Tes Laboratorium pada penyakit tropis

Tes Lab pada Penyakit Infeksi & Tropis

April 11, 2023 2

Tes Darah Rutin pada Penyakit Infeksi Tropis

Pengamatan pada: Eri, Leko Trombos Manifestasi: anemia, lekositosis atau lekopeni dan DIC*

Lekositosis Umumnya Netrofil , bentuk muda Netrofilia lanjutinfeksi kronik Netrofilia menghebat + sel mudareaksi leukemoid

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

*Disseminated Intravascular Coagulation

April 11, 2023 3


Lekopeni Netropeni, mis Demam

Tifoid, brucellosis Infeksi hebat netropeni

hebat prognosis buruk Perubahan

morfologik pd sepsis Döhle bodies Granula toksik vakuolisasi

Eosinofilia : non-bakterial,

biasanya alergi / infeksi parasit.

April 11, 2023 4


Anemia bisa timbul sekalipun cadangan besi

cukup. Anemia akut:

perdarahan/ destruksi eritrosit (misalnya cold agglutinin sehubungan dengan Mycoplasma pneumoniae),

Anemia kronik, dengan cadangan besi yang normal atau meninggi di

sistem retikuloendotelial penurunan besi dalam plasma serta penurunan TIBC (total iron-binding capacity).

April 11, 2023 5


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.

April 11, 2023 6

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

April 11, 2023 7


Hemagglutination Tests Virus + Eri angsaagglutinasi Tes

Negatif Virus + serum (ada atb spesifik)tidak

aglutinasiTes Positif Virus + Eri + serum (tanpa atb spesifik)

aglutiasi Tes negatif

April 11, 2023 8


Inte

rpre

tasi

Specimen 1

Specimen 2

Interpretation

Pre 4th d< 1:20

Post 1-4 wk4x<1:1280

1mary Dengue

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

>1:2560 4x

2ndary Dengue

Pre 7th d> 1:1280 4x not

needed

Presumptive S 2ndary Dengue

April 11, 2023 9

Lab Examinations in Dengue Fever

Complement Fixation Test Ag+[serum,Ab pos]+

Complcomplement fixed+RBC(sheep)un lysed : Pos test

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

Ag

SAb

K

RBC

Pos Neg

April 11, 2023 10

Dengue Hemorrhagic Fever (General)

Tes Lab:2. ELISA (capture

method)1. Anti-dengue IgM

Infeksi primer, akut 7-10 hr

2. IgG (post/kronik) Infeksi

sekunder, sesudahnya

HasilInterpretasi

IgG IgM

+ + D sekunder

- + D primer

+ - Duga D sekund

- - Non-D Primer

sangat dini

April 11, 2023 11

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. Serologic diagnosis may be made by

hemagglutination inhibiting and complement fixation tests using paired sera

but is complicated by cross-reactions with other flavivirus antibodies.

April 11, 2023 12

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.

April 11, 2023 13

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.

April 11, 2023 14

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) Tzanck preparation

Base of lesions Multinucleate giant cells

April 11, 2023 15

Tzanck cell

April 11, 2023 16

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

April 11, 2023 17

Mumps

Darah Lekopeni Serum amilase dlm 10 hari Serologi

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

Biakan Virus dari ludah 1-5 hari

Komplikasi Inflamasi testis/ ovarium: lekositosis, LED Pankreatitis: lekositosis, amylase, hiperglikemia Meningitis: sel LCS < 500/L, mononuclear; glukose

normal, protein agak (20-125 mg/dL)

April 11, 2023 18

Morbilli (Measles, Rubeolla)

Temuan laboratorium Darah

Lekosit , terutama limfo & segmen lekositosissuperinfeksi bakterial Serologi: EIA

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

Sekret Apusan + pulasan imunofluorosen Pulasan Tzank: Multinucleated Giant Cells

Biakan Bahan: sekret resp & urin Identifikasi: jaringan

April 11, 2023 19

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

April 11, 2023 20

HIV/ AIDS

HIV antibody detected by a two-step technique: ELISA as a sensitive screening test Confirmation of positive ELISA

tests with the more specific Western blot technique

April 11, 2023 21

Molluscum Contagiousa

Giemsa-stained shows inclusion bodies within many

large cells or extracellularly

April 11, 2023 22

Verruca Vulgaris

DNA typing: circular-doubel-stranded, 8000 bp Cross-hybridization

> 50% : type seperation < 50%: subtype seperation

April 11, 2023 23

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 anti hyaluronidase Urinalysis: hematuria with erythrocyte

casts and proteinuria in patients with acute nephritis

April 11, 2023 24

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"

April 11, 2023 25

Polio

CSF: Aseptic meningitis Elevated WBCs Elevated protein Normal glucose

April 11, 2023 26

Salmonellosis/ Typhoid Fever

Kultur Darah: positif dlm 10 hari pertama Tinja & Urin: positif dlm minggu 3-5 Sumsum tulang:

Serologi Tes Widal: serum sembuh 4x dpd sakit

Darah rutin: Lekopeni

April 11, 2023 27

Kolera

Isolasi vibrio cholerae dari bahan tinjaidentifikasi serogroup 01 atau 139

Serologi: tes agglutinasi menggunakan

antiserum spesifik

April 11, 2023 28


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.

April 11, 2023 29


Other nonspecific laboratory results Tests (AP,GOT,GPT & LDH)

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

April 11, 2023 30


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.

April 11, 2023 31


Serologic testsWidal test for "febrile

agglutinins,“high rates of false-positivity

and false-negativitynot clinically useful.

Polymerase chain reaction and DNA probe assays are being developed

April 11, 2023 32

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.

April 11, 2023 33

Helmintiasis

Parasitology study !

April 11, 2023 34

Mycosis

Parasitology study !

Documents

Tes Laboratorium pada penyakit tropis