Tes Lab pada Penyakit Infeksi & Tropis
Tes Darah Rutin pada Penyakit Infeksi Tropis Pengamatan
pada:
Eri, Leko Trombos Manifestasi: anemia, lekositosis atau lekopeni dan DIC*
Lekositosis
Umumnya Netrofil , bentuk muda Netrofilia lanjutinfeksi kronik Netrofilia menghebat + sel mudareaksi leukemoid Non-ganas
>25-30 x 10+3/l Inflamasi, stress, trauma
*Disseminated Intravascular Coagulation May 29, 2013
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Tes Darah Rutin pada Penyakit Infeksi Tropis
Lekopeni
Perubahan morfologik pd sepsis
Döhle bodies Granula toksik vakuolisasi
Eosinofilia :
May 29, 2013
Netropeni, mis Demam Tifoid, brucellosis Infeksi hebat netropeni hebat prognosis buruk
non-bakterial, biasanya alergi / infeksi parasit.
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Tes Darah Rutin pada Penyakit Infeksi Tropis
Anemia
bisa timbul sekalipun cadangan besi cukup. Anemia akut:
Anemia kronik, dengan
May 29, 2013
perdarahan/ destruksi eritrosit (misalnya cold agglutinin sehubungan dengan Mycoplasma pneumoniae), cadangan besi yang normal atau meninggi di sistem retikuloendotelial penurunan besi dalam plasma serta penurunan TIBC (total iron-binding capacity).
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Tes Darah Rutin pada Penyakit Infeksi Tropis
Infeksi serius + bakteriemia
Gram negatif DIC. (Gram pos jarang) Trombos PT memanjang FDP Fibrinogen Trombosiopenia
May 29, 2013
bisa juga menjadi tanda sepsis bakterial dan bisa bermanfaat dalam mengobservasi respon pasien terhadap terapi.
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Lab Examinations in Dengue Fever (DF)
Laboratory findings
Hematology
The diagnosis is made by Lab Tests seroimmunology
May 29, 2013
Leukopenia Thrombocytopenia serum aminotransferase (AST, ALT) elevations.
Hemagglutination Tests Complement Fixation Test Neutralization Test IgM ELISA or paired serology during recovery or
by antigen-detection ELISA or RT-PCR during the acute phase.
Virus is readily isolated from blood in the acute phase if mosquito inoculation or mosquito cell culture
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Lab Examinations in Dengue Fever (DF)
May 29, 2013
Hemagglutination Tests Virus + Eri angsaagglutinasi Tes Negatif Virus + serum (ada atb spesifik)tidak aglutinasiTes Positif Virus + Eri + serum (tanpa atb spesifik) aglutiasi Tes negatif
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Lab Examinations in Dengue Fever (DF) Specimen 1
Interpretasi
Pre 4th d < 1:20
Pre 5th d <1:20 <1:20
Pre 7th d > 1:1280 May 29, 2013
Specimen 2 Post 1-4 wk 4x <1:1280
>1:2560 4x
4x not needed
Interpretation
1mary Dengue 2ndary Dengue
Presumptive S 2ndary Dengue 8
Lab Examinations in Dengue Fever
Ag
Complement Fixation Test
S Ab
Ag+[serum,Ab pos]+ Complcomplement fixed+RBC(sheep)un lysed : Pos test Ag+[serum,Ab neg]+ Complcomplement un fixed RBC(shee) lysed : Neg test
K
RBC
Pos
May 29, 2013
Neg
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Dengue Hemorrhagic Fever (General) Tes Lab: 2. ELISA (capture method) 1.
2.
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Anti-dengue IgM Infeksi primer, akut 7-10 hr IgG (post/kronik) Infeksi sekunder, sesudahnya
Hasil
Interpretasi
IgG
IgM
+
+
D sekunder
-
+
D primer
+
-
-
-
Duga D sekund Non-D Primer sangat dini10
DHF pada Anak
In dengue
present by the 2nd day of fever by the 4th or 5th day, the WBC count 2000 to 4000/mL, 20 to 40% granulocytes. Moderate albuminuria and a few casts may be found. Dengue may be confused with Colorado tick fever, typhus, yellow fever, or other hemorrhagic fevers.
Serologic diagnosis may be made by
May 29, 2013
hemagglutination inhibiting and complement fixation tests using paired sera but is complicated by cross-reactions with other flavivirus antibodies. 11
DHF pada Anak
In dengue hemorrhagic fever
May 29, 2013
Hct > 50%: ipresent during shock WBC count in 1/3 of patients. Coagulaive abnormalities Thrombocytopenia (< l00,000/mL) positive tourniquet test prolonged PT. Minimal proteinuria may be present. AST levels may be moderately . Serologic tests usually show high complement fixation antibody titers against flaviviruses, suggestive of a secondary immune response. 12
DHF pada Anak
WHO clinical criteria for diagnosis of dengue hemorrhagic fever:
May 29, 2013
acute onset of high, continuous fever lasts for 2 to 7 days hemorrhagic manifestations, including at least a positive tourniquet test and petechiae, purpura, ecchymoses, bleeding gums, hematemesis, or melena Hepatomegaly thrombocytopenia (< 100,000/mL); or hemoconcentration (Hct increased by > 20%) Those with dengue shock syndrome also have a rapid weak pulse with narrowing of the pulse pressure (< 20 mm Hg) or hypotension with cold, clammy skin and restlessness. 13
Herpes Simplex
Laboratory tests are generally not necessary (viral cultures and Tzanck smear will confirm diagnosis in patients with atypical presentation) Antibody to appropriate serotype
Tzanck preparation
May 29, 2013
Seroconversion Increase Direct immunofluoroscent antibody slide tests (rapid diagnosis) Base of lesions Multinucleate giant cells
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Tzanck cell
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Herper Zoster
May 29, 2013
Laboratory tests are generally not necessary (viral cultures and Tzanck smear will confirm diagnosis in patients with atypical presentation). The Tzanck preparation shows multinucleate giant cells for both varicella-zoster virus and HSV
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Mumps
Darah
Lekopeni Serum amilase dlm 10 hari Serologi
Biakan
Virus dari ludah 1-5 hari
Komplikasi
May 29, 2013
Cold agglutinin IgM , max 2 minggu, menetap 6-9 bln; kadar serum konvalesens 4x dpd serum akut Tes fiksasi komplemen thd atb positif minggu pertama
Inflamasi testis/ ovarium: lekositosis, LED Pankreatitis: lekositosis, amylase, hiperglikemia Meningitis: sel LCS < 500/L, mononuclear; glukose normal, protein agak (20-125 mg/dL) 17
Morbilli (Measles, Rubeolla)
Temuan laboratorium
Darah Lekosit , terutama limfo & segmen lekositosissuperinfeksi bakterial Serologi: EIA
May 29, 2013
IgM: fase akut (± 1-2 hari) IgG : >10 hari
Sekret Apusan + pulasan imunofluorosen Pulasan Tzank: Multinucleated Giant Cells Biakan Bahan: sekret resp & urin Identifikasi: jaringan
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Varicella
Tes lab yang bisa dilakukan
Sediaan apus Bahan: kerokan dasar vesikel Pulasan: TzankMultinucleated Giant Cells Sensitivitas 60% Darah Serologi:
May 29, 2013
Titer atb serum konvalesen 4x dpd serum akut Hemaglutinasi Elisa Fama
PCR: deteksi DNA virus
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HIV/ AIDS
HIV antibody detected by a twostep technique:
May 29, 2013
ELISA as a sensitive screening test Confirmation of positive ELISA tests with the more specific Western blot technique
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Molluscum Contagiousa
Giemsa-stained
May 29, 2013
shows inclusion bodies within many large cells or extracellularly
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Verruca Vulgaris
DNA typing: circular-doubelstranded, 8000 bp
Cross-hybridization > 50% : type seperation < 50%: subtype seperation
May 29, 2013
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Impetigo/ Pyoderma
May 29, 2013
Generally not necessary Gram stain and C&S to confirm the diagnosis when the clinical presentation is unclear Sedimentation rate parallel to activity of the disease Anti-DNAse B and antihyaluronidase Urinalysis: hematuria with erythrocyte casts and proteinuria in patients with acute nephritis 23
Difteri
Diagnosis definitif tergantung pada isolasi C.diphtheriae yang diambil dari bahan di lesi-lesi lokal. Pihak laboratorium harus diberitahukan bahwa bahan disangka difteri agar pihak laboratorium Gram stains of secretions
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club-shaped organisms, appear as "Chinese letters" 24
Polio
CSF:
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Aseptic meningitis Elevated WBCs Elevated protein Normal glucose
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Salmonellosis/ Typhoid Fever
Kultur
Serologi
May 29, 2013
Darah: positif dlm 10 hari pertama Tinja & Urin: positif dlm minggu 3-5 Sumsum tulang: Tes Widal: serum sembuh 4x dpd sakit
Darah rutin: Lekopeni 26
Kolera
Isolasi vibrio cholerae dari bahan tinjaidentifikasi serogroup 01 atau 139 Serologi:
May 29, 2013
tes agglutinasi menggunakan antiserum spesifik
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Salmonellosis/ Typhoid Fever
May 29, 2013
Other than a positive culture, no specific laboratory test is diagnostic for enteric fever. In 15 to 25% of cases, leukopenia and neutropenia are detectable. In the majority of cases, the white blood cell count is normal despite high fever. However, leukocytosis can develop in typhoid fever (especially in children) during the first 10 days of the illness, or later if the disease course is complicated by intestinal perforation or secondary infection.
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Salmonellosis/ Typhoid Fever
Other nonspecific laboratory results
The diagnostic "gold standard" is a culture positive for S. typhi or S. paratyphi.
May 29, 2013
Tests (AP,GOT,GPT & LDH)
90% during the first week of infection and decrease to 50% by the third week.
A low yield is related to low numbers of Salmonella (<15 organisms per milliliter) in infected patients and/or to recent antibiotic treatment. Centrifugation to isolate and culture the buffy coat, which contains abundant blood mononuclear cells associated with the bacteria, decreases time to isolation but does not affect culture sensitivity.
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Salmonellosis/ Typhoid Fever
May 29, 2013
Positive cultures of stool, urine, rose spots, bone marrow, and gastric or intestinal secretions. Unlike blood cultures, bone marrow cultures remain highly (90%) sensitive. Culture of intestinal secretions (best obtained by a noninvasive duodenal string test) can be positive despite a negative bone marrow culture. If blood, bone marrow, and intestinal secretions are all cultured, the yield of a positive culture is >90%. Stool cultures, while negative in 60 to 70% of cases during the first week, can become positive during the third week of infection in untreated patients. Although the majority of patients (90%) clear bacteria from the stool by the eighth week, a small percentage become chronic carriers and continue to have positive stool cultures for at least 1 year. 30
Salmonellosis/ Typhoid Fever Serologic
tests Widal test for "febrile agglutinins,“ high
rates of false-positivity and false-negativitynot clinically useful. Polymerase chain reaction and DNA probe assays are being developed
May 29, 2013
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Disentri basiler/ Shigellosis
Jumlah Lekosit: , Normal atau Serologi: bisa, jarang bermanfaat Tinja:
May 29, 2013
Kultur, harus tinja segar! Mikroskop: Lekosit
Polymerase chain reaction (PCR) may be diagnostic.
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Helmintiasis
May 29, 2013
Parasitology study !
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Mycosis
May 29, 2013
Parasitology study !
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