Dengue infection caused dengue fever or dengue hemorrhagic fever.
The main difference in dengue fever and dengue hemorrhagic fever is the emergence of reflection
In dengue hemorrhagic fever due to plasma leaks.
The criteria for diagnosis of dengue infection are divided 2 (two):
- Criteria for clinical diagnosis and
- Laboratory diagnosis criteria.
▪ Criteria for clinical diagnosis are important in screening cases, common cases, estimating the case prognosis, and surveillance.
▪ Laboratory diagnosis is a diagnosis criterion with an important laboratory confirmation in reporting, surveillance, research and preventive and promotive measures.
Clinical manifestations of dengue infections are very varied and difficult to distinguish from other infectious diseases, especially in the early phase of the course of the disease. With increasing community alertness to dengue infection, often fever patients are brought treatment in the early phase of the disease, even on the first day of fever. The good side of this vigilance is that patients with dengue hemorrhagic fever can be known and obtain treatment in the early phase, but on the other hand in this phase it is very difficult for health workers to enforce the diagnosis of dengue hemorrhagic fever only based on clinical symptoms, therefore instructions are needed in the form of a sign and clinical symptoms and routine laboratory examinations.
The criteria for laboratory diagnosis of dengue infection both dengue fever, dengue hemorrhagic fever and expanded dengue syndrom consists of:
1. probable; If clinical diagnosis is reinforced by the results of the Antidengue serology examination (antibody detection) IgM and IgG Anti DHF serum single and or sufferer residences / ever visited the DHF endemic area within the incubation period.
2. Confirmed; If a clinical diagnosis is strengthened with a lack of one of the following checks:
• Isolation of dengue viruses from serum or autopsy samples.
• HI test examination where there is an increase in antibody titers 4 times on acute serum pairs and convalesents or increased specific IgM antibodies for dengue viruses
• Positive Dengue virus antigens on network autopsy checks, serum or cerebrospinal fluid (LCS) with the Immunohistochemistry method, immunofluoressence or seroconversion of IgG and IgM examinations (from negative to positive) on paired serological examination (Elisa)
• Positive inspection of dengue antigens with polymerase chain reaction (PCR) or Dengue NS1 examination.
To monitor the trips of dengue infection in sufferers there are several types of laboratory examinations including:
• Hematology examination:
Can be found normal or decreased leukocyte, but usually decreases with the dominance of neutrophil cells, an increase in the number of atypical lymphocyte cells or blue plasma lymphocytes (LPB)> 4% in the edge blood which is usually found on the third sick day until the seventh day, the number of platelets in phase The beginning is still within normal limits, the number of platelets ≤100,000 / μL is usually found between days 3-7 illness.
The platelet examination needs to be repeated every 4-6 hours in the critical phase until it is proven that the number of platelets within the normal limit or clinical state of the sufferer has improved. Hematocrit, an increase in hematocrit value illustrates the leakage of blood vessels. This hematocrit assessment is an indicator that is sensitive to plasma perception, so it is necessary to do a hematocrit examination periodically.
In general, platelet decline precedes a hematocrit increase. Hemokontraciation with hematocrit increased> 20% (for example hematocrit value of 35% to 42%), reflects the increase in capillary permeability and plasma permeation. Need to get attention, that hematocrit values ​​are influenced by replacement of fluid or bleeding. This hematological examination must be carried out serially.
• serological examination,
Antibodies in sufferers are infected with dengue viruses.
A. Hemaglutinition Serology Test Inhibition (Haemagluttion Inhibition Test) HI Examination Until now is considered a gold standard (Gold Standard). However this examination requires 2 blood samples (serum) where the specimen must be taken in the acute phase and the convalensen phase (healing), so that it cannot provide fast results. Inhibition hemaglutination (HI) examination is not done at this time.
b. Elisa (IGM / IGG), dengue infection can be distinguished as a primary or secondary infection by determining the Limit ratio of the IGM antibody of the IGG. By testing the IgM and IgG dengue antibody, the test can be done only by using one blood sample (serum), namely acute blood so that the results are quickly obtained. At present the Dengue Rapid Test is available (for example Dengue Rapid Strip Test). In the primary infection of IgM antibody levels after the 4th day of 4 - 5 fever and PPPPPantibodi IgG will arise after the 14th day of fever and survive in the old time termppppppp. In secondary infections, IgG antibodies will arise first, namely 1-2 days after symptoms of embossed fever and Ibodi IgM will arise after a 5-10 fever day.
c. Interpretation of results
Dengue examination Rapid Test in diagnosing primary and secondary viral infections through the determination of IgM and IgM levels where the CUT-OFF IGM is determined to be able to detect IGM antibodies which typically appear in primary and secondary dengue virus infections, while the Cut Off IGG antibodies are determined only detecting high levels of high levels that appear in secondary dengue virus infections (usually this IGG starts to be detected on the 2nd day of fever) and is equipped with titers HI> 1: 2560 (secondary hi test) according to the standard WHO.
Only the active secondary antibody antibody response is detected, while the IgG primary infection or past infection is not detected. In the IgG primary infection appeared after the 14th day, but in the secondary infection of the IgG arose on the 2nd day. The interpretation of the results is if the line that appears only IgM and control without the IgG line, then positive for primary dengue infection (DD). Whereas if three lines appear on control, IgM, and IgG are expressed as positive secondary infections (DHF).
Some of the secondary dengue cases did not appear the IGM line, so only the control line and IGG appeared. The examination is declared negative if only the control line is visible. Repeat the examination in 2-3 more days if clinical symptoms towards DHF. Examination is declared invalid if the control line is not visible and only visible lines on IGM and / or IGG alone.
. Dengue NS-1 antigen examination,
It can be done on the first day until the ninth day of fever both in primary infections and secondary infections, so the NS-1 antigen is an early examination to determine the infection with the dengue virus.
Author: S.M.Susianna., Dr., sp.pk (Doctor in charge of the Pramita Clinic Laboratory Jl. Martadinata No. 135 Bandung)