117983103 tes laboratorium pada penyakit tropis

8/14/2019 117983103 Tes Laboratorium Pada Penyakit Tropis

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Tes Lab pada Penyakit Infeksi& Tropis



November 6, 2013 2

Tes Darah Rutin pada Penyakit

Infeksi Tropis

Pengamatan pada: Eri, Leko Trombos

Manifestasi: anemia, lekositosis atau lekopeni danDIC*

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



November 6, 2013 3


Infeksi Tropis

Lekopeni Netropeni, mis

Demam Tifoid,brucellosis

Infeksi hebat

netropeni hebatprognosis buruk

Perubahanmorfologik pdsepsis Döhle bodies Granula toksik vakuolisasi

Eosinofilia : non-bakterial,

biasanya alergi /

infeksi parasit.



November 6, 2013 4


Infeksi Tropis

Anemia bisa timbul sekalipun cadangan besi

cukup.

Anemia akut: perdarahan/ destruksi eritrosit (misalnyacold agglutinin sehubungan denganMycoplasma pneumoniae),

Anemia kronik, dengan cadangan besi yang normal atau meninggi di

sistem retikuloendotelial penurunan besi dalam plasma serta penurunan TIBC (total iron-binding capacity ).



November 6, 2013 5


Infeksi Tropis

Infeksi serius + bakteriemia

Gram negatif DIC. (Gram pos jarang)

Trombos PT memanjangFDP Fibrinogen

Trombosiopenia bisa juga menjadi tanda sepsis bakterial dan

bisa bermanfaat dalam mengobservasi responpasien terhadap terapi.



November 6, 2013 6

Lab Examinations in Dengue Fever

(DF)

Laboratory findings

Hematology Leukopenia

Thrombocytopenia

serum aminotransferase (AST, ALT) elevations.

The diagnosis is made by Lab Tests seroimmunology 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 phaseif mosquito inoculation or mosquito cell culture



November 6, 2013 7


(DF)

Hemagglutination Tests

Virus + Eri angsaagglutinasi Tes

Negatif

Virus + serum (ada atb spesifik)tidakaglutinasiTes Positif

Virus + Eri + serum (tanpa atbspesifik) aglutiasi Tes negatif



November 6, 2013 8


(DF)

I n t er pr e t a

s i

Specimen1

Specimen2

Interpretation

Pre 4th d

< 1:20

Post 1-4wk

4x

<1:1280

1maryDengue

Pre 5th d

<1:20

<1:20

>1:2560

4x

2ndary

Dengue

Pre 7th d

> 1:12804x not

needed

PresumptiveS 2ndaryDengue



November 6, 2013 9


Complement FixationTest

Ag+[serum,Ab pos]+Complcomplement

fixed+RBC(sheep)unlysed : Pos test

Ag+[serum,Ab neg]+Complcomplement unfixed RBC(shee)

lysed : Neg test

Ag

SAb

K

RBC

Pos Neg



November 6, 2013 10

Dengue Hemorrhagic Fever (General)

Tes Lab:

2. ELISA (capturemethod)

1. Anti-dengue IgM

Infeksi primer,akut 7-10 hr

2. IgG (post/kronik)

Infeksisekunder,sesudahnya

HasilInterpretasi

IgG IgM

+ + D sekunder

- + D primer

+ - Duga Dsekund

- - Non-D

Primer

sangat dini



November 6, 2013 11

DHF pada Anak

In dengue

present by the 2nd day of fever

by the 4th or 5th day, the WBC count 2000 to4000/mL, 20 to 40% granulocytes.

Moderate albuminuria and a few casts may befound.

Dengue may be confused with Colorado tick fever,typhus, yellow fever, or other hemorrhagic fevers.

Serologic diagnosis may be made by

hemagglutination inhibiting and complementfixation tests using paired sera

but is complicated by cross-reactions with otherflavivirus antibodies.



November 6, 2013 12

DHF pada Anak

In dengue hemorrhagic fever 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.



November 6, 2013 13

DHF pada Anak

WHO clinical criteria for diagnosis of denguehemorrhagic fever: acute onset of high, continuous fever lasts for 2 to

7 days

hemorrhagic manifestations, including at least apositive tourniquet test and petechiae, purpura,ecchymoses, bleeding gums, hematemesis, ormelena

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 pulsepressure (< 20 mm Hg) or hypotension with cold,clammy skin and restlessness.



November 6, 2013 14

Herpes Simplex

Laboratory tests are generally not necessary(viral cultures and Tzanck smear will confirmdiagnosis in patients with atypical presentation)

Antibody to appropriate serotype Seroconversion Increase

Direct immunofluoroscent antibody slide tests (rapiddiagnosis)

Tzanck preparation

Base of lesions Multinucleate giant cells



November 6, 2013 15

Tzanck cell



November 6, 2013 16

Herper Zoster

Laboratory tests are generally notnecessary (viral cultures and Tzancksmear will confirm diagnosis inpatients with atypical presentation).

The Tzanck preparation showsmultinucleate giant cells for both

varicella-zoster virus and HSV



November 6, 2013 17

Mumps

Darah Lekopeni Serum amilase dlm 10 hari

Serologi

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

Biakan Virus dari ludah 1-5 hari

Komplikasi Inflamasi testis/ ovarium: lekositosis, LED Pankreatitis: lekositosis, amylase, hiperglikemia Meningitis: sel LCS < 500/L, mononuclear; glukose

normal, protein agak (20-125 mg/dL)



November 6, 2013 18

Morbilli (Measles, Rubeolla)

Temuan laboratorium Darah

Lekosit , terutama limfo & segmen lekositosissuperinfeksi bakterial

Serologi: EIA 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



November 6, 2013 19

Varicella

Tes lab yang bisa dilakukan Sediaan apus

Bahan: kerokan dasar vesikel

Pulasan: TzankMultinucleated Giant Cells

Sensitivitas 60%

Darah

Serologi: Titer atb serum konvalesen 4x dpd serum akut

Hemaglutinasi

Elisa

Fama

PCR: deteksi DNA virus



November 6, 2013 20

HIV/ AIDS

HIV antibody detected by a two-step technique:

ELISA as a sensitive screening test

Confirmation of positive ELISAtests with the more specificWestern blot technique



November 6, 2013 21

Molluscum Contagiousa

Giemsa-stained

shows inclusion bodies within manylarge cells or extracellularly



November 6, 2013 22

Verruca Vulgaris

DNA typing: circular-doubel-stranded, 8000 bp

Cross-hybridization

> 50% : type seperation

< 50%: subtype seperation



November 6, 2013 23

Impetigo/ Pyoderma

Generally not necessary

Gram stain and C&S to confirm thediagnosis when the clinical presentation is

unclear Sedimentation rate parallel to activity of

the disease

Anti-DNAse B and antihyaluronidase

Urinalysis: hematuria with erythrocytecasts and proteinuria in patients withacute nephritis



November 6, 2013 24

Difteri

Diagnosis definitif tergantung padaisolasi C.diphtheriae yang diambildari bahan di lesi-lesi lokal.

Pihak laboratorium harusdiberitahukan bahwa bahandisangka difteri agar pihaklaboratorium

Gram stains of secretions club-shaped organisms, appear as

"Chinese letters"



November 6, 2013 25

Polio

CSF:

Aseptic meningitis

Elevated WBCs

Elevated protein

Normal glucose



November 6, 2013 26

Salmonellosis/ Typhoid Fever

Kultur

Darah: positif dlm 10 hari pertama

Tinja & Urin: positif dlm minggu 3-5

Sumsum tulang:

Serologi

Tes Widal: serum sembuh 4x dpd

sakit

Darah rutin: Lekopeni



November 6, 2013 27

Kolera

Isolasi vibrio cholerae dari bahantinjaidentifikasi serogroup 01 atau139

Serologi:

tes agglutinasi menggunakanantiserum spesifik



November 6, 2013 28


Other than a positive culture, no specific laboratorytest is diagnostic for enteric fever.

In 15 to 25% of cases, leukopenia and neutropeniaare detectable. In the majority of cases, the whiteblood cell count is normal despite high fever.

However, leukocytosis can develop in typhoid fever(especially in children) during the first 10 days ofthe illness, or later if the disease course iscomplicated by intestinal perforation or secondaryinfection.



November 6, 2013 29


Other nonspecific laboratory results Tests (AP,GOT,GPT & LDH)

The diagnostic "gold standard" is a culturepositive for S. typhi or S. paratyphi. 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 patientsand/or to recent antibiotic treatment.

Centrifugation to isolate and culture the buffy coat,which contains abundant blood mononuclear cellsassociated with the bacteria, decreases time toisolation but does not affect culture sensitivity.



November 6, 2013 30


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 despitea negative bone marrow culture. If blood, bone marrow,and intestinal secretions are all cultured, the yield of apositive culture is >90%.

Stool cultures, while negative in 60 to 70% of casesduring 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 percentagebecome chronic carriers and continue to have positivestool cultures for at least 1 year.



November 6, 2013 31


Serologic testsWidal test for "febrile

agglutinins,“ high rates of false-positivityand false-negativitynotclinically useful.

Polymerase chain reaction andDNA probe assays are beingdeveloped



November 6, 2013 32

Disentri basiler/ Shigellosis

Jumlah Lekosit: , Normal atau

Serologi: bisa, jarang bermanfaat

Tinja: Kultur, harus tinja segar!

Mikroskop: Lekosit

Polymerase chain reaction (PCR)may be diagnostic.



November 6, 2013 33

Helmintiasis

Parasitology study !



November 6 2013 34

Mycosis

Parasitology study !

117983103 tes laboratorium pada penyakit tropis

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