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
Tes Darah Rutin pada Penyakit
Infeksi Tropis
Lekopeni
Netropeni, mis Demam Tifoid, brucellosis Infeksi hebat netropeni hebat prognosis buruk Perubahan
morfologik pd
sepsis
Döhle bodies Granula toksik vakuolisasi Eosinofilia :
non-bakterial,
Tes Darah Rutin pada Penyakit
Infeksi Tropis
Anemia
bisa timbul sekalipun cadangan besi
cukup.
Anemia akut:
perdarahan/ destruksi eritrosit (misalnya
cold agglutinin sehubungan dengan
Mycoplasma pneumoniae),
Anemia kronik, dengan
cadangan besi yang normal atau meninggi di
sistem retikuloendotelial
penurunan besi dalam plasma serta
Tes Darah Rutin pada Penyakit
Infeksi Tropis
Infeksi serius + bakteriemia
Gram negatif DIC. (Gram pos jarang)
Trombos
PT memanjang
FDP
Fibrinogen
Trombosiopenia
bisa juga menjadi tanda sepsis bakterial dan
bisa bermanfaat dalam mengobservasi respon
pasien terhadap terapi.
Lab Examinations in Dengue Fever
(DF)
Laboratory findings
Hematology Leukopenia Thrombocytopenia serum aminotransferase (AST, ALT) elevations. The diagnosis is made by Lab Tests
seroimmunology
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
Lab Examinations in Dengue Fever
(DF)
Hemagglutination Tests
Virus + Eri angsa
agglutinasi Tes
Negatif
Virus + serum (ada atb spesifik)
tidak
aglutinasiTes Positif
Virus + Eri + serum (tanpa atb
Lab Examinations in Dengue Fever
(DF)
In
terp
retasi
Specimen
1
Specimen
2
Interpretation
Pre 4th d
< 1:20
Post 1-4
wk
4x
<1:1280
1mary
Dengue
Pre 5th d
<1:20
<1:20
>1:2560
4x
2ndary
Dengue
Pre 7th d
> 1:1280
4x not
needed
Presumptive
S 2ndary
Dengue
Lab Examinations in Dengue Fever
Complement Fixation
Test
Ag+[serum,Ab pos]+ Complcomplement fixed+RBC(sheep)un lysed : Pos test Ag+[serum,Ab neg]+ Complcomplement un fixed RBC(shee)
lysed : Neg test
Ag S Ab K RBC Pos Neg
May 29, 2013 10
Dengue Hemorrhagic Fever (General)
Tes Lab:
2.ELISA (capture
method)
1.Anti-dengue IgM
Infeksi primer,
akut 7-10 hr
2.IgG (post/kronik)
Infeksi
sekunder,
sesudahnya
Hasil
Interpretasi
IgG IgM
+ +
D sekunder
-
+
D primer
+
-
Duga D
sekund
-
-
Non-D
Primer
sangat dini
DHF pada Anak
In dengue
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.
DHF pada Anak
In dengue hemorrhagic fever
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.
DHF pada Anak
WHO clinical criteria for diagnosis of dengue
hemorrhagic fever:
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.
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
Seroconversion Increase
Direct immunofluoroscent antibody slide tests (rapid diagnosis)
Tzanck preparation
Base of lesions
Herper Zoster
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
Mumps
Darah
Lekopeni
Serum amilase dlm 10 hari Serologi
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
Biakan
Virus dari ludah 1-5 hari
Komplikasi
Inflamasi testis/ ovarium: lekositosis, LED
Pankreatitis: lekositosis, amylase, hiperglikemia Meningitis: sel LCS < 500/L, mononuclear; glukose
Morbilli (Measles, Rubeolla)
Temuan laboratorium
Darah
Lekosit
, terutama limfo & segmen
lekositosis
superinfeksi bakterial
Serologi: EIA
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
Varicella
Tes lab yang bisa dilakukan
Sediaan apus
Bahan: kerokan dasar vesikel
Pulasan: Tzank
Multinucleated Giant Cells
Sensitivitas
60%
Darah
Serologi:
Titer atb serum konvalesen 4x dpd serum akut Hemaglutinasi
Elisa Fama
HIV/ AIDS
HIV antibody detected by a
two-step technique:
ELISA as a sensitive screening test
Confirmation of positive ELISA
tests with the more specific
Western blot technique
Molluscum Contagiousa
Giemsa-stained
shows inclusion bodies within many
Verruca Vulgaris
DNA typing:
circular-doubel-stranded, 8000 bp
Cross-hybridization
> 50% : type seperation
< 50%: subtype seperation
Impetigo/ Pyoderma
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
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
club-shaped organisms, appear as
Polio
CSF:
Aseptic meningitis
Elevated WBCs
Elevated protein
Normal glucose
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
Kolera
Isolasi vibrio cholerae dari bahan
tinja
identifikasi serogroup 01 atau
139
Serologi:
tes agglutinasi menggunakan
Salmonellosis/ Typhoid Fever
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
.Salmonellosis/ Typhoid Fever
Other nonspecific laboratory results
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.
Salmonellosis/ Typhoid Fever
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.
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
Disentri basiler/ Shigellosis
Jumlah Lekosit: , Normal atau
Serologi: bisa, jarang bermanfaat
Tinja:
