117983103 tes laboratorium pada penyakit tropis
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8/14/2019 117983103 Tes Laboratorium Pada Penyakit Tropis
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Tes Lab pada Penyakit Infeksi& Tropis
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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
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November 6, 2013 3
Tes Darah Rutin pada Penyakit
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.
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November 6, 2013 4
Tes Darah Rutin pada Penyakit
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 ).
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November 6, 2013 5
Tes Darah Rutin pada Penyakit
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.
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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
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November 6, 2013 7
Lab Examinations in Dengue Fever
(DF)
Hemagglutination Tests
Virus + Eri angsaagglutinasi Tes
Negatif
Virus + serum (ada atb spesifik)tidakaglutinasiTes Positif
Virus + Eri + serum (tanpa atbspesifik) aglutiasi Tes negatif
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November 6, 2013 8
Lab Examinations in Dengue Fever
(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
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November 6, 2013 9
Lab Examinations in Dengue Fever
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
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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
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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.
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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.
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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.
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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
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November 6, 2013 15
Tzanck cell
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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
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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)
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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
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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
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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
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November 6, 2013 21
Molluscum Contagiousa
Giemsa-stained
shows inclusion bodies within manylarge cells or extracellularly
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November 6, 2013 22
Verruca Vulgaris
DNA typing: circular-doubel-stranded, 8000 bp
Cross-hybridization
> 50% : type seperation
< 50%: subtype seperation
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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
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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"
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November 6, 2013 25
Polio
CSF:
Aseptic meningitis
Elevated WBCs
Elevated protein
Normal glucose
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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
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November 6, 2013 27
Kolera
Isolasi vibrio cholerae dari bahantinjaidentifikasi serogroup 01 atau139
Serologi:
tes agglutinasi menggunakanantiserum spesifik
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November 6, 2013 28
Salmonellosis/ Typhoid Fever
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.
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November 6, 2013 29
Salmonellosis/ Typhoid Fever
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.
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November 6, 2013 30
Salmonellosis/ Typhoid Fever
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.
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November 6, 2013 31
Salmonellosis/ Typhoid Fever
Serologic testsWidal test for "febrile
agglutinins,“ high rates of false-positivityand false-negativitynotclinically useful.
Polymerase chain reaction andDNA probe assays are beingdeveloped
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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.
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November 6, 2013 33
Helmintiasis
Parasitology study !
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