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Demam lebih dari 7 hari dapat disebabkan oleh berbagai penyakit sistemik dan infeksi lokal. Diagnosis diferensial meliputi infeksi bakteri, virus, parasit, dan penyakit autoimun. Pemeriksaan fisik dan laboratorium diperlukan untuk mengidentifikasi gejala dan lokasi infeksi, serta mendeteksi agen penyebabnya.
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Demam
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Datenpdf.com Dd Demam 7 Hari Lebih Fever Meningitis
Demam lebih dari 7 hari dapat disebabkan oleh berbagai penyakit sistemik dan infeksi lokal. Diagnosis diferensial meliputi infeksi bakteri, virus, parasit, dan penyakit autoimun. Pemeriksaan fisik dan laboratorium diperlukan untuk mengidentifikasi gejala dan lokasi infeksi, serta mendeteksi agen penyebabnya.
Demam lebih dari 7 hari dapat disebabkan oleh berbagai penyakit sistemik dan infeksi lokal. Diagnosis diferensial meliputi infeksi bakteri, virus, parasit, dan penyakit autoimun. Pemeriksaan fisik dan laboratorium diperlukan untuk mengidentifikasi gejala dan lokasi infeksi, serta mendeteksi agen penyebabnya.
Ro Rabian Rein Roza T. Guidelines • Harrison’s 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 >38ºC 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 PMN Tidak Gejala Fokal Infeksi Sistemik Meningkat Bronkopneumonia Sepsis Infeksi virus : TB Paru Endokarditis Campak dan Pielonefritis Leptospirosis eksantema akut lain Cholangitis, Hepatitis viral Cholesistitis Demam dengue atau Pancreatitis DBD Meningitis purulen HIV Tonsilitis EOSINOFILIA : Infeksi bakteri : Difteri Filariasis Rickettsiosis Disentri basiler Schistosomiasis Demam tifoid Abses piogenik Trichinellosis Infeksi Protozoa : Appendisitis Cysticercosis Malaria Pioderma Tripanosomiasis Limfadenitis Leishmaniasis Otitis Toxoplasmosis FEVER WITH LOCALIZING SIGNS ON EXAMINATION AND WITH NEUTROPHIL Signs and symptoms LEUKOCYTOSIS Disease Investigations Dyspnoe, cough, Chest X-Ray, Sputum pleuritic pain, Bacterial pneumonia culture discoloured sputum Streptococcal tonsilitis, Severe sore throat Culture diphteria Frequency, dysuria, loin Pyelonephritis, UTI Urine culture pain 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 Osteomyelitis X – Ray, CT Scan night) Lymphadenopathy Abscess Culture, serology Cutaneous inflammation Erysipelas, cellullitis Culture Chronic cough for > 4 Mantoux, Acid – Fast weeks or blood in TB stain sputum Description Disease Etiology Discrete lesions that become confluent as rash spreads from hairline Measles/Rubeola Paramyxovirus downward, Koplik’s spots, lasts > 3 days Nonspesific diffuse macules and papules, Primary HIV Infections HIV oral or genital ulcers, pharyngitis, adenopathy Maculopapular eruption, icterohemorrhagic fever, exposure to water Leptospirosis Leptospira interrogans contaminated with animal urine Coated tongue, abdominal pain, diarrhea, Thyphoid fever Salmonella typhii headache, myalgia Rash, headache, leukopenia, biphasic Dengue fever Dengue virus fever, petechiae Butterfly rash, malar SLE Autoimmune disease rash, systemic disease primary chancre in 10% of cases; copper-colored, Description Disease Etiology Tender pink nodules on finger or toe pads, Streptococcus, Bacterial Endocarditis abnormal heart valve, Staphylococcus murmur Macules (2–3 mm) evolving into papules, then vesicles (sometimes umbilicated), on an Varicella VZV erythematous base pustules then forming and crusting Pruritic papule enlarging and evolving into a 1- by 3- cm painless ulcer surrounded by Anthrax Bacillus anthracis vesicles and then developing a central eschar with edema, exposure to infected animals 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.