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Tes Lab pada Penyakit Infeksi & Tropis

Tes Darah Rutin pada Penyakit Infeksi Tropis


Pengamatan

Lekositosis

Eri, Leko Trombos Manifestasi: anemia, lekositosis atau lekopeni dan DIC* Umumnya Netrofil , bentuk muda Netrofilia lanjutinfeksi kronik Netrofilia menghebat + sel mudareaksi leukemoid
Non-ganas

pada:

>25-30 x 10+3/l Inflamasi, stress, trauma

*Disseminated Intravascular Coagulation


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Tes Darah Rutin pada Penyakit Infeksi Tropis

Lekopeni

Perubahan morfologik pd sepsis


Netropeni, mis Demam Tifoid, brucellosis Infeksi hebat netropeni hebat prognosis buruk

Eosinofilia :

Dhle bodies Granula toksik vakuolisasi

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non-bakterial, biasanya alergi / infeksi parasit.

Tes Darah Rutin pada Penyakit Infeksi Tropis

Anemia

bisa timbul sekalipun cadangan besi cukup. Anemia akut:

Anemia kronik, dengan


perdarahan/ destruksi eritrosit (misalnya cold agglutinin sehubungan dengan Mycoplasma pneumoniae),
cadangan besi yang normal atau meninggi di sistem retikuloendotelial penurunan besi dalam plasma serta penurunan TIBC (total iron-binding capacity).

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Tes Darah Rutin pada Penyakit Infeksi Tropis

Infeksi serius + bakteriemia


Gram negatif DIC. (Gram pos jarang) Trombos PT memanjang FDP Fibrinogen Trombosiopenia

bisa juga menjadi tanda sepsis bakterial dan bisa bermanfaat dalam mengobservasi respon pasien terhadap terapi.

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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 phase if mosquito inoculation or mosquito cell culture

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Lab Examinations in Dengue Fever (DF)

Hemagglutination Tests Virus + Eri angsaagglutinasi Tes Negatif Virus + serum (ada atb spesifik)tidak aglutinasiTes Positif Virus + Eri + serum (tanpa atb spesifik) aglutiasi Tes negatif

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Lab Examinations in Dengue Fever (DF)


Specimen 1 Pre 4th d < 1:20

Specimen 2 Post 1-4 wk 4x <1:1280


Interpretation

1mary Dengue
2ndary Dengue

Interpretasi
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Pre 5th d <1:20 <1:20

>1:2560 4x

Pre 7th d > 1:1280

4x not needed

Presumptive S 2ndary Dengue


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Lab Examinations in Dengue Fever

Complement Fixation Test

Ag

Ag+[serum,Ab pos]+ Complcomplement fixed+RBC(sheep)un lysed : Pos test Ag+[serum,Ab neg]+ Complcomplement un fixed RBC(shee) lysed : Neg test
Pos

S Ab K

RBC

Neg

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Dengue Hemorrhagic Fever (General)


Tes Lab: 2. ELISA (capture method)
1.

Hasil IgG IgM

Interpretasi D sekunder D primer Duga D sekund Non-D Primer 10 sangat dini

2.

Anti-dengue IgM Infeksi primer, akut 7-10 hr IgG (post/kronik) Infeksi sekunder, sesudahnya

+
-

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DHF pada Anak

In dengue

present by the 2nd day of fever by the 4th or 5th day, the WBC count 2000 to 4000/mL, 20 to 40% granulocytes. Moderate albuminuria and a few casts may be found. Dengue may be confused with Colorado tick fever,
typhus, yellow fever, or other hemorrhagic fevers. hemagglutination inhibiting and complement fixation tests using paired sera but is complicated by cross-reactions with other flavivirus antibodies.
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Serologic diagnosis may be made by

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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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May 29, 2013

DHF pada Anak

WHO clinical criteria for diagnosis of dengue hemorrhagic fever:


acute onset of high, continuous fever lasts for 2 to 7 days hemorrhagic manifestations, including at least a positive tourniquet test and petechiae, purpura, ecchymoses, bleeding gums, hematemesis, or melena 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 pulse pressure (< 20 mm Hg) or hypotension with cold, clammy skin and restlessness.
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Herpes Simplex

Laboratory tests are generally not necessary (viral cultures and Tzanck smear will confirm diagnosis in patients with atypical presentation) Antibody to appropriate serotype

Seroconversion Increase Direct immunofluoroscent antibody slide tests (rapid diagnosis) Base of lesions Multinucleate giant cells

Tzanck preparation

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Tzanck cell

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Herper Zoster

Laboratory tests are generally not necessary (viral cultures and Tzanck smear will confirm diagnosis in patients with atypical presentation). The Tzanck preparation shows multinucleate giant cells for both varicella-zoster virus and HSV

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Mumps

Darah

Lekopeni Serum amilase dlm 10 hari Serologi


Biakan

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

Komplikasi

Virus dari ludah 1-5 hari 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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May 29, 2013

Morbilli (Measles, Rubeolla)

Temuan laboratorium

Darah Lekosit , terutama limfo & segmen lekositosissuperinfeksi bakterial Serologi: EIA

Sekret Apusan + pulasan imunofluorosen Pulasan Tzank: Multinucleated Giant Cells Biakan Bahan: sekret resp & urin Identifikasi: jaringan

IgM: fase akut ( 1-2 hari) IgG : >10 hari

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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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HIV/ AIDS

HIV antibody detected by a twostep technique:


ELISA as a sensitive screening test Confirmation of positive ELISA tests with the more specific Western blot technique

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Molluscum Contagiousa

Giemsa-stained

shows inclusion bodies within many large cells or extracellularly

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Verruca Vulgaris

DNA typing: circular-doubelstranded, 8000 bp

Cross-hybridization
> 50% : type seperation < 50%: subtype seperation

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Impetigo/ Pyoderma

Generally not necessary Gram stain and C&S to confirm the diagnosis when the clinical presentation is unclear Sedimentation rate parallel to activity of the disease Anti-DNAse B and antihyaluronidase Urinalysis: hematuria with erythrocyte casts and proteinuria in patients with acute nephritis
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Difteri

Diagnosis definitif tergantung pada isolasi C.diphtheriae yang diambil dari bahan di lesi-lesi lokal. Pihak laboratorium harus diberitahukan bahwa bahan disangka difteri agar pihak laboratorium Gram stains of secretions

club-shaped organisms, appear as "Chinese letters"


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Polio

CSF:

Aseptic meningitis Elevated WBCs Elevated protein Normal glucose

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Salmonellosis/ Typhoid Fever

Kultur

Darah: positif dlm 10 hari pertama Tinja & Urin: positif dlm minggu 3-5 Sumsum tulang:
Tes Widal: serum sembuh 4x dpd sakit

Serologi

Darah rutin: Lekopeni


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Kolera

Isolasi vibrio cholerae dari bahan tinjaidentifikasi serogroup 01 atau 139 Serologi:

tes agglutinasi menggunakan antiserum spesifik

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Salmonellosis/ Typhoid Fever

Other than a positive culture, no specific laboratory test is diagnostic for enteric fever. In 15 to 25% of cases, leukopenia and neutropenia are detectable. In the majority of cases, the white blood cell count is normal despite high fever. However, leukocytosis can develop in typhoid fever (especially in children) during the first 10 days of the illness, or later if the disease course is complicated by intestinal perforation or secondary infection.

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Salmonellosis/ Typhoid Fever


Other nonspecific laboratory results

The diagnostic "gold standard" is a culture positive for S. typhi or S. paratyphi.

Tests (AP,GOT,GPT & LDH)

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 patients and/or to recent antibiotic treatment. Centrifugation to isolate and culture the buffy coat, which contains abundant blood mononuclear cells associated with the bacteria, decreases time to isolation but does not affect culture sensitivity.

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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 despite a negative bone marrow culture. If blood, bone marrow, and intestinal secretions are all cultured, the yield of a positive culture is >90%. Stool cultures, while negative in 60 to 70% of cases during 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 percentage become chronic carriers and continue to have positive stool cultures for at least 1 year.
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Salmonellosis/ Typhoid Fever


Serologic

tests Widal test for "febrile agglutinins,


high

rates of false-positivity and false-negativitynot clinically useful. Polymerase chain reaction and DNA probe assays are being developed
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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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Helmintiasis

Parasitology study !

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Mycosis

Parasitology study !

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