INFECTION & INFECTIOUS DISEASE

I MADE SUSILA UTAMA

TROPIC AND INFECTIOUS DISEASE DIVISION
INTERNAL MEDICINE DEPT.
UDAYANA UNIV./SANGLAH HOSPITAL DENPASAR
Definition
Infection= microbial phenomenon characterized by
an inflammatory response to the presence of
microorganisms or the invasion of normally sterile
host tissue by those organisms.

Infectious diseases are caused by pathogenic

microorganisms, such as bacteria, viruses, parasites or
fungi; the diseases can be spread, directly or
indirectly, from one person to another

Zoonotic diseases are infectious diseases of animals

that can cause disease when transmitted to humans
Clinical Spectrum of Infection

Infection

Bacteremia

Sepsis

Severe Sepsis

Septic Shock
 Advanced stage of infection

• Septic
• Fever or hypotermia
• Delirium and decreased of consciousness
• Respiratory rate increased
• Pulse rate increased
• Septic shock
• Septic condition
• Hypotension
• Oligouria/Anuria
• Decreased of consciousness
• Multiple organ dysfunction syndrome
• Bleeding (DIC)
 Bacteremia
Other
Infection SIRS
Fungemia Sepsis Trauma
Parasite

Virus Burns
other
Pancreatitis

Crit Care Med 1992; 20:864

The process of infection
1. Attachment microbes to the target cell
2. Entry into the host cell (intracell pathogen )
3. Development of infection
• Local multiplication of the pathogen
• Spread of the microorganism to distant site
4. Shedding of the organism and transfer to a new
host
 THE CLINICAL MANIFESTATION OF INFECTIOUS
DISEASE AT PRESENTATION ARE MYRIAD

• FULMINANT LIFE THREATENING-BRIEF

• SELF LIMITED-INDOLENT CHRONIC
Sign and symptoms of infection

Local Systemic
•Fever •Fever
•Pain •Aches
•Redness •Chill
•Swelling
•Nausea
•Less of function
•Foul odor discharge •Vomiting
•Pus •weakness
 Non
INFECTION
Infection

Bacteria Mechanical Trauma

Virus, Neoplastic Diseases
Hematopoetic
Yeast, disorders
Parasites Vascular accidents
Immune diseases
Acute metab disor
Microbial structural components and toxins,
antigen-antibody complexes, complement
components, and probably other molecules (as yet
unidentified) are all capable of stimulating
leukocytes and endothelial cells to produce
pyrogenic cytokines, including:
Interleukin (IL)-1, IL-6, tumor necrosis factor,
interferon

These cytokines act on the hypothalamic

endothelium to elevate the thermoregulatory set
point, thus causing fever
PROCEDURE CLINICAL DIAGNOSTIC OF
INFECTION

1. ANAMNESIS
2. PHYSICAL EXAMINATION
3. LABORATORIUM, RADIOLOGY
ANAMNESIS

• personal history
• Age
• Occupation
• Place of origin,Travel History
• Habits
• Sexual Practices
• Injection Drug Abuse
• Excessive Alcohol Use
• Consumption of Unpasteurized Dairy Products
•Underlying Diseases:
• Splenectomy
• Surgical Implantation of Prosthesis
• Immunodeficiency
• Chronic Diseases:
• Cirrhosis
• Chronic Heart Diseases
• Chronic Lung Diseases
•Drug History:
•Antipyretics
•Immune suppressants
•Antibiotics
•Family History:
•TB in the Family
•Recent Infection in the Family
Associated Symptoms:
• Shaking chills
• Ear pain,Ear drainage,Hearing loss
• Visual and Eye Symptoms
• Sore Throat
• Chest and Pulmonary Symptoms
• Abdominal Symptoms
• Back pain, Joint or Skeletal pain
PHYSICAL EXAMINATION

• Vital Signs
• Neurological Exam.
• Skin Lesions,Mucous Membrane
• Eyes
• ENT
• Lymphadenopathy
• Lungs and Heart
• Abdominal Region (Hepatomegaly,Splenomegaly)
• Musculoskeletal
LABORATORY STUDIES

•Assess the extent and severity of the

inflammatory response to infection
•Determine the site(s) and complications
of organ involvement by the process
•Determine the etiology of the infectious
disease
LABORATORY EXAMINATION PANEL
 Urine (Refractometri)
 CBC (Flowcytometri)
 Malaria (Microscopy, rapid)
 Widal and Gaal culture
 IgG & IgM anti Dengue (Immunochromatography)
 Serum Transaminase (IFCC)
 CRP (Immunoturbidimetry)
LABORATORY INVESTIGATIONS

•MICROBIOLOGY
•PARASITOLOGY
•PATHOLOGY ANATOMY
RADIOLOGY

-X-RAY
-ULTRASONOGRAPHY
-CT-SCAN
-MRI
PATTERNS OF FEVER (1)

INTERMITTEN
TEMPERATUR ELEVATION RETURN TO NORMAL AT
LEAST ONCE DURING MOST DAYS
(Abscess, Gonokokus endokarditis, Malaria Falciparum)

REMITTEN
FEVER DO NOT RETURN TO NORMAL EACH DAYS
(Tuberculosis, endocarditis ,typhoid fever)
PATTERNS OF FEVER (2)
CONTINUOUS
FEVER VARIES LESS THAN 1 °C (1,8 ° F) OVER
SEVERAL DAYS
(Encephalitis, Drug fever, typhoid, Factitious
Fever,Pneumonia Pneumokokus)
RELAPSING FEVER
RECCURENT OVER DAYS OR WEEKS
(Relapsing fever, lymphoma –Pel Ebstein fever,
malaria tertian or quartan, brucellosis)
PATTERNS OF FEVER (3)

BIPHASIC
RECURS ONLY ONCE
(Leptospirosis, Dengue, Colorado tick fever,
lymphocytic chorio menigitis)

@Elsevier 2004 Infectious diseases. 2e

www.idreference.com
 Pemeriksaan untuk
diagnosis demam akut

Darah Lengkap
Urine Lengkap
(Flowcytometri)
(Refraktometri)

hsCRP RADIOLOGY Malaria

(Immunoturbidimetri) IMAGING

IgM dan IgM anti DHF

Serum Transaminase
(Immunochromatography)
(IFCC)

Widal atau
IgM anti Salmonella Typhi
dan Gaal Cultuur

26
UL: UTI ? CBC : ?
LEUCOCYTE ++ LOW WBC  VIRAL DISEASE
BACTERIA ++ LOW PLT  VIRAL/SEVERE
NITRITE ++ BACT
HIGH WBC  BACTERIAL OR
LEUCEMIA : CML, CLL, AML, ALL

MALARIA : DIFFERENTIAL COUNT :

NEUTROPHYL
SMEAR : EOSINOPHYL
THICK/THIN LYMPHOCYTE
MONOCYTE
RAPID TEST
SUMARRY

•Infectious diseases are caused by pathogenic

microorganisms, such as bacteria, viruses, parasites
or fungi; the diseases can be spread, directly or
indirectly, from one person to another
• Clinical diagnosis of infection and infectious disease
based on history taking, physical examination and
laboratory, imaging
Thank you