Chapter I A00-B99 Certain Infectious & Parasitic Diseases นพ.บก เจญล กมงานลยกรรม รพ.สวรรประชาก นครสวรร 1 Tuberculosis Active Tuberculosis Miliary Tuberculosis Old Pulmonary Tuberculosis Atypical Mycobacteria 2 แนวทางการนกการจย ‣ ระอยวะดเอ ‣ กรเน Respiratory tuberculosis ใระการจย : by diagnostic confirmed - sputum AFB positive, PCR - culture - histology : by clinical diagnosis - negative investigation - no investigation Active Tuberculosis World TB Day ‘March 24’ 3 Active Tuberculosis A15.0 Tuberculosis of lung, confirmed by sputum microscopy with or without culture Tuberculous: · bronchiectasis · fibrosis of lung · pneumonia · pneumothorax confirmed by sputum microscopy with or without culture A15.1 Tuberculosis of lung, confirmed by culture only Conditions listed in A15.0, confirmed by culture only A15.2 Tuberculosis of lung, confirmed histologically Conditions listed in A15.0, confirmed histologically A15.3 Tuberculosis of lung, confirmed by unspecified means Conditions listed in A15.0, confirmed but unspecified whether bacteriologically or histologically Confirmed diagnosis sputum AFB postitive polymerase chain reaction [PCR] 4
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Tuberculosis - bph.moph.go.th · Active Tuberculosis World TB Day ‘March 24’ 3 Active Tuberculosis 22 WHO’s ICD-10 Tuberculosis (A15-A19) Includes: infections due to Mycobacterium
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Chapter I A00-B99 Certain Infectious
& Parasitic Diseasesนพ.บริรักษ์ เจริญศิลป์
กลุ่มงานศัลยกรรม รพ.สวรรค์ประชารักษ์ นครสวรรค์
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TuberculosisActive Tuberculosis Miliary Tuberculosis Old Pulmonary Tuberculosis Atypical Mycobacteria
Z85.5 Personal history of malignant neoplasm of urinary tract Conditions classifiable to C64-C68 Z85.6 Personal history of leukaemia Conditions classifiable to C91-C95 Z85.7 Personal history of other malignant neoplasms of lymphoid,
haematopoietic and related tissues Conditions classifiable to C81-C90, C96.- Z85.8 Personal history of malignant neoplasms of other organs and
systems Conditions classifiable to C00-C14, C40-C49, C69-C79, C97 Z85.9 Personal history of malignant neoplasm, unspecified Conditions classifiable to C80.-
Z86 Personal history of certain other diseases Excludes: follow-up medical care and convalescence(Z42-Z51 , Z54.-) Z86.0 Personal history of other neoplasms Conditions classifiable to D00-D48 Excludes: malignant neoplasms ( Z85.- )
Z86.1 Personal history of infectious and parasitic diseases Conditions classifiable to A00-B89, B99 Excludes: sequelae of infectious and parasitic diseases ( B90-B94 )
Z86.2 Personal history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Conditions classifiable to D50-D89
Z86.3 Personal history of endocrine, nutritional and metabolic diseases Conditions classifiable to E00-E90
Z86.4 Personal history of psychoactive substance abuse Conditions classifiable to F10-F19 Excludes: current dependence ( F10-F19 with common fourth character
.2) problems related to use of: · alcohol ( Z72.1 ) · drug ( Z72.2 ) · tobacco ( Z72.0 )
‣ มีอาการในระบบทางเดินหายใจ “Sequelae of tuberculosis”
• Haemoptysis, Bronchiectasis, Atelectasis
• Chronic respiratory failure
‣ อาจมีประวัติการวินิจฉัยหรือเคยได้รับการรักษา
Old Pulmonary TB
90 WHO’s ICD-10
Sequelae of infectious and parasitic diseases (B90-B94) Note: Categories B90-B94 are to be used to indicate conditions in
categories A00-B89 as the cause of sequelae, which are themselves classified elsewhere. The "sequelae" include conditions specified as such; they also include late effects of diseases classifiable to the above categories if there is evidence that the disease itself is no longer present. For use of these categories, reference should be made to the morbidity or mortality coding rules and guidelines in Volume 2. Not to be used for chronic infections. Code current infections to chronic or active infectious disease as appropriate.
B90 Sequelae of tuberculosis B90.0 Sequelae of central nervous system tuberculosis
B90.1 Sequelae of genitourinary tuberculosis
B90.2 Sequelae of tuberculosis of bones and joints
B90.8 Sequelae of tuberculosis of other organs
B90.9 Sequelae of respiratory and unspecified tuberculosis Sequelae of tuberculosis NOS
B91 Sequelae of poliomyelitis Excludes: postpolio syndrome (G14)
B92 Sequelae of leprosy
B94 Sequelae of other and unspecified infectious and parasitic diseases B94.0 Sequelae of trachoma
B94.1 Sequelae of viral encephalitis
B94.2 Sequelae of viral hepatitis
B94.8 Sequelae of other specified infectious and parasitic diseases
B94.9 Sequelae of unspecified infectious or parasitic disease
PDx: Respiratory Problem, SDx: Sequelae of Pulmonary Tuberculosis
กรณีผู้ป่วยกำลังเป็นโรคที่สัมพันธ์กับโรคเอดส์ ให้บันทึกเป็น HIV disease with AIDs related conditions และให้รหัส B20.-, B21.-, B22.- หรือ B23.- เป็นการวินิจฉัยหลักทุกครั้ง
Dengue FeverDengue Fever Dengue Without Warning Signs Dengue With Warning Signs Severe Dengue
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๏ First record “Jin Dynasty” (265–420 AD)
“Water poison” associated with flying insects
๏ First confirmed case report dates (1789)
Benjamin Rush “Breakbone fever” symptoms of myalgia and arthralgia
๏ First confirmed transmission by Aedes mosquitoes (1906)
๏ First confirmed showed to be caused by virus (1907)
The second disease after Yellow fever
๏ First noted “Dengue hemorrhagic fever, Dengue shock syndrome”
(1981) in Central and South America
Dengue“Ka-dinga pepo” cramp-like seizure caused by evil spirit
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✦ Dengue virus (DENV)
: a mosquito-borne flavivirus
✦ Serotype
: DENV-1, DENV-2, DENV-3, DENV-4
Dengue VirusArbovirus, family Flaviviridae
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Dengue InfectionLaboratory Testing
Confirmed diagnosis of Dengue infection
๏ Antibody detection
- Hemagglutination inhibition [HAI]
- ELISA (IgG/IgM)
- Rapid test (IgG/IgM)
๏ Antigen detection
- NS1 & E/M antigen
๏ RNA detection
- RT-PCR
๏ Viral isolation
NS1: nonstructural protein 1; RT-PCR: rapid test polymerase chain reaction
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Dengue InfectionCriteria for Highly Suggestive and Confirmed Dengue Infection
Highly suggestive [One of the following]
‣ IgM + in a single serum sample
‣ IgG + in a single serum sample with HI titre >1280
Confirmed [One of the following]
‣ PCR positive
‣ Virus culture positive
‣ IgM seroconversion in paired sera
‣ IgG seroconversion in paired sera or 4-fold IgG titre increase
in paired sera
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Dengue InfectionASEAN Dengue Day ‘June 15’
* Dengue fever # Severe dengue
Clinical Manifestations of Dengue Virus Infection
‣ Asymptomatic
‣ Undifferentiated fever – viral syndrome
‣ Dengue without warning signs*
‣ Dengue with warning signs*
‣ Dengue haemorrhagic fever#
‣ Dengue shock syndrome#
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Classification by Severity
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DF/DHF Grade Symptoms Laboratory
DF DHF without plasma leakage
DHF I
Fever with non-specific constitutional symptoms; the only hemorrhagic manifestation is a positive tourniquet test and/or easy bruising evidence of plasma leakage
Thrombocytopenia <100,000
DHF IIDHF grade 1 plus spontaneous bleeding
DHF III
Circulatory failure manifested by a rapid, weak pulse, narrowing fo pulse pressure, or hypotension, cold & clammy skin, restlessness
DHF IVProfound shock with undetectable blood pressure
WHO classification 1997
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Dengue with or without alarm signs Severe Dengue
without alarm signs with alarm signs1. severe vascular permeability 2. severe hemorrhage 3. severe organ dysfunction
Dengue suspicion Alarm signs 1. Severe vascular permeability that leads to:- shock [DSS]- accumulation of the fluids
that causes respiratory failure2. Severe hemorrhage- evaluated by the clinician3. Severe organ dysfunction- LFT: AST or ALT >1000- CNS: loss of consciousness- cardiac and other organ
dysfunction
Endemic zones of degree with FEVER + two of the following criteria- nausea, vomiting- exanthem- arthralgias- positive TT- leukopenia
LABORATORY CONFIRMATION
- abdominal pain- persisting vomiting- mucosal hemorrhage- edema- lethargy or agitation- hepatomegaly >2cm- LAB: increase in Hct
with platelet decrease
REQUIRES MEDICAL OBSERVATION AND
INTERVENTION
WHO classification 2009
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DF/DHF Grade* Symptoms Laboratory
DF
Fever with two or more of the following signs: headache, retro-orbital pain, myalgia, arthralgia, rash
Leukopenia occasionallyThrombocytopenia, may be present, no evidence of plasma loss