hartantri - unud

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

Golden Tulip Holland Resort - Batu; 4-6 Juli 2019t,,irIr Iloll.rttd Resort- Batu; 4-6 fuli 2019

a t


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


.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.

Golden Tulip Holland Resort - Batu; 4-6 fuli 2019

11,4

Golden Tulip Holland Resorl - Batu; 4-6 fuli 2019

115

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

Golden Tulip Holland Resort - Batu; 4-6 Juli 2019I l, 'll.rrrtl Resort - Batu; 4-6 Juli 2019


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'

References

t.WalterE],Hanna.lummaS,CarrarettoM,ForniL..thepathophysiologicalbasi:'and consequences of fever' Crit Care' 20 t6:20(1):200'

2.shresthaP,RobertsT,HomsanaA,MyatTO,CrumpfA,LubellY'etal'Febriltrillness in eri", g"pi in epidemiology,iiagnosis and management for informittli

health policy. C]in vticrobiol Infect' 2 0 18 ; 24[B) : B 15 -26'

3.WorldHealthorganization(WHo).WHoinformalconsultationonfevermanagementinperipheralhealthcaresettings:Aglobalreviewofevidencc;rrtrlPractice. 20 1 3'

4.VanderschuerenS,KnockaertD'AdriaenssensT'DemeyW'DurnezA'Blot:l<rrr'rtt''D,etal'FromProlongedFebrilelllnesstoFeverofUnknownorigin'Archltttr.lttMed. 2003;163[9):1033'

5.TanseyEA,|ohnsonCD.Recentadvancesinthermoregulation.AdvPhysirllllrltr.

Notional Congress XXIV PETRI

20 15;3 9(3):139-4B.

t, Del Bene VE. Fever. In: Walker H, Hal W, Hurst f, editors. Clinical Methods: The

History, Physical, and Laboratory Examinations. 3rd ed. Bufterworths; 1990.

/ CDC/NHSN Surveillance Definition of Healthcare-Associateh Infection and

Criteria for Specific Types of Infections in the Acute Care Setting' 2013.

ir Rabinstein AA, Sandhu K. Non-infectious fever in the neurological intensive care

unit: incidence, causes and predictors. J Neurol Neurosurg Psychiatry.

2007 ;7 8(11):1278-80.

'i de Naurois j, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F. Management

of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol.

2 0 10;2 1[Supplement 5):v252-6.

lil 'l-aplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al' OutpatientManagement of Fever and Neutropenia in Adults Treated for Malignancy:

Anrerican Society of Clinical Oncology and Infectious Diseases Society of America(llinical Practice Guideline Update. J Clin Oncol. 2018;36[14):1443-53'

! I l;oundation, for lnnovative New Diagnostics (FIND)' Acute Febrile Syndrome

Sl rategy. 201-2.

! Aror-a BS, Matlani M, Saigal K, Biswal I, Rajan S, Padmanandan A, et al. Maior,rr.liologies ofacute undifferentiated fever in 2013 and 2014: an expericttcc irt

r ('rr'ospect. lnt J Adv Med.20\7;4(2):568.

! : (.r rrrrrp fA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, Galloway Itl',(.r .rl. litiology of Severe Non-malaria Febrile lllness in Northern Tanz;rni:t: A

I'r osllcctive Cohort Study. Picardeau M, editor. PLoS Negl Trop Dis.

.'rrt t;7(7):e2324.

! i t'rlr 'l'irm P-Y, Obaro SK, Storch G. Challenges in the Etiology and Diagnosis of,\, rrtt' I;ebrile Illness in Children in Low- and Middle-lncome Countries. J

I'r'r lr.rl ric Infect Dis Soc. 2016;5[2):190-205.

i r\r ,",tor N, Cooksey R, Newton PN, M6nard D, Guerin PJ, Nakagawa J, et al.

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


fqsoFA) Score with Excess Hospital Mortality in Adults with suspected Infection

in Low--and Middle-lncome Countries. JAMA' 20 18;3 19 (21):2202'

18. Petersdorf RG, Beeson PB. Fever of unexplained origin: Report on 100 cases'

Medicine [BaltimoreJ. 1961;40[lJ: 1-30'

lg. Durack DT, Street AC. Fever of unknown origin - reexamined and redefined' curr

Clin ToP Infect Dis. 1991;11:35-51.

20. unger M, Karanikas G, Kerschbaumer A, winkler S, Aletaha D' Fever of unknown

origin 1fUOl revised. Wien Klin Wochenschr' 2016;128(27):796'

21. cunha BA, Lortholary o, cunha cB. Fever of Unknown origin: A clinical

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

121,I20

Golden Tulip Holland Resort - Batu; 4-6 fuli 2019 ,l,l, rr 'l rrlip Holland Resort - Batu; 4-6 Juli 2019

n

hartantri - unud

Documents