Ref Number = PITIKA-ASPR0135
Kamilah Haniyah Munawar, Shella, Ketut Indriani
Dengue infection may present with broad range of clinical manifestation, from mild febrile illness to a life threatening condition. Indonesia is one of the highest burden of dengue infection in the world, and children account for many cases.
Case Illustration 
Three cases dengue infection were reported. All of them were revealed thrombocytopenia and leucocytopenia, and detected anti dengue. First, a 8 years old boy complained for 4th days of febrile, vomiting and nausea. On the 11th day of admission, murmur systolic was found. Chest xray and ECG showed enlargement of heart chambers. Echocardiograpy revealed decreased of ejection fraction. We diagnosed as myocarditis and started corticosteroid. His condition improved and controlled to outpatients clinic. Second child, a 3,5 years old girl came with 2nd day of febrile, changed in mental status, undetected blood pressure and cold extremities. On the 2nd days of admission, there were high fever, bleeding from NGT, petechial rash and ecchymosis observed all over the body. Laboratory examination revealed leucocytosis, severe thrombocytopenia, elevated liver enzyme, uremia and prolonged PT and APTT. Tachypnea, low oxygen saturation and crackles all over chest was found on 4th day of admission. Unfortunately, she died on 5th days of admission. Third, a 8 years old boy presented on the 3rd days of febrile and mild decreased conciousness. On the 2nd days of admission, consciousness worsened, generalized seizure observed and sign of shock was found. Laboratory examination revealed severe thrombocytopenia, and elevated liver enzyme. The day after, he showed tachypnea and low oxygen saturation. Chest xray examination found pleural effusion. We started mechanical ventilation but he died because of untreatable shock.

Dengue infection in children needs comprehensive management in order to make good clinical intervention. 
Keywords: severe dengue infection, expanded dengue syndrome, thrombocytopenia, leucocytopenia, untreatable shock
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