Klebsiella species Extende Spectrum β-Lactamase ESBL

3. Dengue Diagnostics In areas of the world where dengue disease is endemic, including Indonesia, all the cases of acute febrile illness, presenting with nonspecific features, would have dengue viral infection included in the list of differential diagnosis. The steps in assessing a case including prompt anamnesis, physical examination, laboratory and imaging studies. Laboratory investigations can be classified as disease monitoring laboratory test or diagnostics tests. 7 – 10 3.1. Disease monitoring laboratory tests Complete Blood Count CBC.White blood count in the beginning febrile phase usually normal, and rapidly decrease as the disease progress and shows relative lymphocytosis. The presence of non specific leucopenia should raise suspicion of possible dengue infection in appropriate setting. The rise of Hematocrit best known as Hemoconcentration as a result of plasma leakage, differentiate between dengue fever and dengue hemorrhagic fever. Early fluid replacement or blood loss due to bleeding manifestation may mask the Hemoconcentration. It is off a great importance to obtain a baseline Hematocrit in early febrile phase so it can be used to detect early recognition of plasma leakage. Thrombocytopenia might be the most common and prominent laboratory feature in dengue cases. In the early febrile phase, platelet count is usually within normal range and will decrease rapidly as the disease progresses to the late febrile phase or at defervescence. The thrombocyte may continue to remain low for the first few days of recovery phase. There is a significant negative correlation between disease severity and platelet count but it is not predictive of bleeding. Liver profile evaluation. Abnormal transaminates is commonly seen in dengue infection. The elevation of AST usually greater compared to AST. The degree of transaminates usually higher in DHF compared to DF. 3.2. Diagnostic tests Definitive diagnosis of dengue infection can only be concluded by laboratory examinations. However the Interpretation of laboratory diagnostic results shouldonly be done in the clinical context. Laboratory confirmatory tests include detection of dengue virus and or any of its component protein NS1 antigen, virus isolation and detection of virus genetic materials by polymerase chain reaction – PCR or by detecting the antibody response serology response after infection Table 1.