PRESENTASI KASUS dr. Thomas Aquino Kinantyo Tungga Winastu.

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1 PRESENTASI KASUS dr. Thomas Aquino Kinantyo Tungga Winastu

2 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 : Tanggal Masuk : 24/11/2019

3 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

4 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 (-)

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

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

7 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

8 Assesment Susp. Leptospirosis

9 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 x103/uL Trombosit 62 x 103/uL x103/uL Basofil 0 % 0 – 1 % Eosinofil 1 – 3 % Netrofil 76 % 50 – 70 % Limfosit 14 % 20 – 40 % Monosit 10 % 2 – 8%

10 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

11 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

12 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 +

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

14 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)

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

16 FOLLOW UP PERAWATAN DI RUANG RAWAT INAP LT. 5

17 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 x103/uL Trombosit 55 x 103/uL 47 x 103/uL x103/uL

18 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 x103/uL Trombosit 67 x 103/uL 78 x 103/uL 107 x 103/uL x103/uL

19 Tinjauan Pustaka LEPTOSPIROSIS

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

21 Leptospirosis icterohemorrhagic Swinherd Disease Demam Lumpur
Demam Rawa Weil Disease Demam Canicola PDPERSI Jakarta

22 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

23 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

24

25 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

26

27 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)

28 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

29 Patogenesis

30 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

31 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

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

33 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.

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

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

36 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

37 Zein Umar. (2006). “Leptospirosis”, Buku Ajar Ilmu Penyakit Dalam, Jilid III, edisi 4. FKUI : Jakarta. Hal Speelman, Peter. (2005). “Leptospirosis”, Harrison’s Principles of Internal Medicine, 16th ed, vol I. McGraw Hill : USA. Pg 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 Departemen Kesehatan, Pedoman Tatalaksana Kasus dan Pemeriksaan Laboratorium Leptospirosis di Rumah Sakit, Leptospira. Hlm Bagian Pemberantasan Penyakit Menular dan Penyehatan Lingkungan : Jakarta. Wahyuningsih, Dwinur Leptospirosis. accessed on 1 December 2019 DAFTAR PUSTAKA

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

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