TUGAS PENYAKIT PENYAKIT TROPIK
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me$/"$9k"#k%$ keh%3"#%$ ho&* "$*e#me3"%*e l%"$$/%. I$ ;"*#o me$$!kk%$ %h>% Me#&-CoV "&% me$9"$ek&" &el-&el 3%#" &pe&"e& /%$9 e#e3%< *e#m%&k mo$/e*< m%$&"%< %" 3%$ p%p%#%$ 3%#" kel%l%>%#.
8%l%m &e%h %$%l"&"& &e%$/%k 15 k%&&< *e#l"h%* %3% ee#%p% pe#e3%%$ %$*%#% k%&& p#"me# 3%$ k%&& &ek$3e#.1, K%&& p#"me# 2e$3e#$9 le"h %$/%k *e#!%3" p%3% l%k"-l%k" 3e$9%$ pe#%$3"$9%$ (+ e#%$3"$9 +)< Sel%"$ "*< !9% 2e$3e#$9 *e#!%3" p%3% &"% /%$9 le"h *% (&"% #%*%-#%*% : + *%h$ 3"%$3"$9k%$ 4+ *%h$). Pe*9%& ke&eh%*%$ me#p%k%$ , 3%#" k%&& &ek$3e# 3"%$3"$9k%$ , 3%#" k%&& p#"me#. 4 Ke*"k% mem%$3"$9k%$ >%%h Al-7%&% p%3% *%h$ '1, 3e$9%$ k%&& *e#%# p%3% l%$ Ap#"l-Me" '14< k%&& Al-7%&% *e#!%3" p%3% #e$*%$9 &"% /%$9 le"h *% ( *%h$ 3"%$3"$9k%$ 4 *%h$)< 3%$ k%&& le"h %$/%k *e#!%3" p%3% l%k"-l%k" (#%&"o l%k"-pe#emp%$ '.+: 1 e#%$3"$9 1<4: 1)< %3% k%&& /%$9 le"h e#%* (1 3"%$3"$9k%$ 44<)< 3%$ %3% *"$9k%* kem%*"%$ /%$9 le"h *"$99" ( 3"%$3"$9k%$ '+<,). 14<1 '. A9e$* MERS-CoV %3%l%h pe$/%k"* &"$3#om pe#$%p%&%$ /%$9 3"&e%k%$ oleh ;"#& Co#o$% /%$9 me$/e#%$9 &%l#%$ pe#$%p%&%$ ml%" 3%#" /%$9 #"$9%$ &%mp%" e#%*. V"#& "$" Me#p%k%$ !e$"& %# 3%#" kelompok Co#o$%;"#& (No;el Co#o$% V"#&). Co#o$%;"#& %3%l%h ;"#& 3%#" kel%#9% RNA (#"o$2le"2 %2"3) ;"#&. Me#ek% 3"&e* 2o#o$%;"#& k%#e$% 3" %>%h m"k#o&kop elek*#o$ p%#*"kel ;"#& me$$!kk%$ k%#%k*e#"&*"k Fko#o$%F (m%hko*%) 3%#" lo$!%k%$ p#o*e"$ 3" &ek"*%# %mplop l"p"3 *e#&e*. I$ek&" Co#o$%;"#& /%$9 mm *e#!%3" p%3% he>%$ 3%$ m%$&"%< *e*%p" %3% #">%/%* 3"m%$% Co#o$%;"#& mel"$*%&" &pe&"e& 3%$ e#%3%p*%&" 3e$9%$ ho&* %#.1 A3% %$/%k &pe&"e& 3%$ &*#%"$ Co#o$%;"#& /%$9 mem"l"k" k%#%k*e#"&*"k /%$9 e#e3%< me$/e%k%$ e#%9%" *%$3%-*%$3% kl"$"& 3%#" #"$9%$ &%mp%" pe$/%k"* e#%* p%3% m%$&"% 3%$ &pe&"e& "$%*%$9 /%$9 e#e3%.1 ,. 6"$9k$9%$ Se%h &*3" ek&pe#"me$*%l me$9e;%l%&" &*%"l"*%& Me#&-CoV me$99$%k%$ kom"$%&" &h 3%$ kelem%%$. MERS-CoV le"h &*%"l p%3% &h #e$3%h %*% ko$3"&" kelem%%$ #e$3%h 3e$9%$ k"&%#%$ 'C $*k &h 3%$ 4 $*k kelem%%$ #el%*" 3%$ m%&"h "&% pl"h &e*el%h 4+ !%m. Sel%m% %e#o&ol"&%&" Me#&-CoV< 3"%m%*" %h>% *"3%k %3% pe$#$%$ &*%"l"*%& p%3% &h 'C %*% 4 kelem%%$ #el%*".
7%l "$" me$$!kk%$ po*e$&" Me#&-CoV $*k 3"*#%$&m"&"k%$ mel%l" ko$*%k %*% *#%$&m"&" mel%l" om"* k%#e$% keh%3"#%$ e#kep%$!%$9%$ 3" l"$9k$9%$.15 Ep"3em"olo9" 3%#" Me#&-Co; !9% 3"*$!kk%$ mel%l" k%#%k*e#"&*"k o#%$9< *emp%*< 3%$ >%k*. 8"m%$% m%&"$9-m%&"$9 k%#%k*e#"&*"k$/% &e%9%" e#"k* : 1. O#%$9 Se!%h "$"< &em% p%&"e$ /%$9 *e#"$ek&" Me#&-CoV mem"l"k" h$9%$ ko$*%k %"k &e2%#% l%$9&$9 %*% *"3%k l%$9&$9 ke T"m# Te$9%h. 8"m%$% $*k pe$l%#%$ 3%#" m%$&"% ke m%$&"% *el%h *e#!%3" 3" $e9%#%-$e9%#% l%"$< p%3% o#%$9 /%$9 %# &%!% mel%kk%$ pe#!%l%$%$ ke T"m# Te$9%h. K%&& *el%h me$/e%# ke $e9%#% l%"$ &epe#*" I$99#"&< Pe#%$2"&< T$"&"%< I*%l"%< M%l%/&"%< "l"p"$%< Y$%$"< Me&"#< Ame#"k% Se#"k%*< 3%$ ?el%$3% /%$9 e#%&%l 3%#" >"&%*%>%$ /%$9 e#k$!$9 ke Seme$%$!$9 A#%. P%#% pe$/e3"% l%/%$%$ ke&eh%*%$ &e3%$9 me$/el"3"k" kem$9k"$%$ pe#%$ he>%$ &e%9%" &me# *%m% Me#&-Co;.1+ 7%l "$" me$3o#o$9 p%#% >"&%*%>%$ /%$9 e#k$!$9
ke $e9%#%-$e9%#% *e#*e$* 3" %*% 3ek%*
Seme$%$!$9 A#% $*k me$9%m"l *"$3%k%$ pe$2e9%h%$ &e3e#h%$% (&epe#*" 22" *%$9%$) $*k me$2e9%h pe$/e%#%$ km%$ Sel%"$ "*< pe*9%& ke&eh%*%$ 3" &el#h 3$"% 3"3e&%k $*k mempe#*"m%$9k%$ #">%/%* pe#!%l%$%$ p%&"e$ ke $e9%#%-$e9%#% /%$9 3ek%* Seme$%$!$9 A#% ke*"k% me$9e;%l%&" p%&"e$ 3e$9%$ pe$/%k"* pe#$%%&%$. 1+ '. Temp%* =%%h pe#*%m% Me#&-CoV *e#!%3" 3" #m%h &%k"* 3" Yo#3%$"% p%3% l%$ Ap#"l '1'< 3e$9%$ k%&&-k%&& e#"k*$/% 3%$ 2l&*e# *e#!%3" 3" &el#h Seme$%$!$9 A#% E%&*. 1 ?ee#%p% $e9%#% 3" T"m# Te$9%h *el%h mel%po#k%$ k%&& "$ek&" MERS-CoV p%3% m%$&"%< %$*%#% l%"$ @o#3%$"%< %*%#< S%3" A#%"%< 3%$ U$" Em"#%* A#%. ?ee#%p% k%&& !9% 3"l%po#k%$ 3%#" $e9%#%-$e9%#% 3" E#op% %$*%#% l%"$ I$99#"&< Pe#%$2"&< I*%l"%< 3%$ T$"&"%. 7%mp"# &em% k%&& 3" E#op% 3%$ T$"&"% memp$/%" ke&%m%%$ /%"* *"ml$/% 9e!%l% pe$/%k"* &e*el%h mel%kk%$ pe#!%l%$%$ ke $e9%#% *e#*e$* 3" T"m# Te$9%h /%$9 3""k*" 3e$9%$ %3%$/% pe$l%#%$ *e#%*%& 3" l"$9k$9%$ kel%#9%. 8" &%mp"$9 "* pe$l%#%$ MERS-CoV %$*%# m%$&"% !9% *e#!%3" 3" #m%h
&%k"* p%3% pe*9%& /%$9 me#%>%* k%&& ko$"#m%&" MERS-CoV. N%m$ 3em"k"%$< &e!%h "$" elm 3%p%* 3"k*"k%$ %3%$/% pe$l%#%$ /%$9 e#kel%$!*%$.1+ P%3% l%$ Ap#"l '1'< &"$3#om pe#$%%&%$ T"m# Te$9%h 2o#o$%;"#& (me#-CoV) m$2l H1 3%$ me$/e%# 3%#" Seme$%$!$9 A#% ke e#%9%" $e9%#% 3" E#op%< A#"k% U*%#%< A&"% Te$99%#%< Ame#"k% Se#"k%* 3%$ Te$9%h E%&*.1 M"33le E%&* S/$3#om 2o#o$%;"#& (Me#&-CoV) pe#*%m% k%l" *e#3e*ek&" p%3% p%&"e$ /%$9 *"$99%l 3" A#% S%3" p%3% l%$ Sep*eme# '1'. V"#& "$" 3"%$99%p 0oo$o&"& me&k"p$ e#%&%l 3%#" #e&e#;o"# (&) 3%$ #*e pe$l%#%$ ke m%$&"% m%&"h elm !el%&. K%&& &po#%3"& 3%$ 2l&*e# 3" %&"l"*%& pel%/%$%$ ke&eh%*%$ *el%h 3"l%po#k%$ 3" ee#%p% $e9%#%.' P#opo#&" *e#e&%# 3%#" *#%$&m"&" &ek$3e# &%%* "$" *%mp%k$/% *e#!%3" 3" %&"l"*%& pel%/%$%$ ke&eh%*%$. I3e$*""k%&" %k*o#-%k*o# /%$9 mem3%hk%$ pe$l%#%$ 3%l%m pe#%>%*%$ ke&eh%*%$ %k%$ me$$!kk%$ l%$9k%h-l%$9k%h $*k me$2e9%h *e#!%3"$/% *#%$&m"&". ,. =%k* P%3% %kh"# '1'< ;"#& 2o#o$%;"#& /%$9 &eelm$/% *"3%k pe#$%h *e#l"h%* p%3% m%$&"% *el%h 3""3e$*""k%&" $*k pe#*%m% k%l"$/%
p%3%
pe$33k 3" >"l%/%h T"m# Te$9%h. V"#&< /%$9 &ek%#%$9 3"ke$%l &e%9%" M"33le E%&* Re&p"#%*o#/ S/$3#ome Co#o$%;"#& (me#-CoV)< '1 *el%h me$/e%k%$ le"h 3%#" k%&& "$ek&" p%3% m%$&"% 3"ko$"#m%&" e#3%&%#k%$ peme#"k&%%$ l%o#%*o#"m. Sel%m% k%#*%l ke3% '14 (Ap#"l-Me") %3% pe$"$9k%*%$ l%# "%&% 3%l%m !ml%h k%&& /%$9 3"l%po#k%$ 3%#" S%3" A#%"%. Se!%k *%$99%l 11 Ap#"l &%mp%" 3e$9%$ @$" '14< *o*%l 1 k%&& Me#&-CoV 3"l%po#k%$ =7O.'' Se%$/%k 11, k%&& 3"l%po#k%$ p%3% ' @$" '14 &e2%#% #e*#o&pek*" ke =7O. Te#!%3"$/% &e%9"%$ e&%# k%&& *%mp%k$/% me$9"k*" 3"&*#"&" m&"m%$: Ap#"l '1' (J%#% Rm%h S%k"* Ke&eh%*%$ M%&/%#%k%*< @o#3%$)< 4 Ap#"l-Me" '1, (>%%h Al-7%&%)< 3%$ Ap#"l-Me" '14 (>%%h @e33%h 3%$ U$" Em"#%* A#% ) *e#!%3"$/% k%&& 3" m&"m &em" me$"$9k%*k%$ kem$9k"$%$ &"kl& m&"m%$ Me#&-CoV.
D. MANIFESTASI KLINIS
Ge!%l%$/% *%k !%h e#e3% 3e$9%$ pe$/%k"* SARS< 3e$9%$ "$3"k%&" *%m% &epe#*" 3em%m< e#&"$< 3%$ %*k< /%$9 %kh"#$/% e#!$9 p%3% kem%*"%$ %k"%* ee#%p% kompl"k%&" &e#"& /%$9 *e#!%3" &epe#*" A2*e Re&p"#%*o#/ 8"&*#e&& S/$3#ome (AR8S) 3e$9%$ ke9%9%l%$ ml*"o#9%$< 9%9%l 9"$!%l< ko%9lop%*" ko$&m*"< 3%$ pe#"k%#3"*"& &e#*% p$emo$"% e#%*. ', Ke%$/%k%$ o#%$9 /9 *e#"$ek&" MERS-CoV me$$!kk%$ pe$/%k"* pe#$%p%&%$ %k* 3e$9%$ 9e!%l% 3em%m< %*k< 3%$ &e&%k $%p%&. Sek"*%# &e*e$9%h 3%#" me#ek% me$"$99%l 3$"% 3e$9%$ ee#%p% o#%$9 /%$9 3"l%po#k%$ 3"ke*%h" mem"l"k" #">%/%* pe$/%k"* pe#$%p%&%$ #"$9%$. ?ee#%p% 9e!%l% /%$9 3"%k"%*k%$ oleh ko#o$%;"#& MERS %3%l%h 3em%m< %*k< $%p%& /%$9 pe$3ek-pe$3ek< &e#*% m$2l$/% p$emo$"% 3%l%m ee#%p% k%&&. Se%9"%$ e&%# o#%$9 /%$9 *e#"$ek&" MERS-Co; e#kem%$9 me$!%3" pe$/%k"* &%l#%$ pe#$%p%&%$ e#%* 3e$9%$ 9e!%l% 9e!%l% 3em%m< %*k< 3%$ $%p%& pe$3ek. Sek"*%# &ep%#h 3%#" !ml%h pe$3e#"*% me$"$99%l. Se%9"%$ 3%#" pe$3e#"*% 3"l%po#k%$ me$3e#"*% pe$/%k"* &%l#%$ pe#$%p%&%$ *"$9k%* &e3%$9. Ml%-ml% 9e!%l%$/% m"#"p &epe#*" l 3%$ "&% me$2%kp: 3em%m< m/%l9"%< le*h%#9/< 9e!%l% 9%&*#o"$*e&*"$%l< %*k< #%3%$9 *e$99o#ok%$< 3%$ 9e!%l% $o$-&pe&""k l%"$$/%. S%*-&%*$/% 9e!%l% /%$9 &e#"$9 3"%l%m" &el#h p%&"e$ %3%l%h 3em%m 3" %*%& ,+ C (1.4 ) 3%$ kem3"%$ *e#!%3" &e&%k $%p%&. Ge!%l% *e#&e* "%&%$/% m$2l 'L1 h%#" &e*el%h *e#ek&po&< *e*%p" &%mp%" 1, h%#" !9% pe#$%h 3"l%po#k%$ *e#!%3". P%3% ke%$/%k%$ k%&& 9e!%l% "%&%$/% m$2l %$*%#% 'L, h%#". Sek"*%# 1L' k%&& mem*hk%$ ;e$*"l%&" mek%$"&. A>%l$/% *%$3% "&"k *"3%k e9"* *e#l"h%* 3%$ m$9k"$ *"3%k %3%. ?ee#%p% p%&"e$ %k%$ me$9%l%m" *%2h/p$e% 3%$ 2#%2kle p%3% %&2l*%*"o$. Kem3"%$< *%2h/p$e% 3%$ le*h%#9/ kel"h%*%$ !el%&. N%m$< *"3%k &em% 9e!%l% *e#&e* %k%$ *e#!%3" p%3% &e*"%p o#%$9. V"#& "$" %k%$ me$/e#%$9 pe$3e#"*% /%$9 m"l"k" keke%l%$ *h #e$3%h. Me#ek% &epe#*" l%$&"%< o#%$9 /%$9 m3%h lel%h< %$%k ke2"l< &e#*% me#ek% /%$9 &e3%$9 3%l%m pe#!%l%$%$. S%mp%" &%%* "$"< m%&"h *e#& 3"l%kk%$ "$;e&*"9%&" me$9e$%" pol% pe$l%#%$ MERS-Co;. V"#& "$" 3%p%* me$l%# %$*%# m%$&"% &e2%#% *e#%*%&< 3%$ *"3%k *e#3%p%* *#%$&m"&" pe$l%#%$ %$*%# m%$&"% /%$9 e#kel%$!*%$.
8%l%m %$/%k k%&&< pe$3e#"*% MERS-CoV me$9%l%m" kompl"k%&" &e#"& A2*e Re&p"#%*o#/ 8"&*#e&& S/$3#ome (AR8S) /%$9 me$/e%k%$ ke9%9%l%$ ml*"o#9%$< 9%9%l 9"$!%l< ko%9lop%*" ko$&m*"< 3%$ pe#"k%#3"*"& &e#*% p$emo$"% e#%* /%$9 e#!$9 p%3% kem%*"%$. E. PATOFISIOLOGI DAN PATOGENESIS
Coronairus &e%9%" pe$/e% MERS< /%$9 3"$%m%k%$ MERS Coronairus< me$9"$ek&" 3%#" #e&e#;o"# $/% /%"* he>%$ *e#$%k< &epe#*" $*%< 3om%< k%m"$9 &e#*% 3%p%* e#kem%$9 "%k 3" *h %$!"$9 3%$ k2"$9.7%l "$"
3"k%#e$%k%$
he>%$-he>%$
*e#&e*
mem"l"k"
RNA /%$9
3%p%*
mem%&"l"*%&" peme$*k%$ ;"#"o$-;"#"o$ %# 3%#" ;"#& "$". A$%l"&"& pe$el"*" 3" 3$"% &%mp%" 3e$9%$ &%%* "$" me$/"mplk%$ %h>% ;"#& 2o#o$% /%$9 me$!%3" pe$/e% MERS mem"l"k" h$9%$ &pe&"e& 3e$9%$ "oronairus pe$/e% SARS. Pe#e3%%$$/% %3%l%h ;"#& SARS e#kem%$9 "%k 3" 3%l%m kelel%>%# *%$p% me$"mlk%$ %$*"o3/ 3" 3%l%m kelel%>%#< &e3%$9k%$ MERS 2o#o$%;"#& me$9%k*"k%$ %$*"o3/ p%3% he>%$ #e&e#;o"#$/%. Oleh k%#e$% "*< 3%p%* 3"k%*%k%$ %h>% MERS Coronairus mem"l"k" !%l# *#%$&m"&" 3%#" animals to animals< man to man< 3%$ animals to man.'4
G%m%# 1. C%#% Pe$l%#%$ MERS-CoV Co#o$% ;"#& 3%p%* 3"%>% oleh kel%>%# 3%$ &e#%$99% 3"pe#%$*%#%" oleh 3e 3%$ e#p"$3%h ke o$*% kem3"%$ *e#ko$*%m"$%&" 3e$9%$ m%$&"%. 8%$ &"%* 3%#" 2o#o$% ;"#&$/% 0oo$o&"&. '4
C%#% pe$l%#%$ MERS-CoV : 1. V"#& "$" 3%p%* me$l%# %$*%# m%$&"% &e2%#% *e#%*%&< 3%$ *"3%k *e#3%p%* *#%$&m"&" pe$l%#%$ %$*%# m%$&"% &e2%#% l%& 3%$ e#kel%$!*%$. Mek%$"&me pe$l%#%$ elm 3"ke*%h" '. Kem$9k"$%$ pe$l%#%$$/% 3%p%* mel%l" : 6%$9&$9 : mel%l" pe#2"k%$ 3%h%k (3#ople*) p%3% &%%* p%&"e$ %*k %*% e#&"$ T"3%k l%$9&$9 : mel%l" ko$*%k 3e$9%$ e$3% /%$9 *e#ko$*%m"$%&" ;"#&.'4
F. DIAGNOSIS
1. K#"*e#"% 8"%9$o&"& %. A$%m$e&% 8em%m ,+ C • ?%*k< Se&%k N%%& • P%3% ee#%p% k%&&< %3% m%&%l%h GIT &epe#*" 3"%#e • R">%/%* pe#!%l%$%$ 3%#" Seme$%$!$9 A#% %*% $e9%#%-$e9%#% • &ek"*%#$/%1 3%l%m 14 h%#" . R%3"olo9" 6e&" 3"3om"$%&" pe#"e#< "%&%$/% e#kem%$9 3%#" ok& >"l%/%h 3%#% $"l%*e#%l op%2"*/ k eke ml*"o2%l $"l%*e#%l %*% *"m%le-%l"k ke3%$/% &el%m% pe$9o%*%$. 2. 6%o#%*o#"m : RT-PCR.'<' '. 8e"$"&" K%&& %. S&pe2* C%&e I$ek&" Pe#$%%&%$ Ak*< 3e$9%$ 3em%m ,+C 3%$ %*k • S&pe2* pe$/%k"* p%#e$kh"m p%# ( P$emo$"% %*% AR8S) • •
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