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1 () () () () () () () () () () Q&A () () () () () () () () Q&A

() ------------------------------------------------------------- 8 () ------------------------------------------------------------- 9 ()

2 / / /

3 () 1. (1) 38 (2) 12 (3) (4) 24 (breakbone fever) (5)

4 Dengue virus infection Asymptomatic Symptomatic Undifferentiated fever Dengue fever syndrome Dengue hemorrhagic fever (plasma leakage) Without Hemorrhage Unusual hemorrhage No shock Dengue Shock syndrome Fig.1 Manifestations of the dengue syndrome. \CAB INTERNATIONAL Dengue and Dengue Hemorrhagic Fever (eds D.J. Gubler and G.Kuno) 2

$1 Manifestations of the dengue syndrome. \CAB INTERNATIONAL 1997.$

5 ( ) (dengue fever) (DHF/DSS) 1. 絶 PMN 45 atypical lymphocytes large nuclei fine homogenous nuclear chromatin azurophilic cytoplasm, monocytes hypocellular megakaryocytes cortical paracortical area lymphocytes active germinal center 2. DHF/DSS (1) petechiae tourniquet test vasculopathy histamine mediator (2) consumption coagulopathy PT APTT DIC FDP 3

azurophilic cytoplasm, monocytes hypocellular megakaryocytes cortical paracortical area

6 fibrinogen (3) megakaryocytes hemostatic defect 4

7 ( )

8 ( ) 酶 6

9 ( ) (1) teratogenic effect dengue hemorrhagic fever (DHF)dengue shock syndrome (DSS) (2) teratogenic effectaspirin indomethacin bleeding diathesis acetaminophen (3) (4) DHF/DSS DHF/DSS 7

10 ( ) GOTGPT SGOT 8

11 3 5 3~

12 ( ) NSAIDS 10

13 (ITP) (Toxic Shock Syndrome) 11

14 Q&A Q A Q CBC A CBC Q A Q A (ITP) (Toxic Shock Syndrome) Q A 12

15 Q A Q A Acetaminophen Aspirin NSAID Aspirin Q A Q A 13

16 Q10 A10 20% ( ) 14

17 () (Philippines hemorrhagic fever)1956 (Thai hemorrhagic fever) (Dengue hemorrhagic fever) DHF Dr. Halstead & Dr. Suchitra , ,143 24,000 DHF 158 1/3 2/3 15

18 ( ) (Confluent convalescent rash) (Plasma leakage) (hypovolemic shock) 20 mmhg (Dengue shock syndrome) DSS 12 DIC 16

19 ( ) 14 17

20 ( ) (HCT) 20 GOT GPT GOT>GPT A/G 1 APTT PT 18

21 ( ) (HCT) 20 (Tourniquet test) % 45% 50% 1 (WHO) (spontaneous bleeding) 19

22 2 (RT-PCR) (HCT) 20 HCT HCT 20 [HCT (max) - HCT (min) ] HCT (min) 10 DFHem DSAS 10 20

23 21

24 1 / tourniquet test * * 22

25 / Cytokine 23

26 / Paracetamol <1 60 / 1~3 60~120 / 3~6 120 / 6~ / > / 24

27 39 C / 1:2 1: / Halliday & Segar ( maintenance fluid) (replacement fluid) (overhydration) 25

28 . sodium chloride 3.5 ( trisodium citrate dihydrate ) ( sodium bicarbonate) ( potassium chloride) 1.5 ( glucose) / / / / 1:2 1:1 26

29 / > Halliday MA, Segar WE. Maintenance need for water in parental fluid therapy. Pediatrics, 1957, 19: 823. Reproduced by permission of Pediatrics. 27

30 / / 20 5 / / 10 / / 3 / / 15 / /

31 >10 >2 <20 48 (Ringer s lactate) (Ringer s acetate) 5 1:2 1:1 29

32 40dextran 40 5 < / / / / / 30

33 / (Ringer s lactate) (Ringer s acetate)5 >35 10 / / 5 31

34 (Ringer s lactate)

35 chloral hydrate /

36 GOT GPT

37 / ,000 35

38 (Whole blood) (Packed RBC) (Whole blood) (Packed RBC) (Platelet transfusion) 20,000/ul (Spontaneous bleeding) 20,000/ul (DIC) 20,000-50,000/ul random donor single donor single donor random donor random donor 5,000-10,000/ul 36

39 (plasma) (DIC) (Frozen plasma, FP) (Fresh Frozen Plasma, FFP) FFP FP (DIC) (FFP) (DIC) 37

40 Q&A Q A 34 20% Q A Q A CBC Chest PA X GOT / GPTAlbuminPT / APTT DIC DIC profile Q A 38

41 Q A Ringr s lactate Detrose saline Dextran Q A Lasix Q A (Whole Blood) (DIC) (FFP) 20,000/ul 20,000/ul (DIC) 20,000-50,000/ul random donor single donor single donor random donor random donor 5,000-10,000/ul 39

42 TRALI APTT 2 Q A Q A Q10 A10 Q&A Aspirin NSAID Acetaminophen Aspirin IV Steroid 40

43 DF IgGDF IgMRT-PCR Q11 A11 WHO guideline.htm. 41

44 3 \CAB INTERNATIONAL Dengue and Dengue Hemorrhagic Fever (eds D.J. Gubler and G.Kuno) 42

45 4 43

49 47

50 ( ) 48

51 ( ) , cc

52 () 8. 50

53 CDC/Taiwan 1. 5~ reverse transcriptase-polymerase chain reaction RT-PCR2 51

54 3 Capture IgM and IgG ELISA :, IgM IgG IgM IgM IgG 1. 52

55 RT-PCR 70-80%

56 1-2 IgM IgG / IgM IgG 3. IgM IgG 4. 54

58 .., 91 ISBN (02) GPN ISBN ( ) 56

59 57

1.1 (Dengue Fever) 1944 1 1950 2 1953 Philipines hemorrhagic fever 1956 15 Thai hemorrhagic fever Dengue hemorrhagic DHF 3 1 2 3 4 1956 Graham 1903 Ba

(Dengue Fever) 5294 242 21 1. 2. 3. 4. 5. 6. 1 1.1 (Dengue Fever) 1944 1 1950 2 1953 Philipines hemorrhagic fever 1956 15 Thai hemorrhagic fever Dengue hemorrhagic DHF 3 1 2 3 4 1956 Graham 1903 Bancroft