KASUS COVID-19

DAN PENYULIT
dr. Mohammad Subkhan, Sp.P, FAPSR
RS Siti Khodijah Sepanjang
PASIEN DALAM PENGAWASAN (PDP)

4
ORANG DALAM PEMANTAUAN (ODP)

5
 • Suspek yang diperiksa untuk COVID-19,
Kasus namun inkonklusif
Probable • Tidak dapat disimpulkan

Kasus • Seseorang yang terinfeksi COVID-19 dengan

Konfirmasi hasil lab positif

6
7
RESPON TERHADAP PASIEN DLM PENGAWASAN (PDP) DAN
ORANG DLM PEMANTAUAN (ODP)

*Keputusan ditentukan kasus per kasus:

1. Pasien memiliki riwayat komorbid
2. Pasien berusia lansia
3. Ruang isolasi masih mencukupi

Manajemen PDP ODP

Rujuk ke RS Rujukan V
Isolasi Rumah Sakit V V*
Isolasi Rumah V
Pengambilan Spesimen V
Notifikasi ke PHEOC V V
TRIAGE: DETEKSI DINI PDP COVID-19
Infeksi Saluran Napas Akut Ringan
Pneumonia ringan
Pneumonia berat
Acute Respiratory Distress Syndrome (ARDS)
Sepsis
Syok septik
Deteksi dini pasien covid-19
 MANIFESTASI KLINIS PASIEN YANG DIRAWAT DI
WUHAN (AWAL OUTBREAK)

•138 kasus dirawat, usia rerata 56 thn, dengan rentang usia 22-92 thn dan
54.3% adalah laki-laki.

•Hospital-associated transmission was suspected as the presumed

mechanism of infection for affected health professionals 29% and
hospitalized patients [12.3%].

JAMA. 2020 Feb 7. doi: 10.1001/jama.2020.

• Gejala yang umum ditemukan adalah demam 98.6%, fatigue 69.6%, dan
batuk kering 59.4%

• Gambaran lab darah Lymphopenia 70.3%), PT memanjang 58%, dan

peningkatan laktat dehydrogenase 39.9%.

• CT scan thorax menunjukan gambaran bilateral patchy atau ground glass

opacity

JAMA. 2020 Feb 7. doi: 10.1001/jama.2020.

 26.1% mengalami perburukan atau komplikasi dan dirawat di ICU karena
1. ARDS [61.1%]
2. Arrhythmia [44.4%]
3. Shock [30.6%]

Rerata waktu pasien dari gejala awal sampai menjadi sesak adalah 5 hari,
masuk perawatan 7 hari dan ICU 8 hari
Pasien dengan komorbid (72,2%) dan anorexia (66.7%) mengalami perburukan
 FEATURES OF CONFIRMED CASES IN CHINA

• Asymptomatic cases 2% （n=724）

-laboratory testing positive but without symptoms
• Mild cases 81% （n=34869）
-including non-pneumonia cases and mild pneumonia cases
• Severe cases 14% (n=6210)
- RR ≥ 30 times/min, Oxygen saturation ≤ 93%, PaO2/FiO2≤300, diffuse
patchy infiltration greater than 50% of the lungs in 24 to 48h.
• Critical cases 3% (n=1310)
- Respiratory failure, septic shock, MODS/MOF
• Elderly, obesity or a decreased lymphocyte count face poor prognosis
 CLINICAL MANIFESTATIONS
• The incubation period: the incubation period is 1-14 days, mostly 3-7 days.
• Clinical Features:
• Fever, dry cough, fatigue as the main performance.
• A small number of patients have symptoms such as stuffy nose, runny nose, sore throat,
myalgia and diarrhea.
• In severe cases, dyspnea and/or hypoxemia usually occur one week after the onset of the
disease, and dyspnea and/or hypoxemia may rapidly progress to acute respiratory distress
syndrome, septic shock, metabolic acidosis that is difficult to correct, bleeding and
coagulation dysfunction, and multiple organ failure.
• The patients with severe or critical illness may have moderate or low fever, or even no significant
fever.
• The mild patients showed only low fever, mild fatigue, and no pneumonia.
• Most patients have a good prognosis, a few patients are in critical condition. The elderly and those
with chronic underlying diseases have poor prognosis.
 LABORATORY TEST
• In the early stage of the disease, the total number of white blood cells in the peripheral blood was
normal or decreased, while the lymphocyte count was decreased.
• Elevated troponin is seen in some critically ill patients. In most patients, C-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR) were elevated, and procalcitonin was normal. In severe
cases, D-dimer increased and peripheral lymphocyte cells progressively decreased. Severe and
critical patients often have elevated inflammatory factors.
• The new coronavirus nucleic acid can be detected in nasopharyngeal swabs, sputum and other
lower respiratory secretions, blood, feces.
• In order to improve the positive rate of nucleic acid detection, it is suggested that sputum
should be retained as far as possible, and lower respiratory secretions should be collected
from patients with endotracheal intubation, and samples should be submitted for
examination as soon as possible after collection.
KASUS DI SINGAPORE

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 PROBLEM

• Keluhan kasus covid-19 sangat bervariasi

• Pendalaman anamnesa tempat kerja dan aktivitas sangat penting
• Radiologi
• Laboratorium
• Tersedianya rapid test dan swab PCR
 SERIAL FOTO TORAKS
4-4-2020 8-4-2020
 HASIL LABORATORIUM
Darah lengkap 12-4-2020 Darah lengkap 16-4-2020
Hb 13,8 Hb 13,4
Wbc 7,51 Wbc 8,32
Neutrophyl 69,9 Neutrophyl 67,2
Lymfosit 17,9 Lymfosit 19,4
Trombosit 232 Trombosit 429
Pct : 0,18
CRP: 31,73
• Hasil Rapid test Covid-19 negative
• Hasil Swab PCR positif
TERIMA KASIH