paul n harijanto kasus malaria

8/13/2019 Paul N Harijanto Kasus Malaria

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PRACTICAL GUIDELINE FOR PRIMARYCARE PHYSICIAN

To day is The WORLD MALARIA DAY

Theme : Counting Malaria Out


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Identified CasesDiagnosis

Treatment


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Fever/ history fever Living in endemic area/ history

travel to malaria area

Manifestation complication :jaundice, convulsion, comateus


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RDT Microscopic PCR

Test for exclusion : Hematology

Biochemical

Serology for dengue, typhoid,leptospirosis


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Confirmed diagnosis : ACT Suspected/ clinical : Non-ACT/

conventional

Severe Malaria : Artesunate


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A woman 50 years old, main complaint of yellow eyes.

She felt weak and tired since 2 weeks ago. She had

vomiting, giddiness, poor appetite, dark urine, and

defecation normal in color.

Physical examination: concious, BP: 100/70mmHg

Pulse: 90x/m, Temp. : 370C, Resp. : normal

Sclera and skin ; jaundice (+)Heart & Lung : normal, Abdomen: soft, no masses

Liver : hepatomegaly 2 m bcm

L: not palpable

DIAGNOSIS : Acute Viral Hepatitis

Comment : Agree/ NOT Agree / Do not know


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A. Give liver supportive agent B. Hematology & biochemical test C. USG

D. Viral Hepatitis Marker E. Urine microscopic F. CT scan


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Day 2 -3 : still weak, less eating, BP90/60, volume good, no fever. USG :sludge, suggested CHOLECYSTITIS.

What we should do ?A. Put on Antibiotic

B. Request for ERCP

C. Put on Ursodeoxy-cholic acid


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D4, chill, fever,38C. Lab. Hb. 9 gr%, Leuco7800/mm3 (62% neutrophile), thrombocyte63.000. Total bil 8.4 mg/dl (Direct 7.8 mg/dl),gamma-GT 60; Alk.PO4 159. Urea 147, creat1.69. TTl protein 6.2 mg/dl (alb 2.54); Se iron

22, TIBC 271. Malaria smear negative Question :

A. Antibiotik change to Parenteral

B. Do another hematology profileC. Blood culture

D. Do another test for malaria


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D5 : Falcip malaria ++++ ring; count > 3000par/ 200L

Treament :

A. ACT

B. Non- ACT

C. Quinine Parenteral D. Artesunate iv

E. Arthemeter im

Follow-Up : D 14 : bil 2.06 ( indirect 1.4), Hb. 6.5g%. Fever subsided, getting beter.

G- 6 PD enzym : 314


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Patient with fever/ history of fever :

Where they lived

History travelling

Blood transfussion

Liver/ spleen enlargement May not related to liver diseases

Watched for systemic infection

Jaundice : Parenchymal/ Obstruction/ Hemolysis

Systemic Infection


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Thrombocytopenia : NOT always dengue

Common in Malaria, Typhoid fever

Rarely occur in autoimmune/ idiopathic

Anemia :

Not in Acute Infection/ Illnesses Common in haemorhagic, malignancy,

chronic infection

Rarely hemolysis associated with malaria


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A woman, 39 years old, comes with vaginal

bleeding and abdominal pain. She ispregnant 7 months ( G1PoAo ). She hadhistory of fever 6 days, headache. Lived inPapua.

BP 160/100, temp 37.8C, pulse 80x/ minute Lab : Hb. 13 gr%, Mal vivax ring +, 4 par/

200 leuco

Treatment : Suldox 3 tb/ once Paracetamol 1 tb, tds


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A woman, 26 ears old, admiteedhospital with abdominal pain, she ispregnant 24 weeks (G1PoAo).

Hb 6.8 gr%, Thrombocyte 73.000,developed fever 39 C

Malaria falcip ring +, 8 par/200l


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51 years women, admitted with history 4days fever with breathless, temp 37.5, BP

150/100, pulse 108 : resp. : 36x/menit No history of DM, Hpt -, previous admission

Penanganan ? :

A. Furosemide i.v B. Oksigen

C. Foto thorax

D. Nebulizer E. Aminophyllin IV

F. Morphine iv


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18/20

12 hrs after hospitalization BP70/50, pulse 120x/min, temp 35.6,Kussmaul breathing

What you should do ? A. EKG

B. Blood Gas

C. Infuse rapidly with R/L

D. Dopamine/ dobutamine

E. Blood sugar

F. Profile hematologySlides current until 2008


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Hb: 16,3 , WBC: 17900/uL, Diff Leuco : -

/-/82/19/-, Trombo : 109.000. Malariafalciparum: +++, 1100/ 200 WBC, bl.Sugar: HI -,1015mg%, 900mg%, Bil.Total:2.47, bil direct:1.15 mg%,ureum:86.4 mg%, creatinine :2.87mg%, sodium:124 meq/L, potassium: 6.3 meq/L

PRIORITY TREATMENT :1) ( F.

2) ( A ..

3) ( I 4) .. ( A.

paul n harijanto kasus malaria

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