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Pemicu 1

Vania Trixie
Rabies
Definition
• Rabies is a preventable viral disease of
mammals most often transmitted through the
bite of a rabid animal
• The vast majority of rabies occur in wild
animals like raccoons, skunks, bats, and foxes

https://www.cdc.gov/rabies/medical_care/vac
cine.html
The Rabies Virus
• Rabies virus belongs to the order
Mononegavirales
• Viruses with a nonsegmented, negative-
stranded RNA genomes
• Classified in the Rhabdoviridae family (180 nm
long and 75 nm wide)

https://www.cdc.gov/rabies/medical_care/vac
cine.html
Replication
• Adsorption (initiates the infection)the fusion of the rabies
virus envelope to the host membrane
• The virus penetrates (virus entry) the host cells, enters the
cytoplasm
• Uncoating (envelope removal)
• Transcription (synthesis of mRNAs)
• Translation (Synthesis of structural proteins)
• Processing (G-protein gycosylation)
• Replication (production of genomic RNA from intermediate
strand
• Assembly
• Budding (complete virions).
https://www.cdc.gov/rabies/medical_care/vac
cine.html
Sign and symtoms
• The first symptoms -> flu including general weakness or
discomfort, fever, or headache. (last for days)
• Prickling or itching sensation at the site of bite, progressing
within days to symptoms of cerebral dysfunction, anxiety,
confusion, agitation -> delirium, abnormal behavior,
hallucinations, and insomnia. (as the disease progress)
• Acute period of disease typically ends after 2 to 10 days.
• Once clinical signs of rabies appear, the disease is nearly
always fatal, and treatment is typically supportive.
• Disease prevention -> administration of both passive
antibody, rabies vaccine.

https://www.cdc.gov/rabies/medical_care/vac
cine.html
Dignosis
• In animals : direct fluorescent antibody (DFA)
test, which looks for the presence of rabies virus
antigens in brain tissue
• animal be euthanized -> detection of rabies virus
from any part of the affected brain, but in order
to rule out rabies, the test must include tissue
from at least two locations in the brain,
preferably the brain stem and cerebellum.

https://www.cdc.gov/rabies/medical_care/vac
cine.html
• In human : samples of saliva, serum, spinal fluid,
and skin biopsies of hair follicles at the nape of
the neck.
• Saliva can be tested by virus isolation or reverse
transcription followed by polymerase chain
reaction (RT-PCR).
• Serum and spinal fluid are tested for antibodies
to rabies virus.
• Skin biopsy specimens are examined for rabies
antigen in the cutaneous nerves at the base of
hair follicles
https://www.cdc.gov/rabies/medical_care/vac
cine.html
Medical care
• Human rabies immune globulin (HRIG) is
administered only once, at the beginning of
anti-rabies prophylaxis, to previously
unvaccinated persons.
• The recommended dose of HRIG is 20 IU/kg
body weight. This formula is applicable to all
age groups, including children.

https://www.cdc.gov/rabies/medical_care/vac
cine.html
• A regimen of four 1-mL doses of HDCV or PCEC
vaccines should be administered intramuscularly
to previously unvaccinated persons.
• The first dose of the four-dose course should be
administered as soon as possible after exposure.
• Additional doses should be administered on days
3, 7, and 14 after the first vaccination.
• For adults: IM in the deltoid area (arm).
• For children : the anterolateral/thigh. The gluteal
area should never be used for rabies vaccine
injections
https://www.cdc.gov/rabies/medical_care/vac
cine.html
Postexposure Prophylaxis for Non-
immunized Individuals

https://www.cdc.gov/rabies/medical_care/vac
cine.html
Postexposure Prophylaxis for
Previously Immunized Individuals

https://www.cdc.gov/rabies/medical_care/vac
cine.html
Eklampsia
• Gambran klinik
– Kasus akut pd penderita preeklampsia yg disertai dg kejang menyeluruh dan
koma
– Dapat timbul pd ante, intra, dan postpartum (24 jam pertama setelah
persalinan)
• Selalu didahului preeklampsia
• Kejang2 dimulai dg kejang tonik/ twitching dari otot2 muka khususnya
sekitar mulut(wajah mengalami distorsi , bola mata menonjol), beberapa
detik kemudian disusul kontraksi otot2 tubuh yg menegang, sehingga
seluruh tubuh menjadi kaku, kedua tangan fleksi, tangan menggengam,
kedua tungkai mengalami inverse. Keadaan berlangsung 15 – 30 detik.
• Segera disusul dg kejang klonik yg dimulai dg terbukanya rahang scr tiba2
dan tertutup kembali dg kuat disertai juga terbuka tutupnya kelopak mata
(kurang lebih satu menit)
• Kemudian disusul kontraksi intermiten pd otot2 muka dan seluruh tubuh
• Dari mulut sering keluar busa kadang disertai bercak2 darah
• Berangsur2 kontraksi melemah dan berhenti disertai penderita koma(bila
tdk segera diberi obat antikejang)
• Pada waktu kejang tekanan darah dpt cepat meningkat
• Perawatan eklampsia
– Terapi suportif utk stabilisasi fungsi vital, mengatasi dan
mencegah kejang, mengatasi hipoksemia dan asidemia
mencegah trauma pd pasien pd waktu kejang,
mengendalikan TD(krisis hipertensi)
– ABC (airway, brathing, circulation)
• Pengobatan medikamentaso
– Obat antikejang :
• magnesium sulfat: pemberian sama seprti preeklampsia berat
• Jika masih sukar diatasi gunakan tiopental
• Diazepam (alternatif krn penggunaan dg dosis tinggi)
• Diuretikum hanya dg pemantauan plasma elektrolit
• Perawatan waktu kejang
– Mencegah terjadinya trauma selama kejang
– Di isolasi dikamar terang agar cepat dilakukan tindakan
apabila terlihat sianosis
• Perawatan koma
– Bahaya terbesar : terbuntunya jalan napas atas
– Pasien yg jatuh dlm koma harus dianggap bahwa jalan napas atas terbuntu
– Tindakan pertama2 menjaga agar jalan napas atas tetap terbuka
• Manuver head tilt-neck lift -> kepala direndahkan dan dagu ditarik ke atas, mandibula kiri
kanan di ekstensikan ke atas sambil mengangkat kepala ke belakang -> pemasangan
oropharyngeal airway
• Refleks muntah akan hilang , kemungkinan aspirasi bahan lambung sangat besar. Semua
benda yg ada di dalam rongga mulut dan tenggorokan harus segera dihisap scr
intermiten
• Monitoring kesadaran dan dlmnya koma memakai glasgow coma scale
• Diperhatikan pencegahan dekubitus dan makanan penderita (NGT)
– Pengobatan obstetrik
• Semua kehamilan dlm eklampsia harus diakhiri, bila sudah mencapai stabilisasi
(pemulihan) hemodinamika dan metabolisme ibu
• Perawatn pascapersalinan jika pervaginam, monitoring tanda2 vital
• Prognosis
– Gejala perbaikan akan tampak jelas setalah kehamilan diakhiri
– Diuresis terjadi 12 jam setelah persalinan (gejala pertama penyembuhan)
– Tekanan darah kembali normal beberapa jam kemudian
– Eklampsia tidak mempengaruhi kehamilan berikutnya
– Prognosis janin pd pederita eklempsia tergolong buruk. Seringkai janin mati
intruterin