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ZOSTER
BED SIDE TEACHING 2
GROUP MEMBERS
1.
2.
3.
4.
5.
6.
A. Ayu Faradiba
A. Intan P Putri
Jefman E Marzuki H Y
Muh. Firmansyah Kamal
Priska Paramita
Wahyunita Ilham
PATIENTS IDENTITY
Name : Mr. T
Gender : Male
Age : 23 y.o
Marital Status : Single
Religion : Christian
Address : Irian Jaya
Occupation : Army
Registered : 23th March 2013
HISTORY TAKING
Anamnesis
: Autoanamnesis
Chief complaint :
- Multiple tiny blister with pain
below the lower lip
HISTORY TAKING
Fever (+), pain on lesion (+), nausea (-),
vomiting (-), headache(-), dizziness (-),
chest pain (-).
During the appearance of disease, urination
and defecation within normal limit.
PRESENT HISTORY
- Vesicle appeared 2 days ago,
with pain. Location below the
lower lip.
- 4 days ago, went to hospital
with diagnosed suspect malaria
Past history:
history of malaria for 4 days ago.
Allergic history:
No Allergic history
Family history:
No family member that have similar
disease with patient
PRESENT STATUS
General condition:
Moderately ill
Consciousness:
Compos mentis (Alert)
Vital sign:
BP: 130/80 mmHg
Pulse: 62x/minute
Respiratory rate:24x/minute
Temperature: 36,5 0 C
Head Examination
Jaundice(-)
Pale (-)
cyanosis (-)
Cor/ Pulmo
within normal limit/within normal limit
Thorax
Vesiculer, Rh (-/-) Wh(-/-)
Abdomen
Peristaltic (+)
Extremities
Edema (-)
Localization
Universal
Dermatology Status
- Location : regio perioral
- Efflorescence : multiple vesicles, erythematous,
and scaly
Diagnosis:
- Herpes Zoster
Treatment:
Dexamethasone
Gentamycin 80 mg/12 h/i.v
Kenalog oral base+acyclovir
Neurodex 3 x 1
Tramadol 2 x 1
Acyclovir 5 x 400 mg
RESUME
DIAGNOSIS
- Herpes Zooster
DIFFERENTIAL DIAGNOSIS
Herpes simplex, impetigo, smallpox, atopic dermatitis,
poison ivy, atypical measles
MANAGEMENT
Dexamethasone
Gentamycin 80 mg/12 h/i.v
Kenalog oral base+acyclovir
Neurodex 3 x 1
Tramadol 2 x 1
Acyclovir 5 x 400 mg
PROGNOSIS:
- Bonam
Discussion
HERPES ZOSTER
Definition :
The disease is caused by the
varicella zoster virus that attacks the
skin and mucosa. This is a
reactivation of the virus infection
that occurs after primary infection.
Etiology
Patophysiology (Cont...)
Cont.... (1)
Cont... (2)
Clinical Manifestation
Systemic response
Prodromal
pain
typically
is
described
as
muscle
or
toothachelike in origin but may
simulate headache, iritis, pleurisy,
brachial neuritis, cardiac pain,
appendicitis
or
other
intraabdominal disease, or sciatica.
This simulation can result in incorrect
tentative diagnoses; however, the
dermatomal distribution usually helps
clarify the diagnosis.
Differential Diagnosis
Herpes simplex
Impetigo
Smallpox
Atopic dermatitis
Poison ivy
Atypical measles
Lab Test
Tzanck Smear for diagnose acute
infection
Viral culture 3-14 days for viral
growth, sensitivitation 30-70%,
spesific 100%
Antigen IgM detection
Serologic test ELISA, commonly
PCR DNA VZV detection exc. CSS
Treatment
Oral therapy :
Analgetic (symptomatic)
Antibiotic
Antiviral
- Acyclovir 5 x 800 mg/day (7 days)
- Valacyclovir 3 x 1000 mg/day (1 day
Tricyclic antidepresan
- Amytriptilin 75 mg/day
Topical therapy :
MBS talc -> prevent vesicle rupture.
Open compretion-> if theres erotion.
Antibiotic cream -> if theres ulkus.