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FEVER
GROUP 14
• MUNAWWARAH : 110 2015 0004
• INNAL HAMDA : 110 2015 0019
• ROSMIATI : 110 2015 0032
• DIAN YUSTIKARINI : 110 2015 0046
• ARIDAYANA : 110 2015 0063
• REZKY DARMAWAN ARIFIN : 110 2015 0067
• TARNI RESTAMI RUSTAM : 110 2015 0074
• SRI ARIATNA DEWI : 110 2015 0075
• PRATIWI YUNIAR : 110 2015 0086
• FUAD ALAMSYAH : 110 2015 0113
Scenario
Male, 41 years old, Signed into hospital emergency room
with fever since 5 days ago. Sudden fever, height and persistence.
burning feeling throughout the body and not decreasing with the
provision of febrifuge. Chills and skin and yellowing eyes since 3
days ago, the color of his urine turned into brownish yellow like
tea, body limp and pain all over his body since 2 days ago and did
not improve with rest. Vomiting blood since 6 hours ago
frequency 2 times
Keyword
• Male, 41 years old Signed into hospital emergency room with
fever since 5 days ago.
• Sudden fever, height and persistence.
• burning feeling throughout the body and not decreasing with
the provision of febrifuge
• Chills and skin and yellowing eyes since 3 days ago
• the color of his urine turned into brownish yellow like tea
• body limp and pain all over his body since 2 days ago and did
not improve with rest.
• Vomiting blood since 6 hours ago frequency 2 times
Question
1. What’s the definition of fever and explain about the
classification!
2. How’s the pathomechanism of fever?
3. How’s the pathomechanism of jaundice?
4. How’s the pathomechanism of brownish yellow urine?
5. How’s the pathomechanism of vomiting blood?
6. How’s the pathomechanism of chills?
7. Explain about tropical disease that causing fever!
8. Why the fever is not decreasing by using anti fever?
9. What are the differential diagnose?
10. Explain about the step of diagnose!
11. How to prevent the disease?
1.What's the
definition of fever
and classification?
• Fever is an increase in body temperature from the normal
daily temperature variations
which is associated with increasing the temperature point in
the hypothalamus
(Dinarello & Gelfand, 2005).
• Normal body temperature ranges from 36.5 to 37.2 ° C.
The degree of temperature that can be said to be fever is a
rectal temperature ≥38.0 ° C or oral temperature ≥37,5 ° C or
axillary temperature ≥37,2 ° C (Kaneshiro &
Zieve, 2010).
CLASSIFICATION
Hectic fever
Cyclical
Septic fever
Fever
Continuous Remiten
Fever fever
Intermittent
fever
2. How’s the
pathomecanism of
fever?
exogenous pyrogens and endogenous pyrogens
• Classification:
Prehepatic: hemolysis in increased due to an increase in the
number of hemoglobin in the blood due to ineffective
erythropoiesis and circumstances after blood transfusion
Intrahepatic: acute viral hepatitis, cirrhosis
Posthepatic: obstruction of the bile ducts that can be caused by
gallstones, and tumors
4. How’s the
pathomechanism of
brownish yellow
urine?
5.How the
pathomecanism of
vomiting blood?
gastric Vomitus that
inflammation contains blood
increased
structural lesion of parasympathetic
GI nervous system
activity
bleeding from a
motility disorders source proximal to
of the small bowel the ligament of
Treitz
6. How the
pathomecanism of
chill?
the release of cytokines
increases the set point
and prostaglandins as
inflammatory diseases for body temperature
part of the
in the hypothalamus
inflammatory response
References
Stan Tian (2015-04-30). "The Main Flu Symptoms Fever, Aches and Chills". Healthguidance.org. Retrieved 2016-05-12.
7. Explain about
tropical disease that
causing fever!
• Infectious diseases by bacteria :
TBC (Tuberculosis)
Diphtheria
Pertussis
Tetanus Neontorum
Typhoid Fever
Leprosy
Anthrax
Leptospirosis
• Infectious diseases by virus:
DBD (Dengue Fever)
Chikungunya
Measles
Hepatitis
Rabies
HIV-AIDS
Chickenpox
Avian influenza
Polio
• Infectious diseases by parasite:
Malaria
Filariasis
8. Why the fever is
not decreasing by
using anti fever?
Fever not decrease
with anti fever
The patient didn’t follow of the doctor instruction
The drug only treat the symptoms
Physical condition
Pathological factor
Genetic factor
Tolerance factor
9. What are the
differential diagnose?
LEPTOSPIROSIS
Definition
• Leptospirosis is a zoonotic disease caused by a spiral and
active-moving microorganism called Leptospira. The disease is
known by various names such as Mud fever, Slime fever
(Shlamnfieber), Swam fever, Autumnal fever, Infectious
jaundice, Field fever, Cane cutter and others
• Leptospirosis or jaundice is an important disease in humans,
rats, dogs, pigs and cows. The disease is caused by spirochaeta
leptospira icterohaemorrhagiae that lives in the kidney and
urine of mice.
Etiology
The genus Leptospira, the treponemataceae family, a spirochaeta
microorganism
Typical convoluted, thin, flexible, 5-15 um long, very fine spiral, 0-
1-0,2 one end is swollen to form a bundle
Moving active rotation, no foundation flagella Microscope dark
field chain of small coccus
L. icterohaemorrhagica (rat reservoir)
L. canicola (dog reservoir)
L. ponoma (reservoir of cattle and pigs)
Epidemiology
• Spread throughout the world (mostly in the tropics)
• It is found in dog pets, pigs, cattle, horses, cats, guinea pigs,
rodents, rodents Squirrels, weasels, bats,
• Living in kidney / urine
• Seasonal, temperate climates of peak incidence in summer
and fall, tropical climates peak incidence in the rainy season
Transmission
• Contact with groundwater, or mud contaminated with the
urine of infected animals
• Infection occurs when there is wound / erosion of the skin
and mucous membranes
• The bite of an infected animal
• Contact with culture (laboratory)
• Long exposures to puddles contaminated with intact skin
Pathophysiology
• Infectionleptospires appear in the blood invade all
tissues and organs particularly affecting the liver and
kidneycleared from the body by the host's immune
response
• May also settle in the convoluted tubules of the
kidneysshed in the urine for a few weeks to several months
or longer
• Subsequently cleared from the kidneys and other organs (may
persist in the eyes for much longer)
• Produces endotoxinattach onto the endothelial
cellscapillary vasculitis (endothelial necrosis and
lymphocytic infiltration)
• Vasculitis and leakagepetechiae, intraparenchymal bleeding
and bleeding along serosa and mucosa
• Lost of fluids into the third spacehypovolaemic shock and
vascular collapse
• • Humans react to an infection by producing specific anti-
Leptospira antibodies
• • Seroconversion
• – as early as 5–7 days after the onset of disease
• – sometimes only after 10 days or longer
• – IgM appear somewhat earlier than IgG and generally remain
detectable for months or even years but at low titre.
• Humans react to an infection by producing specific anti-
Leptospira antibodies
• • Seroconversion
• – as early as 5–7 days after the onset of disease
• – sometimes only after 10 days or longer
• – IgM appear somewhat earlier than IgG and generally remain
detectable for months or even years but at low titre.
Clinical manifestation
Leptospirosis has two distinct phases
namely the leptospiremia phase and the immune phase.
Phase leptospiremia
- Headaches are usually on the frontal
-Severe muscle pain, especially thigh, calf, and waist with
tenderness
-Mialgia
-High fever
-Shivering
-Nausea, with or without vomiting
-Jaundice
-Rash is macular to the skin
Immune phase
-The fever reaches a temperature of 40 C
-Shivering
-Complete pain in the neck, stomach and muscles
-There is bleeding in the form of epitaxis
-Symptoms of damage to the kidneys and liver
-Uremia
-Jaundice
-Purpura
-Petechiae
Therapy
Mild leptospirosis
• Doksisiklin peroral 2x100mg
• Ampisilin 500-750mg 4 x a day
• Amoksisilin 500mg 4 x a day
Severe leptospitosis
• Penisilin G iv or
• Ampisilin 4x1 gram
• Amoksisilin 4x1gr
• Eritromisin 4x500 mg
• Kemoprofilaksis
• Doksisiklin 200mg/week
Prognosis
If there is no icterus, the disease is rarely fatal. In cases with
icterus, the mortality rate is 5% in under 30 years of age, and in
elderly people reaching 30-40%
HEPATITIS
DEFINITION
Hepatitis is a diffuse inflammatory process in liver cells.
Hepatitis A is hepatitis caused by infection Hepatitis A Virus
ETIOLOGY
Hepatitis A is caused by hepatitis A virus. This virus includes
viruses RNA, single fiber, with molecular weight 2.25-2.28 x 106
dalton, symmetry icosahedral, diameter 27-32 nm and has no
sheath. Have VPg terminal protein at its 5'end and poly (A) at its
3'end. Long HAV genome: 7500-8000 base pairs. Hepatitis A virus
can be classified in the picornavirus family and the hepatovirus
genus.
Transmission of Hepatitis
• The disease is fecally-oral-transmitted from food and drink
infected
• Can also be transmitted through sexual intercourse
• The incubation period of the disease is 14-50 days, with an
average of 28 days
EPIDEMIOLOGY
• An estimated 1.5 million clinical cases of hepatitis A occur
throughout the world every year
• Seroprevalence of hepatitis A virus varies from several countries in
Asia
• In countries with moderate endemicities such as Korea, Indonesia,
Thailand, Sri Lanka and Malaysia
• Hepatitis A is still a health problem in the country growing like
Indonesia
Pathogenesis of Hepatitis A
Virus
CLINICAL SYMPTOMS
Symptoms of hepatitis acute divided into 4 stages:
Incubation phase. It is the time between the entry of the virus and
its incidence symptoms or jaundice. On hepatitis A incubation
phase can last for 14-50 days, on average 28-30 days.
Prodromal phase (pre-jaundice). Phase between the occurrence of
complaints first and onset of jaundice. The onset can be brief or
insidious characterized by general malaise, muscle pain, joint pain,
fatigue, symptoms upper respiratory tract and anorexia
COUNTINOUS
• The Jaundice Phase. Jaundice appears after 5-10 days, but may also
appear along with the appearance of symptoms
• Convalescent phase (healing). Beginning with the disappearance
jaundice and other complaints, but hepatomegaly and
abnormalities of liver function remain there is. Circumstances acute
will usually improve within 2-3 weeks.
\
CLINICAL DIAGNOSIS
Anamnesis
• Jaundice • Stained feces
• The color of urine is like tea • Nausea and vomiting
• Fever • Muscle and joint pain
• Decreased appetite
• Headache
• Anoreksi
Physical Examination
Jaundice (skin and sclera yellowing), urine dark color
Supporting investigation
Urine laboratory test: urinary and bilirubin urobilinogen, total
and direct serum bilirubin, ALT and AST, ALP, prothrombin time
(PT), total protein, serum albumin, IgG, IgA, IgM, and Complete
blood cell count.
PREVENTION
• Diligent hand wash
• Passive immunization with normal immunoglobulin
• Active immunization with dead vaccine
MANAGEMENT
• supportive therapy
• high-calorie diet
• cessation of treatment at risk of hepatotoxic
• restriction of alcohol consumption
Yellow Fever
Yellow fever is a viral disease transmitted to humans
by mosquitoes in certain parts of South America and
Africa. Symptoms of infection include sudden fever,
chills, sore muscles, backache, headache, nausea and
vomiting not until six days after the virus enters the
body. After three to four days most patients recover
and the symptoms disappear.
Epidemiology
• Yellow fever is found in
tropical forests of Africa
and southern American
Asia there has never been
a reported case of yellow
fever but it is still at risk
• because suitable primates
and mosquitoes as
vectors are found widely.
Transmission
Liver and
mouth spleen
fever
Disturbance of the gastrointestinal tract
Disturbance of consciousness
Diagnosis of typhoid fever
Extraintestinal complications
• Haemolytic anemia
• Thrombosis
• Pneumonia
• Hepatitis
• Meningitis
• Delirium
Definition of Malaria
Mal :Bad
Malaria
Area :Air
Plasmodium
• causes malaria ovale or malaria tertiana benign ovale.
ovale
Plasmodium
• causes malaria malariae or quartan malaria.
malariae
a young tropozite form of plasmodium The shape of the Plasmodium
falciparum falciparum schizon
• The patient feels very cold cold, so it shivers. The pulse is fast but weak, the lips and fingers are
blue, the skin is dry and pale. Usually found in children seizures. This stage lasts 15 minutes to 1
hour.
cold
• Patients sweat a lot until wet, the temperature drops drastically even below normal threshold.
Patients usually can sleep soundly and when awake feeling weak but healthy. This stadium lasts 2
Sweating to 4 hours
Classification of malaria epidemiology
using spleen rate parameters (spleen
rate) or parasite rate (parasitic
number), as follows:
• Black
water • Algid
Complications fever malaria
Malaria Disease Malaria can lead to several
complications, including:
Malaria Therapy