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VIRUS, BAKTERI, PARASIT
Dr Retno Indrastiti, SpKK
8/8/2019 Virus, Bakteri, Parasit
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VIRUS VARICELLA
HERPES ZOSTER
HERPES SIMPLEKS
MOLUSKUM KONTAGIOSUM
VERUKA
8/8/2019 Virus, Bakteri, Parasit
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Golongan virus RNA
1.Rhabdo virus : rabies
2.Toga virus : rubella, yellow fever3.Paramyxo virus : morbilli
4.Human Immunodeficiency Virus(HIV) AIDS
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Golongan virus DNA1.Papova virus :
veruka, kondiloma akuminata
2.Pox virus : moluskum kontagiosum,
variola
3.Herpes virus
varisela, herpes zoster,
herpes simpleks
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VARICELLA (CACAR AIR, CHICKEN POX)
VARICELLA ZOSTER VIRUS GEJALA-TANDA
± GEJALA KONSTITUSI/PANAS ± TERUTAMA PADA ANAK ANAK ± VESIKEL TERSEBAR MULAI BADAN KMD
SENTRIFUGAL , BISA KE SALPENCERNAAN, TELAPAK
±
ERITEMA ± EROSI ± KRUSTA ± POLIMORF
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PENYEBARAN : AEROGEN
PADA ANAK2 TANPA KOMPLIKASI
MAKIN DEWASA MAKIN PARAH,BISA TERJADI KOMPLIKASIENCEPHALITIS, PNEMONI
PEM. PENUNJANG : TZANCK TEST
DD/: VARIOLA
PENCEGAHAN : VAKSINASI
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TERAPI: ± ORAL
ASIKLOVIR 5 X 800 mg SELAMA 5 -7 HARI
ANTI PIRETIK
± TOPIKAL BEDAK
ANTIBIOTIK TOPIKAL PROGNOSIS«.VITAM,SANAM,KOSMETIKAM
8/8/2019 Virus, Bakteri, Parasit
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HERPES ZOSTER (DOMPO)
PENYEBAB: REAKTIVASI VARICELLA
VIRUS DALAM KEADAAN DORMAN DI
GANGLION RADIX DORSALIS GEJALA-TANDA :
± GEJALA KONSTITUSI
± NYERI RADIKULER
± VESIKEL/BULA BERGEROMBOL
± UNILATERAL, DERMATOM BERURUTAN!!!!!!!!!!
8/8/2019 Virus, Bakteri, Parasit
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LOKASI : tu..THORAKALIS, OFTALMIKA
KOMPLIKASI :
± NEURAGIA POST HERPETIK (NPH)
DD/ DERMATITIS VENENATA
TERAPI ± ASIKLOVIR 5 X 800 mg atau
± VALASIKLOVIR 3 X 1000 mg
± FAMSIKLOVIR 3 X 250 mg
± ANALGETIK
± >40th + PREDNISON 3 X 20 mg
8/8/2019 Virus, Bakteri, Parasit
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Saraf mana
yg
kena???
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VERUKA (KUTIL, CAPLAK)
HUMAN PAPILOMA VIRUS (HPV)
TRANSMISI MELALUI KONTAK LANGSUNG
GEJALA-TANDA ± PAPUL
± PLAK
± FENOMENA KOEBNER
TERAPI ± BEDAH (skalpel, elektric, kimia, beku)
± imunomodulator
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MOLUSKUM KONTAGIOSUM
Etiologi : Pox virus >>anak-anak wajah, tubuh, ekstremitas
Orang muda aktif seksual
perigenital &perianal Penyebaran : autoinokulasi resolusi
spontan
Gambaran klinis : papul padat bentukkubah dg cekungan ditengah (delle)
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DIAGNOSIS BANDING
±Veruka
±Varisela ±folikulitis ±Akne ±Milia
TER APIEXPRESI
BEDAH BEKU
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HERPES SIMPLEKS/LABIALIS
VIRUS HERPES SIMPLEX ± VHS I (LABIALIS)
±VHS II (GENITALIS)
PATOGENESIS ± PRIMER
± SEKUNDER
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PENCETUS ± LELAH
±STRESS
± DEMAM
± TRAUMA FISIK
±
MENTRUASI ± MAKANAN MERANGSANG
± DINGIN/ANGIN
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KLINIS
PRIMER ± PRODROMAL (MALAISE, PANAS DINGIN), 2-3
HARI
± UKK-ERITEM, VESIKEL, MUDAH PECAH, EROSI,PADA SEKITAR BIBIR
SEKUNDER/REKUREN ± PADA LOKASI YG SAMA ± GEJALA LEBIH RINGAN
± LEBIH PENDEK WAKTU AKTIF
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DIAGNOSIS BANDING
Stomatitis aftosa
Pemfigus vulgaris
Impetigo
Dermatitis kontak
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TERAPI
ASIKLOVIR 5 X 200 mg
VALASIKLOVIR 2 X 500 mg
FAMSIKLOVIR 3 X 250 mg
Selama 5-7 hari
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BAKTERI
PYODERMA
IMPETIGOKUSTA
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IMPETIGO (SULUDEN)
IMPETIGO BULOSA-STREP B HEMOLITIKUS
± LOKASI : TERUTAMA MUKA
± LESI: KRUSTA KUNING SPT MADU
IMPETIGO KRUSTOSA-STAPH AUREUS
± LOKASI : DADA, PUNGGUNG
± LESI : KOLORET DASAR MERAH
8/8/2019 Virus, Bakteri, Parasit
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BISA BERDIRI SENDIRI, BISA
MENUMPANG PADA PENYAKIT YANG
ADA SEBELUMNYA«. Impetiginasi/infeksi
sekunder
BISA BERLANJUT MENJADI SSSS(STAPFYLOCOCCAL SCALDED SKIN
SYNDROME)
AWALNYA VESIKEL/ BULA, TETAPI ATAPSANGAT TIPIS MUDAH PECAH EROSI
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PYODERMA FOLIKULITISFOLIKULITIS
± ± terbatasterbatas padapada folikelfolikel rambutrambut
FURUNKELFURUNKEL ± ±
FolikelFolikel rambutrambut dandan jaringan jaringan sekitarsekitar KARBUNKELKARBUNKEL
± ± BeberapaBeberapa furunkelfurunkel bergerombolbergerombol
EKTIMAEKTIMA ± ± UlkusUlkus ygyg tertutuptertutup krustakrusta lengketlengket,, tepitepiulkusulkus meninggimeninggi,,
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ERISIPELASERISIPELAS ± ± EritemaEritema,, batasbatas tegastegas,,
SELULITISSELULITIS ± ± EritemaEritema,, lebihlebih dalamdalam,, batasbatas taktak tegastegas
ERITRASMAERITRASMA ± ±
o/o/ CorynebacteriumCorynebacterium,, eritemaeritema padpad lipatanlipatan,, PARONIKIAPARONIKIA
± ± EritemaEritema, edema,, edema, bgbg proximal kukuproximal kuku
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TERAPI ± TOPIKAL ANTIBIOTIK
± ±GENTAMISINGENTAMISIN
± ±
ASAM FUSIDATASAM FUSIDAT ± ±ASAM MUPIROSINASAM MUPIROSIN
± SISTEMIK ANTIBIOTIKA BROAD SPECTRUM(BILA PERLU)
±
TINDAKAN KOMPRES
INSISI
DEBRIDEMENT
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MORBUS HANSENMORBUS HANSEN (KUSTA, LEPRA)
PENYEBAB : MYCOBACTERIUMLEPRAE
BERBAGAI MACAM PEMBAGIAN DIAGNOSIS KLINIS MENURUT WHO ± PAUCIBACILER
± MULTIBACILER
8/8/2019 Virus, Bakteri, Parasit
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Chronic infection disease
Mainly affects the ± skin,
± peripheral nerves,
± mucosa upper respiratory tract,
± reticulo endothelial system,
± eye,
± bone ,
± testis, ± except central nervous system.
8/8/2019 Virus, Bakteri, Parasit
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M. lepraep TIDAK BISA DI KULTUR
PEMERIKSAAN BAKTERI : (LESI KULIT, CUPINGTELINGA, MUKOSA HIDUNG)
1.1. DIAGNOSISDIAGNOSIS
2.2. SPECTRUMSPECTRUM
3.3. EVALUASIEVALUASI
4.4. PROGNOSISPROGNOSIS
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DIAGNOSIS :
If shown one or more of the following cardinal
signs :
1. Hipopigmented or reddish skin lession withdefinite loss of sensation
2. Involvement of the peripheral nerves, asdemonstrated by definite enlargement /thickening peripheral nerves with loss of sensation
3. Skin smear positive for Acid Fast Bacilli
No? ----- Observation for 3 6 months
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CLASSIFICATION
SPECTRUM
Ridley &
Jopling
T T B T B B B L L L
MADRID Indeter-minate
Tuber-
culoid
Border-
line
Lepromatous
WHO
( 1988 )
Paucy Bacillar
Leprosy
Multi Bacillar
Leprosy
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CLINICAL LEPROSY
Indeter-minate
T T B T B B B L L L
Infectious
(-)
Infectious
(-)
Infectious
(-)
Infectious
Infectious
Infectious
Children 2 3
lesionSatelit
lesion
PunchOut
Hipopig-mented /
pink :Face, back, buttock
Macules
hipopig-
mented
Macules
:
hipopig-mented / reddish
Dimor-phous
features
and tend
symmetry
Symetrical papul,
nodules
Symetri-cal
papul, nodules
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CLINICAL LEPROSY
Indeter-minate
T T B T B B B L L L
Loss of sensation(-)
(+) (+) (+) Sensoryloss,decreases
sweating andhair growth
Stockingand glovesanesthesia
Nerveswollen (-)
(+) (+) (+) Nervedamaged
Nervedamaged
Lepromin(-)
(+) 4 (+) 3 (+) 1 -2 (-) (-)
Acid Fast Bacilli (-)
(-) (+) /
(-)
(+) 3 (+) 3 - 4 (+) 5 - 6
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W H O ( 1997 ) :
Paucibacillary Single Lesion Leprosy
(one lesion) Paucibacillary Leprosy (2-5 skin lesion)
Multibacillary Leprosy (More than 5 skin
lesion)
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I. P B SINGLE LESION
CHILD ADULT
Rifampicin 300 mg Rifampicin 600 mg
Ofloxacin 200 mg Ofloxacin 400 mg
Minocycline 50 mg Minocycline 100 mg
Dosage : Single Dose R O M
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II. P B 2 5 SKIN LESION
CHILD ADULTMonthly Treatment :
Day 1 :
Rifampicin 450 mg
Dapsone 50 mg
Daily :
Day 2 28
Dapsone 50 mg /daily
Monthly Treatment :
Day 1 :
Rifampicin 600 mg
Dapsone 100 mg
Daily :
Day 2 28
Dapsone 100 mg /dailyDuration of treatment : 6 - 9 Months
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III. M B :
CHILD ADULT
Monthly treatment
Day 1 :
Rifampicin 450 mgClofazimine 150 mg
Dapsone 50 mg
Daily 2 28 :Clofazimine 50 mg / daily
Dapsone 50 mg / daily
Monthly treatment
Day 1 :
Rifampicin 600 mgClofazimine 300 mg
Dapsone 100 mg
Daily 2 28 :Clofazimine 50 mg / daily
Dapsone 100 mg / daily
Duration of treatment : 12 18 months
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Manifestation of :
1. Reversal reactionMild Severe
Skin - Lesion become reddish
& swollen
- Same & rarely new skin lesion
- Fever, malaise
Nerve - Enlarge, painfull (-)- Nerve damage (-)
- < 6 weeks
- Enlarge, painfull (+)- Nerve damage, loss sensation
- > 6 weeks
Skin &
Nerve
- Lesion become reddish
- Painful on peripheralnerves
- < 6 weeks
- Same
- Ulceration- Swollen on hand & foot
- Nerve enlarge
-- > 6 weeks
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2. E N L reaction
MILD SEVERE
Skin Skin nodules :
- Tender reddish
- Ulceration
Skin nodules >>
- Painful
- Ulceration
- Fever & malaise
Nerve EnlargePainful (-)
Nerve damage (-)
EnlargePainful & swollen
Nerve damage
Eye Not involvement Painful
Visual impairment
Testis Swollen, Painful (-) Painful, Enlarge
Skin, nerve, eye, testis
Same - Same
- Very painful
- Fever
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TREATMENT of REACTION :
Prednisone : 30 80 mg / daily and then tappering
off
Continued M D T without interruption
MILD REACTION :
- Immobilization
- Rest
SEVERE REACTION :Reffered to the nearest hospital
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PARASITPARASITSCABIES
PEDICULOSIS
LARVA MIGRAN
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SCABIESSCABIES (GUDIG)
PENYEBAB : SARCOPTES SCABEI
GEJALA-TANDA:
± GATAL TERUTAMA MALAM HARI
± DAERAH KULIT TIPIS
± PAPUL2 ERITEMA
± BANYAK PADA KONDISI ORANG BERKUMPULDNG JANGKA WAKTU LAMA
TERAPI :
± TOPIKAL :PERMETRIN,
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LARVA MIGRAN PENYEBAB :
± NECATOR AMERICANUS
± ANCYLOSTOMA DUODENALIS
GEJALA-TANDA :
± GATAL
± MEMBENTUK LINIER/GARIS ERITEMA YG
BERTAMBAH PANJANG 5mm/HARI
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TERAPI ± CHLOR ETHYL SPRAY
± THIABENDAZOLE
± ALBENDAZOLE 400mg PO atau
5% TOPIKAL
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PEDICULOSIS (KUTU)
PEDICULOSIS ± PUBIS
± CORPORIS
± CAPITIS
KLINIS ± GATAL
± MAKULA MERAH KEBIRUAN (MAKULACERAULAE)
± DIKETEMUKAN PEDICULOSIS/LARVA/TELUR
DD : SCABIES