Abstract Ref Number = APCP959
CONGENITAL DENGUE WITH THE COMPLICATION OF DISSEMINATED INTRAVASCULAR COAGULATION
Rinang Mariko,Eny Yantry,Rinche Annur
Bagian Ilmu Kesehatan Anak FK Unand
Background : Congenital dengue is dengue fever with clinical appearance in infants aged 0-7 days, varying 1-11 days with an average age of 4 days after birth, lasting about 1-5 days, occurring due to vertical transmission of the mother suffering from prenatal dengue fever via trans placental to fetus. Clinical features of the patient are premature birth, low birth weight, unwell, respiratory distress, hepatomegaly, petechial, leukocytosis or leukopenia and thrombocytopenia. Maternal IgM does not cross the placenta, when detected in the neonate is evidence of vertical infection transmission.
Case Presentation Summary : A neonate, boy, 0 hours old, spontaneous birth, 2300 grams, gestational age 34-35 weeks, Apgar score 6/8. A twenty-nine years old mother, was suffering from dengue grade II fever, premature rupture of membranes, remaining amniotic was green, thick and smelly. Groaning from birth, accompanied by shortness of breath. Redness on the skin from birth. High fever at 4 days with gastrointestinal bleeding. The baby had hypovolemic shock at 5 days of age. Clinically appear less active, dyspnea, epigastric and intercostal retractions, abdominal distension, hepatomegaly and petechial. Neonatal reflex weakening. Laboratory examination: normocytic anemia; haemoconcentration; thrombocytopenia; IgG anti dengue (+) (mother and baby), IgM anti dengue (+) from the baby, IgM anti dengue (-) from the mother; recurrent metabolic acidosis; prolonged of prothrombin time, APTT and INR; SGOT and SGPT increased; and real time PCR negative. Patients received fluid resuscitation with 0.9% sodium chloride and antibiotics; platelet, FFP and fresh blood transfusion; used of ventilators; correction of metabolic acidosis by sodium bicarbonate; inotropes and vasopressors. Patient passed away at 8 days of age.
Learning Points/Discussion : A baby born from a mother diagnosed with dengue fever during pregnancy should always be suspected to have congenital dengue. This is because congenital dengue may appear in various levels of symptoms and not specific so that high vigilance is required.
Keywords: dengue virus congenital nenonate infection