Tes Lab pada Penyakit Infeksi

& Tropis

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
March 26, 2015

Tes Darah Rutin pada Penyakit

Infeksi Tropis

Lekopeni

Perubahan
morfologik pd sepsis

Dhle bodies
Granula toksik
vakuolisasi

Eosinofilia :

March 26, 2015

Netropeni, mis Demam

Tifoid, brucellosis
Infeksi hebat
netropeni hebat
prognosis buruk

non-bakterial,
biasanya alergi /
infeksi parasit.

Tes Darah Rutin pada Penyakit

Infeksi Tropis

Anemia

bisa timbul sekalipun cadangan besi

cukup.
Anemia akut:

Anemia kronik, dengan

March 26, 2015

perdarahan/ destruksi eritrosit (misalnya

cold agglutinin sehubungan dengan
Mycoplasma pneumoniae),
cadangan besi yang normal atau meninggi di
sistem retikuloendotelial
penurunan besi dalam plasma serta
penurunan TIBC (total iron-binding capacity).

Tes Darah Rutin pada Penyakit

Infeksi Tropis

Infeksi serius + bakteriemia

Gram negatif DIC. (Gram pos jarang)

Trombos
PT memanjang
FDP
Fibrinogen
Trombosiopenia

March 26, 2015

bisa juga menjadi tanda sepsis bakterial dan

bisa bermanfaat dalam mengobservasi respon
pasien terhadap terapi.

Lab Examinations in Dengue Fever

(DF)

Laboratory findings

Hematology

The diagnosis is made by Lab Tests seroimmunology

March 26, 2015

Leukopenia
Thrombocytopenia
serum aminotransferase (AST, ALT) elevations.
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

Lab Examinations in Dengue Fever

(DF)

March 26, 2015

Hemagglutination Tests
Virus + Eri angsaagglutinasi Tes
Negatif
Virus + serum (ada atb spesifik)tidak
aglutinasiTes Positif
Virus + Eri + serum (tanpa atb
spesifik) aglutiasi Tes negatif

Lab Examinations in Dengue Fever

(DF)
Specimen
1

Interpretasi

Pre 4th d
< 1:20

Pre 5th d
<1:20
<1:20
Pre 7th d
> 1:1280

March 26, 2015

Specimen
2
Post 1-4
wk
4x
<1:1280

>1:2560
4x

4x not
needed

Interpretation

1mary
Dengue
2ndary
Dengue
Presumptive
S 2ndary
Dengue
8

Lab Examinations in Dengue Fever

Ag

Complement Fixation
Test

S
Ab

Ag+[serum,Ab pos]+
Complcomplement
fixed+RBC(sheep)un
lysed : Pos test
Ag+[serum,Ab neg]+
Complcomplement un
fixed RBC(shee)
lysed : Neg test

RBC

Pos

March 26, 2015

Neg

Dengue Hemorrhagic Fever (General)

Tes Lab:
2. ELISA (capture
method)
1.

2.

March 26, 2015

Anti-dengue IgM

Infeksi primer,
akut 7-10 hr
IgG (post/kronik)

Infeksi
sekunder,
sesudahnya

Hasil

Interpretasi

IgG

IgM

D sekunder

D primer

Duga D
sekund
Non-D
Primer
sangat dini10

DHF pada Anak

In dengue

March 26, 2015

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.

11

DHF pada Anak

In dengue hemorrhagic fever

March 26, 2015

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.
12

DHF pada Anak

WHO clinical criteria for diagnosis of dengue

hemorrhagic fever:

March 26, 2015

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.

13

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

Tzanck preparation

March 26, 2015

Seroconversion
Increase
Direct immunofluoroscent antibody slide tests (rapid
diagnosis)
Base of lesions
Multinucleate giant cells

14

Tzanck cell

March 26, 2015

15

Herper Zoster

March 26, 2015

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

16

Mumps

Darah

Lekopeni
Serum amilase dlm 10 hari
Serologi

Biakan

Virus dari ludah 1-5 hari

Komplikasi

March 26, 2015

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

Inflamasi testis/ ovarium: lekositosis, LED

Pankreatitis: lekositosis, amylase, hiperglikemia
Meningitis: sel LCS < 500/L, mononuclear; glukose
normal, protein agak (20-125 mg/dL)

17

Morbilli (Measles, Rubeolla)

Temuan laboratorium

Darah
Lekosit , terutama limfo & segmen
lekositosissuperinfeksi bakterial
Serologi: EIA

March 26, 2015

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
18

Varicella

Tes lab yang bisa dilakukan

Sediaan apus
Bahan: kerokan dasar vesikel
Pulasan: TzankMultinucleated Giant Cells
Sensitivitas 60%
Darah
Serologi:

March 26, 2015

Titer atb serum konvalesen 4x dpd serum akut

Hemaglutinasi
Elisa
Fama

PCR: deteksi DNA virus

19

HIV/ AIDS

HIV antibody detected by a twostep technique:

ELISA

as a sensitive screening test

Confirmation of positive ELISA
tests with the more specific
Western blot technique

March 26, 2015

20

Molluscum Contagiousa

Giemsa-stained
shows

inclusion bodies within many

large cells or extracellularly

March 26, 2015

21

Verruca Vulgaris

DNA typing: circular-doubelstranded, 8000 bp

Cross-hybridization

> 50% : type seperation

< 50%: subtype seperation

March 26, 2015

22

Impetigo/ Pyoderma

March 26, 2015

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 antihyaluronidase
Urinalysis: hematuria with erythrocyte
casts and proteinuria in patients with acute
nephritis
23

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

March 26, 2015

club-shaped organisms, appear as

"Chinese letters"

24

Polio

CSF:
Aseptic

meningitis
Elevated WBCs
Elevated protein
Normal glucose

March 26, 2015

25

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

March 26, 2015

Darah rutin: Lekopeni

26

Kolera

Isolasi vibrio cholerae dari bahan

tinjaidentifikasi serogroup 01 atau
139
Serologi:
tes

agglutinasi menggunakan
antiserum spesifik

March 26, 2015

27

Salmonellosis/ Typhoid Fever

March 26, 2015

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.

28

Salmonellosis/ Typhoid Fever

Other nonspecific laboratory results

March 26, 2015

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.

29

Salmonellosis/ Typhoid Fever

March 26, 2015

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.

30

Salmonellosis/ Typhoid Fever

Serologic

tests
Widal test for "febrile
agglutinins,
high

rates of false-positivity
and false-negativitynot
clinically useful.
Polymerase chain reaction and
DNA probe assays are being
developed

March 26, 2015

31

Disentri basiler/ Shigellosis

Jumlah Lekosit: , Normal atau

Serologi: bisa, jarang bermanfaat
Tinja:
Kultur,

harus tinja segar!

Mikroskop: Lekosit

March 26, 2015

Polymerase chain reaction (PCR)

may be diagnostic.

32

Helmintiasis

March 26, 2015

Parasitology study !

33

Mycosis

March 26, 2015

Parasitology study !

34