Dengue Shock Syndrome

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WHO SIGN FOR AIDS Major sign

Weight loss > 10 % Chronic diarrhea >1 mo Prolonged Fever > 1m0

Minor sign

Persistent cough > 1 mo Pruritic rash Recurrent herpes zoster Oropharyngeal candidiasis Chronic progressive herpes simplex Generalized lymphadenopathy

Diagnosa berdasarkan gejala klinis 2 major sign 1 major + 2 minor sign

Oral Candidiasis  Mucocutaneous candidiasis occurs in 3 forms in persons with HIV

infection: oropharyngeal, esophageal, and vulvovaginal disease  Oropharyngeal candidiasis (OPC) was among the initial manifestations of HIV-induced immunodeficiency to be recognized and typically affects the majority of persons with advanced untreated HIV infection  Candida are normal inhabitants of the human gastrointestinal (GI) tract and may be recovered from up to one third of the mouths of normal individuals and two thirds of those with advanced HIV disease  Symptoms of OPC may include burning pain, altered taste sensation, and difficulty swallowing liquids and solids. Many patients are asymptomatic  Most persons with OPC present with pseudomembranous candidiasis or thrush (white plaques on the buccal mucosa, gums, or tongue) and less commonly with acute atrophic candidiasis (erythematous mucosa) or chronic hyperplastic candidiasis (leukoplakia) involving the tongue, or angular cheilitis (inflammation and cracking at the corners of the mouth).

Infeksi Opportunistik pada HIV

Infeksi opportunistik pada penderita HIV/AIDS dapat disebabkan oleh berbagai organisme:  Protozoa: Toxoplasma gondii, Isospora belli, Cryptosporidium  Jamur: Candida albicans, Cryptococcus neoformans, Coccidioides immitis, Histoplasmosis capsulatum, Pneumocystis carinii.  Bakteri: Mycobacterium avium-intracelulare, Mycobacterium tuberculosis, Listeria monocytogenes, Nocardia asteroides, Salmonella, Streptococcus.  Virus: CMV, HSV, adenovirus, papovavirus JC menusia, virus Hepatitis B.

Pneumonia Etiologi: S.Pneumoniae dan H.Influenza Terjadi akibat adanya perubahan fungsi sel B

dan/atau menurunnya fungsi neutrofil. PCP  hallmark of AIDS gejala: umumnya demam dan batuk (nonproduktif atau produktif). sering juga mengeluhkan nyeri retrosternum yg memburuk pada saat inspirasi.

Pada foto dada: adanya sedikit infiltrat interstisial

bilateral. Adanya leukositosis ringan. AGDA: mungkin menunjukkan hipoxemia dgn penurunan PaO2 dan peningkatan gradien a-A. Diagnosa pasti PCP: ditemukannya adanya bentuk kista

dan tropozoit dalam sputum. Dapat juga dilakukan biopsi terbuka paru-paru. Pengobatan standar: Trimehoprim/ Sulfametoxazole (TMP/ SMX).

Tuberkulosis pada ODHA

Infeksi primer Kompleks primer

menyembuh

Lesi laten

TB primer progresif

TB sekunder

Lesi destruktif Perkejuan terlokalisir

reinfeksi

TB sekunder progresif TB milier

Pada penderita HIV dengan CD4 <200 sel/mm3

konsolidasi lobus tengah dan bawah, limfadenopati hilus (biasanya multifokus), dan sering tidak ada kavitas. Tb ekstraparu 10-15% pada pasien imunosupresi ringan dan >50% pada pasien imunosupresi berat

Terapi anti retroviral (ART) FUSION (fusion inhibitors)

Viral protease (protease inhibitors)

Reverse transcriptase inhibitors

RNA

RNA

Proteins

RT RNA

RNA

DNA RT DNA DNA

Provirus

Aspek Etik  Autonomy  ODHA berhak merahasiakan, memilih

menjalani test (informed consent)  Beneficience  konselor / dokter wajib memberi informasi / pengetahuan yang dapat bermanfaat bagi ODHA  Non maleficence  menghindari pemecahan masalah yang merugikan seperti karantina ODHA  Justice  tidak diskriminatif dalam pelayanan kesehatan  Veracity  jujur  Fidelity  konselor / dokter harus dapat membangun rasa percaya ODHA

Aspek Sosial Adanya stigma negatif terhadap ODHA Adanya perlakuan yang diskriminatif thd ODHA ODHA mempunyai komunitas sendiri

Aspek Psikologi Timbul rasa cemas akan kehilangan hak asasi krn

status ODHA Trauma psikis  antisosial (krn masyarakat tdk menerima) Individu yg tdk dpt menerima status HIVnya  respon negatif  mencoba menularkan kpd org lain

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