infeksi virus - kuliah tkt iv,,221009
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Kelvin Mandela1320220199
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Virus◦Organisme tanpa sitoplasma◦Berukuran sangat kecil → mikroskop elektron
Materi genetik◦Virus DNA◦Virus RNA
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Varisela Herpes zoster Herpes simpleks
Veruka Moluskum kontagiosum
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Sinonim: cacar air, chicken pox Infeksi akut primer oleh virus varisela-
zoster Menyerang kulit dan mukosa
Virus → mukosa sal. napas atas → replikasi lokal → viremia I → sel retikuloendotel → viremia II → diseminasi ke kulit & mukosa → penyakit → saraf sensorik → ganglion sensorik (infeksi laten)
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Masa tunas 2-3 minggu Anak-anak > dewasa Gejala prodromal + 24 jam makula eritematosa → papul →
vesikel → pustul → krusta “Dewdrops on rose petals” Diskret, polimorfik Sentrifugal: kepala/badan → ekstremitas
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Pemeriksaan penunjang: apusan Tzanck
Penatalaksanaan: ◦ Simtomatik
Antipiretik Antihistamin Bedak kocok
◦ Asiklovir 20 mg/kg (maks 800 mg) 4-5 kali sehari selama 5-10 hari. Diberikan dalam 24 jam pertama sakit
◦ Antibiotik topikal
Pencegahan: vaksinasi Prognosis baik
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Jarang
Infeksi sekunder Ensefalitis Pneumonia Glomerulonefritis Keratitis Konjungtivitis
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Penyakit akibat kekambuhan infeksi virus varisela-zoster
Menyerang kulit dan mukosa Kelainan◦Vesikel berkelompok-kelompok◦Di atas dasar eritematosa◦Sepanjang persarafan sensorik◦Sesuai dermatom◦Nyeri
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Sinonim◦ Dampa◦ Cacar ulang◦ Shingles
Etiologi : virus varisela-zoster Gambaran Klinis◦ Masa tunas 7-12 hari◦ Gejala prodromal◦ Eritema – edema – vesikel (bula)◦ Berkelompok◦ Isi vesikel: cairan jernih – keruh – pecah/mengering◦ Gatal/nyeri setempat, hiperestesi, unilateral (diagnostik)◦ Prognosis baik
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Bentuk Klinis◦Herpes zoster torakalis◦Herpes zoster oftalmikus◦Herpes zoster abortif◦Herpes zoster generalisata
Herpes zoster generalisata◦Usia lanjut◦Penyakit kronik◦Keganasan◦KU buruk◦AIDS
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Kerokan dasar vesikel/bula → pulasan Wright/Giemsa
Sel raksasa (keratinosit) berinti banyak
Varisela, herpes zoster, infeksi herpes simpleks
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Nervus fasialis (VII) ganglion genikulatum
Paralisis wajah ipsilateral (paralisis Bell) Kelainan kulit Gangguan telinga (tinitus, tuli, vertigo,
mual, muntah, nistagmus)
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Neuralgia pascaherpes◦Beberapa bulan – tahun◦Di atas 50 tahun
Diagnosis banding◦Dermatitis venenata (dermatitis kontak)◦Luka bakar◦Herpes simpleks◦Saat erupsi kulit (-): angina pektoris, kolik ginjal,
apendisitis
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Umum◦ Istirahat◦ Jaga kebersihan kulit◦ Jaga vesikel agar tidak pecah
Pengobatan Sistemik◦Simtomatik: analgetik◦Antivirus (dalam 3 hari pertama sejak lesi
timbul): asiklovir 5 x 400-800 mg/hari (7 hari)◦Antibiotik (hanya bila diperlukan)◦Obat lain: isoprinosin 4-6 x 500 mg/hari
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Obat sistemik khusus◦Sindrom Ramsay-Hunt: prednison 3 x 20 mg/hari (1
minggu) – tapering off◦Usia >50 tahun: prednison 3 x 20 mg/hari – turun
bertahap dalam 3-4 minggu Obat untuk neuralgia◦Amitriptilin, antikejang (karbamazepin, fenitoin,
gabapentin) Obat topikal◦Bedak salisil 2%◦Vesikel yang pecah: krim/salap antibiotik◦Lesi erosif: kompres asam salisilat 1 %0, PK 1/10.000
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Infeksi kulit & mukosa oleh virus herpes simpleks (VHS)
VHS tipe I : oral VHS tipe II: genital
Vesikel berkelompok di atas kulit yang eritematosa & edematosa
Rekuren
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Sinonim: cacar, small pox Penyakit virus dengan efloresensi
monomorf dan keadaan umum buruk Lesi terutama di perifer 1984 penyakit telah dieradikasi tetapi perlu
waspada
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Stadium inkubasi – erupsi (prodromal) Stadium makula – papular Stadium vesikulo – pustular Stadium resolusi◦ 2 minggu◦Krusta, jaringan parut atrofik
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Pemeriksaan penunjang◦ Inokulasi pada membran korioalantoin◦Mikroskop elektron
DD/: varisela Penatalaksanaan◦Karantina◦Simtomatik◦Atasi infeksi sekunder◦Antivirus, isoprinosin, interferon
Prognosis: mortalitas 1-50%
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Tumor jinak kulit dan batas mukosa Permukaan kasar Virus papiloma manusia (human papilloma
virus, HPV)
Sinonim: kutil, common warts
Infeksi HPV subtipe tertentu → genital (kondiloma akuminata) yi. suatu infeksi menular seksual
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Anak > dewasa Penularan◦kontak langsung◦otoinokulasi
Ekstremitas ekstensor Tonjolan bulat (mm – 1 cm), membesar,
batas tegas, permukaan kasar (verukosa) Warna seperti kulit atau abu-abu Multipel DD/ TBC kutis verukosa,
kromoblastomikosis
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Veruka plana juvenilis◦Milier s/d lentikuler◦Permukaan licin dan datar◦Warna seperti kulit atau kecoklatan◦Wajah, leher, punggung tangan/kaki,
pergelangan Veruka plantaris◦Seperti cincin keras◦Bagian tengah agak lunak◦Kekuningan◦Nyeri +◦Telapak kaki yang tertekan
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Bedah kaustik Bedah skalpel Bedah listrik Bedah beku (CO2, N2) Bedah laser
Prognosis: sering residif
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Penyakit infeksi virus Pox Papul dengan lekukan di tengah (delle) Berisi massa (badan moluskum)
Etiologi: Virus Pox
Penularan: kontak langsung, otoinokulasi Termasuk IMS
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Papul miliar/lentikular, putih seperti lilin, bentuk kubah, bagian tengah cekung (delle +)
Berisi massa putih (badan moluskum) Lokasi pada anak: wajah, ekstremitas,
badan Lokasi pada dewasa: pubis, genitalia
eksterna
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Keluarkan massa putih (menggunakan jarum suntik, pinset, kuret)
Bedah listrik Bedah beku
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Etiologi: virus pencernaan (mis. Coxsackie A 16, Enterovirus 17)
Sangat menular; transmisi oral-oral atau fekal-oral Swasirna. Penyulit (ensefalitis, pneumonia) jarang. Biasanya anak <10 thn Virus masuk mulut → implantasi mukosa (pipi, usus halus) → KGB
regional → viremia (stlh 3 hari) → menyebar ke mukosa oral & kulit tangan/kaki → lesi
Masa tunas 3-6 hari Demam ringan, malese Lesi
◦ Makula yg cepat berkembang menjadi vesikel◦ Telapak, jari bagian samping. ◦ Bentuk linier◦ Lesi mungkin nyeri → sulit makan
Terapi simtomatik
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Terima kasih