hartantri - unud
TRANSCRIPT
Yovita Hartantri
Prinsip Vaksinasi pada Populasi Khusus: Pasien Imunokompromais, Ibu HamilDAFTAR ISI
Kata PengantarDaftar Isi
Algorithm diagnosis in acute fever setting using simple laboratoryexaminationBudi Riyonto
I)illirr:ntial Diagnosis Of Acute Fever Based On EpidemiologY Data(hrto A.iuttowan
I'crrg;rntar DiskusiSotriyo lludi Susilo
Kasus Demam Tifoid, Rickettsiosis dan Leptospirosis
Role of Serologic Test Approach in Opportunistic Infection Diagnosis
Rudi Wisaksana
dan MenyusuiRobert Sinto
Morphology colcnies of dermatophytesSunaryati Sudigdoadi
Morfologi koloni dermatofi ta
Sunaryati Sudigdoadi
Update Anti Fungal ForMuhammad Vitanata
Dermatophytosis In Internal Medicine
Early Reocognition of SePsis
Niniek Budiarti
TerapiAnfn
Supportif Pada SePsis
Evaluasi KualitatifPenggunaan Antibiotika pada Pasien Paska Bedah dengan
Metode Gyssens di Ruang Rawat Inap Bedah dan Instalasi Luka Bakar RSUD
Dr. Saiful Anwar Malang Periode f uli-Agustus 2017 RSUD Dr' Saiful AnwarMalangArviansyah
I nterpretation Of CultureI;tLy Fitria Ruliatna
Result For Definitive Theraphy Of Antibiotics
'l'he new guidelines of malaria in indonesia (pedoman pengobatan malaria diirrdonesia 2019l'.N. Ilarijanto
llprl;rte in new drugs for malaria: Focus in treatment of malaria vivax
1,1,4
10
1,1.6
166
131
13917
20
149
25
71
t6386
87
1,43
Tatalaksana holistikSudirman Katu
pada orang dengan HIV/AIDS : pendekatan test and treat
Dengue Infection Diagnosis in Primary Health Care and Referral FacilityMusofa Rusli
Role ofVaccinationDjoni Djunaedi
in Immunocompromised
Infection Prevention And Control Policies In IndonesiaHindra Irawan Satari
Penilaian Resiko InfeksiRendra Bramanthi
di Rumah Sakit
iiiVaccination procedure and side event
B9lir tti luwita Nelwan t72
'
Diagnostic ApproachI Ketut Agus Somia
Cryptococcosis: EarlYSunaryati Sudigdoadi
In TB-HIV And MDR TB
Detection
179
tB4
2t7
22t
230
237
242
245
242
The Role of Immunonutrition in comprehensive Treatment of lnfectious
DiseaseNasronudin,Brian Eka Rachman
FUO: Diagnosis dan Tatalaksana Demam Kasus Sulit
Ronald lrwanto
Approach to unraveling the cause of perplexing febrile illness
Dewi Dian Sukmawati
Seorang Penderita lnfeksiMusofa Rusli,Dedy Hadi Prawono,Bramantono
HIV Dengan Ko-lnfeksi DHF
Ko-infeksi HIV- TB MDR dengan komplikasi Steven Johnson Syndrome
Anak Agung AYU Yuli
Gayatri
sepsis perkembangan dan permasalahannya [Discussion about difficult
sepsis casesJ
Franciscus Ginting
Prevention of enteric fever: Roie of vaccine and other strategies
IIsman Hadi
Perkembangan Tatalaksana Demam Tifoid
Adityo Susilo
I'rrberkulosis dan Diabetes, strategi skrining, Diagnosis dan Pengelolaan
l(linis yang Rasional
tttchti Alisjahbana
270
273
285
29.1
306
3t4
3t9
Bagaimana MengelolaSudirman Katu
Penggunaan Antibiotik di R'umah Sakit
Pitfall Yang Lazim TerjadiIre,ne Ratridewi
Pada Penggunaan Antibiotik
I{icke ttsiosis, newly emerging disease
I'r'imul Sudjurtu
Recent Managetnent of Diphteria Outbreak: Lessons from Eastfava
Dominicus Husada
TB Screening AndRudi Wisaksano
INH Prophylaxis In HIV
Update on managementi mmuno compro mis ed
Erwin Astha TriYono
of complicated urinary tract infection in
Role ofVaccinationDjoni Djunaedi
in lmmunocomPromised
ManagemenArtfin
Pasien Sepsis Secara Komprehensif
Stunting Dan Penyakit lnfeksi
L94
iv
Dominicus Husada 254
I'r'()venting Sepsis in Diabetes
324
Yosia Ginting337
Fungal Prophylaxis In Immunocompromized Patient
Suharyo HadisaPutro 342
Diagnostic of Challenges and Referral Resuscitation
Management In Rabies Cases402
I Made Susila Utama
Alkoholisme KronikAgung Nugroho
: Komplikasi dan Tatalaksana,...........ij.......................... 4L0
Helmintiasis di Indonesia: Permasalahan, Diagnosis dan PenatalaksanaannYa
Teguh Wahiu Sardjono
Preventive And CurativeDewa Ayu Putri SriMasyeni
Management Of Helminthiasis
Abstrak Lomba MBO dan Poster443
Peserta
345Rika Bur
The Role Of Steroid InCarta A. Gunawan
Dengue Infection
415
350
428
l'cnggunaan Echinacea dalam Tata Laksana Infeksi Saluran Napas Atas
I)jokt Widotlo,Ilolrcrt Sinto
'l'ata l,aksana InfeksiLoctomaseHerdiman T. Pohan,
Robert Sinto
357
Enterobacterioceae pengha srl Extended Spectrum Beta
359
Diagnostic Approach Exstended Spectrum Betalactamase( ESBL)361
Tambar Kembaren
Epidemiologi Filariasis Di lndonesia370
Kurnia Fitri Jamil
Filariasis Preventive And Currative Treatmeni
Muhammad Vitanata'usman Hadi
Tatalaksana Kegawatdaruratan pada Diare Akut
Ronald lrwanto
Alcohol IntoxicationYosia Gintinq
: I'-irst Management
381
391
395
vilvi
-r
National Congress XXIV PETRI
mikroorganisme resisten, seperti Extended spectrum Beta-Lactamase (ESBL) di
komunitas saat ini meniadi maialah yang cukup serius.s'5 Ronald lrwanto Antimicrobial
Stewardship Program IMSPROJ menekankan pemberian antibiotik empirik spektrunt
luas (yang tergolong reserve-re;ticted) hanya dilakukan bila terdapat fokus infeksi dan
geiatittinis infeksilakteri yang nyata dengan kriteria: Sepsis, atau Febril Netropenia'
itau Immunocompromissed / dan atau Diabetes Melitus tidak terkontrol, dengan riwayat
penggunaan antibiotik / dan atau perawatan (re-admisi) / dan atau riwayat penggunaarr
instrument medis < 30 hari.zDemam pada kasus FUO tipe nosokomial, tipe netropenik dan tipe HIV sangatlalt
baik untuk dapat dicari penyebab demamnya dan dikelola sesuai dengan penyebabnyrt
Demam kerap menjadi masilah yang mengancam ketika hosf adalah seorang penderitil
netropenik aiau mungkin anak-anak. Tatalaksana demam pada anak-anak di bawah usi;t
tertentu harus segera dilakukan menginta adanya bahaya timbulnya keiang demam'
Kesimpulanl)cmam merupakan kasus regular yang sering dijumpai pada praktek sehari-hari' Kasttr
strlit rnuncul ketika demarn tinyatakan sebagai FU0' Diagnosis FUO harus dilakukrrrr
s('(';rrJ nrenyeluruh dengan mempertimbangkan berbagai tipe FUO dan umumnya etiokrlll
lrt'rlrisar antara infeksi yang tidak teridentifikasi, malignancy atau outoimntuttt''l'atllaksana demam meliputi iimtomatik dan etiologik' Pada demam yang disebabl('rll
olch infeksi bakterial, pemberian antibiotik harus dilakukan secara bijak.
Daftar Pustaka1. Nelwan RH, Demam: tipe dan pendekatan. Buku Aiar llmu Penyakit Dalam, ed.6, jilirl
I, Pusat Penerbitan Departemen llmu Penyakit Dalam, Fakultas Kedoktct'ttr
Universitas lndonesia, 201'4 : 7 1 : 533-B
2. lrwanto R. RASPRO: Metode Tataguna Antibiotik Bijak dalam Rangka Menjalarrk'rrr
Fungsi PPRA di Rumah Sakit' 2018
3. Armitrong W, Kazanjian P. Fever of Unknown origin in the General Populatiort & ltt
Hlv-infected personi. In: Cohen J & Powderly WG [EditorJ. lnfectious Diseases, l"redition. section 3, Special Problems in Infectious Disease Practice' Edinburgh: Mo:;lrv
2004.871-B4. Widodo D, lrwanto R, Infeksi Nosokomial. Buku Ajar llmu Penyakit Dalam, ed'6, jilirl
I, Pusat Penerbitan Departemen llmu Penyakit Dalam, Fakultas Kedokttrt 'ttt
Universitas Indonesia, 2014 : 7 1 : 533-B
Nrttional Congress XXIV PETRI
Approach to unraveling the cause of perplexing febrile illness
Dewi Dian Sukmawati
Division of Tropical and Infectious Diseases, Department of Inlernal medicine
Faculty of Medicine and Health Sciences Udayana University
;\lrrtt ilct
r,.i'r.r isaprevalentsymptomofmanydiseases.Thechallengeincost-effectivediagnostic,1,1,r'.rr:h in unraveling the cause of acute undifferentiated febrile illness shall prompt a
i,.l,r,isc diagnostic approach with focused history taking, careful interpretation of local
,,,,1 rr'liional disease pattern, exposure and risk factors, thorough physical examination
,rrrl lr.r,;ic laboratory data. The etiology of Fever of Unknown Origin is often a common. !i,ili)l,y with atypical presentation. We present three cases of fever with challenging,ri 'r'ir'r.;is and solved in cost-effective manner.
!t ! I,w(!r-(ls: Acute undifferentiated febrile illness, fever of unknown origin.
Irrtr orlrrr liOl-l
i, , r 1 1', ,r rrOtable feature of disease, its responses regulated by the central nervotts^
. r. ,,r rln.ough endocrine, immunological, neurological and behavioral mechanislrtsl.!!,, |.url,(. 6l potential infectious and non-infectious cause of fever is broad2, antl oltt-'tl
: ,,,t,t,.rrr,rtir.tg conclude a diagnosis from clinical history and physical examinatiotl otrly.
' r,. I'r,)l)l{,nl is evident in deVeloping countrieS eSpecially tropical region, whcrc itt'ttlr'.,,!!ll,.r,.nti,rtod febrile illness [AUFI) account for 20-500/o of fever in childrcn ovcr' 5
,,, ,,t,t,rrrtlarlultlivinginAsiaandAfricaregion3.Therateof unknowncausebcyorltl 7
!. , !.rlu,rlion among cases with fever of unknown origin (FUOJ also ren'rain higlr,
- , ..iir,r tor t.l.U7o cases+, despite tie advance in currentmedical diagnostic method.
r:=, r,.lrrlIl I
i,!, .,.,rr .t ),1 year old male paiien! referral case from district hospital with suspected
,::i i! ,,,1 ol the liver dnd unknown source of fever. Patient has fever for tlvo days
! i, ,.,.ti rrrcrlical care and treated for 10 days at intensive care unit due to shock
, i,,,,,,,. l,r.lor-e referred to Sanglah Hospital. Right upper quadrant pain and icterus. ,,,,rr, r.rt rrr thc past 5 days, alongwith tea colored urine. He received combination of: : ! , ,,u,' ,rrrrl metronidazole antibiotics, also subcutaneous insulin due to high blood
ltr ,1r l1111y11yls6tges his drug user status, but no history of previous diabetes: : i, r,try.;rr.:rl examination revealed alerted, normotensive, tachycardia regular. ,: r ,,lrl,ltrrcrl and fever with axillary temperature 37.7oC, VAS score 4/10 for RUQ
! i', , l,'r ,r:; were icteric, pale conjunctivas, tender hepatomegaly, traube space was
113
6.
Baiio JR, Navarro MD et al, Epidemiology and clinical features of infections catrst'tl l'v
extenied spectrubeta-lactamase producing escheceria coli in nonhospit;rliztlrl
patients. J Clin Microbiol, 2004 i 42 (3) 1089-94
irwanto R, peran Karbapenem grup I (Ertapenem) dalam tatalaksana Ext.ttrllrl
Spectrum Betalactamase (ESBL) pada infeksi intra-abdominal komplikata, lrr rrttt
Basic to Advanced in Infectious Disease, Kongres Nasional PETRI XXI, PETRI (i;rlr'ilrg
Yogyakarta ; 2015 : 26-29
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National Congress XXIV PETRI
dull, and extremities evaluation revealed cold and clammy acrals despite the febrilecondition accompanied with pedal edema. Examination of lungs and cardiac wereunremarkable. Needle tract lesion was untraceable due to full body tattoo.
Laboratory evaluation indicated leukocytosis with neutrophilia, moderate normochromicnormocytic anemia, elevated bilirubin predominantly (B2o/o) direct bilirubin,hypoalbuminemia, prolonged coagulation panel with normal range transaminates.lmbalance of acid base and electrolyte were indicated by respiratory alcalosis andhyponatremia. Imaging study from previous hospital noted the hepatomegaly with un-homogenous parenchymal echo, hypoechoic heterogen area sized 1.3 x 7.7 cm at rightliver lobe.
Diagnosis of sepsis with multiple organ dysfunction syndromes was made, with suspectedpyogenic liver abscess. Blood culture was collected prior to administration of antibioticcomprise of 1 grarn intravenous Meropenem every B hours artd 500 mg inFavenousmetronidazole every 6 hours. Later, the result of procalcitonin test supporting thebacterial sepsis etiology with elevated to the level 10.09 ng/mL.
Case report 2
A 66 year old male patient endured four days of remittent fever prior to admission. Hewas referred from private hospital with diagnosis of suspected dengue infection due tothe presence of acute fever and thrombocytopenia. He was a pensioner, originally residesat east Nusa Tenggara and just arrived in Denpasar when the fever starts. Initialevaluation revealed alerted, normotensive, tachycardia with irregular regular rhythm,elevated axillary temperature of 380C and increased breath rate. The scleras were slighticteric without ciliary injections, cardiomegaly without additional heart sound, andenlarged liver span were present at presentation.
Laboratory evaluation showed leukorytosis with predominance of neutrophils,thrombocytopenia and elevated total bilirubin, the rest of laboratory evaluations wereunremarkable. Cardiomegaly was shown on chest X-ray with non specific pulmonaryimaging. Electrocardiography suggested old myocardial infarction and incomplete rightbundle branch block. Diagnosis suspected leptospirosis was made by physicians in chargeand 4 grams Ciprofloxacin intravenously was provided every 12 hours which laterchanged to meropenem when patient shows no improvement within 3 x 24 hours. Bloodcultures were sent prior to first dose ofantibiotic.
After nine days of inpatient care, no significant improvement was detected: patientbecomes lethargic, the fever lasted, and shortness of breath persisted, basal rhales andpedal edema were noticed. The case then consulted to tropical disease division.Reevaluation of clinical history, physical examination, laboratorium, electrocardiographyand imaging were leading to the diagnosis of sepsis and suspected subacute bacterialendocarditis was made. Treatment of 3 grams intravenous ceftriaxon every \2 hours and
National Congress XXIV PETRI
.i20 miligrams intravenous gentamycin was started. Consultation to cardiology
department was made. The patient shows remarkable improvement and later the
Streptococcus viridians were detected from blood culture. The possible infected
endocarditis diagnosis was made based on modified Duke criter{"a, and patient was
discharged after 14 days of inpatient treatment. Cardiologist planed ihe transesophageal
cchocardiography at outpatient care.
Case report 3
An elderly female of 72 years old was hospitalized for the third time in the past twomonths. Altered consciousness, fever, and cough were the predominance symptoms in
every admission and she recurrently diagnosed with delirium syndrome, pneumonia and
acute exacerbation of chronic obstructive pulmonary disease. Despite taking antibiotics,
mucolytics, steroid and bronchodilator regularly, the symptoms always reoccur.
Reevaluation of clinical history revealed persistence low grade fever, difficulty inswallowing even liquid food and water, and generalized weakness gradually worsened in
the past two months. The examiner noticed the neck stiffness and inflexibiliry of the
limbs, poor cough reflexes and further her daughter also mentioned that her mother's
hands occasionally shaking at rest. Physical evaluation disclosed the alert, underweight
elderly, normotensive, tachycardia, tachypneu without prolonged expiratory phase.
Cavum oris was scattered with white plaque at lingual, buccal mucosa, palatum,
peritonsilar up to pharyngeal area indicating the presence of oral thrust. Neck rigitlitywas positive but negative result for Lasegue test, Kernig's sign, Brudzinsky 1 and 2 sigrrs.
Intercostals spaces were wide without obvious barrel chest's appearance. Wct t't';tcklcs
were heard on both lungs without wheezing and slightly cleared after coughing. I{igitlityof limbs upon passive movement also noted.
Laboratory evaluations were unremarkable. Culture of sputum and blood from previous
hospitalization was sterile. Chest X-ray showed dome shaped low position of diaphragm.
Blood gas analyses not indicate COz retention. Despite the chronic respiratory complain,
the patient never had a pulmonary function test. Based on clinical history, physical
examination supported by the laboratory and imaging study, the case was concluded as
fever of unknown origin with parkinsonism suspected due to Parkinson's disease,
moderate dehydration, .oroesophageal candidiasis and malnutrition. She received
comprehensive manageme:lt consist of hydration, medication for OEC, nutritionaltherapy for malnutrition, and physical rehabilitation including chest physiotherapy. As
for the parkinsonism with suspected Parkinson's disease, a consultation to neurologic
was made and she was given levodopa.
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National Congress )$lV PETRI
The definition offever
There are wide variability of body temperature in relation to several environmental (time
of the measurement, environmentai temperatureJ and biological factors [site of
temperature measurement, level of activity prior to measurement, age, sex and race)s'
Rectal temperature measurement is typilaity 0.27o-0380C higher compared to oral
temperaturl, whereas axillary temperatuie ls O.SSoC less than the oral temperature6' The
definition of fever is subjective and depends on the purpose and the sensitivity of thermal
indicator to be utilized. Fever ancl hyperthermia both indicated the elevation of cortr
temperature above the normal limit; ;hile fever considered as a regulated physiologit'
.""ition, hyperthermia occurs when thermoregulation set point failed its function' Sonte
institutions and literatures defined fever as core temperature above 380C6'7 or oral
i"*pe.atr.e above 37,50C; other sources^ defined fever as documented one measuremcrll
of elevated core temperature above 3B.3oC on two consecutive dayss' In patients who ;tt ''neutropenic, the febiile neutropenia (FN) is defined as an oral iemperature above 38 5"t'
or two consecutive reading, oiou"a jB.g'C foa 2 hours and an absolute neutrophil crrtrrtl
lcss than 0.5 ' 10qll, or expected to fall below 0.5 x 10s/le'10'
Acute unrlifferentiated febrile illness
'l'he source oftebrile illness can be localized to organ system or non-localized referrctl 'r"
acute undifferentiated febrile illness. AUFI defined as fever with onset less thart lwrt
weeks' duration without apparent organ-specific symptoms at the onset3' Etiologit's ot
AUFI in non-tropical ."gion i." commonly due viral illness, in contrary; tropical antl r;ttlr
tropical area facing various differential diagnoses with relatively similar characteristi(\ 'tl
initial presentation. For the ease of diagnostic and management approach, AUFI frrrtlr{'r
classified as malarial febrile illness and non-malarial febrile illness3'11.
Studies indicate that the maior causes of non malarial AUFI in Asia and Africa regiotr w'. t s
arboviral infection (77.i%o), bacterial blood stream infection (10'5%), z()orrtl1l1
commonly leptospirosis 1+.Ooto) and rickettsioses [4.0%J3'12-16. The typical steltwlrr'
"pp.or.h to iyntiresis informaiion from history and epidemiology. including se'r1{rrirl
involvement, p-otential exposure to pathogen, followed with careful physical exarnirr'rllt'rr
is the mainfiame of constructing diagnosis. The knowledge of evolving patl('rrr lfcommon infection by region is very important. Leptospirosis, once considered as;t rrrtsl
illness, no- .o**only seen also in urban area; and dengue infection cases epidclltinllS:v
is evolving from commonly infection of urban setting, now increasingly observetl itt t rtt sl
area. Typical fever pattern for specific disease, rarely found nowadays, sittil'llre
availability of over t-he counter antipyretic, the fever pattern often becomc :ttvlrir al
Information related to patient factors, including age, pregnancy, co morbidity, tttttttrrt'-
compromisestate,mayassistinnarrowingthedifferentialdiagnosis.
examination first step is to look for the red flag signs indicatins tltt'tti'r'rl "r
treatment and hospitalization: prostration, hyperthermia' hyltrtlltr'r l'i:
Nutional Congress XXIV PETRI
rlisturbance of circulatory indicating compensated shock or shock state, neurological,rlrnormalities, abdominal pain and persistent vomiting, signs of anemia, icterus, anylrlccding manifestations and sepsis based on qSOFA score3,rz. The next approach is reviewrrl system and looking for the presence of localized signs of itrfection and possible,lr,rlynostic clues (see Figure).
Lrlroratory evaluation is tailored based on the results of clinical evaluation. Cases with..rr..pcct€d malaria will require rapid diagnostic test for malaria, thick and thin blood.,'r,.,rr and complete blood count. Dengue endemic area will benefit for complete blood!',irrr :rnd NS1 anti Dengue, if available. Urinalysis may reveal urinary tract infection,,1"'rially in women, pregnancy, and elderly, as in these populations rarely showni',, ,rlrzr.ci symptoms. Other biochemical tests and imaging studies reserved for cases withL',.rlrzcrl symptoms and patients who present with red flags or severe illness.i,,.lnnrltory diagnostic for specific infection may be requested based on suspected
' ii,,lr11'y, for example paired specimen for serological test or culture. The limitations of, ','tir ur;rtory diagnostics are their availability, sensitivity and cost. In practice however,.!, ti.rrrv{' diagnostics often circumvented and the cases were treated as "probable,ii,.t.,:.".
Red Fl&gs(ProslEtion, hyperthelmia, hypothermia,drculatory di$tubsnce, Gl tract disturbance,neurologic manifeslatrons. agns of anemia,rcleruB, blmding milrfealatrons, sepsiEqsOFA)
Locali:ed signs of infeclions
i i =
!i i i ,t pp r o:rch for acute undifferentiated febrile illness. The red flag signs and. ', rrr,'rrl ol rlSOFA fconsist of altered mental status GCS < 15, respiratory rate > 22
i,iirrrrrr' .ur(l systolic BP < 100 mmHg) are the first step evaluation in physical,,.,',,'l t),rticnts presentingwith AUFI.
Physicalurgent
Hospitalizrtion:
ll qSOFA > ?: follow sepsisprotocol, lrcst other conditionsaccordingly
olrsc{ of fever
1-2dayswith co morbidity:CBC, eildemid RDTmelarial NSI anti-
3-4d.ys
CBC, endemic: RDTmnhrid NS'l anli-
> 4 dsys
a€per3-4days,mayffiider bl6dculture
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National Congress XXIV PETRI
Fever of unknown origin
The classical definition of FUO by Perersdorf and Beeson consist of: the presence of
elevated core tempera*.a "U*. lg.3oC on several occasion for more than three weeks
duration and failure to obtain diagnosis despite one week of inpatient evaluationle' Since
the emergence of HIV inf..tion Ind extended use of immunomodulating therapy' FUO
;";;;;;;;d to fall into four categories: classical FUO, hospital-acquired FUO,
ilnrnunoco.promised or neutropenic FU0 and HIV-related FU01e'20'
The etiologies of FUO was change overtime due to shift in disease pattern and advance itt
diagnostic method. Alth;";t liieratures lisred more than 200 differential diagnosis for
FUO, most of solved."..r-or,.n due to atypical presentation ni_._o^*T^o^1 disease. studic
indicates the classical FUO's major etiologies were infection {20oio-40o/o}' malignancit:s
(20o/o-30o/o), non-infectious inflammatory dit""t" (l0o/o-30o/o), miscellaneous [10%r
2ooloJ, undiagrrosed [up to 500/0J4,?1-23. there is no standard diagnostic approach for FlJo'
t'e evaluation requires , ro.ur"a FUo-relevant history taking, physiral examination atttl
,,,r.,.,i". nonspecific diagnostic test rather than excessive over testing2l'
(.onclusion
Rcvcaling the culprit of acute undifferentiated febrile illness in a case require a stepwisr'
,ppr"r.i., *irh focused history taking, careful interpretation of local and regional dis.;tsr'
i'"ia".", ".n"sure and ,irri r".,orr, frorough physical examination and basic labor:rt.tv
data. prolonged undiagnosed fever may lead to Flver of unknown origin, often causctl lrv
common pathogen with atypical presentation'
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20 15;3 9(3):139-4B.
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r i.r ppirrg the Aetiology of Non-Malarial Febrile lllness in Southeast Asia through a
', t' ,l''rnirtic Review-Terra tncognita lmpairing Treatment Policies' Bassat Q,,, I rt rrr I'l,oS One. 2012;7 (9):e44269.
' i lrrr r Ir Ii, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S, et al. Acutei,ii,lrllcr tntiated fever in India: a multicentre study of aetiology and diagnostic
" ' 1,,.ri V. IIMC lnfect Dis.20t7;77(l):665.
i ,,,1,i !ill. Seymour CW, Aluisio AR, Augustin ME, Bagenda DS, Beane A, et al.
' ,,{ r.rlr)u of the QuickSequential [sepsis-Related) Organ Failure Assessment
Golden Tulip Hollantl Resort - Batu; 4-6 f uli 2019i 't,1' !l,rll,rrrrl Resort- Batu; 4-6Juli 2019
L19
National Congress XXIV PETRI
fqsoFA) Score with Excess Hospital Mortality in Adults with suspected Infection
in Low--and Middle-lncome Countries. JAMA' 20 18;3 19 (21):2202'
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Medicine [BaltimoreJ. 1961;40[lJ: 1-30'
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Clin ToP Infect Dis. 1991;11:35-51.
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Approach. Arn I Med. 20L5;128.
22. Mir T, Nabi Dhobi G, Nabi Koul A, saleh T. clinical profile of classical Fever of
unknown origin [FUO). Casp I Intern Med' 2014;5(1J:35-9'
'2'-1. Rupali P, Garg D, Viggweswarupu S, Sudarsanam TD, f eyaseelan V' Abraham OC'
EtiologyofClassicFeverofUnknownoriginIFUOJamonglmmunocompetentlndian Adults .Yol.6T,f ournal of The Association of Physicians of India. 2019'
Nttl !t,nrtl ktngrcss XXIV PE'I'RI
SEORANG PENDERITA INFEKSI HIV DENGAN KO-INFEKSI DHF
Musofa Rusli, Dedy Hadi Prawono, Bramantonot;
Divisirropik-tiry;!;;y::#:i"!H"l::no:i;"''"'
A!r\ l llAKI'otar Belakang: Infeksi human immunodeficiency virus (HIV) merupakun
i,, rtl,rrtiit infeksi cukup binyai teriadi di lndonesia. Situasi ini akan menimbulkan potensi
1.,, trtl.ksi itrngon penyakii infeksi lain yang endemik rli Indonesia, misalnya infeksi virus
it. ntlllt'.Kasus: Seorang laki-laki penderita infeksi Hlv datang dengan keluhan demam dan
,,tirtl lt('j,(tt. Keluhan penyerta lain juga didapatkan, yaitu nyeri sendi' ruam kemerahan di
,t,.,ttt,ntilus dtas. Pasien rutin meminum Lopinavir/ Ritonavir selama 2 tahun terakhir'
ti,t..tt ltatneriksaan laboratorium menuniukkan hemokonsentrasi, Ieukopenia, dan
r,,,trrl,rttsi(openia. Hasil serologi lgM dan lgG Dengue menuniukkan infeksi Dengue'
t,i.tnt.t!l(suun serial serologi iemastikan diagnosis infeksi Dengue. Pasien didiagnosis
., ltrlilrtt Dernam Berdarah iengue grade II. Pengobatan secara suportif. Pasien pulang pada
!ut, t rlrilteln ke-g.l)iskusl: Geiala yang muncul pada HIV dengan ko-infeksi DHF tidok khos dun
, t i!,.ttlirli tumpang tindih. Fasien datang ke rumah sakit kebanyakan dengart keluhatr
,!t ,t,tnn (l(:ngo; komplikasi penyerta lainnya. Hasil pemeriksaan laboratorium mungkirt ltistt
!,i,,tt'trrtrl tindih. Ko-infeksi HIV dan Dengue membawa risiko komplikasi bt:rril l)rtrttlrtt'
, irirrrlrltr nemerlukan pengobatan dan observasi yang lebih ketat'
Kesimpulan: Diignosis kedua penyakit tersebut harus segera diteglokkun, u11ttr
i,, rr,tultrrt en dan monitoring penyakit dapat dilakukan dengan tepat'
I'I NIIAIITJLUANInfeksi human immunodeficiency virus [HIV) merupakan penyakit infeksi cukup
l, rrry.rt< rcriadi di Indonesia. Sekiiar 640.000 orang diperkirakan teriangkit infeksi ini'
ri rr r trrrrrl:lh tersebut, hanya sekitar 300.000 orang yang telah terdiagnosis dan hanya
, I,rr,rr t lo/o lang telah reiah tertangani dengan obat anti retroviral [ARV)1' Situasi ini
!t ,, irr(,rimbulkan potensi ko-infe[si dengan penyakit infeksi lain yang endemik di
r i,, L r r r r ";i.r, misalnya infeksi virus Dengue.
InfeksivirusDengueadalahinfeksivirusyangbanyakterjadipadadaerah!!,ir!,,. I,r:nyakit ini ditulaikan dengan perantara nyamuk (Aedes aegypttl. Demam
i,,i,irr.rlr banyak terjadi pada negara tropis. lndonesia termasuk negara dengan
1.r, , .rlr,rrsi tertinggi infeksi Dengue. Endemisitas terjadi hampir sepaniang tahun,
!. ! ilr.[il.r musim penghujan. Epidemi dapat teriadi sewaktu-waktu setidaknya beberapa
i ,i, rl,rl.rr l satu dekade. Pasien dengarr demam dengue datang ke fasilitas kesehatan
I
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