MODUL 1

KEDOKTERAN
TROPIS
dr.Nurul Fadilah Ali Polanunu,M.Biomed
 GROUP 12b

1. 11020190232 Maghfirah Tara Zakiyyah 7. 11020190243 Farah Zhafirah Sudirman

2. 11020190234 Syu’a Almadina 8. 11020190246 Puput S

3. 11020190236 Nadhifah Wasila Khairun 9. 11020190248 Wira Pratiwi Oktaviani

4. 11020190238 Andi Nirwana Widya Ningsih 10. 11020190250 Andi Batari Ramadhina .S

5. 11020190240 Adinda Pradana Putri 11. 11020190251 Nur Afdhaliyah

6. 11020190242 Ahmad Fajar Fitrah

 SCENARIO 6

A 35-year-old man came with a complaint of fever for 10 days. The patient also
complained of nausea, vomiting, calf pain and urinating like tea. On examination of
vital signs, blood pressure was 100/60 mmHg, pulse was 100 beats per minute, and
axillary temperature was 38 C. On physical examination, jaundice and scleral
injection were found. One week earlier the patient's house was flooded.
 DIFFICULT WORDS
01 JAUNDICE
Jaundice also known as
hyperbilirubinemia is defined
as a yellow discoloration of the
body tissue resulting from the
accumulation od excess
bilirubin
Reference : Joseph, Abel,
Samant Hrisnikesh.2021.
Jaundice.ncbi
02 Scleral
injection
The main sign of inflammation in the
eye. Most cases are mild condisitions
and can recover completely. Red eye
is divided into 2 types, namely ciliary
injection and conjunctival injection.
Reference : Akbar, Muhammad, dkk. 2019 .
Conjunctival Laceration of The Tarsalis Palpebra
Inferior Et Cousing By A Fishing Hook. Jurnal
Medical Proffesion. 1 (2) Juni 2019
 Key words

1. A 35 year old man

2. Fever for 10 days
3. The patient also complained of nausea, vomiting, calf pain and urinating like tea
4. Blood pressure was 100/60 mmHg
5. Pulse was 100 beats per minute
6. Axillary temperature was 38 C
7. On physical examination, jaundice + and scleral injection were found
8. One week earlier the patient's house was flooded
Question &
discussion
 01.
Explain the definition,
classification, etiology of
fever!
 The Definition
fever/febrile as a state of elevated core temperature, which is often (but not
necessarily) part of the defense response of a multicellular organism (host)
against invading microorganisms or inanimate objects that are pathogenic or
foreign to the host.

Pratiwi, N. R. R. (2018). Penerapan Kompres Hangat pada Anak Demam dengan Gangguan Pemenuhan Kebutuhan Nyaman di RSUD Sleman.
Eprints.Poltekkesjogja.Ac.Id, 8–30.
El-Radhi AS, Carroll J, Klein N, Abbas A. Fever. Dalam: El-Radhi SA, Carroll J, Klein N, penyunting. Clinical manual of fever in children. Edisi ke-9.
Berlin: Springer-Verlag; 2009.h.1-24.
 The classification

 Septic fever
 Remittent fever
 Intermittent fever
 Continuous fever
 Periodic Fever

Pratiwi, N. R. R. (2018). Penerapan Kompres Hangat pada Anak Demam dengan Gangguan Pemenuhan Kebutuhan Nyaman di RSUD Sleman.
Eprints.Poltekkesjogja.Ac.Id, 8–30.
El-Radhi AS, Carroll J, Klein N, Abbas A. Fever. Dalam: El-Radhi SA, Carroll J, Klein N, penyunting. Clinical manual of fever in children. Edisi ke-9.
Berlin: Springer-Verlag; 2009.h.1-24.
 The etiology
1. Upper respiratory tract infection
2. - Otitis media
- Sinusitis
3. – Brochiolitis
- Pneumonia
4. – Pharyngitis
- Gastroenteritis
5. – Urinary tract infection
- Immune reaction

Pratiwi, N. R. R. (2018). Penerapan Kompres Hangat pada Anak Demam dengan Gangguan Pemenuhan Kebutuhan Nyaman di RSUD Sleman.
Eprints.Poltekkesjogja.Ac.Id, 8–30.
El-Radhi AS, Carroll J, Klein N, Abbas A. Fever. Dalam: El-Radhi SA, Carroll J, Klein N, penyunting. Clinical manual of fever in children. Edisi ke-9.
Berlin: Springer-Verlag; 2009.h.1-24.
 02.
Explain what tropical desease
that can cause fever and their
etiology!
 Bacteria Virus Parasite Helminth

Dengue Hemorrhagic fever

Typhoid fever Malaria Trichinosis
(DBD)

PES Yelow fever Schistosomiasis

Leptospirosis Hepatitis
Diphtheria Rubeola
Anthrax SARS
Tetanus Influenza
Varicella
Ebola
Mumps
Polio
Avian Influenza
Rabies

- Brooks, G.F., Butel, J.S., Ornston, L.N., Jawetz, E., Melnick, J.L., Adelberg, E.A., Jawetz, Melnick & Adelberg’s: Medical Microbiology,
20 edition, Prentice-Hall International Inc.
- Widoyono. 2011. Buku Ajar Penyakit Tropis : Epidemiologi, Penularan, Pencegahan & Pemberantasannya. Edisi 2. Jakarta : Erlang ga.
- Prevention and control of schistosomiasis and soiltransmitted helminthiasis. Geneva : WHO. 2020
 03.
Explain the
pathomecanism of the
main complaint ( fever )
based on the scenario!
 FEVER

FEVER
infection, microbial Cyclic
toxins, inflammatory AMP
Microbial
mediators, toxins Heat conservation
immunological reactions.
PGE-2 and production

monocytes,
macrophages, arachido increase set
endothelial cells etc. nic acid. points

pyrogens, cytokines, IL- hypothalamic

1, IL-6, TNF-a, IFN-ǹ endothelium.
Circulation.

Price Sylvia A, Wilson Lorraine M. Patofisiologi: Konsep Klinis Proses-Proses Penyakit. Jakarta: EGC; 2012.
 04.
Explain the diagnostic
step of the scenario!
 anamnesis

1.Identity; name,address,date of birth,age: 35 years 6.Exposure history

old,gender:male,occupation. 7.Family history

2. Chief complaint: 10 days fever 8. History of going to a dentist or other doctor

3. Take a history of disease: 9. Drug history

Onset and duration of fever: sudden onset, when?
Fever nature: intermittent, continuous, higher in the afternoon 10. Vaccination history; date and type of vaccination

4. Ask the accompanying symptoms,

Respiratory system disorders,
Gastrointestinal disorders,Urogenital disorders.

5. Travel history
So based on the history according to the
scenario, it was found that a 35-year-old
man came with complaints of fever for 10
days, accompanied by complaints of
nausea and vomiting, urinary and calf pain
like tea. And one week earlier the patient's
house was flooded.
 Physical Examination

Inspection
- Assess the presence of anemia, jaundice, edema etc
- Check status: decreased consciousness, dry hair, dirty tongue
- Watch for bleeding manifestations
- Test tourniquet
- Pay attention to the presence or absence of skin efflorescence
Based on scenario
On physical examination, positive jaundice and scleral injection were found.
Palpation
Check for reflex disturbances
Auscultation
Abdominal examination: hepatomegaly, splenomegaly
Vital signs
body temperature, respiration, pulse, blood pressure
Based on scenario
Examination of vital signs obtained BP 100/60 mmHg, pulse 100x/minute and axillary
temperature 38 degrees C.
 Supporting investigation

1. routine blood
2. serological test
3. bacteriological
4. stool examination
5. Radiology

• X-ray: Through X-ray examination, it can be seen whether there are worms in the
intestine. X-rays can also be done to see if there are larvae in the lungs.
• Ultrasound: Can show if there are worms in the pancreas or liver.
• CT scan or MRI: These two examination methods are useful to see if worms are
blocking the ducts of the liver or pancreas.

Referensi:
Vitayani,dkk.2015. Buku Panduan Kerja Clinical Skill Lab
Kedokteran tropis. Fakultas Kedokteran Universitas Hasanuddin
 05.
What are the
differential diagnosis
related to the scenario!
1. LEPTOSPIROSIS

Definition Epidemiology Etiology clinical

manifestation
Leptospirosis is a zoonotic disease Leptospirosis occurs in various Humans can get leptospirosis The clinical symptoms caused by
caused by infection with spiral-shaped
leptospira bacteria of the genus parts of the world but generally in through direct contact with infected Leptospirosis are divided into 3
Leptospira which are pathogenic, tropical and subtropical areas with animal urine or through water, soil, phases, namely:
transmitted directly and indirectly from
animals to humans.
high rainfall. Based on reports of or food contaminated with animal 1. Leptospiremic phase (3-7
Leptospira bacteria are spiral-shaped recent years, the global incidence urine. days)
with hook-like ends, measuring 5-15 of Leptospirosis cases is 1. Small mammal species, such 2. Immune phase (3 – 30
micrometers long and 0.1-0.2
micrometers wide, flexible, thin and
estimated from 0.1-1 per 100,000 as wild rats (including mice, days)
flexible. per year in temperate climates porcupine squirrels) 3. Convalescent Phase (15 –
and 10-100 per 100,000 per year 2. Domestic animals (cows, 30 days)
in the humid tropics. pigs, dogs, sheep, goats,
The number of male patients with horses, buffalo)
leptospirosis is higher than 3. Fur-producing animals (silver
female. fox) in captivity
4. Reptiles and amphibians
may also carry leptospires
Reference :
1. Setadi, B., Setiawan, A., Effendi, D. & Hadinegoro, SRS Practical Instructions for Leptospirosis. Sari Pediatr. 3, 163–167
(2001).
2. Rampang, NH Leptospirosis Novie H. Rampengan. J. Biomedicine 8, 143–150 (2016).
3. Sitohang, RV, Burni, E., Gasem, MH & Muhadir, A. Instructions for Leptospirosis Control Techniques. Ministry. health. RI 126
(2017).
 supporting
Management Complications Prognosis Prevention
investigation
1. Microscopic 1. Medicine 1. Aseptic meningitis Mortality in severe 1. Familiarize yourself
2. Immunoserological • Severe cases of 2. Encephalitis leptospirosis is about 10%, with Clean and
tests: Microscopic leptospirosis should 3. myelitis death is most often caused Healthy Life
Agglutination Test, be given high doses 4. Radiculitis by kidney failure, massive Behavior (PHBS)
Enzymelinked of IV penicillin (IV 5. Peripheral neuritis bleeding or ARDS. 2. Wash hands with
immunosorbent benzylpenicillin 30 soap before eating
assay (ELISA), mg/kg, maximum Severe complications: and drinking.
polymerase chain 1.2 g, 6 hours for 5- shock, massive 3. Use clean water for
reaction (PCR) and 7 days). bleeding and ARDS bathing and
dipstick assays, and • Milder cases may washing.
Leptospira-specific be treated with oral 4. Avoid contact with
antigen, namely antibiotics such as flood waters.
lipoprotein rLipl32 amoxicillin, 5. Store food properly
ampicillin, and correctly to
doxycycline (2 avoid the reach of
mg/kg, maximum rats (closed tightly,
100 mg, every 12 put in the
hours for 5-7 days), cupboard).
or erythromycin.
2. Supportive therapy and
dialysis
Reference :
1. Setadi, B., Setiawan, A., Effendi, D. & Hadinegoro, SRS Practical Instructions for Leptospirosis. Sari Pediatr. 3, 163–167 (2001).
2. Rampang, NH Leptospirosis Novie H. Rampengan. J. Biomedicine 8, 143–150 (2016).
3. Sitohang, RV, Burni, E., Gasem, MH & Muhadir, A. Instructions for Leptospirosis Control Techniques. Ministry. health. RI 126
(2017).
 Malaria
Definition Malaria is disease infection which caused by parasite the
plasmodium life and develop breed in in cell blood man. Disease
this by experience transmitted through bite mosquito anopheles
female.
Epidemiolo - in countries that climate tropical and subtropical as continent
gy Africa and Southeast Asia.
- Year 2019, estimated there is 229 million case malaria in whole
world
- Total case malaria in Indonesia year 2019 as much 250,644.
Pathogene Skizon in blood broken → emit antigen → stimulate macrophages,
sis monocytes or lymphocytes emit various type cytokines, among
them Tumor Necrosis Factor (TNF) → TNF brought Genre blood to
hypothalamus → fever → consequence fever happen vasodilation
peripheral
TETANUS
Tetanus is an acute toxemia caused by a neurotoxin
produced by Clostridium tetani characterized by
periodic and severe muscle spasm.
• The prevalence is higher in developing countries
than in developed countries.
• It can occur at any age, but the highest
prevalence is in newborns and the elderly who
have decreased immunity over time
• It is more commonly found in areas where the soil
is cultivated, in warm climates, and among males.
C. Tetani spores enter through contaminated
wounds → The wound becomes anaerobic
accompanied by necrotic tissue and dead
leukocytes → Spores become vegetative and
develop → Cell wall lysis: produces exotoxins
(Tetanospasmin and tetanolysin) → Tetanospasmin
enter the central nervous system where there is an
anaerobic atmosphere and produce toxins → Toxins
go to the presynaptic nerve → Inhibit the release of
inhibitory neurotransmitters → Muscle contraction
and spasm.
 Malaria TETANUS

Etiology • Plasmodium falciparum, Plasmodium vivax, Plasmodium Tetanus is caused by an exotoxin

malariae, Plasmodium ovale, or Plasmodium knowlesi which (tetanospasmin) from the bacterium Clostridium
transmitted through bite mosquito anopheles female. tetani. Clostridium tetani is an anaerobic Gram
• Infection congenital.. positive bacterium found in soil and animal
waste.
Clinical - Fever • Incubation period: 2-21 days
- Diaphoresis
• There is a history of injury
Manifestati - Hot cold
• Trismus
- Fatigue
on - Nauseous • Disfagia
- Gag • Seizure
- Sick head • Generally good awareness
- myalgia (especially sick back)
- Arthralgia
• Opistotonus, stiff arms, hands clenched
- Sick stomach • Risus sardonicus
- Diarrhea • Hyperreflection

Diagnosis Inspection preparation wipe blood thick and thin:
• There is whether or not parasite malaria
• Plasmodium species and stages
• Density parasite :
Semi quantitative
(-) : parasite in 100 LPB
(+) : 1-10 parasite/100 LPB
(++): 11-100 parasite/100 LPB
(+++) : 1-100 parasite /1 LPB
(++++) : 11-100 parasite/1 LPB
• History and Physical examination: Trismus,
dysphagia, risus sardonicus or painful muscle
spasm and usually preceded by a history of
trauma.
• Support Examination: Cultur examination of C.
tetani on the wound (+)
 Malaria TETANUS
Management Drug therapy • Non-farmacology
Chloroquine, Hydroxychloroquine,China sulfate, Tetracycline, • Farmacology:
Doxycycline, Clindamycin, Primaquine, taphenoquine, 1. Toxin Neutralization: TIG dose 3000-6000 U
Mefloquine, Atovaquone-proguanil, Artemeter-lumefantrine, intramuscularly
2. ATS 100.000-200.000 U
Artesunate
3. Treat muscle spasm and rigidity: Diazepam 0,1-0,3
mg/kgBB intervals of 2-4 hour, Phenobarbital and
Chlorpromazine
4. Treat infection: Metronidazole initial dose 15
mg/kgBW, continued dose 30 mg/kgBW every 6 hour
during 7-10 days
5. Penicilin procain 50.000 U/kgBB during 7-10 days
Prognosis Depends on treatment which given. In malariatropical could arise Mortality depends on:
complications which dangerous which called black water fever ( • Incubation period: The shorter the incubation
hemoglobinuric feber) with fail kidney NS. period, the worse the prognosis, less than 7 days
is generally fatal.
• Age: Neonates or elderly with high mortality
• Frequent seizures or trismus
• Fast therapy
Complication - Malaria cerebral 1. Airway: Aspiration, Laryngospasm/obstruction
- Edema lungs 2. Respiration: Apnea,Hypoxia,ARDS
- syndrome difficulty respiration NS 3. Cardiovascular: Tachycardia, hypertension, heart
- Attack heart
failure
- Fail kidney
- Rupture spleen
4. Kidney: Kidney failure
- Coagulation intravascular disseminated 5. Others: Thromboembolism
- hemolysis
- Complications pregnancy
- Death because failure multiorgan
 References:

WHO: World Malaria Report 2019. WHO; 20192. Collins WE et al: Plasmodiummalariae: parasites and diseases.
ClinMicrobiolRev. 20(4):579-92, 20073. Collins WE et al: Plasmodium ovale: parasites and diseases. ClinMicrobiolRev.
18(3):570-81, 20054. WHO: Management of Severe Malaria - A Practical Handbook. 3rd ed. WHO; 2013 5. CDC:
Malaria: Treatment of Malaria: Guidelines for Clinicians (United States). CDC website. Last Reviewed May 29, 2020.
Accessed July 29, 2020.https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html 6. Ministry of Health of the
Republic of Indonesia. Malaria: The World's Leading Cause of Death. 2021. https://www.malaria.id. accessed 14
November 2021 01:15 7. Teuku Romi ImansyahSon. Malaria and its problems. Shia medical journalkuala Volume 11
Number 2 August 2011

Harrison, Tetanus in :Principles of Internal Medicine, volume 2, ed. 13th, McGrawHill. Inc, New York, 1994,
.577-579.
Ritarwan K. (2017). Tetanus. Department of Neurology, Faculty of Medicine, University of North Sumatra /
RSU H. Adam Malik
Mubin H. Practical Guide to Medicine in Diagnosis and Therapy. 2th edition. Medical Book Publisher: EGC
 06.
What prevention can be
given to the patient?
Prevention can be given to the patient

Increase public
Health education Maintain the cleanliness awareness of the dangers
of this disease

References : Journal of Health Epidemiology and Communicable Disseases, 2019

 07.
What are the
complications that can
occur regarding the
scenario?
 Complications

Respiratory disorders
Cardiovascular
Acute Kidney Failure Acute Liver Failure and Pulmonary Acute Pancreatitis
Disorders
Bleeding

Reference : Andani, L. 2014. Evaluations of The Use of Leptospirosis Diagnostic Criteria ( WHO Searo 2009 ) in Leptospirosis Patients At Dr. Kariadi Hospital Semarang.
Faculty of Medicine, Diponegoro University
 08.
Perspective islam based
on scenario.
Rasulullah shallallahu ‘alaihi wa sallam mengatakan:

‫ث ْال َحدِّي ِّدا‬ ‫ِّب ْال ِّك ُا‬

‫ير َخبَ َا‬ ‫ َك َما ايُ ْذه ُا‬،‫طايَا بَنِّي آ َد َام‬ ‫ فَإِّنَّ َها ت ُ ْذه ُا‬،‫سبِّي ْال ُح َّمى‬
َ ‫ِّب َخ‬ ُ َ‫َلا ت‬
“Janganlah Engkau mencela demam. Karena demam itu bisa menghilangkan
kesalahan-kesalahan (dosa) manusia, sebagaimana kiir (alat yang dipakai
pandai besi) bisa menghilangkan karat besi.” (HR. Muslim no. 2575).

Oleh karena itu, tidak boleh bagi seorang mukmin mencaci maki penyakit yang
dideritanya, menggerutu, apalagi sampai berburuk sangka pada Allah dengan
musibah sakit yang dideritanya.

“ Bergembiralah wahai saudaraku, sesungguhnya Rasulullah shallallahu ‘alaihi

wa sallam bersabda, “Sakit demam itu menjauhkan setiap orang mukmin dari
api Neraka” (HR. Al Bazzar )
Thank you!