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DIFFERENTIAL DIAGNOSIS

DEMAM LEBIH DARI 7 HARI


Ro Rabian Rein Roza T.

Guidelines
Harrisons 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
>38C
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

Gejala Fokal
Bronkopneumonia
TB Paru
Pielonefritis
Cholangitis,
Cholesistitis
Pancreatitis
Meningitis purulen
Tonsilitis
Difteri
Disentri basiler
Abses piogenik
Appendisitis
Pioderma
Limfadenitis
Otitis

Infeksi Sistemik
Sepsis
Endokarditis
Leptospirosis

EOSINOFILIA :
Filariasis
Schistosomiasis
Trichinellosis
Cysticercosis

PMN Tidak
Meningkat
Infeksi virus :
Campak dan
eksantema akut lain
Hepatitis viral
Demam dengue atau
DBD
HIV
Infeksi bakteri :
Rickettsiosis
Demam tifoid
Infeksi Protozoa :
Malaria
Tripanosomiasis
Leishmaniasis
Toxoplasmosis

FEVER WITH LOCALIZING SIGNS ON


EXAMINATION AND WITH NEUTROPHIL
LEUKOCYTOSIS
Signs and symptoms
Disease
Investigations
Dyspnoe, cough,
pleuritic pain,
discoloured sputum

Bacterial pneumonia

Chest X-Ray, Sputum


culture

Severe sore throat

Streptococcal tonsilitis,
diphteria

Culture

Frequency, dysuria, loin


pain

Pyelonephritis, UTI

Urine culture

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


night)

Osteomyelitis

X Ray, CT Scan

Lymphadenopathy

Abscess

Culture, serology

Cutaneous inflammation

Erysipelas, cellullitis

Culture

Chronic cough for > 4


weeks or blood in
sputum

TB

Mantoux, Acid Fast


stain

Description

Disease

Etiology

Discrete lesions that


become confluent as rash
spreads from hairline
Measles/Rubeola
downward, Kopliks spots,
lasts > 3 days

Paramyxovirus

Nonspesific diffuse
macules and papules,
oral or genital ulcers,
pharyngitis, adenopathy

Primary HIV Infections

HIV

Maculopapular eruption,
icterohemorrhagic fever,
exposure to water
contaminated with
animal urine

Leptospirosis

Leptospira interrogans

Coated tongue,
abdominal pain, diarrhea,
headache, myalgia

Thyphoid fever

Salmonella typhii

Rash, headache,
leukopenia, biphasic
fever, petechiae

Dengue fever

Dengue virus

Butterfly rash, malar


rash, systemic disease

SLE

Autoimmune disease

primary chancre in 10%


of cases; copper-colored,

Description

Disease

Etiology

Tender pink nodules on


finger or toe pads,
abnormal heart valve,
murmur

Bacterial Endocarditis

Streptococcus,
Staphylococcus

Macules (23 mm)


evolving into papules,
then vesicles (sometimes
umbilicated), on an
erythematous base
pustules then forming
and crusting

Varicella

VZV

Pruritic papule enlarging


and
evolving into a 1- by 3cm
painless ulcer surrounded
by
Anthrax
vesicles and then
developing a
central eschar with
edema, exposure to
infected animals

Bacillus anthracis

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.