FARIDA OESMAN DEPARTMENT OF CLINICAL PATHOLOGY FACULTY OF MEDICINE, UNIVERSITY OF INDONESIA
TYPHOID FEVER DENGUE FEVER MALARIA LEPTOSPIROSIS
NOT SPECIFIC DEFINITIVE HOST RESPONSE HEMATOLOGY ACUTE PHASE PROTEIN SEROLOGY SPECIFIC ANTIBODY ANTIGEN DETECTION MICRO- ORGANISM CULTURE PCR COMPLICATION SCREENING CONFIRMED DIAGNOSIS
GRAM NEGATIVE BACTERIA >1700 SEROTYPES 100 ARE PATHOGENIC TO HUMAN MOST COMMON IS S.typhi
SERO SERO O H Ag H Ag GROUP TYPE ANTIGEN PHASE 1 PHASE 2 A S paratyphi A 1, 2,12 a 1, 5 B C D S paratyphi B S paratyphi C S typhi 1, 4, 5, 12 6, 7 9, 12 b c d 1, 2 1, 5 -
SECONDARY BACTEREMIA PRIMARY BACTEREMIA
COMPLETE BLOOD COUNT HEMOGLOBIN NORMAL, ANEMIA LEUCOPENIA, LEUCOCYTOSIS THROMBOCYTE NORMAL, THROMBOCYTOPENIA BLOOD FILM NEUTROFILIA
GOLD STANDARD IN BLOOD, BM, URINE, STOOL POSITIVE CONFIRMED DIAGNOSIS NEGATIVE NOT EXCLUDE DIAGNOSIS LOW SENSITIVITY TIME SPECIMEN COLLECTION PRESENCE OF ANTIBIOTIC
LOW SPECIFICITY CRUDE ANTIGEN WIDAL HIGH SPECIFICITY PURIFIED ANTIGEN TYPHI DOT (OMP) ELISA (LPS) TUBEX (LPS O9)
SOMATIC (O) FLAGELLA (H) APPEAR DAY 6-8 APPEAR DAY 10-12 DISAPPEAR WITHIN 6-12 MONTHS PERSIST SEVERAL YEARS
POSITIVE TYPHOID/PARATYPHOID INFECTION PREVIOUS IMMUNIZATION REPEATED EXPOSURE TO S.typhi IN ENDEMIC AREA CROSS REACTION WITH ENTEROBACTERIACEA ANAMNESTIC REACTION
NEGATIVE NOT EXCLUDE TYPHOID FEVER EARLY ANTIBIOTIC TREATMENT IMMUNOSUPRESSIVE DRUG DEFECT OF ANTIBODY SYNTHESIS MALNUTRITION IMMUNODEFICIENCY MALIGNANCY EARLY SPECIMEN COLLECTION
SINGLE SERA PAIRED SERA ENDEMIC AREA 10-14 DAYS ESTABLISHED TITER IN POPULATION INCREASED TITER 2-4 TIMES
TO LPS T INDEPENDENT TO LPS-PEPTIDE T DEPENDENT
SENSITIVE IMMUNODOMINANT & ROBUST IMMUNOGENIC IN INFANT EARLY DETECTION POTENT B CELL MITOGEN T INDEPENDENT SPECIFIC ONLY IN GROUP D SALMONELLA
% positive 100 90 80 70 BLOOD AGLUTININ 60 50 STOOL 40 30 URINE 20 10 0 1 2 3 4 5 6 7 8 Week
GENUS FLAVIVIRUS 4 SEROTYPE DENV 1-4
DENGUE VIRUS SECONDARY INFECTION HETEROLOG DENGUE VIRUS IMMUNE COMPLEXES HETEROLOG DENGUE VIRUS NON NUTRALIZING Ab COMPLEMENT ACTIVATION INCREASED PERMEABILITY CAPILER PLATELET AGGREGATION ENDOTHELIAL CELL DAMAGED PLASMA LEAKAGE DSS DECREASED PLATELET COAGULATION ACTIVATION DIC
COMPLETE BLOOD COUNT HEMOGLOBIN NORMAL, ANEMIA LEUCOPENIA TO MILD LEUCOCYTOSIS THROMBOCYTOPENIA INCREASED HEMATOCRIT 20% BLOOD FILM NEUTROPENIA ATYPICAL LYMPHOCYTE COAGULATION POSITIVE RUMPELL LEEDE, D-DIMER PROLONGED BT, PT & APTT DECREASES FIBRINOGEN
PRIMARY INF SECONDARY INF
POSITIVE PRIMARY/SECONDARY INFECTION CROSS REACTION WITH OTHER FLAVIVIRUS NEGATIVE NO INFECTION EARLY INFECTION IMMUNOCOMPROMISED
IgG(-)IgM(+) IgG(+)IgM(+) IgG(+)IgM(-) ACUTE PRIMARY INFECTION ACUTE PRIMARY INFECTION ACUTE SECONDARY INFECTION SECONDARY INFECTION CROSS REACTION WITH OTHER FLAVIVIRUS
POSITIVE PRIMARY INFECTION SECONDARY INFECTION NEGATIVE NO INFECTION LATE INFECTION (>5 DAYS)
SUSPECT DENGUE INF UNKNOWN 5 DAYS NS1 Ag DAYS AFTER ONSET OF FEVER IgM & IgG > 5 DAYS POS CONFIRMED EARLY ACUTE INF NEG IgM POS DENGUE INF OTHER FLAVI- VIRUS INF NEG DENGUE INF UNLIKELY IMMUNOCOMPROMISED POS PRESUMABLY EARLY ACUTE INF NEG EARLY ACUTE INF IS UNLIKELY
COMPLETE BLOOD COUNT HEMOLYTIC ANEMIA LEUCOPENIA THROMBOCYTOPENIA BLOOD FILM RELATIVE MONOCYTOSIS CHEMISTRY MODERATE INCREASED AST, ALT
LOW SENSITIVITY MICROSCOPIC PARASITEMIA <0.01% SEROLOGY ANTIGEN DETECTION POLIMERASE CHAIN REACTION
Indeks Spesimen vs Angka Postip 2500000 2000000 15 0 0 0 0 0 10 0 0 0 0 0 500000 S P ECIMEN P OSITIV E 0 19 9 7 2001 S P ECIMEN 2484558 12 10 5 3 0 P OSITIV E 14 9 4 7 86277
HISTIDINE RICH PROTEIN 2 (HRP 2) PRODUCE BY TROPHOZOIT & GAMETOCYTE OF P. FALCIPARUM DETECT ON DAY 7 STILL PRESENT ON DAY 28 (27% CASES) PARASITE LACTATE DEHIDROGENASE (pldh) PRODUCE BY PARASITE (ASEXUAL & SEXUAL PHASE) OF P. VIVAX AND PAN MALARIA (VIVAX, FALCIPARUM, MALARIAE, OVALE)
P. FALCIPARUM HISTIDINE RICH PROTEIN2 (HRP2) P. VIVAX P. VIVAX SPECIFIC pldh PLASMODIUM LAIN PAN MALARIA SPECIFIC pldh
L. INTERROGANS RAT, MICE PRIMARY HOST DOG, DEER, RABIT, COW, SHEEP SECONDARY HOST
FEVER RENAL IMPAIRMENT JAUNDICE PRESENCE OF LEPTOSPIRA PRESENCE OF ANTIBODY
COMPLETE BLOOD COUNT LEUCOCYTOSIS BLOOD FILM NEUTROPHILA CHEMISTRY INCREASED UREUM, CREATININE INCREASED BILIRUBIN, AST, ALT
DARK FIELD MICROSCOPE DIRECT IFA CULTURE POLIMERASE CHAIN REACTION
REFERENCE METHOD MAT ELISA CRUDE ANTIGEN LIVE LEPTOSPIRA PURIFIED ANTIGEN Ig TOTAL PAIRED SERA IgG & IgM SINGLE SERA
SINGLE SERA PAIRED SERA NEGATIVE EARLY INFECTION SEROCONVERSION INCREASED TITER 2-4 X HIGH TITER CURRENT INFECTION CURENT INFECTION
SUGGESTIVE OF LEPTOSPIROSIS < 7 DAYS 7 DAYS MAT BLOOD CULTURE PCR NEG ELISA POS POS NEG REPEAT POS NEG REPEAT >3 DAYS SEROCON VERSION CONFIRMED DIAGNOSIS BLOOD CULTURE NOT EXCLUDE DIAGNOSIS HIGH TITER LOW TITER REPEAT RISING TITER
BACTERIA /VIRAL/PARASITE DETECTION CONFIRMED INFECTION ANTIBODY DETECTION CAREFULL INTERPRETATION DIAGNOSIS BASED ON CLINICAL & LABORATORY FINDING