Pemeriksaan Laboratorium...
Transcript of Pemeriksaan Laboratorium...
Irmawanty Setiaputri
RS PARU dr.H.A ROTINSULU
Pemeriksaan LaboratoriumCOVID-19
(2019-nCoV)
WHONovel Corona Virus= 2019-nCoV
COVID-19Corona Virus Disease
Karakteristik COVID 19 (2019-nCoV)
• Virus corona adalah zoonosis (ditularkan dari hewan dan manusia)
• Merupakan virus single-strand, positive-sense RNA, panjang genom bervariasi dari 26 to 32 kb
• Transmisi virus melalui droplet namun diduga dapat melalui airborne
Guidance:
1
2
3
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6
Specimen Type
Biosafety Level
Safety Procedures During Sample Collection and Transport
Lab
GuidanceTesting of 2019-nCoV in Reference Laboratories
Diagnostic Knowledge Gaps
Reporting of Cases and Test Results5
Jenis spesimen dan prioritas
Untuk meningkatkan deteksi CDC merekomendasikan:
•Pengambilan 3 jenis spesimen dari :
• saluran nafas bagian atas
• saluran nafas bagian bawah
• Serum darah
•Jika memungkinkan/diperlukan: urine dan feses
SPESIMEN UNTUK PENEGAKAN DIAGNOSIS
Spe
cim
en
Typ
e
Tipe Spesimen
Spesimen Jumlah Container
Saluran nafas bagian atas
- Apus nasofaring- Apus orofaring
1 apus1 apus
Virus Transport Media
Saluran nafas bagian bawah
- Sputum- Tracheal aspirate- BAL
2-3 ml2-3 ml
Pot sputumSputum trap
Darah - Serum Whole blood 5 ml
Tabung eppendorf
CDC, WHO 2020
Nasopharyngeal swab:
•Masukkan swab kedalam lubang hidung sejajar langit langit
mulut.
•Diamkan beberapa saat agar sekret NP meresap pada swab,
lakukan dari kedua belah lubang hidung
•Segera masukan swab ke dalam tabung berisi VTM
Oropharyngeal swab (e.g., throat swab):
•Lakukan swab pada daerah belakang faring jangan sampai
menyentuh lidah
•Segera masukkan swab ke dalam tabung berisi VTM
Viral Transport Medium (VTM)
Eppendorf tube
Swab sintetik berbahan DACRON dgn
GAGANG PLASTIK
!!!! Jangan pakai swab calcium alginate swabs atau swab
gagang kayu : karena dapat mengandung bahan yang
menginaktivasi virus dan menghambat proses PCR
Masukkan SEGERA swab O/N disatukan ke
tabung VTM
Simpan spesimen pada suhu 4°C segera kirim ke reff lab
dalam rantai dingin
Safe
typ
roce
du
res
Safety procedures sample transport
• Triple layer packaging
Form Pengantar Spesimen Balitbangkes
Test
ing
20
19
-nC
oV
• Patients that meet the case definition for suspected 2019-nCoV should be screened for the virus with PCR.
• Laboratories may desire to use a pan-coronavirus assay for amplification followed by sequencing of amplicons from non- conserved regions for characterization and confirmation.
• Several molecular assay have been and are currently under development. Some groups shared their molecular assays, most procedures assume a basic familiarity with PCR/RT-PCR assay.
Testing of 2019-nCoV in reference laboratories
Pemeriksaan COVID 19 di BALITBANGKES
Menggunakan 2 protokol dari:
1. US CDC: rRT-PCR
2. Jerman:
Menggunakan 2 target gen:
- Gen N (nucleocapsid)
- gen RdRp (RNA-dependent RNA polymorphism)
• TAT: + 2 hari
https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance/laboratory-guidance
In-house developed molecular assays
Test
ing
20
19
-nC
oV
https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance/laboratory-guidance
In-house developed molecular assays
• China CDC Primers and probes for detection 2019-nCoV (24 January 2020)
• Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR –Charité, Berlin Germany (17 January 2020)
• Detection of 2019 novel coronavirus (2019-nCoV) in suspected human cases by RT-PCR – Hong Kong University (23 January 2020)
• PCR and sequencing protocol for 2019-nCoV - Department of Medical Sciences, Ministry of Public Health, Thailand (Updated 28 January 2020)
• PCR and sequencing protocols for 2019-nCoV- National Institute of Infectious Diseases Japan (24 January 2020)
• US CDC panel primer and probes– U.S. CDC, USAV – U.S. CDC, USA (28 January 2020)
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China
Chest X-Ray
Blood Tests
• Bilateral pneumonia (75%), unilateral pneumonia (25%), ground-glass opac (14%)
• Leukocytosis (24%)
• Lymphopenia (35%)
• Anemia (51%)
• Prothrombin time decreased (30%)
• D-dimer increase (36%)
• Albuminemia (98%)
• ALT increased (35%)
• LDH increased (76%)
• ESR increased (85%)
• Serum feritin increased (63%)
• CRP increased (86%)
Cases Characteristic
•Usia 21 – 82 (55.5)
•man : woman = 3 : 1
•51% w chronic ilnness:
•CV dan CVD 40%
•ICU: ARDS (17%), acute respiratory injury (8%), septic shock (4%)
•Co-infection:
– Bacteria (1%)
– Fungus (4%)
– Other virus (0%)
Chen N, et al. Published Online January 29, 2020
Hal yang perlu diperhatikan dalam Pengambilan spesimen
Perhatikan kewaspadaan standard dan Kewaspadaan berbasis transmisi
• Kebersihan tangan
• Gunakan APD lengkapa. Masker N95/respirator partikulatb. Sarung tanganc. Pelindung wajah atau mata/face shieldd. Baju/coat/gaun/aprone. Tutup kepalaf. Sepatu tertutup atau memakai cover shoes
• Higiene petugas
• Kebersihan ruangan: dekontaminasi permukaan dengan desinfektan
TERIMA KASIH