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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana Medical Journal of Indonesia MNJ (Malang Neurology Journal) Bali Journal of Anesthesiology The Indonesian Journal of Infectious Diseases Callosum Neurology Journal : Jurnal Berkala Neurologi Bali ISM (Intisari Sains Medis) : Jurnal Kedokteran Majalah Kedokteran Neurosains Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Indonesian Archives of Biomedical Research (InABR) Cermin Dunia Kedokteran Magna Neurologica Neurona
Raka-Sudewi A. A.
Udayana University, Bali-Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Journal : Cermin Dunia Kedokteran

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Patogenesis Rabies - Aspek Neurotransmiter Imelda, Yuliana Monika; Sudewi, A.A. Raka
Cermin Dunia Kedokteran Vol 42, No 2 (2015): Bedah
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (105.501 KB) | DOI: 10.55175/cdk.v42i2.1035

Abstract

Rabies merupakan penyakit virus yang menyebabkan peradangan otak akut pada manusia dan hewan berdarah panas lain. Penyebaran penyakit rabies biasanya melalui gigitan atau goresan yang mengandung air liur hewan terinfeksi virus rabies. Virus rabies akan menuju ke susunan saraf pusat (SSP) dan akan menyebar secara sentrifugal dari SSP ke berbagai organ, termasuk kelenjar ludah. Ada tiga reseptor virus rabies, yaitu reseptor nikotinat asetilkolin (NAChR), reseptor molekul adhesi sel neural, dan reseptor neurotropin P75 low-affinity. Asetilkolin, serotonin dan gamma amino butyric acid (GABA) merupakan neurotransmiter yang mempengaruhi terjadinya disfungsi saraf pada penyakit rabies.Rabies is a viral disease that causes acute inflammation of the brain in human and warm-blooded animal. The spread of rabies is through bites or scratches containing saliva of an infected animal. Rabies virus will go to the central nervous system (CNS) and will spread centrifugally from CNS to various organs, including salivary glands. Three rabies virus receptors are nicotinic acethylcholine receptor, neural cell adhesion molecule receptors and low-affinity receptor neurotropin P75. Acetylcholine, serotonin and GABA are neurotransmitters that play a role in neuronal dysfunction in rabies.
Karakteristik Penderita Rabies Paralitik di RSUP Sanglah, Denpasar Ginting, Ernesta; NM, Susilawathi; AA, Raka Sudewi
Cermin Dunia Kedokteran Vol 41, No 11 (2014): Infeksi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (112.722 KB) | DOI: 10.55175/cdk.v41i11.1068

Abstract

Latar belakang: Ada dua tipe manifestasi klinis rabies pada manusia, yaitu tipe galak dan tipe paralitik. Rabies tipe galak biasanya dapat dengan mudah didiagnosis berdasarkan tanda dan gejalanya yang khas, tetapi diagnosis rabies tipe paralitik sering merupakan dilema bagi klinisi, karena gejalan yang tidak khas dan mirip dengan sindrom Guillain-Barre. Tujuan: Mengetahui karakteristik pasien rabies paralitik di RSUP Sanglah. Metode: Penelitian deskriptif observasional dengan metoda pengumpulan data sekunder dari catatan medis penderita rabies di bangsal perawatan Neurologi RSUP Sanglah dari Januari 2009 – Desember 2010. Hasil: Pada penelitian ini ditemukan 13 (19,69%) kasus rabies paralitik. Gejala prodromal berupa: kesemutan daerah gigitan (69%), demam (46%), mual dan muntah (15%), insomnia dalam 2-5 hari sebelum masuk RS (7%). Gambaran klinis tipe paralitik berupa: paraparesis flaksid simetris (62%), paraparesis flaksid asimetris (15%), monoparesis (15%), fasikulasi (15%), inkontinensia urin (38%), retensi urin (15%), gejala gastrointestinal (distensi abdomen dan ileus paralitik) (53%). Pada stadium akhir (terminal) beberapa gejala klinis khas tipe galak juga muncul, yaitu: gangguan kesadaran berupa fase delirium dan agitasi yang berfluktuasi pada semua penderita (100%), hidrofobia (100%), hipersalivasi (84%), hiperhidrosis (38%), aerofobia (69%), dan fotofobia (7%). Pemeriksaan LCS mendapatkan jumlah sel normal pada 5 pasien dan sel meningkat pada 7(58%) pasien dengan rata-rata jumlah sel 32/mm3. Protein LCS normal pada 4 pasien dan meningkat pada 8(66%) pasien dengan rata-rata 184 mg/dl. Simpulan: Rabies tipe paralitik dan sindrom Guillain-Barre memiliki gejala klinis yang mirip yaitu adanya paralisis flaksid akut yang sering bersifat ascendens. Pada rabies tipe paralitik sering didapatkan beberapa gambaran klinis lain berupa demam, kesemutan di daerah luka gigitan, fasikulasi, inkontinensia urin, progresivitas gejala sangat cepat dan perubahan status kesadaran.Background: Human rabies can present in two clinical forms, furious and paralytic. Diagnosis of furious (encephalitic) form can be made based on typical symptoms and signs. In contrast, paralytic form poses a diagnostic dilemma to distinguish it from Guillain-Barre syndrome. Objective: To describe characteristics of paralytic rabies patients at Sanglah Hospital. Method: This is an observational descriptive study. All data was collected from secondary data from medical records of rabies patients in Neurology ward, Sanglah Hospital from January 2009 – December 2010. Result: There were a total of 13 (19,69%) cases of paralytic rabies. Prodromal symptoms consisted of: paresthesias at the site of healed bite wound (69%), fever (46%), nausea and vomiting (15%), insomnia in about 2-5 days prior to admissions (7%). The clinical features of the paralytic form were: symmetrical flaccid paraparesis (62%), asymmetrical flaccid paraparesis (15%), monoparesis (15%), fasciculation (15%), urinary incontinence (38%), urinary retention (15%), gastrointestinal symptoms (abdominal distention and paralytic ileus) (53%). Particularly all patients showed features of furious rabies in terminal stage: fluctuating consciousness between lucid calm and agitation (100%), hypersalivation (84%), hyperhydrosis (38%), hydrophobia (100%), aerophobia (69%), photophobia (7%). CSF cell counts were normal in 5 patients and increased in 7 (58%) patients with mean cell count of 32 cells/mm3. CSF protein was normal in 4 patients and increased in 8 (66%) patients with mean protein 184 mg/dl. Conclusion: Despite similarities between paralytic rabies and Guillain-Barre syndrome, some clinical features i.e., fever, distal paresthesia, fasciculation, urinary incontinence, rapid progression of symptoms and alteration in sensorium may help clinicians to differentiate rabies from Guillain-Barre syndrome. All paralytic rabies cases showed features of furious rabies in terminal stage.
Gejala Otonom Tidak Spesifik pada Penderita Rabies di RSUP Sanglah, Denpasar Widanta IGN, Putra Martin; NM, Susilawathi; AA, Raka Sudewi
Cermin Dunia Kedokteran Vol 41, No 10 (2014): Hematologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (142.373 KB) | DOI: 10.55175/cdk.v41i10.1095

Abstract

Latar belakang: Manifestasi klinis rabies sangat bervariasi. Gejala otonom tidak spesifik ditemukan pada 2/3 kasus terutama pada stadium prodromal menyebabkan misdiagnosis yang memperlambat penanganan rabies. Tujuan: Mengetahui manifestasi gejala sistem saraf otonom tidak spesifik pada penderita rabies di RSUP Sanglah. Metodologi: Penelitian retrospektif dari bulan Januari 2009 – Desember 2010 di RSUP Sanglah Denpasar. Data diperoleh dari catatan medis penderita rabies. Hasil: Ditemukan 13 kasus rabies dengan manifestasi gejala otonom tidak spesifik, terdiri dari 8 kasus tipe galak (61,5%) dan 5 kasus tipe paralitik (38,5%). Pada stadium prodromal gejalanya adalah mual-muntah (38,5%), gangguan miksi (30,8 %), perut kembung (30,8%), nyeri uluhati/perut (15,4%), nyeri dada (15,4%), sesak nafas (53,8) dan diare (7,7%). Gejala sistem otonom pada stadium neurologi akut berupa gangguan miksi (inkontinensia dan retensio urine) (38,5%) dan distensi abdomen (30,8%). Pasien dirawat oleh bagian Ilmu Penyakit Dalam (69,2%), Ilmu Penyakit Anak (15,4%), Ilmu Penyakit Jantung (15,4%) antara 24 jam sampai 48 jam sebelum dikonsulkan ke bagian Ilmu Penyakit Saraf. Simpulan: Manifestasi gejala sistem otonom tidak spesifik sangat bervariasi, dapat ditemukan pada stadium prodromal dan neurologis akut.Background: Clinical manifestations of rabies may be preceded by nonspecific prodromal symptoms in 2/3 cases. This often leads to misdiagnosis resulting in delays in the management of rabies. Objective: To determine the non-specific autonomic nervous system symptoms in rabies patients in Sanglah Hospital. Method: This is descriptive retrospective study from January 2009 - December 2010 in Sanglah Hospital, Denpasar. Data obtained from medical records of rabies patients. Results: During the period, there were 13 cases of rabies with non-specific autonomic nervous system symptoms, 8 cases were furious type (61.5%) and 5 cases paralytic rabies (38.5%). Symptoms at prodromal stage are nausea/vomiting (38.5%), urinary symptoms (30.8%), abdominal distention (30.8%), abdominal/epigastric pain (15.4%), chest pain (15.4 %), shortness of breath (53.8%) and diarrhea (7.7%). The autonomic symptoms at acute neurologic stage were urinary disorders (urinary incontinence and retention) (38.5%) and abdominal distension (30.8%). All patients were treated by other departments between 24 to 48 hours prior to neurological consultation. Those departments were Internal Medicine (69.2%), Pediatrics (15.4%), Cardiology (15.4%). Summary: non-specific autonomic nervous system symptoms of rabies are diverse and complicate the diagnosis. It can occur in a prodromal and acute neurological stage.
Gejala Otonom Tidak Spesifik pada Penderita Rabies di RSUP Sanglah, Denpasar Putra Martin Widanta IGN; Susilawathi NM; Raka Sudewi AA
Cermin Dunia Kedokteran Vol 41, No 10 (2014): Hematologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v41i10.1095

Abstract

Latar belakang: Manifestasi klinis rabies sangat bervariasi. Gejala otonom tidak spesifik ditemukan pada 2/3 kasus terutama pada stadium prodromal menyebabkan misdiagnosis yang memperlambat penanganan rabies. Tujuan: Mengetahui manifestasi gejala sistem saraf otonom tidak spesifik pada penderita rabies di RSUP Sanglah. Metodologi: Penelitian retrospektif dari bulan Januari 2009 – Desember 2010 di RSUP Sanglah Denpasar. Data diperoleh dari catatan medis penderita rabies. Hasil: Ditemukan 13 kasus rabies dengan manifestasi gejala otonom tidak spesifik, terdiri dari 8 kasus tipe galak (61,5%) dan 5 kasus tipe paralitik (38,5%). Pada stadium prodromal gejalanya adalah mual-muntah (38,5%), gangguan miksi (30,8 %), perut kembung (30,8%), nyeri uluhati/perut (15,4%), nyeri dada (15,4%), sesak nafas (53,8) dan diare (7,7%). Gejala sistem otonom pada stadium neurologi akut berupa gangguan miksi (inkontinensia dan retensio urine) (38,5%) dan distensi abdomen (30,8%). Pasien dirawat oleh bagian Ilmu Penyakit Dalam (69,2%), Ilmu Penyakit Anak (15,4%), Ilmu Penyakit Jantung (15,4%) antara 24 jam sampai 48 jam sebelum dikonsulkan ke bagian Ilmu Penyakit Saraf. Simpulan: Manifestasi gejala sistem otonom tidak spesifik sangat bervariasi, dapat ditemukan pada stadium prodromal dan neurologis akut.Background: Clinical manifestations of rabies may be preceded by nonspecific prodromal symptoms in 2/3 cases. This often leads to misdiagnosis resulting in delays in the management of rabies. Objective: To determine the non-specific autonomic nervous system symptoms in rabies patients in Sanglah Hospital. Method: This is descriptive retrospective study from January 2009 - December 2010 in Sanglah Hospital, Denpasar. Data obtained from medical records of rabies patients. Results: During the period, there were 13 cases of rabies with non-specific autonomic nervous system symptoms, 8 cases were furious type (61.5%) and 5 cases paralytic rabies (38.5%). Symptoms at prodromal stage are nausea/vomiting (38.5%), urinary symptoms (30.8%), abdominal distention (30.8%), abdominal/epigastric pain (15.4%), chest pain (15.4 %), shortness of breath (53.8%) and diarrhea (7.7%). The autonomic symptoms at acute neurologic stage were urinary disorders (urinary incontinence and retention) (38.5%) and abdominal distension (30.8%). All patients were treated by other departments between 24 to 48 hours prior to neurological consultation. Those departments were Internal Medicine (69.2%), Pediatrics (15.4%), Cardiology (15.4%). Summary: non-specific autonomic nervous system symptoms of rabies are diverse and complicate the diagnosis. It can occur in a prodromal and acute neurological stage.
Patogenesis Rabies - Aspek Neurotransmiter Yuliana Monika Imelda; A.A. Raka Sudewi
Cermin Dunia Kedokteran Vol 42, No 2 (2015): Bedah
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v42i2.1035

Abstract

Rabies merupakan penyakit virus yang menyebabkan peradangan otak akut pada manusia dan hewan berdarah panas lain. Penyebaran penyakit rabies biasanya melalui gigitan atau goresan yang mengandung air liur hewan terinfeksi virus rabies. Virus rabies akan menuju ke susunan saraf pusat (SSP) dan akan menyebar secara sentrifugal dari SSP ke berbagai organ, termasuk kelenjar ludah. Ada tiga reseptor virus rabies, yaitu reseptor nikotinat asetilkolin (NAChR), reseptor molekul adhesi sel neural, dan reseptor neurotropin P75 low-affinity. Asetilkolin, serotonin dan gamma amino butyric acid (GABA) merupakan neurotransmiter yang mempengaruhi terjadinya disfungsi saraf pada penyakit rabies.Rabies is a viral disease that causes acute inflammation of the brain in human and warm-blooded animal. The spread of rabies is through bites or scratches containing saliva of an infected animal. Rabies virus will go to the central nervous system (CNS) and will spread centrifugally from CNS to various organs, including salivary glands. Three rabies virus receptors are nicotinic acethylcholine receptor, neural cell adhesion molecule receptors and low-affinity receptor neurotropin P75. Acetylcholine, serotonin and GABA are neurotransmitters that play a role in neuronal dysfunction in rabies.
Karakteristik Penderita Rabies Paralitik di RSUP Sanglah, Denpasar Ernesta Ginting; Susilawathi NM; Raka Sudewi AA
Cermin Dunia Kedokteran Vol 41, No 11 (2014): Infeksi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v41i11.1068

Abstract

Latar belakang: Ada dua tipe manifestasi klinis rabies pada manusia, yaitu tipe galak dan tipe paralitik. Rabies tipe galak biasanya dapat dengan mudah didiagnosis berdasarkan tanda dan gejalanya yang khas, tetapi diagnosis rabies tipe paralitik sering merupakan dilema bagi klinisi, karena gejalan yang tidak khas dan mirip dengan sindrom Guillain-Barre. Tujuan: Mengetahui karakteristik pasien rabies paralitik di RSUP Sanglah. Metode: Penelitian deskriptif observasional dengan metoda pengumpulan data sekunder dari catatan medis penderita rabies di bangsal perawatan Neurologi RSUP Sanglah dari Januari 2009 – Desember 2010. Hasil: Pada penelitian ini ditemukan 13 (19,69%) kasus rabies paralitik. Gejala prodromal berupa: kesemutan daerah gigitan (69%), demam (46%), mual dan muntah (15%), insomnia dalam 2-5 hari sebelum masuk RS (7%). Gambaran klinis tipe paralitik berupa: paraparesis flaksid simetris (62%), paraparesis flaksid asimetris (15%), monoparesis (15%), fasikulasi (15%), inkontinensia urin (38%), retensi urin (15%), gejala gastrointestinal (distensi abdomen dan ileus paralitik) (53%). Pada stadium akhir (terminal) beberapa gejala klinis khas tipe galak juga muncul, yaitu: gangguan kesadaran berupa fase delirium dan agitasi yang berfluktuasi pada semua penderita (100%), hidrofobia (100%), hipersalivasi (84%), hiperhidrosis (38%), aerofobia (69%), dan fotofobia (7%). Pemeriksaan LCS mendapatkan jumlah sel normal pada 5 pasien dan sel meningkat pada 7(58%) pasien dengan rata-rata jumlah sel 32/mm3. Protein LCS normal pada 4 pasien dan meningkat pada 8(66%) pasien dengan rata-rata 184 mg/dl. Simpulan: Rabies tipe paralitik dan sindrom Guillain-Barre memiliki gejala klinis yang mirip yaitu adanya paralisis flaksid akut yang sering bersifat ascendens. Pada rabies tipe paralitik sering didapatkan beberapa gambaran klinis lain berupa demam, kesemutan di daerah luka gigitan, fasikulasi, inkontinensia urin, progresivitas gejala sangat cepat dan perubahan status kesadaran.Background: Human rabies can present in two clinical forms, furious and paralytic. Diagnosis of furious (encephalitic) form can be made based on typical symptoms and signs. In contrast, paralytic form poses a diagnostic dilemma to distinguish it from Guillain-Barre syndrome. Objective: To describe characteristics of paralytic rabies patients at Sanglah Hospital. Method: This is an observational descriptive study. All data was collected from secondary data from medical records of rabies patients in Neurology ward, Sanglah Hospital from January 2009 – December 2010. Result: There were a total of 13 (19,69%) cases of paralytic rabies. Prodromal symptoms consisted of: paresthesias at the site of healed bite wound (69%), fever (46%), nausea and vomiting (15%), insomnia in about 2-5 days prior to admissions (7%). The clinical features of the paralytic form were: symmetrical flaccid paraparesis (62%), asymmetrical flaccid paraparesis (15%), monoparesis (15%), fasciculation (15%), urinary incontinence (38%), urinary retention (15%), gastrointestinal symptoms (abdominal distention and paralytic ileus) (53%). Particularly all patients showed features of furious rabies in terminal stage: fluctuating consciousness between lucid calm and agitation (100%), hypersalivation (84%), hyperhydrosis (38%), hydrophobia (100%), aerophobia (69%), photophobia (7%). CSF cell counts were normal in 5 patients and increased in 7 (58%) patients with mean cell count of 32 cells/mm3. CSF protein was normal in 4 patients and increased in 8 (66%) patients with mean protein 184 mg/dl. Conclusion: Despite similarities between paralytic rabies and Guillain-Barre syndrome, some clinical features i.e., fever, distal paresthesia, fasciculation, urinary incontinence, rapid progression of symptoms and alteration in sensorium may help clinicians to differentiate rabies from Guillain-Barre syndrome. All paralytic rabies cases showed features of furious rabies in terminal stage.
Co-Authors Adinda Putra Pradhana Agung Bagus S. Satyarsa Agus Eka Darwinata Akira Ito Anak Agung Bagus Ngurah Nuartha Anak Agung Ngurah Subawa Angelia Carolin Bagiada I N. A. Christine Ekawati, Christine Christopher Ryalino Cokorda Istri Dyah Sintarani Sintarani Dedi Silakarma Desak Gde Diah Dharma Santhi Dewa Ngurah Suprapta Djoenaidi Widjaja Ernesta Ginting F. S. Wignall Ge Aris Geson Ginting, Ernesta Gitari, Ni Made I Dewa Made Sukrama I Gde Raka Widiana I Gede Ketut Sajinadiyasa I Gusti Kamasan Nyoman Arijana I Gusti Ngurah Kade Mahardika I Ketut Suastika I Made Jawi I Nyoman Adi Putra I Putu Eka Widyadharma I Wayan Niryana I Wayan Putu Sutirta Yasa I. B. P. Dwija Ida Ayu Jasminarti Dwi Kusumawardani Ida Ayu Sri Wijayanti Ida Bagus Ngurah Rai Imelda, Yuliana Monika Ivan Elisabeth Purba K. Subrata K. Wirasandhi Kade Agus Sudha Naryana Kazuhiro Nakaya M Wiryana Made Nyandra Made Wiryana N ADIPUTRA, N N. K. Susilarini NFN Moestikaningsih Ni Luh Putu Eka Arisanti Ni Made Adi Tarini Ni Made Susilawathi Ni Nengah Dwi Fatmawati Ni Nyoman Sri Budayanti Ni Putu Sriwidyani Ni Wayan Candrawati Oka Adnyana Pangkahila W Paramita, Dyah Pradnya Pramitasuri, Tjokorda Istri Pusaka, Semerdanta Putra Martin Widanta IGN Putu Yogi Pramana Sanjaya, Feliani Senja Decy Ningrum Sri Maliawan Sukmawati, Ni Made Dewi Dian Suryapraba, Anak Agung Ayu Susilawathi, Ni Made Thomas Eko Purwata Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Tjokorda Istri Pramitasuri Toni Wandra Vania, Aurelia Widanta IGN, Putra Martin Yasuhito Sako Yuliana Monika Imelda