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Shivering Fever

STEP 1

1. Shivering : keadaan dimana kompensasi dari peningkatan set point yang menyebab

vasokontriksi pembuluh darah.2. Preventive medication : pengobatan pencegahan3. Fever!ree periode : keadaan dimana bebas demam". Sclera #aundice : keadaan dimana terdapat $arna kekuningan pada sclera dikarenak

peningkatan bilirubin indirect.

STEP 2

1. %hy the patient !eels high !ever by shivering and !ollo$ed by s$eating& 'nd !ollo$e

!ever !ree periode !or about 12 hours &2. %hat is the relation bet$een the patient arrived !rom Papua &3. %hy the physical e(amination sho$s a pale palpebral con#unctiva) sclera #aundice) a

splenomegaly &". %hy the peripheral blood sho$ed an abnormal erythrocyte &*. %hat is the preventive medication given by the doctor be!ore the patient back to the

papua &+. %hat kind o! mos,uito that can be transmitted the disease &-. ho$ is the li!e cycle o! plasmodium &. $hat are classi/cation o! plasmodium &0. $hy he got better a!ter medication but no$ relaps &1.$hat are etiology o! the scenario&11.%hat are dierential diagnose o! the scenario &12.%hat are the medical treatment !or the patient &13.%hat are complication and prognosis &

1".%hat are clinical mani!estation &

STEP 3

1. %hy the patient !eels high !ever by shivering and !ollo$ed by s$eating& 'nd !ollo$e

!ever !ree periode !or about 12 hours &ametosit makrogametosit mikrogametosit  ookinet  oocyt  sporo4oid  

transmisi nyamuk  hepatosit 5hipno4it 5relaps6) sporo4oit 6  ski4on  ski4on matu

mero4oit S78  tropo4it muda  tropo4oit muda  ski4on  mero4oid.

Mengapa menggigil ?2. %hat is the relation bet$een the patient arrived !rom Papua &

 9adi menurut epidemiologi) malaria di seluruh ndonesia. Tapi endemisitasnya) lebih

papua. Plasmodium untuk #a$a ada p. !alciparum dan p. viva() sedangkan di ind tim

dengan #enis p. malaria) untuk papua dan ntt p. ovale.

;arena $ilayah papua banyak hutan 5iklim dingin) tropics) and subtropics6

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3. %hy the physical e(amination sho$s a pale palpebral con#unctiva) sclera #aundice) a

splenomegaly &Plasmodium : ski4on  mero4oiyt  S78 meningkat 5anemis6Eritosit di pecah :

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11.%hat are dierential diagnose o! the scenario &

8alariaBepatitis

 Ti!oid

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n!( plasmodium darah  !agositosis ole makro!ag  C 1) C 3 C +) TGF alpha.  

hipotalamus sintesis PE 2  peningkatan set point  suhu peri!er turun  menggi

metabolism meningkat demam  kompensasinya berkeringat

8alaria termasuk demam yang intermitten.

Sumber : P72. %hat is the relation bet$een the patient arrived !rom Papua &

Tanggal 25 April adalah Hari Malaria Internasional. Radio Australia melihat

keadaan di wilayah Papua, yang hingga kini masih tercatat seagai wilayah

endemik malaria teresar di Indonesia. Tahun 2!"2 lalu tercatat ada leih da

#$" riu warga yang menderita malaria dengan rasio ke%adian &' kasus per

"!!! kelahiran. (umlah kasus yang tinggi ini diperparah dengan tingkat

kesadaran yang rendah.

http:>>$$$.radioaustralia.net.au>indonesian>radio>onairhighlights>malariapembunuhnomor

satudipapua>1121*2"

Plasmodium yang sering di#umpai adalah Plasmodium viva( yang menyebabkan malaria

tertiana 5

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3. %hy the physical e(amination sho$s a pale palpebral con#unctiva) sclera #aundice) a

splenomegaly &

 Acute malaria

  n nonimmune individuals) there is usually no anaemia $ithin 2"?" h o! the onset o

!ever) but there is then a rapid !all o! the Bb and Bct over "?* days) $ith the degree

anaemia corresponding

  appro(imately to the intensity o! parasitaemia. The anaemia is normochromic and

normocytic. The reticulocyte count is lo$ at this stage) although the bone marro$ s

erythroid hyperplasia $ith minimal dyserythropoietic changes. he total plasma

bilirubin and unconjugated raction are raised" increased conjugated biliru

indicates complicating hepatic dysunction#

  $ major mechanism o haemolysis is rupture o red cells at the time o rele

o mero%oites) but anaemia is o!ten more severe and more persistent than can be

accounted !or directly by parasitaemia# he &b may continue to all or bet'een

and )* days ollo'ing clearing o the parasites, due apparently to both

continued haemolysis and delayed release o red cells rom the marro'#

  Survival o! both autologous nonparasiti4ed red cells and donated red cells is shorten

here is phagocytosis o the parasiti%ed and unparasiti%ed red cells) seen e

in the bone marro$. The direct

Splenomegali 

Cimpa merupakan organ retikuloendothelial) dimana plasmodium dihancurkan oleh smakro!ag dan lim!osit. Penambahan selsel radang ini akan menyebabkan splenome

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*. %hat is the preventive medication given by the doctor be!ore the patient back to the

papua &8inum obat kloro,ui 1 minggu sebelum berangkat dan + minggu sesudah. 5p. viva(67oksisiklin 5p. !alciparum6

+. $hat are etiology o! the scenario&P. Diva( 8. Diva(>8alaria tertiana benigna

P.8alariae

 8. IuartanaP. Hvale 8. HvaleP. Falsiparum 8alaria Tropika>8alaria tertiana malignaP. ;no$lesi Simian 8alaria

HARRISON’S Infectious Diseases ANTHONY S. FAUCI

 DENNIS L. AS!ER MD c"a te$ %%& Nic"o'as . )"

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Sumber: Parasitologi F; J

Sumber: P7 9ilid ed D

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-. %hat kind o! mos,uito that can be transmitted the disease & Tribus anophelini punya 2" spesies.%aktu aktivitas menggigit vector #am 1-1 anophelini tessilatus . sebelum #am 2" 52

236 anopheles acconnitus) anopheles vagus. Setelah 2" ? " #am pagi  anophelini

coliensis carautti leukospirosis) untulatus.

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. ho$ is the li!e cycle o! plasmodium &

0. $hat are classi/cation o! plasmodium &

1.$hy he got better a!ter medication but no$ relaps &in!eksi belum sembuh

bisa #uga pada p. viva(  hipno4oid bertahan bertahun2 di hepar  relaps

rekrudens : berulangnya ge#ala setelah minggu serangan primer.K !alcivarum L malaria

elaps : berulangnya ge#ala klinik. Cebih lama dari masa laten nya. 5* thn6  viva( dan ova

11.%hat are dierential diagnose o! the scenario &

8alaria dan typhoid

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 Typhoid : demam remiten. Turun tidak sampe normal. 52=6

e#alla8alaria : T) kterus) syok) oedem paru) hipoglikemi) malaria cerebral'nemia kronisSplenomegaly

8alariae : rekudensi s>d * thn. Splenomegaly;nolesi : hiperparasitemia.

7emam typhoid : diare ) konstipasi) demam12.%hat are clinical mani!estation &

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13.%hat are the medical treatment !or the patient &

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1".%hat are complication and prognosis &a. 8alaria cerebral : malaria disertai dengan penurunan kesadaranb. Bipoglikemi :pengaruh obat kinac. 'nemia berat.d. agal gin#al akut

e.