DD demam 7 hari lebih

7/23/2019 DD demam 7 hari lebih

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DIFFERENTIAL DIAGNOSIS

DEMAM LEBIH DARI 7 HARI

Ro Rabian Rein Roza T.



Guidelines

• Harrison’s rin!i"les o# In$ernalMedi!ine %&$' edi$ion

•

Di(eren$ial Dia)nos$i!s o# Fe*er #ro+ Tro"i!s and Sub$ro"i!s, De"ar$+en$o# Tro"i!al Medi!ine , -'arlesni*ersi$/, Hos"i$al Bulo*0a

• An$ibio$i!s Guidelines 12%3 4 12%& 5o'ns Ho"0ins Medi!ine



O*er*ie6

• De+a+

• Di(erensial Dia)nosis De+a+ 7

'ari• en/a0i$ 4 "en/a0i$ /an)

ber'ubun)an den)an de+a+ 7'ari



De+a+

• De+a+ adala' "enin)0a$an su'u $ubu' /an)+elebi'i su'u nor+al dan $er8adi a0iba$"eruba'an dari se$ "oin$ 'i"o$ala+us, !on$o'n/adari 97 4 9:-

• Hi"er$er+ia adala' "en)a$uran /an) $ida0beruba' dari "usa$ $er+ore)ulasi ;'i"o$ala+us<dan $er8adi a0iba$ "enin)0a$an su'u $ubu' /an)$ida0 $er0on$rol /an) +elebi'i 0e+a+"uan $ubu'un$u0 +en)eluar0an "anas.

• Di0a$a0an de+a+ bila su'u = Re0$al 9>º-

Oral 97.&

A0sila 97.9



a$o?siolo)i De+a+



Ana+nesis De+a+

• Riwayat bepergian@ Proflaksis@ Obat – obatan

@ Diet@ Kontak seksual@ Alergi

@ Masalah kesehatan@ Pekerjaan@ Riwayat keluarga



e+eri0saan Fisi0 De+a+

@ uli$4e0san$e+a, 'e+or'a)ia, i0$erus, ede+a

@ Ma$a

4i0$erus, ane+ia

@ elen8ar Ge$a' Benin)

4lo0al, )eneralisa$a@ Tanda "eran)san)an +enin)eal

4sa0i$ 0e"ala, +un$a', $re+or

@ Ten))oro0an@ Dada

@ He"a$o+e)ali dan S"leno+e)ali



Labora$oriu+• T'i!0 and $'in blood ?l+

• Blood !ul$ure

• Blood !oun$ di(eren$ial !oun$

• -CRea!$i*e ro$ein

• -'es$ 4 Ra/

• rine !ul$ure

• Serolo)/

• -R

• Lu+bal un!$ion



DIFFERENTIAL DIAGNOSISDARI DEMAM 7 HARI

MN Menin)0a$ MN Tida0Menin)0a$Ge8ala Fo0al In#e0si Sis$e+i0

Bron0o"neu+onia TB aru

ielone#ri$is-'olan)i$is,-'olesis$i$isan!rea$i$isMenin)i$is "urulen Tonsili$is

Di#$eriDisen$ri basilerAbses "io)eni0A""endisi$isioder+aLi+#adeni$is

O$i$is

Se"sisEndo0ardi$is

Le"$os"irosis

EOSINOFILIA =

FilariasisS!'is$oso+iasis Tri!'inellosis-/s$i!er!osis

In#e0si virus =-a+"a0 dan

e0san$e+a a0u$ lainHe"a$i$is *iralDe+a+ den)ue a$auDBDHIIn#e0si bakteri =

Ri!0e$$siosisDe+a+ $i#oidIn#e0si Protozoa =Malaria Tri"anoso+iasisLeis'+aniasis

Too"las+osis

FEER ITH LO-ALIING SIGNS ON



FEER ITH LO-ALIING SIGNS ONEAMINATION AND ITH NETROHIL

LEO-TOSISSigns an sy!pto!s Disease "nvestigations

D/s"noe, !ou)',"leuri$i! "ain,dis!oloured s"u$u+

Ba!$erial "neu+onia -'es$ CRa/, S"u$u+!ul$ure

Se*ere sore $'roa$S$re"$o!o!!al $onsili$is,di"'$eria

-ul$ure

FreJuen!/, d/suria, loin

"ain

/elone"'ri$is, TI rine !ul$ure

Heada!'e, ne!0 s$i(ness Ba!$erial +enin)i$is Lu+bal un!$ion, !ul$ure

Ear se!re$ion, 'eada!'e O$i$is Ear !ul$ure

Blood/ diarr'ea Ba!illar/ d/sen$er/ S$ool !ul$ure

ain and s6ellin) a$ 8oin$ Se"$i! ar$'ri$is 5oin$ as"ira$ion

Bone "ain ;6orse a$ni)'$<

Os$eo+/eli$is 4 Ra/, -T S!an

L/+"'adeno"a$'/ Abs!ess -ul$ure, serolo)/

-u$aneous inKa++a$ion Er/si"elas, !ellulli$is -ul$ure

-'roni! !ou)' #or 6ee0s or blood ins"u$u+

TBMan$ou, A!id 4 Fas$

s$ain



Des#ription Disease $tiology

Dis!re$e lesions $'a$be!o+e !onKuen$ as ras's"reads #ro+ 'airlinedo6n6ard, o"li0’s s"o$s,

las$s 9 da/s

MeaslesRubeola ara+/o*irus

Nons"esi?! di(use+a!ules and "a"ules,oral or )eni$al ul!ers,"'ar/n)i$is, adeno"a$'/

ri+ar/ HI In#e!$ions HI

Ma!ulo"a"ular eru"$ion,

i!$ero'e+orr'a)i! #e*er,e"osure $o 6a$er!on$a+ina$ed 6i$'ani+al urine

Le"$os"irosis Leptospira interrogans

-oa$ed $on)ue,abdo+inal "ain, diarr'ea,

'eada!'e, +/al)ia

T'/"'oid #e*er Salmonella typhii

Ras', 'eada!'e,leu0o"enia, bi"'asi!#e*er, "e$e!'iae

Den)ue #e*er Den)ue *irus

Bu$$erK/ ras', +alarras', s/s$e+i! disease

SLE Au$oi++une disease

"ri+ar/ !'an!re in %2o# !ases !o""erC!olored,



Des#ription Disease $tiology

Tender "in0 nodules on?n)er or $oe "ads,abnor+al 'ear$ *al*e,+ur+ur

Ba!$erial Endo!ardi$isS$re"$o!o!!us,S$a"'/lo!o!!us

Ma!ules ;149 ++<e*ol*in) in$o "a"ules,$'en *esi!les ;so+e$i+esu+bili!a$ed<, on aner/$'e+a$ous base"us$ules $'en #or+in)

and !rus$in)

ari!ella

ruri$i! "a"ule enlar)in)ande*ol*in) in$o a %C b/ 9C!+"ainless ul!er surroundedb/*esi!les and $'ende*elo"in) a!en$ral es!'ar 6i$'ede+a, e"osure $oin#e!$ed ani+als

An$'ra Bacillus anthracis



• T'e "ro!esses o# 'ea$ !onser*a$ion ;*aso!ons$ri!$ion< and'ea$ "rodu!$ion ;s'i*erin) and in!reased +e$aboli!a!$i*i$/< !on$inue un$il $'e $e+"era$ure o# $'e bloodba$'in) $'e '/"o$'ala+i! neurons +a$!'es $'e ne6$'er+os$a$ se$$in). On!e $'a$ "oin$ is rea!'ed, $'e'/"o$'ala+us +ain$ains $'e $e+"era$ure a$ $'e #ebrilele*el b/ $'e sa+e +e!'anis+s o# 'ea$ balan!e $'a$ areo"era$i*e in $'e a#ebrile s$a$e. 'en $'e '/"o$'ala+i! se$"oin$ is a)ain rese$ do6n6ard ;due $o ei$'er a redu!$ion in$'e !on!en$ra$ion o# "/ro)ens or $'e use o# an$i"/re$i!s<,$'e "ro!esses o# 'ea$ loss $'rou)' *asodila$ion and

s6ea$in) are ini$ia$ed. Loss o# 'ea$ b/ s6ea$in) and*asodila$ion !on$inues un$il $'e blood $e+"era$ure a$ $'e'/"o$'ala+i! le*el +a$!'es $'e lo6er se$$in).

-ON-LSION



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DD demam 7 hari lebih