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
Tes Darah Rutin pada Penyakit Infeksi Tropis
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
Tes Darah Rutin pada Penyakit Infeksi Tropis
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
Tes Darah Rutin pada Penyakit Infeksi Tropis
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
Lab Examinations in Dengue Fever (DF)
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
Lab Examinations in Dengue Fever (DF)
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
Salmonellosis/ Typhoid Fever
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
Salmonellosis/ Typhoid Fever
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
Salmonellosis/ Typhoid Fever
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
Salmonellosis/ Typhoid Fever
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 !
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