2. Pendahuluan
— Masalah yang sering dijumpai dalam praktek sehari hari
— Dari yang berbentuk sederhana sampai dengan yang
mengancam jiwa
— Sebagian karena penyakit infeksi
Budi Riyanto SPEED 2019
4. Kasus 1
Tanda dan gejala
— Demam 4 hari
— Batuk / pilek
— Conjunctivitis
— Muntah, diare
Lain lain
— Vaccine (-)
— Riwayat bepergian
— Kontak penderita (+)
Budi Riyanto SPEED 2019
5. Case 2
• Macular/papular
– morbilliform
• Begins on face and
spreads caudally
• Usually spares palms and
soles
• Over time:
– Confluence
– Deepening color
– Desquamation
Budi Riyanto SPEED 2019
6. Measles - campak
— Virus rubeola
— Penularan : droplet, udara
— Sangat menular
Budi Riyanto SPEED 2019
8. § Severe fever (as high as 39° C)
§ Rash
§ Muscle and joint pain
§ Headache
§ Pain behind the eyes
§ Nausea and vomiting
§ Bleeding from mouth and nose
Budi Riyanto SPEED 2019
Kasus ke 2
14. Case 10
•Scattered papules on erythematous base
•Palms and Soles
•Tender
•Ulcers on tongue and buccal mucosa
KASUS : 4Budi Riyanto SPEED 2019
15. Hand Foot and Mouth
• Coxsackie A
– Picornavirus
• Enterovirus
– Polio
– Non-polio: Coxsackie A and B, Enteroviruses, Echovirus,
• Young children
– Transmitted via oral/nasal secretions
• Self limited
Budi Riyanto SPEED 2019
18. PENDEKATAN DIAGNOSIS
— Demam dan rash : kead ini dapat merupakan penyakit
primer pada kulit, tetapi dapat merupakan tanda dari
penyakit sistemik
— Anamnesa yang baik tentang : riw bepergian,kontak dg
binatang, gigitan serangga, minum obat, kontak dengan
penderita, bagaimana staus imun nya
— Diskripsi rash, timbul mendadak ? Melinputi seluruh
tubuh atau sebagian
— Tanda dan gejala yg menyertai
Budi Riyanto SPEED 2019
26. definitionsdefinitions
Macule — Nonpalpable, circumscribed flat ,< 1 cmMacule — Nonpalpable, circumscribed flat ,< 1 cm
Papule — Palpable ,solid, elevated, < 1 cmPapule — Palpable ,solid, elevated, < 1 cm
Maculopapular -erythematous rash made up of bothMaculopapular -erythematous rash made up of both
macular and papular lesions.macular and papular lesions.
Purpura — Papular or macularPurpura — Papular or macular nonblanchingnonblanching lesionslesions
Nodule — Deep-seated, roundish < 1.5 cmNodule — Deep-seated, roundish < 1.5 cm
Plaque — A palpable elevated > 1Plaque — A palpable elevated > 1
Vesicle —elevated ,contains fluid ,<1 cmVesicle —elevated ,contains fluid ,<1 cm
Bulla —vesicle > 1 cmBulla —vesicle > 1 cm
Pustule —vesicle + pusPustule —vesicle + pus
Budi Riyanto SPEED 2019
27. Tanda dan gejala yg menyertai rash
— Demam, berapa lama dan tipe demam
— Apakah ada tanda syok ?
— Gelisah
— Nyeri kepala
— Gangguan pernapasan
— Perubahan pada mata
— Lesi pada membrana mukosa
— Pembengkakan dan nyeri sendi
Budi Riyanto SPEED 2019
28. RASH MEMERLUKAN PERHATIAN
KHUSUS
— Dengan riwayat penyakit jantung
— STDs
— Penurunan imunitas krn sitostatika
— Status imun penting karena penderita dengan demam dan
rash pd penderita dg status imun rendah manifestasi
klinisnya berbeda
Budi Riyanto SPEED 2019
32. Demam dan rash dalam bidang neurologi
Budi Riyanto SPEED 2019
on the trunk (mostly HSV-2) in patients with a
history of meningitis (often recurrent) or inter-
mittent radiculopathy. Herpetic mucosal and
skin lesions are not usually seen with HSV-1
encephalitis. The lesions in Behçet disease can
Lyme disease causes “target” lesions.
Table Skin rash in meningitis and meningoencephalitis
Cause of meningitis and
meningoencephalitis Rash type and distribution Other features
Rocky Mountain spotted fever: Rickettsia
rickettsii (figure 1, A and B)
Early: maculopapular rash, mostly at wrists and ankles.
Later: petechiae, spreads to palms, soles, and trunk
Rash in 90% of cases
Neisseria meningitidis (figure 1C) Early: macular rash, extremity . face, palate, conjunctiva.
Later: petechiae and purpura, particularly severe in the
setting of sepsis
Rash in 50%–75% of cases; evolves and spreads quickly;
intracellular gram-negative diplococci detectable in
petechial and purpuric lesions
Syphilis: Treponema pallidum (figure 1D) Secondary syphilis-associated rash consists of macules,
papules, plaques, erythema multiforme, and pustules;
palms and soles . trunk and extremity
Rash .80% of cases with coincident primary chancre in
10%; more common in HIV1 subjects
HSV (figure 2A) Vesicular rash, typically seen on mucosal surfaces
(HSV-1 and -2); HSV-2 lesions on the skin are patchy
Painful rash due to reactivation; HSV-1 is typically oral;
HSV-2 is typically genital or on the trunk and often seen with
HSV-2 meningitis or intermittently radiculopathy
Varicella-zoster virus (figure 2B) Vesicular rash on an erythematous base in unilateral
dermatomal distribution
Painful rash due to reactivation and may also be pruritic;
rash may be absent in meningoencephalitis
Behçet syndrome (figure 2, C and D) Oral and genital aphthous ulcers Recurrent painful ulcers required for diagnosis; other skin
lesions include erythema nodosum; distinguish from HSV
lesions; uveitis and venous sinus thrombosis common
West Nile virus (figure 4A) Erythematous macular, papular, or morbilliform rash;
truncal location most common
Rash in 25%–50% of cases; greater incidence in late
summer/early fall; mosquito-borne
Enterovirus (figure 4B) Early: face; later: trunk and extremities; rubelliform
(discrete) or morbilliform (confluent) rash; sometimes
erythema multiforme, vesicular, urticarial, petechial,
or purpuric
ECHO virus 9 rash may mimic meningococcal purpura
Epstein-Barr virus (figure 4C) Maculopapular rash on trunk or arms Rash in 5%–10%
Lyme disease: Borrelia burgdorferi
(figure 5)
Erythema chronicum migrans over days to weeks:
expanding annular lesion at site of tick bite, sometimes
with central induration or vesicle; within a few days,
half of patients develop multiple similar but smaller
lesions at sites distant from bite
Rash in .50% of cases, usually preceding neurologic
disease; even if untreated, rash can fade in a month or
persist for a year; arthralgias common; facial palsy common
Vogt-Koyanagi-Harada
(uveomeningoencephalitis) (figure 3)
Localized hypopigmentation of face and scalp Associated skin findings include alopecia, lightening of
eyebrows and lashes; aseptic meningitis often recurs; uveitis
common
Abbreviation: HSV 5 herpes simplex virus.
33. Demam dan munculnya Rash
HARI PENYAKIT
1 RUBELLA
2 DEMAM SCARLET / CACAR
3 Cacar air
4 MEASLES ( Bercak Koplik )
5 TYPHUS & RICKETSIA ( bervariasi)
6 DENGUE ( punggung,dorsum manus tangan dan
kaki)
7 DEMAM ENTERIC( rose spot dinding perut,
panggul, punggung)
Budi Riyanto SPEED 2019
34. Take Home Message
— Demam dan rash dapat di diagnosis dengan :
§ anamnesis keadaan saat ini dan riwayat sebelumnya
§ Riwayat paparan
§ Waspada terhadap demam + rash yang mengancam jiwa,
misalnya :
§ Meningococcemia
§ Toxic shock syndrome
§ RMSF
§ Tanyakan riwayat vaksinasi
§ Ingat demam + rash yang bukan penyakit infeksi
§ Kawasaki
§ Steven johnson syndrome
Budi Riyanto SPEED 2019
