Uji diagnostik limfosit pironinofilik pada demam berdarah dengue pada anak

ABSTRACT Background: Dengue hemorrhagic fever (DHF) is still a problem in Indonesia. Early diagnosis is important in the management. The cytoplasm of activated lymphocytes in dengue infection contains ribonucleic acid (RNA). RNA can be specifically shown by pyronin staining. Objective: To know the diagnostic value of lymphocyte pyroninophilic in DHF in children. Methods: Subjects were patients hospitalized in the Pediatric Department of Faculty of Medicine/Pediatric Ward Sardjito General Hospital, from September 1995 to December 1996, with 2-7 days of fever, positive tourniquet test, and 0-14 years of age. Clinical diagnosis of DHF was based on WHO 1986 criteria. Hemagglutination inhibition (HI) test and/or antibody antidengue were used to confirm the diagnosis of DHF. Peripheral blood smear was stained with pyronin stain according to Sutaryo modification. Lymphocyte percentage was counted per 100 leukocyte under light microscope. Results: Means of pyroninophilic lymphocyte numbers were increased from day-3 to day-5 of fever and then decreased. There were significant difference between the means in non-dengue infection and in dengue infection from day-3 to day-7 of fever, between dengue fever (DF) and DHF from day-3 to day-6 of fever, and between non shock (DHF-I and DHF-II) and shock cases (DHF-III and DHF-IV) from day-3 to day-9 of fever. The number of pyroninophilic lymphocytes correlated with the degree of DHF. Using cut-off point of 4 at day-5 of fever, the sensitivity was 86,2%, specificity was 84,3%, positiv predictive value was 92,6%, and negative predictive value was 65,1%. Conclusion: Pyroninophilic lymphocyte has a high diagnostic value in DHF in children. Key words: Dengue hemorrhage fever - ribonucleic acid - pyroninophilic lymphocyte - diagnosis Latar belakang penelitian: Diagnosis dini pada demam berdarah dengue (DBD) penting untuk pengelolaan. Pada infeksi dengue ditemukan limfosit yang teraktivasi, yang banyak mengandung ribonucleic acid (RNA) dalam sitoplasmanya. Pironin merupakan cat khusus untuk RNA. Tujuan penelitian: Untuk mengetahui nilai diagnostik limfosit pironinofilik pada DBD anak. Bahan dan cara penelitian: Subjek penelitian adalah pasien rawat inap di Bagian Anak FK-UGM/IRNA II RSUP Dr. Sardjito Yogyakarta, dari bulan September 1995 sampai Desember 1996 dengan kriteria inklusi demam 2-7 hari, uji tourniquet positif, umur 0-14 tahun. Diagnosis klinis DBD didasarkan atas kriteria WHO 1986. Preparat apus darah tepi dicat dengan cat pironin menurut modifikasi Sutaryo. Persentase limfosit dihitung per 100 leukosit. Konfirmasi diagnosis dengan uji hemagg/utination inhibition (HI) dan atau antibodi anti dengue. Hasil penelitian: Rerata persentase limfosit pironinofilik pada infeksi dengue meningkat sampai hari ke-5 demam, kemudian turun sampai hari ke-9 demam. Ada perbedaan persentase yang bermakna antara bukan infeksi dengue dan infeksi dengue mulai hari ke-3 demam sampai hari ke-7 demam, antara demam dengue (DD) dan DBD mulai hari ke-3 demam sampai hari ke-6 demam, dan antara kasus tidak syok (DBD-I dan DBD-II) ..