• Spontanneus bleeding
• Hepato/Splenomegali
• Rumple-Leede show positive result
• Trombocytopenia /
Hemoconcentration
Diagnosis
• Physical examination may reveal the following:

• Low blood pressure
• A weak, rapid pulse
• Rash
• Red eyes
• Red throat
• Swollen glands
• Enlarged liver (hepatomegaly)
Lab Finding
•
• Platelet count
• Electrolytes
• Coagulation studies
• Hematocrit
• Blood gases
Diagnosis
– Tourniquet test (causes petechiae below

the tourniquet)
– X-ray of the chest (may demonstrate
pleural effusion)
– Serologic studies (demonstrate antibodies
to Dengue viruses)
– Serum studies from samples taken during
acute illness and convalescence (increase
in titer to Dengue antigen)
Diagnosis
• WHO criteria for DHF:
• 1. Fever
• 2. Minor or major haemorrhagic
manifestations
• 3. Thrombocytopenia ( <100.000/mm3)
• 4. Objective evidence of increased
capillary permeability
Grading for DHF patients ( WHO )
• Grading is important to manage the therapy

and also predict the prognosis of the
patient
• Stadium I: Fever + Non-spesific
constitutional symptom + Positive Rumple-
Leede test + No spontanneus bleeding
• Stadium II : Stadium I + Spontanneus
bleeding
Grading for DHF patients ( WHO )
• Stadium III : Stadium II + circulatory failure

with tachycardi and weak pulse, hypotension,
cold and wet skin and restlesness
• Stadium IV : Stadium III + Deep shock with
unpalpable pulse and unmeasured blood tension
• Stad I and II called as PRE-SHOCK
• Stad III and IV called as Dengue Shock
Syndrome
Differential Diagnosis
• Viral Respiratory infection

• All “flu like” disease
• Mild yellow fever
• Leptospirosis
• Scrub Typhus
• ITP
Treatment
• Because Dengue hemorrhagic fever is caused by a virus

for which there is no known cure or vaccine, the only
treatment is to treat the symptoms.
• Bed Rest
• Rehydration with intravenous (IV) fluids is often
necessary to treat dehydration.
• IV fluids and electrolytes are also used to correct
electrolyte imbalances.
• A transfusion of fresh blood or platelets can
correct bleeding problems.
• Oxygen therapy may be needed to treat abnormally
low blood oxygen.
• Antipyretics for maintain body temperature
Complication
• Shock
• Encephalopathy
• Residual brain damage
• Seizures
• Liver damage
• Special treatment care for patient with
refracter shock wich doesn't give any
reponse with fluid therapy and show
excessive GI bleeding at same time with
the shock
Prognosis
• Death occur on 40-50% patients with

shock but with adequate the number
could be minimalize about 2%
• Depend with Early Diagnosis and
Intensive care on the patient
Prevention
• Make sure the house is free from

mosquito by using spray insectiscide
periodically
• Individual protection from the bites

by using repellent or traditional
blanket
Prevention
• Breaking the vector cycle by
• 5M
• Change the water in every water container

once a week
• Kill the larva using abate powder SG 1% with

dose ppm, 10gr for 100ltrs water ( repeated
2-3month )
DHF in Pediatri Aspect
• DHF is a disease with high morbidity and
mortality rate. In the other hand mostly
dhf patient are children
• To reduce/minimalize dhf incidence is a
main purpose that we should think about
• Don’t let DHF take life children of our
country again. Let's think forward for a
Better Future
AIDS
• Etiology
• Epidemiology
• Transmission
• Background
• Diagnosis
• Pathogenesis
• Clinical Manifestation
• Treatment
• Prognosis
Etiology
• Human
Immunodefficien
cy Virus type 1
( Retrovirus )
Background
➔
HIV infection on children progresses more
rapidly than in adults and some untreated
children die within the 1st 2year of life. In
general, this rapid progression is correlated
with higher viral burden and faster depletion
of infected CD4 lymphocytes in infants and
children than in adults
Epidemiology
• AIDS could be found all around the world
• Sub-Saharan Africa accounts fot the
fastest growing epidemic, with 90% of the
world total population of HIV infected
children ( Nelson 17th edition )
• India and Thailand dominated epidemic in
Asia
Vertical Transmission
• Vertical transmission can occur intra-uterine,

during ( intra-partum ) and through breast-feeding
• Intra-uterine transmission has been suggested by
identification of HIV by culture or PCR in fetal
tissue as early as 10 weeks' gestation
• Generally 30-40% infected newborn caused by
intra-uterine transmission
VERTICAL TRANSMISSION
• There are some risk factor such as:

• Preterm Delivery
• Low maternal antenatal CD4 count
• Using ilicit drugs during pregnancy
• PROM >4hr
• BW <2500gr. ( the last two are Most
impotant factor )
Pathogenesis
• Depletion of CD4 due
to viral invasion ->
Immune Dsyfunction
-> Opportunistic
Infevtion, Malignancy
etc -> t
• The clinical manifestation of HIV infection

vary widely among infants, children and
adolescents
• Initial symptom could be lymphadenopathy,
hepatosplenomegaly or chronic diarhhea
• In children, oppurtunistic infection is more
common than in adult
• Opportunistic infection are generally seen
in children with severe depression of the
CD4 count
• These type of OI could be:
• # Pneumocystisis (the most common )
• MAC ( Mycobacterium Avium Intracelullar)
• Oral Candidiasis
• Gingivostomatitis Herpetic
•Poor general condition
•Rapid Weight Loss
•Anemia ( 70%)
•Anorexia
•Fever & Fatigue
•Malignancy ( ex: Burkitt's Lymphoma )But uncommon

Images
Diagnosis
➢
Enzim Immuno Assay ( EIA )
➢
Confirmatory Test ( Western-Blot,
Immunofluorescence Assay )
➢
Viral Diagnostic assays : HIV DNA or RNA PCR,
HIV culture or HIV p24 antigen -immune
dissociated ( ICD p-24 )
➢
Viral Diagnostic Testing should be performed
within the 1st two days of life at 1-2 mo of age
and at 4-6 mo of age
➢
A diagnosis of HIV infection could established
with two positive virologic tests obtained from
different blood samples
Treatment
• Specific antibiotic for opportunistic infection.

( Cotromoxazole for PnC , Tuberculostatic etc)
• AntiRetroviral drugs to supress viral
replication and to prove general state of the
patient
• ZDV ( Zidovudine ) to interrupt intra-uterine
transmission
Treatment
• ZDV is given approximately 4 week of

gestation and continued during
delivery till The 1st 6 week of newborn
life
• 5 times/24hrs per oral

Prevention
• Avoid pregnancy for HIV positive mother
• Using only sterile syringe
• Condoms using for high-risk population
• Avoid Sexual Activity with many partner
• Screening for every blood donor

Prognosis
• Serious symptom before 1 year : poor

prognosis
• GLH ( Generalised Lymphadenophaty
Hyperplasia ) with low virulency virus :
good prognosis
ThaNk 4 YoUr aTteNtion...

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VIRAL INFECTION;

Dengue Haemorrhagic Fever and

Joze Rizal ( 030.02.118 )

• Dengue Viruses are

• Considered that mostly DHF patients

• Nausea and 100

followed the fever 70 Fever

• Myalgia and 50 Headache

• Physical examination may reveal the following:

– Tourniquet test (causes petechiae below

• Grading is important to manage the therapy

• Stadium III : Stadium II + circulatory failure

• Viral Respiratory infection

• Because Dengue hemorrhagic fever is caused by a virus

• Death occur on 40-50% patients with

• Make sure the house is free from

• Individual protection from the bites

• Breaking the vector cycle by

• Change the water in every water container

• Kill the larva using abate powder SG 1% with

• Vertical transmission can occur intra-uterine,

• There are some risk factor such as:

• The clinical manifestation of HIV infection

•Rapid Weight Loss

•Fever & Fatigue

•Malignancy ( ex: Burkitt's Lymphoma )But uncommon

• Specific antibiotic for opportunistic infection.

• AntiRetroviral drugs to supress viral

replication and to prove general state of the

• ZDV ( Zidovudine ) to interrupt intra-uterine

• ZDV is given approximately 4 week of

• 5 times/24hrs per oral

• Avoid pregnancy for HIV positive mother

• Using only sterile syringe

• Condoms using for high-risk population

• Avoid Sexual Activity with many partner

• Screening for every blood donor

• Serious symptom before 1 year : poor

• GLH ( Generalised Lymphadenophaty

Hyperplasia ) with low virulency virus :

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