PRESENTASI KASUS dr. Thomas Aquino Kinantyo Tungga Winastu

Identitas Pasien Nama : Tn. M Umur : 42 thn, 6 bln, 2 hr (5/6/77) Jenis Kelamin : Laki-laki Pekerjaan : Buruh kasar Alamat : Jl. Bukit Duri Pangkalan RT 004/RW12 Agama : Islam No. RM : 129396 Tanggal Masuk : 24/11/2019

Anamnesis Keluhan Utama Demam Keluhan Tambahan Nyeri Ulu Hati Nyeri hebat pada betis Keluhan Tambahan Demam dialami ±10 hariSMRS, terus menerus, terdapat sakit kepala, tidak menggigil, tidak pusing, mual dan muntah disangkal. Tambahan

Riw. Pekerjaan sebagai Buruh Kasar di Pasar dengan kondisi banyak air tergenang Anamnesis Pe↓an BB (-) Riw. Kontak dgn pasien demam (-) Riw. Kontak dgn hewan (-) Riw. Hepatitis (-) Riw. HT, DM (-) Riw. Merokok, Minum Alkohol (-)

Status Gizi Pasien BB = 51 kg TB = 160 cm IMT = 19,92 Gizi Cukup (Normal)

Tanda Tanda Vital TD : 106/68 mmHg HR : 120 x/menit reguler RR : 18x/menit Tipe : Thoracoabdominal T : 38,3oC

Pemeriksaan Fisik Kepala : normocephali Mata : CA -/- SI -/- tampak kemerahan THT : dalam batas normal Thorax : Pulmo : Vesikuler +/+, Rh -/-, Wh -/- Cor : BJ I dan II reguler, murmur -, gallop - Abdomen : Supel, BU +, NT -, organomegali – Ekstremitas : Akral hangat, CRT < 2 detik, Rumple Leeds -, NT pada gastrocnemius D/S

Assesment Susp. Leptospirosis

Pemeriksaan Laboratorium Jenis Pemeriksaan Hasil (24/11/2019) Nilai Rujukan HEMATOLOGI Hemoglobin 14.3 g/Dl 11.0 – 17.0 g/dL Eritrosit 5.18 x 106/Ul 4.00 – 6.02 x 106/uL Hematokrit 43% 35 – 55% MCV 83 Fl 82 – 92 fL MCH 28 pg 27 – 31 pg MCHC 34 gr/dl 31 – 37 gr/dl Leukosit 7.99 x 103/uL 4.0-12.0x103/uL Trombosit 62 x 103/uL 150-400x103/uL Basofil 0 % 0 – 1 % Eosinofil 1 – 3 % Netrofil 76 % 50 – 70 % Limfosit 14 % 20 – 40 % Monosit 10 % 2 – 8%

Pemeriksaan Laboratorium KIMIA KLINIK Kreatinin 1.4 mg/dL 0.5 – 1.1 mg/Dl WIDAL S Typhosa O - S Para typhi AO S Para typhi BO S Para typhi CO S Typhosa H S Para typhi AH S Para typhi BH S Para typhi CH

Pemeriksaan Laboratorium URINALISIS 24/11/2019 Warna Kuning Kejernihan Keruh Jernih pH 6.0 4.5 – 8.0 BJ 1.020 1.005 – 1.035 Nitrit - Negative Protein ++ 2 Reduksi Keton + 1 Urobilinogen Bilirubin Blood Leukosit

Pemeriksaan Laboratorium URINALISIS 24/11/2019 MIKROSKOPIS Eritrosit 10 – 15 /LPB 0 – 1 /LPB Leukosit 3 – 4 /LPB 0 – 3 /LPB Silinder - Negative Epitel + Kristal Amorf +

Pemeriksaan Penunjang Foto Rontgen Thorax PA Cor dan Pulmo dalam batas normal KESAN

Planning Diet makanan lunak PCT 1000mg drip IVFD RL 20 tpm Konsul dr. Randy, Sp.PD: Acc Rawat inap Inj.Ceftriaxon 1X3gr IV dlm NS 0,9% 100cc Omeprazole 20mg 1 x 1 tab PO Paracetamol 500mg 3 x 1 tab PO (k/p)

Prognosis Quad ad functionam : Dubia et bonam Quad ad sanationam : Quad ad vitam :

FOLLOW UP PERAWATAN DI RUANG RAWAT INAP LT. 5

Pemeriksaan Laboratorium Jenis Pemerikaan Hasil (25/11/2019) (26/11/2019) (27/11/2019) Nilai Rujukan HEMATOLOGI Hemoglobin 12.2 g/Dl 11.8 g/Dl 11.0 – 17.0 g/dL Eritrosit 4.45 x 106/Ul 4.34 x 106/Ul 4.38 x 106/Ul 4.00 – 6.02 x 106/uL Hematokrit 37% 36% 35 – 55% MCV 83 Fl 82 Fl 82 – 92 fL MCH 27 pg 28 pg 26 pg 27 – 31 pg MCHC 33 gr/dl 34 gr/dl 32 gr/dl 31 – 37 gr/dl Leukosit 5.96 x 103/uL 4.37 x 103/uL 5.00 x 103/uL 4.0-12.0x103/uL Trombosit 55 x 103/uL 47 x 103/uL 150-400x103/uL

Pemeriksaan Laboratorium Jenis Pemerikaan Hasil (28/11/2019) (29/11/2019) (30/11/2019) Nilai Rujukan HEMATOLOGI Hemoglobin 13.0 g/Dl 10.8 g/Dl 11.2 g/Dl 11.0 – 17.0 g/dL Eritrosit 4.82 x 106/Ul 4.02 x 106/Ul 4.01 x 106/Ul 4.00 – 6.02 x 106/uL Hematokrit 39% 33% 35 – 55% MCV 82 Fl 83 Fl 82 – 92 fL MCH 27 pg 28 pg 27 – 31 pg MCHC 32 gr/dl 34 gr/dl 31 – 37 gr/dl Leukosit 4.92 x 103/uL 3.69 x 103/uL 6.14 x 103/uL 4.0-12.0x103/uL Trombosit 67 x 103/uL 78 x 103/uL 107 x 103/uL 150-400x103/uL

Tinjauan Pustaka LEPTOSPIROSIS

Spirochaeta  Leptospira icterohaemorrhagiae LEPTOSPIROSIS Spirochaeta  Leptospira icterohaemorrhagiae INADA JEPANG ADOLF WEIL ISOLASI Ginjal & Urin Tikus Anjing Babi Sapi HIDUP

Leptospirosis icterohemorrhagic Swinherd Disease Demam Lumpur Demam Rawa Weil Disease Demam Canicola PDPERSI Jakarta - 2007

Etiologi Leptospirosis ORDO SPIROCHAETA Organisme fleksibel, tipis, berlilit padat panjang 5-15 μm, disertai spiral halus lebarnya 0,1-0,2 μm Leptospira interrogans Diidentifikasi lebih dari 200 serotipe Spirochaeta L. interrogans MUDAH DIBIAKKAN Aerob, suhu 28-30ºC dan pada pH 7,4 Media semisolid kaya protein Leptospira biflexa Bersifat tidak patogen / saprofit Mudah Dibiakkan L. biflexa

Epidemiologi Leptospirosis Seluruh dunia, kecuali Antartika. Terutama iklim Tropis. PENYEBARAN Tikus  Utama (L.icterohaemorrhagica ) leptospira menetap dan membentuk koloni serta berkembangbiak di dalam epitel tubulus ginjal tikus dan secara terus menerus ikut mengalir dalam filtrat urin PENYEBARAN

Manifestasi Klinis Leptospirosis FASE LEPTOSPIREMI / SEPTIKEMIA Masa inkubasi dari leptospira virulen adalah 7-12 hari, ±10 hari Demam tiba-tiba, menggigil, sakit kepala, mialgia, ruam kulit, mual, muntah, conjunctival suffusion, dan tampak lemah Trombositopenia, hepatomegali, UL ditemukan proteinuria FASE IMUN Leptospiuria dan berhubungan dengan timbulnya antibodi IgM Ringan  gejala minimal Berat  tanda meningeal, neuritis optikus, uveitis, iridosiklitis, dan neuropati perifer Jaundice, gagal ginjal, oliguria, syok, dan miokarditis

Spesimen Laboratorium Anikterik DAN Ikterik Sindroma, Fase Gambaran Klinik Spesimen Laboratorium Leptospirosis anikterik Fase leptospiremia Fase imun Demam tinggi, nyeri kepala, mialgia, nyeri perut, mual, muntah, conjunctival suffusion Demam ringan, nyeri kepala, muntah, meningitis aseptik Darah, LCS, Urin Leptospirosis ikterik Fase imun (sering overlapping) Demam, nyeri kepala, mialgia, ikterik, gagal ginjal, hipotensi, manifestasi perdarahan, pneumonitis hemorrargik, leukositosis Darah, LCS (minggu 1), Urin (minggu ke-2)

Patologi Leptospirosis Ginjal infiltrasi sel mononuklear merupakan bentuk lesi pada leptospirosis yang dapat terjadi tanpa gangguan fungsi ginjal Hati nekrosis sentilobuler fokal dengan infiltrasi sel limfosit fokal dan proliferasi sel kuppfer dengan kolestasis Mata Leptospira dapat masuk ruang anterior dari mata selama fase leptospiremia Jantung epikardium, endokardium dan miokardium dapat terlibat berupa perdarahan fokal pada miokardium dan endokarditis Weil Disease ikterus, biasanya disertai perdarahan, anemia, azotemia, gangguan kesadaran dan demam tipe kontinu Otot Rangka lokal nekrotis, vakuolisasi dan kehilangan striata

Patogenesis

Diagnosis Daftar Pertanyaan Jawaban Nilai A. Jenis gejala dan laboratorium Sakit kepala mendadak Ya/tidak 2/0 Conjunctival suffusion bilateral 4/0 Demam Bila demam >38 C Meningismus Nyeri otot terutama betis Meningismus, nyeri otot dan konjungtiva suffosion bersamaan 10/0 Ikterik 1/0 Albuminuria atau azotemia Kriteria WHO oleh Feine untuk diagnosa Leptospirosis

Diagnosis Berdasarkan kriteria di bawah, Faktor epidemiologi seperti riwayat kontak binatang ke hutan, rekreasi, tempat kerja atau diduga atau diketahui kontak dengan air yang terkontaminasi. Ya/tidak 10/0 C. Hasil laboratorium serologi : Serologi (+) di daerah endemik : Single (+), titer rendah 2/0 Single (+), titer tinggi Pair sera, titer meningkat 25/0 Serologi (+) bukan daerah endemik : 5/0 15/0 Diagnosis Berdasarkan kriteria di bawah, leptospirosis dapat ditegakkan bila jumlah A+B >25, atau A+B+C >25 disebut presumptive leptospirosis; dan bila A+B nilai antara 20-25 disebut suggestive leptospirosis. Kriteria WHO oleh Feine untuk diagnosa Leptospirosis

Diagnosis Leptospirosis 1 PEMERIKSAAN MIKROBIOLOGIK 2 KULTUR 3 INOKULASI HEWAN 4 SEROLOGI

TATALAKSANA This PowerPoint Template has clean and neutral design that can be adapted to any content and meets various market segments. With this many slides you are able to make a complete PowerPoint Presentation that best suit your needs.

Komplikasi Leptospirosis PARU HATI GINJAL JANTUNG GANGGUAN RESPIRASI AKUT 38% GAGAL HEPAR AKUT 72% GAGAL GINJAL AKUT 95% GANGGUAN KARDIOVASKULER AKUT 33%

Prognosis Leptospirosis 30-40% 5% BAIK KEMATIAN Jika ada Ikterus > 60 TAHUN KEMATIAN Jika ada Ikterus < 30 TAHUN Jika tidak ada Ikterus

1 2 3 4 PENCEGAHAN MENGURANGI PAPARAN DENGAN TANAH DAN AIR MELINDUNGI SANITASI PENDUDUK SEKITAR 3 FILTRASI DAN DEKLORINASI UNTUK MENCEGAH INVASI LEPTOSPIRA 4 VAKSINASI PADA HEWAN

Zein Umar. (2006). “Leptospirosis”, Buku Ajar Ilmu Penyakit Dalam, Jilid III, edisi 4. FKUI : Jakarta. Hal.1845 - 1848. Speelman, Peter. (2005). “Leptospirosis”, Harrison’s Principles of Internal Medicine, 16th ed, vol I. McGraw Hill : USA. Pg.988-991. Dit Jen PPM & PL RSPI Prof. DR. Sulianti Saroso. (2003). Pedoman Tatalaksana Kasus dan Pemeriksaan Laboratorium Leptospirosis di Rumah Sakit. Departemen Kesehatan RI : Jakarta. Dharmojono, Drh. Leptospirosis, Waspadailah Akibatnya!. Pustaka Populer Obor : Jakarta. 2002. Departemen Kesehatan, 2003. Pedoman Tatalaksana Kasus dan Pemeriksaan Laboratorium Leptospirosis di Rumah Sakit, Leptospira. Hlm. 8-15. Bagian Pemberantasan Penyakit Menular dan Penyehatan Lingkungan : Jakarta. Wahyuningsih, Dwinur. 2016. Leptospirosis. http://eprints.ums.ac.id/41309/5/BAB%20I.pdf, accessed on 1 December 2019 DAFTAR PUSTAKA

Lucy, Andani. 2014. Infeksi Tropis : Leptospirosis. http://eprints Lucy, Andani. 2014. Infeksi Tropis : Leptospirosis. http://eprints.undip.ac.id/44817/3/BAB_II.pdf , accessed on 1 December 2019 Isselbacher, Braunwald, et all. 2002. Harrison : Prinsip-prinsip Ilmu Penyakit Dalam Volume 2. Jakarta. EGC. Soedarto. 2009. Penyakit Menular di Indonesia. Surabaya: Sagung Seto Soedarto. 2012. Penyakit Zoonosis Manusia Ditularkan oleh Hewan. Surabaya: Sagung Seto Sudoyo, Aru W, dkk. 2009. Buku Ajar Ilmu Penyakit Dalam. Jakarta : Interna Publishing DAFTAR PUSTAKA

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