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DIFFERENTIAL DIAGNOSIS

DEMAM LEBIH DARI 7 HARI


Ro Rabian Rein Roza T.
Guidelines
• Harrison’s Principles of Internal
Medicine 16th edition
• Differential Diagnostics of Fever from
Tropics and Subtropics, Department
of Tropical Medicine , Charles
University, Hospital Bulovka
• Antibiotics Guidelines 2015 – 2016
Johns Hopkins Medicine
Overview
• Demam
• Differensial Diagnosis Demam > 7
hari
• Penyakit – penyakit yang
berhubungan dengan demam > 7
hari
Demam
• Demam adalah peningkatan suhu tubuh yang
melebihi suhu normal dan terjadi akibat
perubahan dari set point hipotalamus, contohnya
dari 37 – 39C
• Hipertermia adalah pengaturan yang tidak
berubah dari pusat termoregulasi (hipotalamus)
dan terjadi akibat peningkatan suhu tubuh yang
tidak terkontrol yang melebihi kemampuan tubuh
untuk mengeluarkan panas.
• Dikatakan demam bila suhu : Rektal >38ºC
Oral >37.6
Aksila >37.3
Patofisiologi Demam
Anamnesis Demam
• Riwayat bepergian
• Profilaksis
• Obat – obatan
• Diet
• Kontak seksual
• Alergi
• Masalah kesehatan
• Pekerjaan
• Riwayat keluarga
Pemeriksaan Fisik Demam
• Kulit
–eksantema, hemorhagia, ikterus, edema
• Mata
–ikterus, anemia
• Kelenjar Getah Bening
–lokal, generalisata
• Tanda perangsangan meningeal
–sakit kepala, muntah, tremor
• Tenggorokan
• Dada
• Hepatomegali dan Splenomegali
Laboratorium
• Thick and thin blood film
• Blood culture
• Blood count &
differential count
• C-Reactive Protein
• Chest X – Ray
• Urine culture
• Serology
• PCR
• Lumbal Punction
DIFFERENTIAL DIAGNOSIS
DARI DEMAM > 7 HARI
PMN Meningkat
PMN Tidak
Gejala Fokal Infeksi Sistemik Meningkat
Bronkopneumonia Sepsis Infeksi virus :
TB Paru Endokarditis Campak dan
Pielonefritis Leptospirosis eksantema akut lain
Cholangitis, Hepatitis viral
Cholesistitis Demam dengue atau
Pancreatitis DBD
Meningitis purulen HIV
Tonsilitis EOSINOFILIA : Infeksi bakteri :
Difteri Filariasis Rickettsiosis
Disentri basiler Schistosomiasis Demam tifoid
Abses piogenik Trichinellosis Infeksi Protozoa :
Appendisitis Cysticercosis Malaria
Pioderma Tripanosomiasis
Limfadenitis Leishmaniasis
Otitis Toxoplasmosis
FEVER WITH LOCALIZING SIGNS ON
EXAMINATION AND WITH NEUTROPHIL
Signs and symptoms
LEUKOCYTOSIS
Disease Investigations
Dyspnoe, cough,
Chest X-Ray, Sputum
pleuritic pain, Bacterial pneumonia
culture
discoloured sputum
Streptococcal tonsilitis,
Severe sore throat Culture
diphteria
Frequency, dysuria, loin
Pyelonephritis, UTI Urine culture
pain
Headache, neck stiffness Bacterial meningitis Lumbal Punction, culture
Ear secretion, headache Otitis Ear culture
Bloody diarrhea Bacillary dysentery Stool culture
Pain and swelling at joint Septic arthritis Joint aspiration
Bone pain (worse at
Osteomyelitis X – Ray, CT Scan
night)
Lymphadenopathy Abscess Culture, serology
Cutaneous inflammation Erysipelas, cellullitis Culture
Chronic cough for > 4
Mantoux, Acid – Fast
weeks or blood in TB
stain
sputum
Description Disease Etiology
Discrete lesions that
become confluent as rash
spreads from hairline Measles/Rubeola Paramyxovirus
downward, Koplik’s spots,
lasts > 3 days
Nonspesific diffuse
macules and papules,
Primary HIV Infections HIV
oral or genital ulcers,
pharyngitis, adenopathy
Maculopapular eruption,
icterohemorrhagic fever,
exposure to water Leptospirosis Leptospira interrogans
contaminated with
animal urine
Coated tongue,
abdominal pain, diarrhea, Thyphoid fever Salmonella typhii
headache, myalgia
Rash, headache,
leukopenia, biphasic Dengue fever Dengue virus
fever, petechiae
Butterfly rash, malar
SLE Autoimmune disease
rash, systemic disease
primary chancre in 10%
of cases; copper-colored,
Description Disease Etiology
Tender pink nodules on
finger or toe pads, Streptococcus,
Bacterial Endocarditis
abnormal heart valve, Staphylococcus
murmur
Macules (2–3 mm)
evolving into papules,
then vesicles (sometimes
umbilicated), on an Varicella VZV
erythematous base
pustules then forming
and crusting
Pruritic papule enlarging
and
evolving into a 1- by 3-
cm
painless ulcer surrounded
by Anthrax Bacillus anthracis
vesicles and then
developing a
central eschar with
edema, exposure to
infected animals
CONCLUSION
• The processes of heat conservation (vasoconstriction) and
heat production (shivering and increased metabolic
activity) continue until the temperature of the blood
bathing the hypothalamic neurons matches the new
thermostat setting. Once that point is reached, the
hypothalamus maintains the temperature at the febrile
level by the same mechanisms of heat balance that are
operative in the afebrile state. When the hypothalamic set
point is again reset downward (due to either a reduction in
the concentration of pyrogens or the use of antipyretics),
the processes of heat loss through vasodilation and
sweating are initiated. Loss of heat by sweating and
vasodilation continues until the blood temperature at the
hypothalamic level matches the lower setting.