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URETHRITIS GONORRHEA
Herin Arini Natalia : C111 09 143
Dewi Siswantini : C111 09 138
Nur Fatminsari Almaidin : C111 09 272
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Case Report Name : Mr. A
Age : 29 Years Old
Address : Regge II Makassar Date of admission : 9 10 2012
No. MR : 238851
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Anamnesis Chief complaint : dysuria
Brief anamnesis :
Dysuria accompanied pus since 3weeks ago Fever since 3 weeks ago, higher at night
Malaise
Backbone and legs pain
Touch pain skin Sexual history + 2 months ago with not an official
partner, not use condoms
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Present Status General condition : mild
Hygiene : moderate
Consciousness : composmentisVital signs :
BP : 110/60 mmHg
Pulse : 88x/min
RR : 18x/min
Temp : 36,5C
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Dermatovenerology Location : external genitalia (OUE)
Size :
Efflorescence : OUE eritematous, oedema
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Laboratory Result (19/7/2012)WBC : 6,3 x 103/ mm3
RBC : 5,26x106 mm3
Hb : 14,9 gr/dL Hct : 46,9%
LED/BBS : 15 mm/ 1 hour
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ResumeA man, 29 years old, come to the hospital with chief
complaint of dysuria accompanied with pus since 3weeks ago. Fever since 3 weeks agom higher at night,malaise, backbone pain, touch pain skin
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Diagnosis Urethritis gonorrhea
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Therapy Rifampisin 600 mg/month 12 blister
DDS 100 mg/month and 100 mg/day 12 blister
Clofazimine 300 mg/month and 50 mg/day 12
blister For ENL reaction
Metilprednisolon 16 mg 1x2
Meloxicam 2x1 Vitamin B complex 3x1
Cetirizine 10 mg 2x1
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Hansen's disease, is a chronic infectious diseasethat attacks the nervous system. This disease
can cause severe deformity of the feet, handsand face.
Discovered by Gerhard Armauer Hansen in1873.
LEPROSY/ HANSENS DISEASE
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Leprosy is caused by a type of
bacteria calledMicrobacterium Leprae.
ETIOLOGY
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M. leprae has low power of pathogenicinvasion, because patients that contain more
germs do not necessarily provide a more seversymptoms. The Unbalance between the degreeof infection with the degree of disease, causedby the different immune responses. Therefore
be called a disease of leprosy imunologicbecause clinical symptoms comparable to thelevel of cellular reactions.
Patogenesis
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Numbness of skin lesions
Accompanied by thickening of nerve function
impairment BTA(+)
Cardinal sign
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Sign on the skin
1. red skin patches
2.shiny skin
3. patches do not itch
4. skin lesions that do not sweat or hair
5. blisters are not painful
Clinical Symptoms
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Sign on the nerve
1. tingling, or stabbing pain-pierced
2. movement disorders in the limbs or face
3. defect or deformity
4. ulcer that does not go away
Clinical Symptoms
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Treating a case
with MDT
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Multi Drug Therapy
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How to manage complications
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Leprosy reactions
Side-effects
Disabilities
Some patients may develop
complications
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1 or 2 patients in 10 may develop reactions Reactions are not a side effect of MDT. They are the bodys
response to leprosy
More commonly seen in MB cases (more than 5 lesions)
Signs and symptoms include Skin: patch/s becomes reddish and/or swollen;
sometimes painful reddish nodules appear
Nerves: pain in the nerve and/or joint;loss of sensation and weakness of muscles (commonlyof hands, feet and around eyes)
General: fever, malaise, swelling of hands/feet
Leprosy reactions
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Reactions which only involve the skin: rest and pain-killers are usually sufficient.
If there is no improvement within few days orworsening, then specific treatment is needed
Reactions which involves the nerves
start treatment with a course of corticosteroids (e.g.prednisolone) as soon as possible
will control all signs/symptoms of reaction
Managing reactions
S d f
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40 mg (8 tablets) every morning for 14 days 30 mg (6 tablets) every morning for 14 days 20 mg (4 tablets) every morning for 14 days 15 mg (3 tablets) every morning for 14 days
10 mg (2 tablets) every morning for 14 days 5 mg (1 tablets) every morning for 14 days
Note: Continue rest and aspirin or paracetamol as required Examine the patient every 14 days before reducing the dose If there is no improvement or worsening, refer to hospital Continue MDT regularly
Suggested course of
prednisolone
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Congratulate the patient Thank family/friends for their support Reassure that MDT completely cures leprosy
Any residual lesions will fade away slowly Show them how to protect anaesthetic areas and/or
disabilities Encourage to come back in case of any problem
Tell that they are welcome to bring other members offamily or friends for consultation Remove the patients name from the treatment register
When treatment is completed