demam 4 hari naik turun

8/9/2019 Demam 4 Hari Naik Turun

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Demam 4 hari naik turun (tinggi pada malam hari)

Batuk berdahak dan pilek

Sakit kepala

Nafsu makan menurun

BAK BAB Normal

BAKTER !arang diba"ah #$% tahun& biasan'a pada a"al$a"al masuk sekolah&

berkurang saat beran!ak rema!a dan de"asa (Radang tenggorokan& tidak ada

batuk& demam, sakit kepala& perut dan muntah) TABAAN *D+N*,A-A. (/0$

%12 KAS3S ADA ANAK& 0$/12 KAS3S ADA DE5ASA)

Pemfs (aring hiperemis, tonsil bengkak biasanya denganeksudat kuning atau darah, ptechie di palatum atau aring posterior,

uvula merah dan bengkak, kgb cervical anterior bengkak, scarlet ever)

6irus Biasan'a sekitar ada 'ang menderita hal 'ang sama. (Batuk& pilek& diare&

kon!ungti7itis& serak& 8or'9a (meler& muka bengkak& bersin#)

Pemfs tergantung masing-masing virus.

SU!"# $"%S&$

'nalisis

Demam 4 hari naik turun (tinggi pada malam hari) biasanya bakteri

Batuk berdahak dan pilek biasanya virus

Tidak ada pembesaran kgb biasanya virus

Tidak ada n'eri menelan biasanya virus

Sakit kepala biasanya bakteri

asil aringitis akut dengan virus ditambah ineksi sekunder dari

bakteri. ahahahahaha

Usulan pemeriksaan #apid test, kultur tenggorokan, kultur virus, P*#

P"$'+'%'S'$''$ +"#'P '$+!&+

The onset of streptococcal pharyngitis is often rapid with prominent sore throat,

absence of cough, and fever. Headache and gastrointestinal symptoms (abdominal pain,

vomiting) are frequent. The pharynx is red, and the tonsils are enlarged and classically

covered with a yellow, blood-tinged exudate. There may be petechiae or doughnut!


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lesions on the soft palate and posterior pharynx, and the uvula may be red, stippled, and

swollen. The anterior cervical lymph nodes are enlarged and tender. The incubation period

is "#$ days. Some patients demonstrate the additional stigmata of scarlet fever: circumoral

pallor, strawberry tongue, and a red, finely papular rash that feels like sandpaper and

resembles sunburn with goose pimples (see Chapter 1! ".

The onset of viral pharyngitis may be more gradual, and symptoms more often include

rhinorrhea, cough, and diarrhea. % viral etiology is suggested by the presence of

con&unctivitis, cory'a, hoarseness, and cough.

%denovirus pharyngitis may feature concurrent con&unctivitis and fever

(pharyngocon&unctival fever).

oxsacievirus pharyngitis may produce small (*#" mm) grayish vesicles and punched-out ulcers in the posterior pharynx (herpangina), or small (+# mm) yellowish-white

nodules in the posterior pharynx (acute lymphonodular pharyngitis).

n /0 pharyngitis, there may be prominent tonsillar enlargement with exudate,

cervical lymphadenitis, hepatosplenomegaly, rash, and generali'ed fatigue as part of the

infectious mononucleosis syndrome (see hapter "$* ).

1rimary H20 infections in young children often present as high fever and

gingivostomatitis, but pharyngitis may be present (see hapter "34 ).

SP'

#pper respiratory tract infections account for a substantial portion of visits to pediatricians.

$ppro%imately 5 of such illnesses feature a sore throat as the primary symptom.

T67689.

The most important agents causing pharyngitis are viruses, (adenoviruses, coronaviruses,enteroviruses, rhinoviruses, respiratory syncytial virus &'S), *pstein+arr virus &*),

herpes simple% virus &-S), metapneumovirus" and group % :-hemolytic streptococcus

(8%/H2). ther organisms sometimes associated with pharyngitis include group C

streptococcus, Arcanobacterium haemolyticum, Francisella tularensis, Mycoplasma

pneumoniae, Neisseria gonorrhoeae, and Corynebacterium diphtheriae. ther bacteria, such

as Haemophilus influenzae and Streptococcus pneumoniae, may be cultured from the throats

of children with pharyngitis, but their role in causing pharyngitis has not been established.

1;


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yr of age, has a pea incidence in the early school years, and declines in late adolescence

and adulthood. /llness occurs most often in winter and spring and spreads among siblings

and classmates. 0haryngitis from group C streptococcus and A. haemolyticum occurs most

freuently among adolescents and adults. 0rimary infection with -/ also manifests with

pharyngitis and a mononucleosis+like syndrome.

1%TH68=22.

Coloni2ation of the pharyn% by 3$-S can result in either asymptomatic carriage or

acute infection. The < protein is the ma&or virulence factor of 8%/H2 and facilitates

resistance to phagocytosis by polymorphonuclear neutrophils. Type-specific immunity

develops during infection and provides protective immunity to subsequent infection

with that particular < serotype.

Scarlet fever is caused by 3$-S that produces 1 of 4 streptococcal erythrogenic e%oto%ins

($, , and C" that can induce a fine papular rash (see Chapter 1! ". *%oto%in $ appears to

be most strongly associated with scarlet fever. *%posure to each e%oto%in confers specificimmunity only to that to%in and, therefore, scarlet fever can occur up to + times.

7=%7 2T%T6=2.

The onset of streptococcal pharyngitis is often rapid with prominent sore throat,

absence of cough, and fever. Headache and gastrointestinal symptoms (abdominal pain,

vomiting) are frequent. The pharynx is red, and the tonsils are enlarged and classically

covered with a yellow, blood-tinged exudate. There may be petechiae or doughnut!

lesions on the soft palate and posterior pharynx, and the uvula may be red, stippled, and

swollen. The anterior cervical lymph nodes are enlarged and tender. The incubation period

is "#$ days. Some patients demonstrate the additional stigmata of scarlet fever: circumoral pallor, strawberry tongue, and a red, finely papular rash that feels like sandpaper and

resembles sunburn with goose pimples (see Chapter 1! ".


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The onset of viral pharyngitis may be more gradual, and symptoms more often include

rhinorrhea, cough, and diarrhea. % viral etiology is suggested by the presence of con&unctivitis, cory'a, hoarseness, and cough.

%denovirus pharyngitis may feature concurrent con&unctivitis and fever

(pharyngocon&unctival fever).

oxsacievirus pharyngitis may produce small (*#" mm) grayish vesicles and punched-

out ulcers in the posterior pharynx (herpangina), or small (+# mm) yellowish-white

nodules in the posterior pharynx (acute lymphonodular pharyngitis).

/n * pharyngitis, there may be prominent tonsillar enlargement with e%udate, cervical

lymphadenitis, hepatosplenomegaly, rash, and generali2ed fatigue as part of the infectiousmononucleosis syndrome (see Chapter !51 ".

0rimary -S infections in young children often present as high fever and gingivostomatitis,

but pharyngitis may be present (see Chapter !67 ".

The illnesses attributed to group C streptococcus and A. haemolyticum are generally similar

to those caused by 3$-S. /nfections with A. haemolyticum are sometimes accompanied by

a blanching, erythematous, maculopapular rash. 3onococcal pharyngeal infections are

usually asymptomatic but can cause acute pharyngitis with fever and cervical lymphadenitis.

;%8=622.


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The goal of specific diagnosis is to identify 8%/H2 infection. The clinical presentations of

streptococcal and viral pharyngitis show considerable overlap. 0hysicians using clinical

8udgment often overestimate the likelihood of a streptococcal etiology, so laboratory testing is

useful in identifying children who are most likely to benefit from antibiotic therapy. Throat

culture remains an imperfect gold standard for diagnosing streptococcal pharyngitis.

>alse-positive cultures can occur if other organisms are misidentified as 8%/H2, andchildren who are streptococcal carriers can also have positive cultures. >alse-negative

cultures are attributed to a variety of causes, including inadequate throat swab

specimens and patients? surreptitious use of antibiotics.

The specificity of rapid tests to detect group % streptococcal antigen is high, so if a rapid

test is positive, throat culture is unnecessary and appropriate treatment is indicated.

/ecause rapid tests are generally less sensitive than culture, confirming a negative

rapid test with a throat culture is recommended, especially if the clinical suspicion of

8%/H2 is high.

Special culture media and a prolonged incubation are reuired to detect A. haemolyticum.

0iral cultures are often unavailable and are generally too expensive and slow to be

clinically useful. 0iral polymerase chain reaction (1@) is more rapid and may be

useful but is not always necessary. $ complete blood cell (CC" count showing many

atypical lymphocytes and a positive slide agglutination (or 9spot" test can help to confirm a

clinical diagnosis of * infectious mononucleosis.

T@%T


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compliance and provides adeuate blood levels for more than 1; days. 'eports that a high

proportion of patients treated with oral or intramuscular penicillin remain culture positive

after treatment deserve further evaluation. rythromycin (erythromycin ethyl succinate 6;

mg


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spontaneously have fewer episodes over time, however, so the anticipated clinical benefit

must be balanced against the risks of anesthesia and surgery. #ndocumented histories of

recurrent pharyngitis are an inadeuate basis for recommending tonsillectomy.

Complications and 0rognosis.

0iral respiratory tract infections may predispose to bacterial middle ear infections.

The complications of streptococcal pharyngitis include local suppurative complications,

such as parapharyngeal abscess, and later nonsuppurative illnesses, such as acute

rheumatic fever (see Chapter 1!.1 " and acute postinfectious glomerulonephritis (see

Chapter 511.1 ".

0revention.

Dultivalent streptococcal vaccines based on D protein peptides are under development.

$ntimicrobial prophyla%is with daily oral penicillin prevents recurrent 3$-S infections butis recommended only to prevent recurrences of acute rheumatic fever (see Chapter 1!.1 ".

demam 4 hari naik turun

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