Case report dengue with vasculopathy and the role of innate immunity
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Transcript of Case report dengue with vasculopathy and the role of innate immunity
EMERGENCY ROOM NIGHT SHIFTCASE REPORT
Dengue with vasculopathy On Wednesday, 2ND SEPTEMBER 2015
GP on duty: dr. Wulan
dr. NitaSupervisior : dr Soroy Lardo SpPD FINASIM (Divisi Tropik dan Infeksi
Departemen Penyakit Dalam)Coass on duty:
Ardian Ajeng
Universitas Kristen Jakarta (UKRIDA)Indonesia Army Central Hospital Gatot Soebroto
PATIENT RECAPITULATION
Mr. B , 22 y.o , dengue hemorrhage feverMs. T , 24 y.o , dyspepsia Mrs. E , 45 y.o , GERDMr. P , 78 y.o , susp. Hepatitis BMrs. S , 57 y.o, ca mammaeMr. P, 67 y.o , GEA +low intakeMrs. V , 55 y.o, gastritisMrs W, 44 y.o, SIDA + low intake
Patient’s Identity
• Name : BP• MR no : 81 30 39• Sex : male• Age : 22 years old• Religion : Christian• Marital status : single• Ethnic : Javanese• Occupation : Army Soldier
History of Present IllnessPatient came to the ER with the complain of the fever he had since 2 days ago. Fever that he had occurred all day long, even with the anti fever medication. The complaint also came with the headache that occurred from behind his eye balls. He also had muscles and joints pain and loss of eating appetite. Patient often felt nausea, but never vomitted. Patient once came to the 24 hours clinic, but didn’t feel better and decided to go to the ER for a check up.
History of Past Illness
- Patient has never been hospitalized before- Patient has neither hypertention, diabetes,
nor heart disease history.
Family Illness
• Diabetes Mellitus (-)• Hypertension (-) • Heart disease (-)
HABITS AND LIFESTYLE
•Smoking (+)•Alcohol consumption (-)
History of Medication
• Patient is not on any medication at this moment
• Patient never have a routine drugs to take for a long time
PHYSICAL EXAMINATIONVITAL SIGNS• General State : Moderate Illness• Consciousness : Compos Mentis, E4M6V5 GCS 15• Blood Pressure : 120/80 mmHg• Heart rate : 90x/minute• Respiratory Rate : 22x/minute• Temperature : 38,8 oC• Body Weight : 75kg• Body Height : 170 cm• Habit : athletic
PHYSICAL EXAMINATION
General Examination•Head : Normal
–Eye : anemic conjunctiva (-/-), icteric sclera (-/-)–Ears : normal, discharge (-)–Nose : septum deviation (-), discharge (-)–Mouth : dry lips (-) ptechie (+)
•Neck : lymph nodes enlargement (-), JVP 5 – 2 cmH2o
COR• Inspection: Ictus cordis (-)• Palpation: ictus cordis palpable (+), thrill (-)• Percussion: normal impression• Auscultation : irregular 1st and 2nd heart
sound, murmur (-), gallop (-)
PULMOInspection : chest within normal shape, symmetries
on static and dynamic statePalpation : tactile vocal fremitus in both of lungs were symmetries.Percussion : sonor in both of lungsAuscultation : Vesicular Breath Sound +/+, rhonki -/-, wheezing -/-
Abdomen : convex (+), intestinal motility (n), tenderness on epigastric regio.Extremities: no edema , petechiae (+) rumple leed (+)
Laboratory Results
RESULT NORMAL RANGE
Hematologi rutin:Hb 14 13 - 18 g/dlHt 44 40 – 52 %
Erythrocyte 4,7 4.3 - 6.0 mil /ulLeukocyte 5.620** 4800 - 10800/ul
Thrombocyte 144.000** 150000 - 400000/ul
LABORATORIUM
RESUMEPatient came to the ER with the complain of the fever he had since 2 days ago. Fever that he had occurred all day long, even with the anti fever medication. The complaint also came with the headache that occurred from behind his eye balls. He also had muscles and joints pain and loss of eating appetite. Patient often felt nausea, but never vomitted. Patient once came to the 24 hours clinic, but didn’t feel better and decided to go to the ER for a check up. Blood pressure: 120/80 mmHg, Heart rate:90x/minute, Respiratory rate :22x/minute, Temperature:38,8 o C, petechiae (+), leukocyte : 5.620.
List of problems
• Dengue hemorrhage fever Grade 2
Problem Analysis
• 2 days fever with retroorbital pain, arthralgia, myalgia, tenderness in epigastric
• Petechiae (+), rumple leede (+) • Trombocyte: 144.000 /µl Therapy 1. IVFD 2500 ml/days 2. Paracetamol 3x 500 mg
Prognosis
Quo ad Vitam = bonamQuo ad functionam = bonamQuo ad sanationam = bonam
THANK YOU
Vasculopathy in DHF
Viral infection
Endotelial cell
CD4/8 ratio
inversion, IL-6 and
cytocine overproduction
Trombocyte
dysfunction and vascular damage
Innate immunity in DHF
Innate Imunity in DHF
• Interstitial dendritic cells (DCs) are believed to constitute the first line of the innate host defense against invading DV
• Early activation of natural killer (NK) cells and type-I interferon-dependent immunity may be also important in limiting viral replication at the early times of dengue infection
Innate imunity in DHF