demam pada anak --riva

8/18/2019 Demam Pada Anak --Riva

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Demam Pada AnakDemam Pada AnakRiva Auda,dr, SpA,MKes


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PendahuluanPendahuluan

Demam merupakan salah satu tandapenyakit

Pasien dibawa ke UGD atau poliklinikDefnisi demam penin!katan suhu

tubuh diatas normal

Suhu tubuh suhu permukaan dansuhu inti


3/129

DemamDemamSuhu tubuh normal

◦

"#,$%"&,' (◦ "#,'%"&,' (

Defnisi demam penin!katan suhu

tubuh di atas normalPenin!katan suhu di atas "&,) (*oral+,

atau "),*rektal+Paterson

Penin!katan suhu ")(*rektal+, "&,#(*oral+ atau "&," *aksila+-arkin

Penin!katan suhu rektal.") (,aksila

"&,/(, atau oral "&,'

-rayden


4/129

Proses pen!aturan suhuProses pen!aturan suhu

tubuhtubuhPusat pen!aturan suhu tubuh re!iopreoptik hipotalamus anterior◦ re!io deteksi suhu *termostat+◦ re!io pen!atur suhu *set point +

◦ re!io e0ektor *re!io penin!katan suhu danpelepasan panas+Mekanisme umpan balik 1ermostat men!ukur suhu tubuh

deteksi suhu darah arteri yan! sampaike otak2n0ormasi dan reseptor panas dan

reseptor din!in 3alur a0eren kulit


5/129

2n0ormasi dan reseptor panas dan reseptordin!in 3alur a0eren kulit

Paparan suhu din!in dari lin!kun!an sekitar reseptor din!in pada kulit bereaksi 3alur

a0eren kulit ke neuron tidak peka suhu*temperature-insensitive neurons+ di kiasmaoptikum

Suhu 4 set point *di bawah "&5(+ men!hambat neuron e0ektor peka panas*warm-sensitive efector neurons) di korpusmamilaris pelepasan panas 6 neurone0ektor peka din!in *cold-sensitive efectorneurons+ terpa7u produksi panas 8


6/129

Paparan suhu panas dari lin!kun!ansekitar akan menyebabkan reseptorpanas pada kulit bereaksi danmenyampaikan in0ormasi tersebutmelalui 3alur a0eren kulit ke neuron pekapanas *warm-sensitive neurons+ dikiasma optikum

Suhu . set point *diatas "&5(+ mema7u neuron e0ektor peka panas

*warm-sensitive efector neurons) dikorpus mamilaris pelepasan panas 8 neuron e0ektor peka din!in *cold-sensitive efector neurons) dihambat produksi panas 6


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Produksi panasProduksi panas

Pembentukan ener!i pada tin!katmitokondria katabolisme 0os0orilasioksidati0 ADP A1P sel prosesseperti transpor akti0, sintesis berba!aimolekul, dan kontraksi otot panas

Peran!san!an din!in se7ara lan!sun!pada 9pusat motorik untuk men!!i!il:yan! terletak pada ba!ian dorsomedialhipotalamus posterior dekat dindin!

ventrikel keti!a akan menyebabkanproduksi panas akibat kontraksi ritmikotot ran!ka; Kontraksi ini dikenalden!an men!!i!il


8/129

2katan antara norepinephrin den!anreseptor adrener!ik pada membransel lemak 7oklat *brown at + sintesis7AMP 8, pen!akti0an protein kinase A,

dan penin!katan 0os0orilasi lipase%sensiti0 hormon hidrolisis tri!liseridamen3adi !liserol dan asam lemakbebas ADP A1P panas

Produksi Thyroid Releasing Hormone

*1R


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Pelepasan panasPelepasan panas

Pelepasan panas tersebut dikenalden!an mekanisme konduksi,konveksi, radiasi, dan pen!uapan

Pemindahan panas ke kulit

pen!hambatan pusat simpatis dihipotalamus posterior vasokonstriksi dihambat vasodilatasi pada pembuluh darahkulit ke7epatan pemindahan panas

ke kulit sampai delapan kali lipat=0ek lain yan! ter3adi berkerin!at

pen!uapan


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Patofsiolo!i panasPatofsiolo!i panas

" mekanisme◦ produksi panas 8 dan pelepasan panas 6 set point di hipotalamus 8 in0eksiatau ke!anasan

◦

produksi panas 8 atau paparan suhupanas dan lin!kun!an yan! berlebihansedan!kan pelepasan panas normal heatstroke

◦ produksi panas normal tetapi pelepasanpanas ter!an!!u displasia ektodermal

Mekanisme kedua dan keti!a disebut 3u!a seba!ai heat illness.


11/129Dinarello, 1997


12/129

-akteri Gram >e!ati0 -akteri Gram >e!ati0

/ ma7am piro!en lipopolisakarida*?PS+ dan peptido!likan

?PS merupakan komponen piro!enikutama pada kuman !ram ne!ati0

berikatan den!an lipopolysaccharidebinding protein *?-P+ ?PS trans0erprotein men!katalis ikatan den!an?PS pada reseptor ?PS yan! dikenalden!an (D $ 8 produksi dan

pen!eluaran sitokin dari sel terutamatumor necrosis 0a7tor *1>@+


13/129 Nogare, 1997


14/129

-akteri Gram Positi0 -akteri Gram Positi0

Komponen piro!enik berupapeptido!likan, asam lipoteikoat *?1A+,dan polisakarida !rup -

Peptido!likan komponen utamadindin! sel bakteri !ram e0ekpiro!enik muramyl dipeptide *MDP+ berikatan den!an (D $ stimulasi

produksi sitokin◦ Aktivasi 3alur perubahan komplemen◦ 2nduksi makro0a! untuk men!eluarkan 1>@


15/129

Polisakarida !rup - B rhamnoseglucose polymers *RGP+ berikatanden!an monosit melalui perantara (D$ stimulasi produksi 1>@

=ksotoksin berikatan den!anmolekul M@ dansitokin lainnya


16/129 Nogare, 1997


17/129

-CD 1=MP=RA1UR= E-CD 1=MP=RA1UR= E

M=ASUR=M=>1M=ASUR=M=>1*11+*11+

1e7hni7al ◦ /' F o0 thermometers ina77urate a0ter )

months o0 usa!e stora!e◦ Positionin! Cral Real sublin!ual -eneath 0oenum *anterior mounth Hoor+

1he deep o0 insertin! in to the re7tum I


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(ore temperature

◦ DiJ7ult to measure

◦ Deeper lo7ation hi!her temperature

◦ Generally a7nowled!e as brain temperature

Pulmonary artery

◦ -est avalaible measure o0 7ore temperature

◦ Pulmonary 7atheter invasive

=sopha!us

◦ (losed to arterier that 7arry blood to the brain

◦

>ot uni0orm alon! the len!th o0 the esopha!us◦ 2nHuen7ed by tra7hel air

◦ $" lower esopha!us parallel that o0 pulmonaryartery


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Urinary -ladderUrinary -ladder

Urine is fltrate o0 blood*euivalent to /LF o0 7ardia7output+ urine temperature

reHe7t blood temperatureA77ura7y vary dependin! on the

rate o0 urinary output


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Re7tumRe7tum


21/129

MCU1


22/129

1ympani7 Membrane 1ympani7 Membrane

1heoreti7ally ideal sitePer0used by artery whi7h

per0used thermore!ulatory 7enter


23/129

AksilaAksila

Relati0 mudah, nyaman, risikoke7il penyebaran penyakit

Sensitivitas rendah, dan variasi

suhu yan! tin!!i


24/129

Alat pen!ukur suhuAlat pen!ukur suhu

1ermometer air raksa 1ermometer di!ital

1ermometer membran timpani

1ermometer arteri temporalis


25/129

Ma7am demamMa7am demam

Demam intermittendemam d!n penurunansuhu ke suhu normal sian! hari, penin!katansuhu pada sore hari

Demam remiten demam den!an variasi suhu.L,' ( tanpa ada penurunan ke suhu normal

Demam septik demam den!an Huktuasibesar

Demam kontinyu demam terus menerusden!an variasi suhu 4 L,' (


26/129


27/129

1reatment 1reatment

>on Medikamentosa

◦ Men3a!a kenyamanan penderita

◦ -anyak minum

◦ Kompres

Medikamentosa

◦ Simtomatikmenurunkan set point di

hipotalamusmen!hambat enOimsiklooksi!enase

◦ Kausati0 sesuai penyakit dasar


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Ma7am antipiretikaMa7am antipiretika

Asetamino0en$L%$' m!k!bbN

2bupro0en '%$L m!k!bbN

MetamiOole $L m!k!bbhari diba!i"% dosis

Asam me0enamat /L m!k!bbhari

diba!i " dosis


29/129

TYPHOID FEVERTYPHOID FEVER


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ETIOLOGY ETIOLOGY 1yphoid 0ever Salmonella typhi %%.

the most 0reuent and severeParatyphoid 0ever

Salmonella paratyphi S.schottmuelleri *S.paratyphi !+S.hirscheldii *S.paratyphi "+

Cther Salmonella serotypes


31/129

EPIDEMIOLOGY EPIDEMIOLOGY Incidence

Developed countries markedlyUSA, estern =urope, Qapan4 L;/$LL;LLL

Southern =urope

;" $;' $LL;LLL

Developing countries'LL$LL;LLL *L;' F+


32/129


33/129

1he inoculum sie! "#$ % "#& S. typhi org'nisms

(tom'ch 'cidit)! import'nt determin'nt o*suscepti+ilit) to ('lmonell'

,tt'cchment to the microvilli o* the ile'l +rush+orders

Inv'de intestin'l epithelium -through pe)er.s

p'tches/

Tr'sported to intestin'l l)mph nodes

-multiplic'tion 0ithin the mononucle'r cells/

1 mesenteric l)mph node


34/129

Re'ch the +loodstre'm through the thor'cic duct

2ircul'ting org'nisms %%3 reticuloendotheli'l cellsLiver4 spleen4 +one m'rro04 other org'ns

5'cteremi' recurs-p'rticul'rl) g'll+l'dder/

continued


35/129

P'thogenesis


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-one marrow Mononu7lear

response

Gallbladder @o7al inHammation

?un! -ron7hitis is 7ommon

Pneumonia

Cthers

% Septi7 arthritis % Pyelonephritis

% Csteomyelitis % =ndophtalmitis% Menin!itis


37/129

2LI6I2,L M,6IFE(T,TIO6

Incu+'tion period9%": d')s -r'nge ;%;# d')s/

Depend on 'ge

(chool%,ge children 'nd 'dolescents Initi'l s)mptoms

Fever4 m'l'ise4 'nore


38/129

2nd wk sustained high fever, fatigue, anorexia, cough,and abdominal symptoms

ppear acutely ill, disoriented, and lethargy

Delirium, stupor !elative bradycardia, hepatomegaly, splenomegaly,

distended abdomen

"acular or maculopapular rash

#rose spots$ 7th %1&th day'(esions$ discrete, erythematous, 1%) diameter,slightly raised, and blanch on pressure

(continued)


39/129

!honchi * scattered rales

+f complications #%' %% symptoms-physical findingsgradually resolve #2 % . wk'

"alaise and lethargy may persist #1%2 mo'

Infants and young children < 5 year "ild$

fever, malaise %% misinterpreted as viral syndrome

Diarrhea$ is more common in young children %%misdiagnosis as acute gastroenteritis

/ign and symptoms of lower respiratory tractinfection

(continued)


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Neonates bortion and premature delivery

During late pregnancy %% transmitted vertically

Neonatal disease $ usually begins within 0 days of

delivery $omiting diarrhea, abdominal distention,

emperature is variable % maybe .&o3

/ei4ures may occur

5epatomegaly, 6aundice

norexia and weight loss

(continued)


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DIAGNOSIS

3ulturing the Salmonella strain: the basis for confirmingthe diagnosis lood cultures (!)

Stool "urine cultures (!) after the first #ee$

%ulture of bone marro# (!) during later stages:&he single most sensiti'e methods ( (!) 5*5+ and lessinfluenced by ,rior antimicrobial thera,y)

Stool

-rine (sometimes)

.or earlier diagnosis:

S.typhi /i antigen (urine)

0olymerase chain reaction (blood)

%ulture (!) : chronic carriers


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yphoid should be considered in any patient with

prolonged unexplained fever in endemic areas and in

those with a history of recent travel to endemic area

8rolonged fever, rose spots, relative bradycardia and

leucopenia make typhoid strongly suggestive

idal test measures titres of serum agglutinins

against somatic #:' and flagellar #5' antigens whichusually begin to appear during the 2nd week +n the

absence of recent immuni4ation, a high titre of

antibody to : antigen 1$;.& is suggestive but not

specific


43/129

8olymerase chain reaction #83!' can be performed on

peripheral mononuclear cells he test is more sensitive

than blood culture alone #92< compared with )&%7&one marrow aspirate cultures give the best

confirmation #?)%9)


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(aboratory findings

% Normochromic normocytic anemia

% (eukopenia usually not A 2)&& cells-mm0

8yogenic abscesses %% (eukocytosis % hrombocytopenia #1 wk'

% 8roteinuria

% Becal leukocyte and blood $ very common

(continued)


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!8+D C// B:! D+N:/+N!8+D C// B:! D+N:/+N

E85:+DE85:+D

&y,hidot test that detects presence of +g" and +g inone hour #sensitivity9)


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(ontrol o0 1yphoid 0ever(ontrol o0 1yphoid 0ever12AS-32S DI32%&2D &O 32S23/OI3

a' %ase detection and treatment

b) Isolation

c)Disinfection of stools and urine

d)Detection 4 treatment of carriers

12AS-32S A& 3O-&2S O. &3ANS1ISSION a' ater sanitation

b) .ood sanitation

c) 26creta dis,osal

d) .ly control

12AS-32S .O3 S-S%20&I72S

a) immuno,ro,hyla6is

b)health education


47/129

8ee, the ,remises and $itchen utensils clean9 Dis,ose rubbish ,ro,erly9 8ee, hands clean and fingernails trimmed9 ash hands ,ro,erly #ith soa, and #ater before eating or handling

food and after toilet or changing dia,ers9 Drin$ing #ater should be from the mains and ,referably boiled9

0urchase fresh food from reliable sources9 Do not ,atroni;e illegalha#$ers9

A'oid highris$ food li$e shellfish ra# food or semicoo$ed food9 ear clean #ashable a,rons and ca,s during food ,re,aration9 %lean and #ash food thoroughly9

Scrub and rinse shellfish in clean #ater9 Immerse them in clean #aterfor sometime to allo# self,urification9

3emo'e the 'iscera if a,,ro,riate %ont

=2A7&= 03O1O&ION


48/129

Store ,erishable food in refrigerator #ell co'ered9=andle and store ra# and coo$ed food es,ecially seafood

se,arately (u,,er com,artment of the refrigerator forcoo$ed food and lo#er com,artment for ra# food) toa'oid cross contamination9

%lean and defrost refrigerator regularly and $ee, thetem,erature at or belo# >?c

%oo$ food thoroughly9

Do not handle coo$ed food #ith bare hands@ #ear glo'es ifnecessary9%onsume food as soon as it is done9 If necessary refrigerate coo$ed lefto'er food and consume

as soon as ,ossible9 3eheat thoroughly before

consum,tion9 Discard any addled food items926clude ty,hoid carrier from handling food and from

,ro'iding care to children9


49/129

Spe7if7 prote7tionSpe7if7 prote7tion

5!CC E8C/ :B 33+NC/

1 +n6ectable yphoid vaccine

#TYPHIM @i'

2 he live oral vaccine #E85:!('

0 > vaccine


50/129

Inectable &y,him /i

1 his single%dose in6ectable typhoid vaccine, from the

bacterial capsule of S. typhi strain of y21a

2 his vaccine is recommended for use in childrenover 2 years of age

0 +ntramuscular in6ection

. Cfficacy $ ;.< %72<


51/129

DI..232N&IA7 DIAGNOSIS

+nitial stageastroenteritis, viral syndrome, bronchitis,

bronchopneumonia

/ubse=uently

% /epsis #other bacterial pathogen'

% +nfectious caused by intracellular microorganisms

#tuberculosis, brucellosis, tularemia,

leptospirosis, rickettsial disease,viral infections'

% "alignancies #leukemia, lymphoma'


52/129

&32A&12N&

3hloramphenicol)& mg-kg-2. hr po or

7) mg -kg-2. hr iv in four e=ual doses

moxicillin$ 1&& mg-kg-2. hr po, 0 doses mpicillin$ 2&& mg-kg-2. hr iv . doses

rimethoprim % /ulfamethoxa4ole $

1& mg "8 * )& mg /"F-kg-2. hr po in

2 doses

( ti d)


53/129

!esistant strains$ usually susceptible to thirdgeneration cephalosporins

3efixime 2& mg-kg-2. hr po, 2 divided doses for ?days

3eftriaxone )& mg-kg-2. hr im for five days :floxacin 1) mg-kg-2. hr po for 2 days

/hock, obtundation, stupor, or coma$

! Dexamethasone 0 mg-kg #initial dose' %%

1 mg-kg every ; hr for .? hr

(continued)

(continued)


54/129

/upportive-maintenance$

ppropriate fluid and electrolyte balance

+ntestinal hemorrhage is severe$ >lood transfusion

+ntestinal perforation$ /urgical

hrombocytopenia$ 8latelet transfusion

(continued)


55/129

%O107I%A&ION /evere intestinal hemorrhage$ 1 % 1&<

5emorrhage $ emperature>lood pressure

8ulse rate

+ntestinal perforation #distal ileum'$ &) % 0 <

bdominal pain , tenderness, vomiting, and

sign of peritonitis

/epsis $ aerobic gram #%' bacilli * anaerobes

5epatitis, cholecystitis, pancreatitis #serum amylase ' 8neumonia$ /uperinfection with other

organisms #1&


56/129

oxic myocarditis, endocarditis

rombosis,phlebitis$ rarely

Neurologic complications$

+ntracranial pressure, cerebral thrombosis, acutecerebellar ataxia, chorea, aphasia, deafness,

psychosis, transverse myelitis, peripheral-opticneuritis

8yelonephritis, nephrotic syndrome, meningitis

8arotitis,orchitis

>one marrow necrosis /uppurative lymphadenitis

:steomyelitis and septic arthritis

(continued)


57/129

03OGNOSIS De,ends on:

8rompt therapy

ge

8revious state of health

/almonella serotype ppearance of complications$

% astrointestinal perforation

% /evere hemorrhage

% "eningitis

% Cndocarditis

% 8neumonia

(continued)


58/129

1ortality rates:

Developed countries$ A 1 <

Developing countries$ 1& <

he appearance of complication is associated

with high morbidity and mortality rates

!elapse$ .% ? < #are not treated with antibiotics '

!elapse 2 wk after stopping antibiotics, usually

milder and shorter duration

3arriers$ 1 % )<

(continued)


59/129

D=MAM -=RDARAGU=D=>GU=

ETIOLOGYETIOLOGY


60/129

ETIOLOGYETIOLOGY

VIR7(VIR7(

Den!ue virion are spheri7al parti7lesapproNimately 'L nm in diameter;

7ontains a sin!le plus strand o0 R>A;

Surrounded by a lipid bilayer;Mature virions are 7omposed o0 #F

R>A, TF 7arbohydrate, and $&F

lipid;-e7ause o0 the lipid envelope,

Havviviruses are readily ina7tivated

by or!ani7 solvents and deter!ents;

ETIOLOGYETIOLOGY


61/129

ETIOLOGYETIOLOGY

VIR7(VIR7(

1hree viral proteins are asso7iatedwith virions;

1he = *envelop+, M *membrane+and ( *7apsid+ proteins;


62/129

VIR7(VIR7(

1he = protein is the ma3or sur0a7eprotein o0 the viral parti7leprobably intera7ts with viral

re7eptors, and mediates virus%7ellmembrane 0usion;

Antibodies that neutraliOe virus

in0e7tivity usually re7o!niOe thisprotein and mutations in = 7anae7t virulen7e;


63/129

VIR7(VIR7(

M protein is a small proteolyti70ra!ment whi7h is important 0ormaturation o0 the virus into an

in0e7tious 0orm;

( protein is a 7omponent

nu7leo7apsid;

=tiolo!y=tiolo!y


64/129

=tiolo!y=tiolo!y

1ypes 1ypes

@our distin7t anti!eni7ally relatedserotypes * $to + o0 den!ue virus o0

the 0amily Haviviridae are

etiolo!i7ally responsible;2n0e7tion in human by one serotypes

produ7es li0e lon! immunity a!ainst

re%in0e7tion by the same serotype;subseuent in0e7tion with other

serotypes may result in a severe

illness ie;, D


65/129

EPIDOMIOLOGYEPIDOMIOLOGY

Den!ue outbreaks in urban areas in0estedwith A;ae!ypti may be eNplosive upto &L%)LF o0 population may be involved;

Durin! epidemi7 most disease o77ur in older

7hildren and adults be7ause A;ae!ypti has alimited ran!e spread, epidemi7 o77ursmainly throu!h viremi7 human bein!s and0ollows the main lines o0 transportation ;

here den!ue is endemi7 7hildren andsus7eptible 0orei!ners may be the onlypersons to a7uire overt disease adultshavin! be7ome immune;



66/129


VectorVector

Den!ue viruses are transmittedby mosuitoes o0 the ste!omyia0amily;

A7des ae!ypti a day time bitin!mosuito is the prin7ipal ve7torand all types o0 virus have been

re7overed 0rom it;


67/129


68/129

VectorVector

Aedes mosuitoes *1i!ermosuito+ distin!uished by whitestripes on bla7k body;

2mportant members aedes0amilyA; ae!ypty, A;vittatus andA; albopi7tus;

1hey are most abundent durin!rainy season;


69/129

VectorVector

?ays e!! sin!ly, and e!!s are7i!ar shaped;

@emale mosuito a7ts as ve7tor;

1hey do not Hy over lon!distan7e% 4$LLmts*$$Lyards+,

this 0a7tor 0a7ilitates its

eradi7ation;


70/129

Tr'nsmissionTr'nsmission

2n most tropi7al areas A%ae!ypti ishi!hly urbaniOed;

1hey breed in 0resh water like waterstored 0or drinkin! or bathin! and inrain water 7olle7ted in any 7ontainer;

Den!ue viruses have also beenre7overed 0rom Aedes% Albopi7tus;

Dem'm Dengue -DD/ d'nDem'm Dengue -DD/ d'n


71/129

Dem'm Dengue -DD/ d'nDem'm Dengue -DD/ d'n

Dem'm 5erd'r'h Dengue -D5D/Dem'm 5erd'r'h Dengue -D5D/

Viral arthroborne disease yan! palin! serin!'L $LL 3uta kasus DD per tahun/'L 'LL ribu kasus D-D per tahun 2ndonesia

◦ Semua propinsi A-A<


72/129

+nfeksi irus Dengue

simtomatik

Demam Dengue #DD'

iral /yndrome

anpa

perdarahan

Demam >erdarah Dengue #D>D'

/imtomatik

Dengan

perdarahan

anpa syok Dengan syok#D//'

PA1C@2S2C?CG2PA1C@2S2C?CG2


73/129

PA1C@2S2C?CG2PA1C@2S2C?CG2

Demam Den!ueDemam Den!ue


74/129

Demam Den!ueDemam Den!ueMasa inkubasi " $ hariPanas tin!!i mendadak, sakit kepala, sakit

retroorbital>yeri sendi, tulan! pun!!un! *ba7kborne

0ever+?emah, malaise

@lushin! muka, leher@oto0obi, hiperestesi, sakit menelan, batukRuam primer makulopapular, toraks, lipat

sendi, se!era hilan!Perdarahan petekiae, epistaksis, !usi, saluran

7erna, hematuri mikroskopis, menorrha!i


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Demam Den!ueDemam Den!ue

Demam !e3ala bisa◦ Men!hilan! hari ke%" atau sembuh◦ -erkuran! hari ke%" atau lalu timbul la!i setelah

$ " hari saddle back appearance 1otal lama demam ' & hari

Ruam sekunder◦ Setelah hari ke%, terserin! hari ke%# atau &◦ Makulopapularptekiaepurpurik7ampuran◦ KonHuen, biasanya kaki dan tan!an◦

Kadan!%kadan! !atal?eukopeni, trombositopeni serin! ditemukan


76/129

2 V2V V22 V22222222 2V

"#o(

"To(

Lo(

")o("&o(

Ru'mprime

r

Ruamsekunder

Pola Panas pada D@Pola Panas pada D@


77/129

Demam -erdarah Den!ueDemam -erdarah Den!ue

*D-D+*D-D+ Suhu mendadak tin!!iGe3ala mirip DD @ase awal petekiae, ekstremitasmukaaksila

palatum mole


78/129

Demam -erdarah Den!ueDemam -erdarah Den!ue

?aboratorium◦ Unik trombosit turun *4 $LL;LLLWl+

disusul

bersamaan den!an


79/129

Kriteria Kasus D-D *

M l h


80/129

MasalahMasalah

-eda D- den!an DD◦ Den!an pemeriksaan


81/129

Dia!nosisDia!nosis

Klinis kriteria


82/129

Pen!elolaanPen!elolaan

DD

◦ 2stirahat

◦ Antipiretik

asetamino0en◦ -anyak minum

◦ 2V@D bilamuntah

D-D

◦ Antipiretik

◦ -anyak minum

◦

Antikonvulsan bila ke3an!◦ 2V@D Qumlah rumatan 7airan

pen!!anti

Qenis

Kristaloid R?, RA, D'R?,D'RA

Koloid Albumin, Dekstran,


83/129

V21A? S2G> A>D a(l L,TF

*#%& mlk!kh+

+"8!:C"CN

5aematocrit falls, pulse rate and blood

pressure stable, urine output rises

2MPRCV=M=>1

Redu7e iv therapy*' mlk!kh+

Redu7e iv therapy*" mlk!kh+

@UR11

iv colloid th

5t !+/C/ #or distress'

V21A? S2G> CR1

2MPRCV=M=>1

>C 2MPRCV=M=>1

N: +"8!:C"CN5t or pulse rate rises, pulse pressure falls below

2& mm5g #2,7k8a', urine output falls

2n7rease iv therapy *$L mlk!kh+

5t B(( /

>lood transfusion

2n7rease iv therapy *$' mlk!kh+

U>S1A-?= V21A? S2G>Urine output 0alls, si!ns o0 sho7k

=stablish 7entral venous a77ess andurinary 7atheter, administer rapid Huid

bolus


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Glang bolus

Hristaloid 0 ml-kg-6am

+nfus hentikan

#tidak lebih .? 6am'

>:(G/ 1& ml-kg>>-1& menit

I

Holoid 2& ml-kg>>-1& menit

% 8asang 38

% Horeksi gangguan asam, basa dan

elektrolit% Nilai$

o Bungsi kontraktilitas miokardium

o +rama 6antung

% Darah atau 8!3$

o 5b A 1& g<

o 8erdarahan masif

o 8erdarahan internal

etap baik 8ertahankan

dalam 12 @ 2. 6am

Hristaloid ) ml-kg-6am

etap stabil ; @ 12 6am

SCK

imbang >>, !esusitasi >3, kses vena, contoh darah,

Hateter urin, 8ipa orogastrik, !awat 8+3G, >olus

kristaloid 1& @ 2& ml-kg>>-0& menit

/E:H C!/+ J

Hritaloid 1& ml-kg>>-6am

8antau tanda vital, diuresis,

5b, 5t

+DH C!/+

+DH C!/+ C!/+ J

1erapi1erapi


85/129

1erapi 1erapi

C/, timban! --, akses vena, ukur outputurin

Resusitasi 7airan $L /L 77k!-- dalamwaktu /L "L, bisa diulan! / " N

Qenis (airan

◦ Kristaloid setelah /L "L hanya /'F yan! bertahan dalam

intravaskuler

Kadar


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PREVE6TIO6PREVE6TIO6

1issue 7ulture%based va77ines 0orden!ue virus types $, /, " and areimmuno!eni7 but not available 0or!eneral use;

ProphylaNis depends on use o0inse7ti7ides, repellents, body prote7tive

7lothin!, and s7reenin! o0 houses toavoid the bite o0 the mosuito;

Destru7tion o0 A; ae!ypti breedin! sites

also is ee7tive;



87/129


20 water stora!e is mandatory, ali!ht%fttin! lid or a thin layer o0 oilmay prevent e!! deposits orhat7hin!;

A larvi7ide, su7h as Abate,available as a $F sand !ranule0ormulation and ee7tive at a

7on7entration o0 $ part per million,may be added sa0ely to drinkin!water;

EPIDEMI2 ME,(7RE(EPIDEMI2 ME,(7RE(


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orld


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90/129


ith limited 0unds, su7heuipment and inse7ti7ides 7anbe sto7kpiled 7entrally 0or rapid

transportation where reuired;Priority areas 0or laun7hin!!round appli7ations are thosehavin! a 7on7entration o0 7ases;



91/129


Spe7ial attention should be 0o7used on areaswhere people 7on!re!ate durin! dayli!ht hours,0or eNample, hospitals and s7hools; 20 ne7essary,

ultra%low%volume inse7ti7ides may be applied 0romair7ra0t; (& or similar air7ra0t, smaller a!ri7ulturalspray planes, and heli7opters have been used tomake aerial appli7ations;

Durin! the early sta!es o0 epidemi7s, ultra%low%volume spray o0 F malathion in diesel oil orkerosene may be used to spray all houses within a$LL%m radius o0 the residen7e o0 D


92/129

Er'dic'tion 'nd 2ontrolEr'dic'tion 'nd 2ontrol

A; ae!ypti was eradi7ated 0rom7ountries and whole 7ontinentswith use o0 the te7hniues

pioneered by the Ro7ke0eller@oundation;

ith time, the spe7ies

su77ess0ully reestablished itsel0 inmu7h o0 its 0ormer ran!e;

E di ti d 2 t lEr'dic'tion 'nd 2ontrol


93/129


An eradi7ation 7ampai!n in theUnited States was abandoned and

was repla7ed by a pro!ram o0disease surveillan7e and7ontainment o0 introdu7ed virus;



94/129


Mosuito 7ontrol or eradi7ationpro!rams reuire the simultaneous use

o0 two approa7hesRedu7tion in breedin! sites

Appli7ation o0 larvi7ides

Alternatively, a si!nif7ant redu7tion inpopulation may be ee7ted by 7loselyspa7ed appli7ation o0 adulti7ides;

Redu7tion in breedin! sitesRedu7tion in breedin! sites


95/129

Redu7tion in breedin! sites!

Sour7e redu7tion 7ampai!ns shouldbe well or!aniOed, supervised, andevaluated;

2n7ludes proper disposal o0 dis7arded7ans, bottles, tires, and otherpotential breedin! sites not used 0orstora!e o0 drinkin! or bathin! water;

Drinkin! and bathin! water stora!e7ontainers and Hower vases should beemptied 7ompletely on7e weekly;

Redu7tion in breedin! sitesRedu7tion in breedin! sites


96/129

!!

ater 7ontainers that 7an not beemptied should be treated withAbate $F sand !ranules at

dosa!e o0 $ ppm *e;!;, $L ! o0sand to $LL ? o0 water+;

1reatments should be repeated atintervals o0 / to " months;

Appli7ation o0 larvi7idesAppli7ation o0 larvi7ides


97/129

pppp

Vehi7les%mounted or portable ultra%low%volume aerosol !enerators ormist blowers 7an be used to applyte7hni7al !rade malathion or0enitrothion at ") m?ha;

1hree appli7ations made at $%weekintervals 7an suppress; A ae!ypti

populations 0or about / months;

He'lth Educ'tionHe'lth Educ'tion


98/129


A; ae!ypti 7ontrol has beenmaintained ee7tively in sometropi7al areas throu!h the simpleeNpedient o0 emptyin! water7ontainers on7e a week;

Durin! the yellow 0ever7ampai!ns, stron! sanitary laws

made the breedin! o0 mosuitoeson premises a 7rime punishable byfne or 3ail



99/129


2n the modern era, Sin!aporeand (uba have adopted thesemeasures su77ess0ully;


100/129


101/129

Penyakit virus umum – akut

– pembesaran kelenjar liur

terutama kelenjar parotitis – rasa sakit

% Paramyxovirus

- Satu serotipe

- Isolasi dari saliva, LCS, darah, urin,

otak, jaringan lainnya


102/129

- Endemis- Penularan kontak langsung

droplet udara

muntahan

- Laki-laki ! Perempuan- "sia # $% tahun pra imunisasi- Isolasi virus dari saliva

& hari sebelum – ' hari sesudah

pembesaran kelenjar saliva- (ekebalan bertahan lama setelah in)eksi- *ntibodi dari ibu &-+ bulan I


103/129

- asa inkubasi $-.$ hari

- Prodromal /jarang pada anak0

- Panas – sakit otot – sakit kepala - malaise

(has Pembesaran satu1dua kelenjar parotits 2 sakit

Pun3ak pembengkakan $ – 4 hari→ berkurang 4 – 5 hari


104/129


105/129

:rkitis, epididimis Sering pada adolesens - de;asa


106/129

Pankreastitis

- >ingan 2 subklinik

- Sakit epigastrium 2 panas 2 menggigil

- ual 2 muntah – lemah

- *milase serum↑

?e)ritis

Pada anak 9

$6-$ hari sesudah parotitis

iokarditis

Sakit prekardial – bradikardia – rasa lelah


107/129

@uli unilateral

@uli sara)

@ransien atau permanen

Lain-lain


108/129

- =ejala khas 2 pemeriksaan )isik A- Lab rutin tidak spesi)ik leukopeni 2 lim)ositosis relati)

(omplikasi → leukositosis P?

*milase serum↑

≈ Pembengkakan

→ normal dalam

. minggu

- B1 etiologi - Isolasi virus

- Peningkatan antibodi khas


109/129

% Parotitis virus lain *IBS

Coxsa3kie virus -

- Parotitis supurativa → Pus

- Parotitis rekurens → *lergi

- @umor parotis Lim)osarkoma

- Lim)adenitis

- (alkulus saliva Intermiten


110/129

% Pasi) =amaglobulin hiperimun@idak e)ekti) men3egah

engurangi komplikasi

% *kti)

D aksin hidup yang dilemahkan

D Parotitis post vaksinasi jarang

5 - $6 hari post vaksinasi

D


111/129

Simptomatik dan suporti)

- Istirahat

- Biet

% *nalgetik, sedativa

V,RI2ELL, -2HI2HE6 PO>/V,RI2ELL, -2HI2HE6 PO>/


112/129

V,RI2ELL, -2HI2HE6 PO>/V,RI2ELL, -2HI2HE6 PO>/

1his is a hi!hly 7onta!ious in0e7tion 7hara7teriOed by a pleomorphi7rash;

Etiology: Vari7ella%Ooster virus whi7h 7ause (hi7ken poN in a nonimmune and


113/129

Se7ondary ba7terial in0e7tion o0 skin lesions;


114/129

Vari7ella rash


115/129


116/129

M=>2>GC(C((A? S=P12(A=M2AM=>2>GC(C((A? S=P12(A=M2A


117/129


MCR1A?21 '%$LF *TLF i0 D2(+

MCR-2D21 $LF

*Dea0ness, neurolo!i7al problems,amputations+

Peak in7iden7e 4 yrs

2mmunisation pro!ramme in7ludes Men (#LF o0 ba7terial menin!itis in UK due to Men -



118/129


(?2>2(A? @=A1UR=S

@ever, non%spe7if7 malaise, lethar!y,vomitin!, menin!ism, resp distress,

irritability, seiOures

Ma7ulopapular rash 7ommon early in

disease

Pete7hial rash seen in 'L%#LF



119/129


MA>AG=M=>1 2> PR2MAR (AR=

2MM=D2A1= 2V2M A>12-2C12(S

-enOylpeni7illin $;/! . $Lyrs -enOylpeni7illin #LLm! $%Tyrs -enOylpeni7illin "LLm! 4 $yr

(C>1A(1 PRCP


120/129


2MP=12GC2MP=12GC


121/129

2MP=12GC2MP=12GC

Staph Aureus or Gp A Strep Pyo!enes(lassi7ally ruptured vesi7les withhoney%7oloured 7rustin!

May be bullous

More 7ommon in pre%eNistin! skindiseaseVery 7onta!ious, rapid spread(ommonly starts around 0a7emouth

RN; 1opi7al 0usidi7 a7id or oralHu7loNa7illinAdvi7e re nurserys7hool

2MP=12GC2MP=12GC


122/129

2MP=12GC2MP=12GC

S1AP


123/129

SK2>SK2>

(aused by Staphylo7o77al eN0oliativetoNin=rythematous tender skin, pro!ressin!

to desuamation a0ter /%)hrs>ikolsky si!n#/F 4 /yrs, T)F 4 'yrs-(s usually ne!ative in 7hildrenUsually 0ebrile, may rapidly pro!ress

to dehydrationsho7kRN; Systemi7 antistaphylo7o77al abN;,

emollients, may need 2V Huids

S1AP< S(A?D=D SK2>S1AP< S(A?D=D SK2>


124/129

S1AP< S(A?D=D SK2>S1AP< S(A?D=D SK2>

S(AR?=1 @=V=RS(AR?=1 @=V=R


125/129

S(AR?=1 @=V=RS(AR?=1 @=V=R

Gp A beta%haemolyti7 Strep/% days post%Strepto7o77al pharyn!itis@ever, heada7he, sore throat, unwell@lushed 0a7e with 7ir7umoral pallorRash may eNtend to whole bodyRou!h Ysandpaper skinDesuamation a0ter '&, parti7ularly soles

and palmsS7hool a!e 7hildren

hite strawberry ton!ueDN; 1hroat swab, ASC titresRN; Peni7illin $L&

S(AR?=1 @=V=RS(AR?=1 @=V=R


126/129

S(AR?=1 @=V=RS(AR?=1 @=V=R

H'nd Foot Mouth Dise'seH'nd Foot Mouth Dise'se


127/129

' d oo ou se'se

=nterovirus 0amily(oNsa7kie virus A$#

in0e7tion M((Sores in mouth with

asso7iated blisters onhands and 0eet7lassi7ally

May only have soresin mouth on eNam in a

lot o0 7ases

H'nd Foot MouthH'nd Foot Mouth


128/129

H'nd Foot Mouth

(ant 7at7h it 0romanimalsZ

Mostly in 7hildrenunder $L yo

Spread to other7hildren throu!h hand7ontamination

"%& day in7ubation

period


129/129

demam pada anak --riva

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