Virus, Bakteri, Parasit

8/8/2019 Virus, Bakteri, Parasit

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VIRUS, BAKTERI, PARASIT

Dr Retno Indrastiti, SpKK



VIRUS VARICELLA

HERPES ZOSTER

HERPES SIMPLEKS

MOLUSKUM KONTAGIOSUM

VERUKA



Golongan virus RNA

1.Rhabdo virus : rabies

2.Toga virus : rubella, yellow fever3.Paramyxo virus : morbilli

4.Human Immunodeficiency Virus(HIV) AIDS



Golongan virus DNA1.Papova virus :

veruka, kondiloma akuminata

2.Pox virus : moluskum kontagiosum,

variola

3.Herpes virus

varisela, herpes zoster,

herpes simpleks



VARICELLA (CACAR AIR, CHICKEN POX)

VARICELLA ZOSTER VIRUS GEJALA-TANDA

± GEJALA KONSTITUSI/PANAS ± TERUTAMA PADA ANAK ANAK ± VESIKEL TERSEBAR MULAI BADAN KMD

SENTRIFUGAL , BISA KE SALPENCERNAAN, TELAPAK

±

ERITEMA ± EROSI ± KRUSTA ± POLIMORF



PENYEBARAN : AEROGEN

PADA ANAK2 TANPA KOMPLIKASI

MAKIN DEWASA MAKIN PARAH,BISA TERJADI KOMPLIKASIENCEPHALITIS, PNEMONI

PEM. PENUNJANG : TZANCK TEST

DD/: VARIOLA

PENCEGAHAN : VAKSINASI



TERAPI: ± ORAL

ASIKLOVIR 5 X 800 mg SELAMA 5 -7 HARI

ANTI PIRETIK

± TOPIKAL BEDAK

ANTIBIOTIK TOPIKAL PROGNOSIS«.VITAM,SANAM,KOSMETIKAM



HERPES ZOSTER (DOMPO)

PENYEBAB: REAKTIVASI VARICELLA

VIRUS DALAM KEADAAN DORMAN DI

GANGLION RADIX DORSALIS GEJALA-TANDA :

± GEJALA KONSTITUSI

± NYERI RADIKULER

± VESIKEL/BULA BERGEROMBOL

± UNILATERAL, DERMATOM BERURUTAN!!!!!!!!!!



LOKASI : tu..THORAKALIS, OFTALMIKA

KOMPLIKASI :

± NEURAGIA POST HERPETIK (NPH)

DD/ DERMATITIS VENENATA

TERAPI ± ASIKLOVIR 5 X 800 mg atau

± VALASIKLOVIR 3 X 1000 mg

± FAMSIKLOVIR 3 X 250 mg

± ANALGETIK

± >40th + PREDNISON 3 X 20 mg



Saraf mana

yg

kena???



VERUKA (KUTIL, CAPLAK)

HUMAN PAPILOMA VIRUS (HPV)

TRANSMISI MELALUI KONTAK LANGSUNG

GEJALA-TANDA ± PAPUL

± PLAK

± FENOMENA KOEBNER

TERAPI ± BEDAH (skalpel, elektric, kimia, beku)

± imunomodulator



MOLUSKUM KONTAGIOSUM

Etiologi : Pox virus >>anak-anak wajah, tubuh, ekstremitas

Orang muda aktif seksual

perigenital &perianal Penyebaran : autoinokulasi resolusi

spontan

Gambaran klinis : papul padat bentukkubah dg cekungan ditengah (delle)



DIAGNOSIS BANDING

±Veruka

±Varisela ±folikulitis ±Akne ±Milia

TER APIEXPRESI

BEDAH BEKU



HERPES SIMPLEKS/LABIALIS

VIRUS HERPES SIMPLEX ± VHS I (LABIALIS)

±VHS II (GENITALIS)

PATOGENESIS ± PRIMER

± SEKUNDER



PENCETUS ± LELAH

±STRESS

± DEMAM

± TRAUMA FISIK

±

MENTRUASI ± MAKANAN MERANGSANG

± DINGIN/ANGIN



KLINIS

PRIMER ± PRODROMAL (MALAISE, PANAS DINGIN), 2-3

HARI

± UKK-ERITEM, VESIKEL, MUDAH PECAH, EROSI,PADA SEKITAR BIBIR

SEKUNDER/REKUREN ± PADA LOKASI YG SAMA ± GEJALA LEBIH RINGAN

± LEBIH PENDEK WAKTU AKTIF



DIAGNOSIS BANDING

Stomatitis aftosa

Pemfigus vulgaris

Impetigo

Dermatitis kontak



TERAPI

ASIKLOVIR 5 X 200 mg

VALASIKLOVIR 2 X 500 mg

FAMSIKLOVIR 3 X 250 mg

Selama 5-7 hari



BAKTERI

PYODERMA

IMPETIGOKUSTA



IMPETIGO (SULUDEN)

IMPETIGO BULOSA-STREP B HEMOLITIKUS

± LOKASI : TERUTAMA MUKA

± LESI: KRUSTA KUNING SPT MADU

IMPETIGO KRUSTOSA-STAPH AUREUS

± LOKASI : DADA, PUNGGUNG

± LESI : KOLORET DASAR MERAH



BISA BERDIRI SENDIRI, BISA

MENUMPANG PADA PENYAKIT YANG

ADA SEBELUMNYA«. Impetiginasi/infeksi

sekunder

BISA BERLANJUT MENJADI SSSS(STAPFYLOCOCCAL SCALDED SKIN

SYNDROME)

AWALNYA VESIKEL/ BULA, TETAPI ATAPSANGAT TIPIS MUDAH PECAH EROSI



PYODERMA FOLIKULITISFOLIKULITIS

± ± terbatasterbatas padapada folikelfolikel rambutrambut

FURUNKELFURUNKEL ± ±

FolikelFolikel rambutrambut dandan jaringan jaringan sekitarsekitar KARBUNKELKARBUNKEL

± ± BeberapaBeberapa furunkelfurunkel bergerombolbergerombol

EKTIMAEKTIMA ± ± UlkusUlkus ygyg tertutuptertutup krustakrusta lengketlengket,, tepitepiulkusulkus meninggimeninggi,,



ERISIPELASERISIPELAS ± ± EritemaEritema,, batasbatas tegastegas,,

SELULITISSELULITIS ± ± EritemaEritema,, lebihlebih dalamdalam,, batasbatas taktak tegastegas

ERITRASMAERITRASMA ± ±

o/o/ CorynebacteriumCorynebacterium,, eritemaeritema padpad lipatanlipatan,, PARONIKIAPARONIKIA

± ± EritemaEritema, edema,, edema, bgbg proximal kukuproximal kuku



TERAPI ± TOPIKAL ANTIBIOTIK

± ±GENTAMISINGENTAMISIN

± ±

ASAM FUSIDATASAM FUSIDAT ± ±ASAM MUPIROSINASAM MUPIROSIN

± SISTEMIK ANTIBIOTIKA BROAD SPECTRUM(BILA PERLU)

±

TINDAKAN KOMPRES

INSISI

DEBRIDEMENT



MORBUS HANSENMORBUS HANSEN (KUSTA, LEPRA)

PENYEBAB : MYCOBACTERIUMLEPRAE

BERBAGAI MACAM PEMBAGIAN DIAGNOSIS KLINIS MENURUT WHO ± PAUCIBACILER

± MULTIBACILER



Chronic infection disease

Mainly affects the ± skin,

± peripheral nerves,

± mucosa upper respiratory tract,

± reticulo endothelial system,

± eye,

± bone ,

± testis, ± except central nervous system.



M. lepraep TIDAK BISA DI KULTUR

PEMERIKSAAN BAKTERI : (LESI KULIT, CUPINGTELINGA, MUKOSA HIDUNG)

1.1. DIAGNOSISDIAGNOSIS

2.2. SPECTRUMSPECTRUM

3.3. EVALUASIEVALUASI

4.4. PROGNOSISPROGNOSIS



DIAGNOSIS :

If shown one or more of the following cardinal

signs :

1. Hipopigmented or reddish skin lession withdefinite loss of sensation

2. Involvement of the peripheral nerves, asdemonstrated by definite enlargement /thickening peripheral nerves with loss of sensation

3. Skin smear positive for Acid Fast Bacilli

No? ----- Observation for 3 6 months



CLASSIFICATION

SPECTRUM

Ridley &

Jopling

T T B T B B B L L L

MADRID Indeter-minate

Tuber-

culoid

Border-

line

Lepromatous

WHO

( 1988 )

Paucy Bacillar

Leprosy

Multi Bacillar

Leprosy



CLINICAL LEPROSY

Indeter-minate

T T B T B B B L L L

Infectious

(-)

Infectious

(-)

Infectious

(-)

Infectious

Infectious

Infectious

Children 2 3

lesionSatelit

lesion

PunchOut

Hipopig-mented /

pink :Face, back, buttock

Macules

hipopig-

mented

Macules

:

hipopig-mented / reddish

Dimor-phous

features

and tend

symmetry

Symetrical papul,

nodules

Symetri-cal

papul, nodules



CLINICAL LEPROSY

Indeter-minate

T T B T B B B L L L

Loss of sensation(-)

(+) (+) (+) Sensoryloss,decreases

sweating andhair growth

Stockingand glovesanesthesia

Nerveswollen (-)

(+) (+) (+) Nervedamaged

Nervedamaged

Lepromin(-)

(+) 4 (+) 3 (+) 1 -2 (-) (-)

Acid Fast Bacilli (-)

(-) (+) /

(-)

(+) 3 (+) 3 - 4 (+) 5 - 6



W H O ( 1997 ) :

Paucibacillary Single Lesion Leprosy

(one lesion) Paucibacillary Leprosy (2-5 skin lesion)

Multibacillary Leprosy (More than 5 skin

lesion)



I. P B SINGLE LESION

CHILD ADULT

Rifampicin 300 mg Rifampicin 600 mg

Ofloxacin 200 mg Ofloxacin 400 mg

Minocycline 50 mg Minocycline 100 mg

Dosage : Single Dose R O M



II. P B 2 5 SKIN LESION

CHILD ADULTMonthly Treatment :

Day 1 :

Rifampicin 450 mg

Dapsone 50 mg

Daily :

Day 2 28

Dapsone 50 mg /daily

Monthly Treatment :

Day 1 :

Rifampicin 600 mg

Dapsone 100 mg

Daily :

Day 2 28

Dapsone 100 mg /dailyDuration of treatment : 6 - 9 Months



III. M B :

CHILD ADULT

Monthly treatment

Day 1 :

Rifampicin 450 mgClofazimine 150 mg

Dapsone 50 mg

Daily 2 28 :Clofazimine 50 mg / daily

Dapsone 50 mg / daily

Monthly treatment

Day 1 :

Rifampicin 600 mgClofazimine 300 mg

Dapsone 100 mg

Daily 2 28 :Clofazimine 50 mg / daily

Dapsone 100 mg / daily

Duration of treatment : 12 18 months



Manifestation of :

1. Reversal reactionMild Severe

Skin - Lesion become reddish

& swollen

- Same & rarely new skin lesion

- Fever, malaise

Nerve - Enlarge, painfull (-)- Nerve damage (-)

- < 6 weeks

- Enlarge, painfull (+)- Nerve damage, loss sensation

- > 6 weeks

Skin &

Nerve

- Lesion become reddish

- Painful on peripheralnerves

- < 6 weeks

- Same

- Ulceration- Swollen on hand & foot

- Nerve enlarge

-- > 6 weeks



2. E N L reaction

MILD SEVERE

Skin Skin nodules :

- Tender reddish

- Ulceration

Skin nodules >>

- Painful

- Ulceration

- Fever & malaise

Nerve EnlargePainful (-)

Nerve damage (-)

EnlargePainful & swollen

Nerve damage

Eye Not involvement Painful

Visual impairment

Testis Swollen, Painful (-) Painful, Enlarge

Skin, nerve, eye, testis

Same - Same

- Very painful

- Fever



TREATMENT of REACTION :

Prednisone : 30 80 mg / daily and then tappering

off

Continued M D T without interruption

MILD REACTION :

- Immobilization

- Rest

SEVERE REACTION :Reffered to the nearest hospital



PARASITPARASITSCABIES

PEDICULOSIS

LARVA MIGRAN



SCABIESSCABIES (GUDIG)

PENYEBAB : SARCOPTES SCABEI

GEJALA-TANDA:

± GATAL TERUTAMA MALAM HARI

± DAERAH KULIT TIPIS

± PAPUL2 ERITEMA

± BANYAK PADA KONDISI ORANG BERKUMPULDNG JANGKA WAKTU LAMA

TERAPI :

± TOPIKAL :PERMETRIN,



LARVA MIGRAN PENYEBAB :

± NECATOR AMERICANUS

± ANCYLOSTOMA DUODENALIS

GEJALA-TANDA :

± GATAL

± MEMBENTUK LINIER/GARIS ERITEMA YG

BERTAMBAH PANJANG 5mm/HARI



TERAPI ± CHLOR ETHYL SPRAY

± THIABENDAZOLE

± ALBENDAZOLE 400mg PO atau

5% TOPIKAL



PEDICULOSIS (KUTU)

PEDICULOSIS ± PUBIS

± CORPORIS

± CAPITIS

KLINIS ± GATAL

± MAKULA MERAH KEBIRUAN (MAKULACERAULAE)

± DIKETEMUKAN PEDICULOSIS/LARVA/TELUR

DD : SCABIES



TERAPI ±PERMETRIN

±GAMMA BENZENE HEXACHLORIDE

±MALATHION

±CROTAMITON ±PYRETHRINE

Virus, Bakteri, Parasit

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