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INFORMASI UMUM
• Presentasi ini disampaikan pada kegiatan 1ST ASMP-ID
• Hari / Tanggal : Sabtu - Minggu / 27-28 Oktober 2018
• Tempat : Hotel Novotel Tangerang
• Narasumber : UKK Infeksi dan Penyakit Tropis
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Curiculum Vitae
• Nama : Yulia Iriani
• Institusi : Divisi Infeksi dan Penyakit Tropis
Departemen Kesehatan Anak FK UNSRI/
RS Mohammad Hoesin Palembang
• Pendidikan : S1 FK UNPAD (1995)
SpA FKUI (2004)
S3 FK UNAIR (2011)
Fellowship IPT FK UNPAD (2013)
Non–Blanching Rash
Kewaspadaan terhadap Infeksi Meningococcus
Yulia Iriani
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Introduction
• Non-blanching rash (NBR)
• Concern by doctors and parents
• Infectious diseases with haemorrhagic rash can be fulminant fatal events or
relatively benign illnesses
• 90% will NOT have MCD
• is one of the most recognised signs of possible meningococcal disease (MCD)
• 20% MCD do not have NBR
• Wide range of underlying diagnosis
• some of which are life threatening MCD
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NBR – Etiology
• Infection • Mechanical
• Viral • coughing or vomiting local pressure or
• Common: Enterovirus and tourniquet application, strangulation
adenovirus • Hematological
• Bacterial
• Thrombocytopenia, leukemia and
• Meningococcal disease (MD) hypersplenism, platelet dysfunction,
• Haemophillus influenzae B coagulopathy
• Infeksi Streptococcal • Vascular
• Infective endocarditis
• Vasculitis, scurvy, drugs, fat embolism,
• Ricketsia dysproteinemia
Tabel. Infectious Agents Associated with Illnesses in Which Petechial and Purpuric Exanthems
Occur
Infectious Agents Disease
Infectious Agents Disease Rickettsia typhi Murine typhus
Human parvovirus B19 Gloves-and-socks syndrome Rickettsia prowazekii Epidemic typhus
Varicella zoster virus Hemorrhagic chickenpox Rickettsia rickettsii and other Rocky Mountain spotted fever tick-borne rickettsiae
Cytomegalovirus Congenital cytomegalovirus infection
Ehrlichia spp. Ehrlichiosis
Variola virus Hemorrhagic smallpox
Mycoplasma pneumoniae
Coxsackieviruses A4, A9
Streptococcus pyogenes Scarlet fever atau septicemia
Coxsackieviruses B2–B4
Streptococcus pneumoniae Pneumococcal septicemia
Echoviruses 4, 7, 9
Enterococcal and viridans group Endocarditis streptococci
Colorado tick fever virus r Colorado tick fever
Neisseria gonorrhoeae Gonococcemia
Rotavirus
Neisseria meningitidis Meningococcemia
Alphaviruses: chikungunya,
Moraxella catarrhalis
o’nyong- nyong fever, Ross
River, Sindbis Haemophilus influenzae H. influenzae septicemia
Rubella virus Rubella atau congenital rubella Pseudomonas aeruginosa Ecthyma gangrenosa
Respiratory syncytial virus Streptobacillus moniliformis
Measles virus Hemorrhagic (black measles) atau atypical measles Yersinia pestis Septicemic plague (black death)
Lassa virus Lassa fever Bartonella henselae Cat-scratch fever
Marburg virus Treponema pallidum Congenital syphilis
Hepatitis C virus Mixed cryoglobulinemia Borrelia spp. Relapsing fever
Hantavirus Hemorrhagic fever with renal syndrome Toxoplasma gondii Congenital toxoplasmosis
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Assessing NBR
• Is the child well?
• Can I make a positive diagnosis?
• Can I rule out serious illness?
General examination – The overall appearance of a child will help guide further management.
Patients who have purpuric lesions and are ill-appearing and/or hemodynamically unstable need to
be rapidly assessed to determine the underlying etiology
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http://pediatrics.aappublications.org/content/72/4/469
Ninis N, Nadel S, Glennie L (2010) Lessons from Research for Doctors in Training:
Recognition and Early Management of Meningococcal Disease in Children and
Young People.
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TERIMA KASIH