2. demam pada bayi dan anak umy

7/27/2019 2. DEMAM Pada Bayi Dan Anak Umy

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DEMAM DANINFEKSI TROPIS

Nur Muhammad Artha


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Kasus I

Seorang anak perempuan 8 tahun di bawa ke puskesmas

dengan keluhan demam hilang timbul sejak 2 minggu yang lalu

disertai menggigil dan berkeringat. Buang air kecil berwarna

merah gelap. Dari pemeriksaan fisik didapatkan anak sakit

berat, delirium,pucat. Suhu 390C, nafas 30x/menit. Pada

pemeriksaan abdomen ditemukan hepar teraba per 1/3, lien

S2. Pada pemeriksaan laboratorium, didapatkan Hb: 4,8

leukosit 19000, trombosit 85000. Apakah diagnosis yang

paling mungkin?


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INTRODUCTION

Fever in childhood

among the most likely reason to seek for medical help

may be infectious / non-infectious; viral origin is themajority; serious bacterial infection may ensue

Differentiation between viral and bacterial disease may bedifficult, especially in neonates and young infants

Evaluation and management is evolving at a rapid pace (1.amount of research conducted, 2. introduct of HIB vaccine,3. Streptococus pneumoniae vaccine, 4. ever-evolvingdiagnostic technologies and therapies)


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What is fever

A rise in the temperature set point at hypothalamus by a

variety of physiological mechanism

Fever usually occurs as a result of the bodys exposure to

infecting micro organism, immune complexes or other sourcesof inflammation


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Definition

Normal variation in body temperature no singlevalue defined as fever

Generally accepted values:

rectal temperature above 100.40F (380C)oral temperature above 99.50F (38.50C)axillary (armpit) temperature above 990F (37.40C)ear temperature above 100.40F (380C) in rectal modeor above 99.50F (38.50C) in oral mode

UpToDate last updated Jan 2008


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Definition of fever

Pathophysiologically : is an IL-1 mediated elevation of the

thermoregulatory set point of the hypothalamic center

Clinically: fever is body temperature of 1 C (1.8F) or greater

above the mean at the site of temperature recording.

El Radhi et al 2009


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The following degrees of temperature are accepted asfever :

Rectal : > = 38.0 C

Oral : > = 37.6 C

Axillary : > = 37.4 C Tympanic membrane : > 37.6 C

The importance of at least 1C higher than the meantemperature lies in the diurnal variation of normal body

temp, reaches its highest level in early evening (5-7 pm).


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Arch Dis Child Educ Pract Ed 2008;93:2629.


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PATTERN OF FEVER

Continuous (sustained ) fever :

persistent elevation of body temperature with a maxfluctuation of 0.4 C during a 24-h period

Remitten : a fall in temp each day but not to a normal

level Intermitten : temp returns to normal each day, usually in

the morning and peaks in the afternoon

Hectic (septic) : when remitten or intermittent fevershows a very large difference between the peak and the

nadir Recurrent : describes a single illness involving the same

organ or multiple organ system in which fever recurs atregular


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Prolonged : a single illness in which duration of fever exceeds

that expected for this illness (for viral ARI > 10 days)

Recurrent : involving the same organ or

multiple organ system in which fever recurs at irregular

intervals


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The pattern of temperature changes may occasionally hint at the diagnosis: Continuous fever: Temperature remains above normal throughout the day and

does not fluctuate more than 1 C in 24 hours, e.g.lobar pneumonia, typhoid,urinary tract infection, brucellosis, or typhus. Typhoid fever may show a specificfever pattern, with a slow stepwise increase and a high plateau. (Drops due to

fever-reducing drugs are excluded.)

Intermittent fever: Elevated temperature is present only for some hours ofthe dayand becomes normal for remaining hours, e.g., malaria, kala-azar, pyaemia, orsepticemia. In malaria, there may be a fever with a periodicity of24 hours(quotidian), 48 hours (tertian fever), or 72 hours (quartan fever, indicatingPlasmodium malariae). These patterns may be less clear in travelers.

Remittent fever: Temperature remains above normal throughout the day andfluctuates more than 1 C in 24 hours, e.g., infective endocarditis.

Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma,being high for one week and low for the next week and so on. However, there issome debate as to whether this pattern truly exists.[10]
http://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Lobar_pneumoniahttp://en.wikipedia.org/wiki/Typhoidhttp://en.wikipedia.org/wiki/Urinary_tract_infectionhttp://en.wikipedia.org/wiki/Brucellosishttp://en.wikipedia.org/wiki/Typhushttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Lobar_pneumoniahttp://en.wikipedia.org/wiki/Typhoidhttp://en.wikipedia.org/wiki/Urinary_tract_infectionhttp://en.wikipedia.org/wiki/Brucellosishttp://en.wikipedia.org/wiki/Typhushttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Kala-azarhttp://en.wikipedia.org/wiki/Pyaemiahttp://en.wikipedia.org/wiki/Septicemiahttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Kala-azarhttp://en.wikipedia.org/wiki/Pyaemiahttp://en.wikipedia.org/wiki/Septicemiahttp://en.wikipedia.org/wiki/Plasmodium_malariaehttp://en.wikipedia.org/wiki/Plasmodium_malariaehttp://en.wikipedia.org/wiki/Infective_endocarditishttp://en.wikipedia.org/wiki/Infective_endocarditishttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Hodgkin%27s_lymphomahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Hodgkin%27s_lymphomahttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Pel-Ebstein_feverhttp://en.wikipedia.org/wiki/Infective_endocarditishttp://en.wikipedia.org/wiki/Plasmodium_malariaehttp://en.wikipedia.org/wiki/Plasmodium_malariaehttp://en.wikipedia.org/wiki/Septicemiahttp://en.wikipedia.org/wiki/Pyaemiahttp://en.wikipedia.org/wiki/Kala-azarhttp://en.wikipedia.org/wiki/Kala-azarhttp://en.wikipedia.org/wiki/Kala-azarhttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhushttp://en.wikipedia.org/wiki/Brucellosishttp://en.wikipedia.org/wiki/Urinary_tract_infectionhttp://en.wikipedia.org/wiki/Typhoidhttp://en.wikipedia.org/wiki/Lobar_pneumoniahttp://en.wikipedia.org/wiki/Medical_diagnosis


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ETIOLOGIES OF FEVER

Infectious and non-infectious processes (drug fever, CNS dysfunction,chronic inflammatory conditions)

Children with FWS are clinically categorized:

infants younger than 3 monthschildren 3 months to 36 monthschildren who have fever lasting for 7-10 days

Fever during the first 2 mos, uncommon, serious

temp 38.90C suggests SBI in 36% cases infants 4 wks40%; 2 wks5%


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Demam tanpa tanda lokal

Sumber: Guidelines for the Management of Common Illnesses with Limited Resources, 2005 . WHO, 2005


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Demam tanpa tanda lokal



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Demam Dengan Tanda Lokal


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Demam dengan Tanda Lokal



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Demam > 7 hari



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Demam > 7 hari



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DEMAM DENGAN RUAM PADA

ANAK


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PATOGENESIS RUAM

Patogenesis manifestasi kulit dari penyakitsistemik :

Penyebaran mikroorganisma melalui darah yangkemudian menghasilkan infeksi sekunder di kulit

(Varicella, enterovirus, meningococcemia) Infeksi terjadi di lokasi tertentu, namun toksin yang

dihasilkan kemudian menyebar dan mencapai kulitmelalui darah (TSS, SSSS)

Dugaan dasar imunologis (eritema multiformeeksudativum)

Keterlibatan vaskuler


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KLASIFIKASI DAN ETIOLOGI

Pembagian ruam dapat dilakukan menurut beberapa metodeseperti :

Morfologi ruam

Infeksi dan non infeksi

Penyebab infeksi

Gejala dan tanda penyerta

Klaster temuan / syndromic diagnosis

Potensi tingkat kegawatan


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KLASIFIKASI MORFOLOGI

RUAM

Krugman : makulopapular dan papulovesikular

Pakar lain : Makular

Makulopapular Vesikular, Bullosa, dan Pustular

Petekial dan Purpural

Urtikarial

Papular, Nodular, Ulseratif

Eritema Multiforme

Eritema Nodosum

Eritroderma Difus

Distinctive Rashes

Ruam Anulare


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DEFINISI

SKIN LESION DESCRIPTION

Macule

Patch

PapulePlaque

Nodule

Vesicle

Bulla

PustuleWheal

Petechiae

Ecchymosis

Diffuse erythema

Flat discoloration 1 cm in diameter

Solid elevated lesion 1.5 cm in diameter

Rounded elevated lesion >1 cm in diameter

Fluid-filled elevated lesion up to 1 cm in diameter

Vesicle >1 cm in diameter

Elevated lesion filled with pusWell-demarcated raised lesion lasting


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Bentuk dan Susunan Lesi Kulit


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MORFOLOGI

Makula Nodula


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MORFOLOGI

Papula Urtika


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MORFOLOGI

Vesikula Pustula


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Klasifikasi Krugman

Krugman membuat deskripsi darisetiap penyakit di dalam daftar yangmeliputi 5 aspek : Riwayat penyakit infeksi dan imunisasi

sebelumnya Gejala prodromal Bentuk ruam Tanda patognomonik dan tanda

diagnostik lain Tes laboratorium


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Klasifikasi KrugmanMAKULOPAPULAR PAPULOVESIKULAR

MeaslesAtypical measlesRubellaScarlet feverStaphylococcal scalded skin syndromeStaphylococcal toxic shock syndromeMeningococcemiaTyphus and tick feverToxoplasmosisCytomegalovirus infectionErythema infectiosum (parvovirus)Roseola infantum (HHV-6)Enteroviral infectionsInfectious mononucleosisToxic erythema

Drug eruptionsSunburnsMiliariaKawasaki disease

Varicella zoster infectionSmallpoxEczema herpeticumEczema vaccinatumCoxsackievirus infectionOther enterovirus infectionsAtypical measlesRickettsialpoxImpetigoInsect bitesPapular urticariaDrug eruptionsMolluscum contagiosumDermatitis herpetiformis


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Demam Dengan Ruam

Sumber: Guidelines for the Mana ement of Common Illnesses with Limited Resources 2005 . WHO 2005


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Ruam Campak
http://www.google.com/url?sa=i&rct=j&q=ruam%20campak&source=images&cd=&cad=rja&docid=vP9SYhelVDesDM&tbnid=JNCV8lk19BMdBM:&ved=0CAUQjRw&url=http%3A%2F%2Fhealth.kompas.com%2Fread%2F2012%2F07%2F17%2F06361637%2FCampak.Bisa.Dicegah.dengan.Imunisasi&ei=Z483UujeC4OpkAXL_IGoAQ&psig=AFQjCNFrfrgaym7TYeRtxy05mpRY6leWGA&ust=1379459021077354http://www.google.com/url?sa=i&rct=j&q=ruam%20campak&source=images&cd=&cad=rja&docid=htJEan_uAny-KM&tbnid=Icvdzl4-V4z0tM:&ved=0CAUQjRw&url=http%3A%2F%2Fparamedik.bbfr.net%2Ft8243-demam-campak-measles&ei=aI43UrjMApDvkAWjiIDwBA&bvm=bv.52164340,d.dGI&psig=AFQjCNFrfrgaym7TYeRtxy05mpRY6leWGA&ust=1379459021077354


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Summary

Several clinical practice guidelines established and evaluated. could

be useful to improve clinicians ability in handling patients

especially the management of febrile illness in young infants

Clinical evaluation, observation, history, and physical exam

represent the most effective means of determining the cause of

fever without apparent source.


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TERIMA KASIH


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Adapted from Baraff L. Ann emergency med 2000; 36:605

Management of febrile ( 38C) healthy infant 28-90 days without source


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2. demam pada bayi dan anak umy

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