08 Pembahasan Introp 2014 By Mawar.pdf

1. B “A viral quasispecies, is a cloud of diverse variants that are genetically linked through mutation, interact cooperatively on a functional level, and collectively contribute to the characteristics of the population.” Contohnya di virus RNA kayak HIV-1, HIV-2, HCV http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001005 2. A Virus isolation in culture is the most sensitive method to diagnose poliovirus infection. Poliovirus is most likely to be isolated from stool specimens. It may also be isolated from pharyngeal swabs. Isolation is less likely from blood or CSF. To increase the probability of isolating poliovirus, collect at least two stool specimens 24 hours apart from patients with suspected poliomyelitis. These should be collected as early in the course of disease as possible (ideally within 14 days after onset). Real-time reverse transcription PCR is used to differentiate possible wild strains from vaccine-like strains (“intratypic differentiation”), using virus isolated in culture as the starting material. Partial genome sequencing is used to confirm the poliovirus genotype and determine its likely geographic origin. Serology may be helpful in supporting the diagnosis of paralytic poliomyelitis, particularly if a patient is known or suspected to not be vaccinated. An acute serum specimen should be obtained as early in the course of disease as possible, and a convalescent specimen should be obtained at least three weeks later. A four-fold neutralizing antibody titer rise between the acute and convalescent specimens suggests poliovirus infection. Nondetectable antibody titers in both specimens may help support the rule out of poliomyelitis but may also be falsely negative in immunocompromised persons, who are also at highest risk for paralytic poliomyelitis. 3. B Diagnosis: campak/morbili/measle. Penyebab: measle virus (MeV), RNA virus, genus Morbilivirus, family Paramyxoviridae. Sign/symptom: fever, cough, coryza, conjunctivitis, koplik’s spot (pathognomonic), red maculopapular rash (muncul awal di belakang telinga beberapa hari setelah onset demam, menyebar ke kepala leher seluru badan). 4. E Khasnya P. falciparum sering infeksi multiple parasit dalam satu eritrosit  trophozoid (bentuknya cincin) ganda, kalo P. malariae jarang infeksi multiple. Di stadium gametosit bentuknya kayak pisang, kalo P. ovale, vivax, malariae bentuknya bulat. P. vivax khasnya eritrosit membesar, di trofozoid sitoplasma ireguler, titik schuffner. 5. D Diagnosis: Leptospirosis/Weil’s disease Carier: rodent, anjing, dkk  biasanya di kasus habis kebanjiran, sumbernya dari urin hewan (krn bakterinya bisa bertahan lama di tubulus renalis). Penyebab: bakteri Leptospira kelompok spirochaete

Ada 2 fase klinis (septicemic dan immune): − Septicemic phase (leptospiremic phase): bakterinya bisa di isolasi dari kultur darah, CFS. Tanda gejalanya kayak “nonspecific flulike illness”  sudden onset of high fever, headache, myalgias, conjuctival suffusion (pathognomonic). − Immune phase (leptospiruric phase): produksi IgM (bertahan 1 bulan), bakteri bisa di isolasi dari urin di fase ini. Terjadi kerusakan organ spesifik  paling sering aseptic meningitis, lainnya gejala2 renal (uremia, hematuria, azotemia, pyuria), pulmonary (cough, dyspnea, ards), liver (kenaikan enzim2 liver, bilirubin, jaundice, hepatomegali) Kalo parah bisa sampai Weil’s disease  bentuk paling parah dari leptospirosis, bisa terjadi kapan saja saat infeksi akut tergantung progresifitas penyakit. Tanda gejala  “high fever (>40°C), significant jaundice, renal failure, hepatic necrosis, pulmonary involvement, cardiovascular collapse, neurologic changes and hemorrhagic diathesis, with a variable clinical course”. Komplikasi paling sering  acute renal failure. Diagnosis: gold standard kultur tapi susah bgt dan lama, darkfield microscopy susah mahal  diagnosisnya pake serologi  MAT (microscopic agglutination test  gold standard buat serologi) ngitung titer antibodinya, lainnya IgM-ELISA. http://www.jmedicalcasereports.com/content/5/1/7 6. C Penyebab V. cholera gram negative coma shaped berflagel. Virulence factor: toxin coregulated pilus (TCP)  untuk adherence & kolonisasi; cholera toxin (CT)  enterotoxin. 7. E Kemungkinan uncomplicated UTI karena E. coli. “Nearly 95% of cases of UTIs are caused by bacteria that typically multiply at the opening of the urethra and travel up to the bladder.” 8. B The effects of the normal flora are inferred by microbiologists from experimental comparisons between "germ-free" animals (which are not colonized by any microbes) and conventional animals (which are colonized with a typical normal flora). Briefly, some of the characteristics of a germ-free animals that are thought to be due to lack of exposure to a normal flora are: − vitamin deficiencies, especially vitamin K and vitamin B12 − increased susceptibility to infectious disease − poorly developed immune system, especially in the gastrointestinal tract − lack of "natural antibody" or natural immunity to bacterial infection http://textbookofbacteriology.net/normalflora_4.html 9. A 10. B Kemungkianan typhoid fever 11. A B sm C kemungkinan masih bisa nularin ke pasien lain soalnya TB penularannya airborne, yang D sm E setauku kalo pasien paru itu yang pake masker harusnya

pasiennya juga, petugasnya pake respirator, kecuali kasus HIV yang make masker yang meriksa soalnya takut kita yang nularin penyakit ke pasiennya.

http://www.cdc.gov/tb/education/corecurr/pdf/chapter7.pdf 12. D Lama-lama kalo ga ditangani jadi heat stroke 13. C ?? dulu di blok apa gtu ada slide yang bilang paling bagus malah aksila? 14. E Ada di slide dr. Dhani Redono – Penyakit infeksi bakteri 15. B Ada di slide dr. Dhani Redono – Penyakit infeksi bakteri 16. D

17. D HBsAg sama anti HBc tanda lagi infeksi akut.

Ada HBeAg tanda lagi masa replicative  bisa nularin ke orang lain.

18. B Kalo pasiennya infeksi HBV harusnya HBsAg terdeteksi kecuali ada mutasi, anti HBs nya bisa karena vaksinasi. 19. E 20. D 21. A NS-1 terdeteksi sampai hari ketiga demam, setelah itu yang bisa dideteksi IgMnya.

22. A Ada kontak langsung dengan bangkai unggas. 23. E Rotavirus infection alters the function of the small intestinal epithelium, resulting in diarrhea. The diarrhea was generally considered to be malabsorptive, secondary to enterocyte destruction (34). In addition to enterocyte destruction, absorption of Na+, water, and mucosal disaccharidases are decreased (10, 28), while mucosal cyclic AMP appears not to be altered (16). Malabsorption results in the transit of undigested mono- and disaccharides, carbohydrates, fats, and proteins into the colon. The undigested bolus is osmotically active, and the colon is unable to absorb sufficient water, leading to an osmotic diarrhea (27). Another study suggested that the diarrhea was malabsorptive and resulted from epithelial damage caused by villus ischemia (58). A secretory component of the diarrhea was suggested, based on elevated levels of prostaglandin E2 (PGE2) in the infected gut and the stimulation of secretion by PGE2 (79). The fact that gut lesions often do not correlate with the presence of diarrhea stimulated the search for other mechanisms of diarrhea induction. The viral nonstructural protein NSP4, a secreted fragment of NSP4, or certain NSP4 peptides were found to have toxin-like activity and to induce diarrhea when inoculated into mice (3, 23, 77). The NSP4 enterotoxin activity provides a way to mediate diarrheagenic changes in the absence of significant damage or to mediate changes at uninfected sites. Recently, it was shown that several drugs that block the action of the ENS attenuate rotavirus-induced secretion in the intestine, suggesting a role for the ENS in rotavirus diarrhea (44, 45, 46). It was estimated that ∼67% of the fluid and electrolyte secretion in rotavirus diarrhea in experiments with mice was due to activation of the ENS (46). Thus, it is clear that rotavirus diarrhea is multifactoral, resulting from the direct effects of virus infection and the indirect effects of infection and the host response. CDC  The virus enters the body through the mouth. Viral replication occurs in the villous epithelium of the small intestine. Recent evidence indicates that up to two-

thirds of children with severe rotavirus gastroenteritis show the presence of rotavirus antigen in serum (antigenemia). Infection may result in decreased intestinal absorption of sodium, glucose, and water, and decreased levels of intestinal lactase, alkaline phosphatase, and sucrase activity, and may lead to isotonic diarrhea. 24. D Diagnosis: varicella/chicken pox According to the model of varicella zoster virus (VZV) cell-associated viraemia, tonsil T cells are infected following VZV inoculation and replication in respiratory mucosal epithelial cells. T cells traffic into and out of tonsils across the squamous epithelial cells that line the tonsilar crypts (left panel). VZV has increased tropism for activated memory T cells that have skin-homing markers, which are common in tonsils (centre panel). These T cells are programmed for immune surveillance and can transport the virus across capillary endothelial cells into skin. VZV glycoprotein E (gE) (through its unique amino terminus), gI and the viral kinases ORF47 and ORF66 are important for T cell infection. Proteins that regulate cellular gene expression are activated (in the case of signal transducer and activator of transcription 3 (STAT3)) or inhibited (in the case of STAT1) in infected T cells. The microvasculature is extensive at the base of hair follicles, where T cells transit into the surrounding skin and initial VZV replication is observed (right panel). http://www.nature.com/nrmicro/journal/v12/n3/fig_tab/nrmicro3215_F2.html 25. C 26. C Kasus mumps/parotitis, penyebab mumps virus (RNA). Penegakan diagnosisnya pake RT-PCR sampel saliva hari ke 3-5 onset gejala. Juga bisa dideteksi di urin hingga hari ke 14 setelah onset gejala. 27. E 28. E Exanthema subitum/roseola infantum Mirip measle tapi gejala lebih ringan. Menyerang anak usia 6 bulan – 2 tahun. Gejala demam mendadak beberapa hari (bisa sampai seizure). Setelah demam turun muncul maculopapular rash mulai dari badan ke leher dan kaki, tidak gatal, 1-2 hari (kalo measles gatal, bisa sampai 8 hari mulai dari belakang telinga ke leher kepala badan). Disebabkan infeksi primer HHV-6 (type B) dan HHV-7. Bisa sembuh spontan, pengobatan simptomatis. Sumber lain: http://saripediatri.idai.or.id/pdfile/4-3-1.pdf http://wwwnc.cdc.gov/eid/article/5/3/99-0306_article 29. E DHF 30. D Malaria  khas trias malaria: cold stage, hot stage, sweating stage. Demam intermitten. Gold standard: mikroskopis, apusan tebal buat deteksi ada parasitnya, untuk tau jenisnya pake apusan tipis. 31. D Ada opistotonus, spasme, riwayat ketusuk paku berkarat.

32. A 33. E 34. B DENV-2 paling sering berkaitan dengan DSS  plasma leakage lebih tinggi. DENV3 dan DENV-4 kecenderungan ke liver involvement (ditandai dengan kenaikan AST ALT). – http://apps.who.int/iris/bitstream/10665/148790/1/dbv24p53.pdf Sebenernya beberapa sumber menyebutkan DENV-3 juga berhubungan dengan DSS. 35. B DHF is characterised by a transient increase in vascular permeability resulting in plasma leakage, with high fever, bleeding, thrombocytopenia and haemoconcentration, which can lead to shock (termed dengue shock syndrome (DSS).

36. D

37. C Infeksi Enterobius vermicularis  pyrantel pamoat (lainnya albendazo, mebendazol) single dose awal dan diulang single dose 2 minggu setelahnya (obatnya ga bisa bunuh telurnya, makanya diulang 2 minggu kemudian buat bunuh cacing dewasa yang netes dari telur). Sebaiknya anggota keluarga juga ikut diobati sekalian di saat yang bersamaan. 38. E 39. D Vermisid: Mebendazol, praziquantel, niklosamida. 40. A 41. B

42. D 43. E 44. D 45. B Kuliah dr. Brian – dasar infeksi bakteri 46. E Menghambat COX-1 dan COX-2. 47. B 48. E WHO GUIDELINES: Faine’s Criteria For Diagnosis Of Leptospirosis Faine had evolved a criteria for diagnosis of leptospirosis on the basis of clinical, epidemiological and laboratory data (Parts A, B and C respectively) (Table 4). A presumptive diagnosis of leptospirosis may be made if: (i) Parts A and B score = 26 or more (Part C laboratory report is usually not available before fifth day of illness; thus it is mainly a clinical and epidemiologic diagnosis during early part of disease) (ii) Part A+B+C = 25 or more. A score between 20 and 25 : Suggests a possible but unconfirmed diagnosis of leptospirosis. http://www.japi.org/june2005/R-545.pdf

49. A Kalo di https://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potentialrelated-health-problems/opportunistic-infections/ CD4 <50 cells/mm3 itu MAC. Yang paling mendekati CMV. 50. D 51. B Kencing berwarna seperti teh.

52. B Slide malaria dr. Dhani

53. D

54. C 55. D Entamoeba coli, E. hartmanni, E. polecki masuk di non pathogenic intestinal protozoa. 56. A 57. D

58. B Kasus varicella  ada gambaran tear drop (vesikel dinding tipis sehingga terlihat seperti kumpulan tetesan air di atas kulit). 59. C Slide Antibiotik 2014

60. E Slide Antibiotik 2014

61. A 62. A 63. D 64. A 65. D 66. A 67. C 68. C 69. A

70. E 71. A 72. D 73. D 74. C 75. C 76. C 77. B 78. C 79. E 80. D