VIRUS, BAKTERI, PARASIT

Dr Retno Indrastiti, SpKK

 VIRUS
• VARICELLA
• HERPES ZOSTER
• HERPES SIMPLEKS
• MOLUSKUM KONTAGIOSUM
• VERUKA
Golongan virus RNA

1.Rhabdo virus : rabies

2.Toga virus : rubella, yellow fever
3.Paramyxo virus : morbilli
4.Human Immunodeficiency Virus
(HIV) AIDS
Golongan virus DNA
1.Papova virus :
• veruka, kondiloma akuminata
2.Pox virus :
• moluskum kontagiosum,
• variola
3.Herpes virus
• varisela, herpes zoster,
• herpes simpleks
VARICELLA (CACAR AIR, CHICKEN POX)
• VARICELLA ZOSTER VIRUS
• GEJALA-TANDA
– GEJALA KONSTITUSI/PANAS
– TERUTAMA PADA ANAK ANAK
– VESIKEL TERSEBAR MULAI BADAN KMD
SENTRIFUGAL , BISA KE SAL PENCERNAAN,
TELAPAK
– ERITEMA
– EROSI
– KRUSTA
– POLIMORF
• PENYEBARAN : AEROGEN
• PADA ANAK2 TANPA KOMPLIKASI
• MAKIN DEWASA MAKIN PARAH,
BISA TERJADI KOMPLIKASI
ENCEPHALITIS, PNEMONI
• PEM. PENUNJANG : TZANCK TEST
• DD/: VARIOLA
• PENCEGAHAN : VAKSINASI
• TERAPI:
– ORAL
• ASIKLOVIR 5 X 800 mg SELAMA 5 -7 HARI
• ANTI PIRETIK
– TOPIKAL
• BEDAK
• ANTIBIOTIK TOPIKAL
• PROGNOSIS….VITAM,SANAM,KOSMETIKAM
 HERPES ZOSTER (DOMPO)
• PENYEBAB: REAKTIVASI VARICELLA
• VIRUS DALAM KEADAAN DORMAN DI
GANGLION RADIX DORSALIS
• GEJALA-TANDA :
– GEJALA KONSTITUSI
– NYERI RADIKULER
– VESIKEL/BULA BERGEROMBOL
– UNILATERAL, DERMATOM BERURUTAN!!!!!!!!!!
• LOKASI : tu…..THORAKALIS, OFTALMIKA
• KOMPLIKASI :
– NEURAGIA POST HERPETIK (NPH)
• DD/ DERMATITIS VENENATA
• TERAPI
– ASIKLOVIR 5 X 800 mg atau
– VALASIKLOVIR 3 X 1000 mg
– FAMSIKLOVIR 3 X 250 mg
– ANALGETIK
– >40th + PREDNISON 3 X 20 mg
Saraf
mana
yg
kena
???
 VERUKA (KUTIL, CAPLAK)
• HUMAN PAPILOMA VIRUS (HPV)
• TRANSMISI MELALUI KONTAK LANGSUNG
• GEJALA-TANDA
– PAPUL
– PLAK
– FENOMENA KOEBNER
• TERAPI
– BEDAH (skalpel, elektric, kimia, beku)
– imunomodulator
 MOLUSKUM KONTAGIOSUM
 Etiologi : Pox virus
 >>anak-anak  wajah, tubuh,
ekstremitas
 Orang muda aktif seksual  perigenital
& perianal
 Penyebaran : autoinokulasi  resolusi
spontan
 Gambaran klinis : papul padat bentuk
kubah dg cekungan ditengah (delle)
 DIAGNOSIS BANDING
–Veruka
–Varisela
–folikulitis
–Akne
–Milia
• TERAPI
• EXPRESI
• BEDAH BEKU
 HERPES SIMPLEKS/LABIALIS

• VIRUS HERPES SIMPLEX

– VHS I (LABIALIS)
– VHS II (GENITALIS)
• PATOGENESIS
– PRIMER
– SEKUNDER
• PENCETUS
– LELAH
– STRESS
– DEMAM
– TRAUMA FISIK
– MENTRUASI
– MAKANAN MERANGSANG
– DINGIN/ANGIN
 KLINIS
• PRIMER
– PRODROMAL (MALAISE, PANAS DINGIN), 2-3 HARI
– UKK-ERITEM, VESIKEL, MUDAH PECAH, EROSI,
PADA SEKITAR BIBIR
• SEKUNDER/REKUREN
– PADA LOKASI YG SAMA
– GEJALA LEBIH RINGAN
– LEBIH PENDEK WAKTU AKTIF
• DIAGNOSIS BANDING
• Stomatitis aftosa
• Pemfigus vulgaris
• Impetigo
• Dermatitis kontak
 TERAPI
• ASIKLOVIR 5 X 200 mg
• VALASIKLOVIR 2 X 500 mg
• FAMSIKLOVIR 3 X 250 mg

• Selama 5-7 hari

 BAKTERI
• PYODERMA
• IMPETIGO
• KUSTA
 IMPETIGO (SULUDEN)
• IMPETIGO BULOSA-STREP B HEMOLITIKUS
– LOKASI : TERUTAMA MUKA
– LESI: KRUSTA KUNING SPT MADU

• IMPETIGO KRUSTOSA-STAPH AUREUS

– LOKASI : DADA, PUNGGUNG
– LESI : KOLORET DASAR MERAH
• BISA BERDIRI SENDIRI, BISA
MENUMPANG PADA PENYAKIT YANG
ADA SEBELUMNYA….
Impetiginasi/infeksi sekunder
• BISA BERLANJUT MENJADI SSSS
(STAPFYLOCOCCAL SCALDED SKIN
SYNDROME)
• AWALNYA VESIKEL/BULA, TETAPI
ATAP SANGAT TIPIS  MUDAH
PECAH EROSI
 PYODERMA
• FOLIKULITIS
– terbatas pada folikel rambut
• FURUNKEL
– Folikel rambut dan jaringan sekitar
• KARBUNKEL
– Beberapa furunkel bergerombol
• EKTIMA
– Ulkus yg tertutup krusta lengket, tepi
ulkus meninggi,
• ERISIPELAS
– Eritema, batas tegas,
• SELULITIS
– Eritema, lebih dalam, batas tak tegas
• ERITRASMA
– o/ Corynebacterium, eritema pad lipatan,
• PARONIKIA
– Eritema, edema, bg proximal kuku
• TERAPI
– TOPIKAL
• ANTIBIOTIK
– GENTAMISIN
– ASAM FUSIDAT
– ASAM MUPIROSIN
– SISTEMIK
• ANTIBIOTIKA BROAD SPECTRUM(BILA PERLU)
– TINDAKAN
• KOMPRES
• INSISI
• DEBRIDEMENT
MORBUS HANSEN (KUSTA, LEPRA)
• PENYEBAB : MYCOBACTERIUM
LEPRAE
• BERBAGAI MACAM PEMBAGIAN
• DIAGNOSIS KLINIS MENURUT
WHO
– PAUCIBACILER
– MULTIBACILER
• Chronic infection disease
• Mainly affects the
– skin,
– peripheral nerves,
– mucosa upper respiratory tract,
– reticulo endothelial system,
– eye,
– bone ,
– testis,
– except central nervous system.
• M. leprae  TIDAK BISA DI KULTUR

PEMERIKSAAN BAKTERI : (LESI KULIT, CUPING

TELINGA, MUKOSA HIDUNG)
1. DIAGNOSIS
2. SPECTRUM
3. EVALUASI
4. PROGNOSIS
 DIAGNOSIS :
If shown one or more of the following cardinal
signs :
1. Hipopigmented or reddish skin lession with
definite loss of sensation
2. Involvement of the peripheral nerves, as
demonstrated by definite enlargement /
thickening peripheral nerves with loss of
sensation
3. Skin smear positive for Acid Fast Bacilli

No? ----- Observation for 3 – 6 months

 CLASSIFICATION
SPECTRUM

Ridley & TT BT BB BL LL
Jopling

MADRID Indeter- Tuber- Border- Lepromatous

minate culoid line

WHO Paucy Bacillar Multi Bacillar

( 1988 ) Leprosy Leprosy
 CLINICAL LEPROSY
Indeter- TT BT BB BL LL
minate
Infectious Infectiou Infectiou Infectiou Infectiou Infectiou
s s s s s
(-) (-) (-)
Children 2–3 Satelit Punch
lesion lesion Out
Hipopig- Macules Macules Dimor- Symetric Symetri-
mented / –hipopig- : phous al papul, cal
pink : mented hipopig- features nodules papul,
Face, mented and tend nodules
back, / reddish symmetr
buttock y
 CLINICAL LEPROSY
Indeter- TT BT BB BL LL
minate
Loss of (+) (+) (+) Sensory Stocking
sensation loss, and gloves
(-) decreases anesthesia
sweating and
hair growth
Nerve (+) (+) (+) Nerve Nerve
swollen (-) damaged damaged

Lepromin (+) 4 (+) 3 (+) 1 -2 (-) (-)

(-)
Acid Fast (-) (+) / (+) 3 (+) 3 - 4 (+) 5 - 6
Bacilli (-) (-)
 W H O ( 1997 ) :

• Paucibacillary Single Lesion Leprosy

(one lesion)
• Paucibacillary Leprosy (2-5 skin lesion)
• Multibacillary Leprosy (More than 5 skin
lesion)
 I. P B SINGLE LESION
CHILD ADULT

Rifampicin 300 mg Rifampicin 600 mg

Ofloxacin 200 mg Ofloxacin 400 mg

Minocycline 50 mg Minocycline 100 mg

Dosage : Single Dose R O M

 II. P B 2 – 5 SKIN LESION
CHILD ADULT
Monthly Treatment : Monthly Treatment :
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Dapsone 50 mg Dapsone 100 mg

Daily : Daily :
Day 2 – 28 Day 2 – 28
Dapsone 50 mg/daily Dapsone 100 mg/daily
Duration of treatment : 6 - 9 Months
 III. M B :
CHILD ADULT
Monthly treatment Monthly treatment
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Clofazimine 150 mg Clofazimine 300 mg
Dapsone 50 mg Dapsone 100 mg

Daily 2 – 28 : Daily 2 – 28 :
Clofazimine 50 mg / daily Clofazimine 50 mg / daily
Dapsone 50 mg / daily Dapsone 100 mg / daily
Duration of treatment : 12 – 18 months
 Manifestation of :
• 1. Reversal reaction
Mild Severe
Skin - Lesion become reddish - Same & rarely new skin lesion
& swollen - Fever, malaise
Nerve - Enlarge, painfull (-) - Enlarge, painfull (+)
- Nerve damage (-) - Nerve damage, loss sensation
- < 6 weeks - > 6 weeks
Skin & - Lesion become reddish - Same
Nerve - Painful on peripheral - Ulceration
nerves - Swollen on hand & foot
- < 6 weeks - Nerve enlarge
-- > 6 weeks
 2. E N L reaction
MILD SEVERE
Skin Skin nodules : Skin nodules >>
- Tender reddish - Painful
- Ulceration - Ulceration
- Fever & malaise
Nerve Enlarge Enlarge
Painful (-) Painful & swollen
Nerve damage (-) Nerve damage
Eye Not involvement Painful
Visual impairment
Testis Swollen, Painful (-) Painful, Enlarge
Skin, Same - Same
nerve, eye, - Very painful
testis - Fever
 TREATMENT of REACTION :
• Prednisone : 30 – 80 mg / daily and then tappering
off
• Continued M D T without interruption
• MILD REACTION :
- Immobilization
- Rest
• SEVERE REACTION :
Reffered to the nearest hospital
 PARASIT
• SCABIES
• PEDICULOSIS
• LARVA MIGRAN
 SCABIES (GUDIG)
• PENYEBAB : SARCOPTES SCABEI
• GEJALA-TANDA:
– GATAL TERUTAMA MALAM HARI
– DAERAH KULIT TIPIS
– PAPUL2 ERITEMA
– BANYAK PADA KONDISI ORANG BERKUMPUL DNG
JANGKA WAKTU LAMA
• TERAPI :
– TOPIKAL :PERMETRIN,
 LARVA MIGRAN
• PENYEBAB :
– NECATOR AMERICANUS
– ANCYLOSTOMA DUODENALIS
• GEJALA-TANDA :
– GATAL
– MEMBENTUK LINIER/GARIS ERITEMA YG
BERTAMBAH PANJANG 5mm/HARI
• TERAPI
– CHLOR ETHYL SPRAY
– THIABENDAZOLE
– ALBENDAZOLE 400mg PO atau
• 5% TOPIKAL
 PEDICULOSIS
• PEDICULOSIS(KUTU)
– PUBIS
– CORPORIS
– CAPITIS

• KLINIS
– GATAL
– MAKULA MERAH KEBIRUAN (MAKULA CERAULAE)
– DIKETEMUKAN PEDICULOSIS/LARVA/TELUR
• DD : SCABIES
• TERAPI
– PERMETRIN
– GAMMA BENZENE HEXACHLORIDE
– MALATHION
– CROTAMITON
– PYRETHRINE