paul n harijanto kasus malaria
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PRACTICAL GUIDELINE FOR PRIMARYCARE PHYSICIAN
To day is The WORLD MALARIA DAY
Theme : Counting Malaria Out
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Identified CasesDiagnosis
Treatment
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Fever/ history fever Living in endemic area/ history
travel to malaria area
Manifestation complication :jaundice, convulsion, comateus
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RDT Microscopic PCR
Test for exclusion : Hematology
Biochemical
Serology for dengue, typhoid,leptospirosis
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Confirmed diagnosis : ACT Suspected/ clinical : Non-ACT/
conventional
Severe Malaria : Artesunate
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A woman 50 years old, main complaint of yellow eyes.
She felt weak and tired since 2 weeks ago. She had
vomiting, giddiness, poor appetite, dark urine, and
defecation normal in color.
Physical examination: concious, BP: 100/70mmHg
Pulse: 90x/m, Temp. : 370C, Resp. : normal
Sclera and skin ; jaundice (+)Heart & Lung : normal, Abdomen: soft, no masses
Liver : hepatomegaly 2 m bcm
L: not palpable
DIAGNOSIS : Acute Viral Hepatitis
Comment : Agree/ NOT Agree / Do not know
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A. Give liver supportive agent B. Hematology & biochemical test C. USG
D. Viral Hepatitis Marker E. Urine microscopic F. CT scan
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Day 2 -3 : still weak, less eating, BP90/60, volume good, no fever. USG :sludge, suggested CHOLECYSTITIS.
What we should do ?A. Put on Antibiotic
B. Request for ERCP
C. Put on Ursodeoxy-cholic acid
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D4, chill, fever,38C. Lab. Hb. 9 gr%, Leuco7800/mm3 (62% neutrophile), thrombocyte63.000. Total bil 8.4 mg/dl (Direct 7.8 mg/dl),gamma-GT 60; Alk.PO4 159. Urea 147, creat1.69. TTl protein 6.2 mg/dl (alb 2.54); Se iron
22, TIBC 271. Malaria smear negative Question :
A. Antibiotik change to Parenteral
B. Do another hematology profileC. Blood culture
D. Do another test for malaria
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D5 : Falcip malaria ++++ ring; count > 3000par/ 200L
Treament :
A. ACT
B. Non- ACT
C. Quinine Parenteral D. Artesunate iv
E. Arthemeter im
Follow-Up : D 14 : bil 2.06 ( indirect 1.4), Hb. 6.5g%. Fever subsided, getting beter.
G- 6 PD enzym : 314
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Patient with fever/ history of fever :
Where they lived
History travelling
Blood transfussion
Liver/ spleen enlargement May not related to liver diseases
Watched for systemic infection
Jaundice : Parenchymal/ Obstruction/ Hemolysis
Systemic Infection
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Thrombocytopenia : NOT always dengue
Common in Malaria, Typhoid fever
Rarely occur in autoimmune/ idiopathic
Anemia :
Not in Acute Infection/ Illnesses Common in haemorhagic, malignancy,
chronic infection
Rarely hemolysis associated with malaria
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A woman, 39 years old, comes with vaginal
bleeding and abdominal pain. She ispregnant 7 months ( G1PoAo ). She hadhistory of fever 6 days, headache. Lived inPapua.
BP 160/100, temp 37.8C, pulse 80x/ minute Lab : Hb. 13 gr%, Mal vivax ring +, 4 par/
200 leuco
Treatment : Suldox 3 tb/ once Paracetamol 1 tb, tds
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A woman, 26 ears old, admiteedhospital with abdominal pain, she ispregnant 24 weeks (G1PoAo).
Hb 6.8 gr%, Thrombocyte 73.000,developed fever 39 C
Malaria falcip ring +, 8 par/200l
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51 years women, admitted with history 4days fever with breathless, temp 37.5, BP
150/100, pulse 108 : resp. : 36x/menit No history of DM, Hpt -, previous admission
Penanganan ? :
A. Furosemide i.v B. Oksigen
C. Foto thorax
D. Nebulizer E. Aminophyllin IV
F. Morphine iv
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12 hrs after hospitalization BP70/50, pulse 120x/min, temp 35.6,Kussmaul breathing
What you should do ? A. EKG
B. Blood Gas
C. Infuse rapidly with R/L
D. Dopamine/ dobutamine
E. Blood sugar
F. Profile hematologySlides current until 2008
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Hb: 16,3 , WBC: 17900/uL, Diff Leuco : -
/-/82/19/-, Trombo : 109.000. Malariafalciparum: +++, 1100/ 200 WBC, bl.Sugar: HI -,1015mg%, 900mg%, Bil.Total:2.47, bil direct:1.15 mg%,ureum:86.4 mg%, creatinine :2.87mg%, sodium:124 meq/L, potassium: 6.3 meq/L
PRIORITY TREATMENT :1) ( F.
2) ( A ..
3) ( I 4) .. ( A.