Imunopatofisiologi Kep

7/23/2019 Imunopatofisiologi Kep

1/96

IMUNOPATOFISIOLOGI

Aris Dwi Cahyono, S.Kep.Ns., M.Kes.


2/96

Pertahanan nonspesifi

! "arrier fisi

! "ahan anti#ateri

! Miroor$anis%e o%ensa&! Fa$osit

! Inf&a%asi

! De%a%


3/96

Ko%p&e%en

! Protein 'a&a% 'arah yan$ #erperan 'a&a%

pertahanan t(#(h

!Se#anya )* protein y$ terati+asi searaasa'e

! Terati+asi %e&a&(i - a&(r / a&(r &asi,

a&ternatif 'an Mannose0#in'in$ Letin


4/96

Ati+asi o%p&e%en


5/96

Pertahanan Spesifi

! Li%fosit T

! Li%fosit "

! Anti#o'i


6/96

Li%fosit T

! Mat(rasi 'i ti%(s

! Me%i&ii T Cell Receptor1TC23

! Men$ena& anti$en! Me%i&ii (taan tipe 1C&one3

! Me%i&ii #er#a$ai tipe se&


7/96

Tipe Li%fosit T

! T he&per 4 CD 5/ %e%#ant( 'an

%en$ati+asi sisti% i%(n

!T sitotosi 4 CD 6 / %e%#(n(h se& yan$terinfesi +ir(s

! T re$(&ator / %e%#ant( %ere$(&asi7

%en$at(r sisti% i%(n


8/96

Li%fosit "

! Pro'(si anti#o'i

! Mat(rasi 'i s(%s(% t(&an$

! Me%i&ii anti#o'i se#a$ai reseptornya


9/96

Anti#o'i

! Protein #er#ent( h(r(f 8

! Me%i&ii #a$ian/

! Fa#/ anti$en #in'in$ fra$%ent! Te%pat %e&eat anti$en

! F/ rista&&i9a#&e fra$%ent

! Te%pat %e&eat pa'a reseptor anti#o'i


10/96

Anti#o'i


11/96

Ke&as Anti#o'i

! I%(no$&o#(&in/

! I$ M / perta%a a&i ter#ent(

! I$ G / ter#ent( e'(a, ter#anya '&%'arah

! I$ : / %eran$san$ 7 %e%i( a&&er$i

! I$ D / s#$ reseptor (nt( anti$en! I$ A / 'iseresi &ewat ASI, Li(r, air %ata


12/96

2eseptor anti#o'i

! Te%pat %e&eatnya anti#o'i sete&ah

%en$iat anti$en

! Ter'apat pa'a se&/ Marofa$, Ne(trofi&,

:osinofi& 'an Se& Mast

! "erf(n$si 'a&a% %e%per%('ah

fa$ositosis 'an pe&epasan %e'iator

inf&a%asi


13/96

;arin$an Li%foi'

! Se& &i%fosit T 'an " yan$ #erasa& 'ari

Ti%(s 'an S(%s(% t(&an$ aan

%enye#ar e/

! Ke&enar $etah #enin$

! Tonsi& 1 %(&(t3

! Li%pa! Peyer p&a


14/96

2espon I%(n

! Anti$en yan$ %as( aan 'i tan$ap o&eh

Fa$osit

! Fa$osit %e%presentasian e Li%fosit T

! Li%fosit T aan %e%#eritah( Li%fosit ",

'an %eran$san$ (nt( %e%pro'(si

anti#o'i


15/96

2easi hipersensiti+itas


16/96

2easi hipersensiti+itas TIP: =

! Diperantarai I$ :

! I$ : %en$iat anti$en 1 A&&er$en 3

! I$ : %e&eat pa'a reeptornya pa'a#asofi&0 %ast e&& 'an %enye#a#an

&epasnya %e'iator inf&a%asi

! Me'iator inf&a%asi aan %enye#a#ant(#(h %en$a&a%i per(#ahan


17/96

Penyait pa'a >S tipe =

! Siste%i anafi&asis

! Asth%a

! :9e%a! A&&er$y %aanan

! Urtiaria


18/96

2easi hipersensiti+itas TIP: )

! Di perantarai o&eh I$ G 'an Ko%p&e%en

! Anti$en pa'a per%(aan se& aan

%eran$sa%$ %e&eatnya I$G

! "eri(tnya I$G aan %eran$san$

%e&eatnya o%p&e%en

! I$G 'an o%p&e%en aan %e&eat pa'aLi%fosit T sitotosi yan$ #erai#at

er(saan pa'a se& terse#(t


19/96

Penyait pa'a >S Tipe )

! 2easi Tranf(si

! :ritro#&astosis Foeta&is

! Ane%ia he%o&iti a(toi%(n


20/96

2easi hipersensiti+itas TIP: -

! Di perantarai Anti$en0anti#o'i o%p&es

! A$0A# Ko%p&es %eran$san$ ati+asi

o%p&e%en

! Ati+asi o%p&e%en %eran$san$

'atan$nya se& inf&a%asi ter(ta%a ne(trofi&

e te%pat terse#(t


21/96

Penyait pa'a >S tipe -

! 2easi Arth(s

! Ser(% siness

! G&o%er(&onephritis! 2he(%atoi' arthritis

! Siste%i L(p(s :rithro%atos(s


22/96

2easi hipersensiti+itas TIP: 5

! Diperantarai o&eh se&

! Anti$en aan %en$ati+asi se& T

%e&epasan %e'iator, Me'iator aan

%eran$san$ ati+asi Marofa$ ata(

Li%fosit T sitotosi

! Marofa$ ata( T sitotosi aan %er(sa

se& ata( arin$an


23/96

Penyait pa'a >S tipe 5

! Der%atitis onta

! Lesi Gran(&o%a

! Graft 2eetion


24/96

A&&er$i

! Meanis%e >S tipe =

! Atopi / >S pa'a in'i+i'( tertent(

! Men$enai sat( sa%pai #e#erapa or$anyan$ %e%#erian %anifestasi yan$

#er#e'a


25/96

Anafi&asis

! Meanis%e >S tipe =

! Mer(paan a&&er$i siste%i %en$enai

or$an +as(&er, pernafasan , (&it 'an

&ainnya.

! Tera'i %en'a'a sete&ah terena a&er$en

! Syo anfi&asis / anafi&asis 'isertaipen(r(nan teanan 'arah 1syo3.


26/96

Definisi Anafi&asis

! Anafi&asis a'a&ah sin'ro%a &ini yan$ #er(pa

reasi a&er$i siste%i yan$ #erat yan$ 'i sti%(&i

o&eh a&er$en, onset %en'a'a 'an ti'a

#erahir 'a&a% )5 a%, %en$enai sat( ata(&e#ih siste% or$an 'an %e%#erian sat( ata(

&e#ih $ea&a seperti (rtiaria, f&(shin$, $ata&,

an$ioe'e%a, stri'or, whee9in$, nafas pen'e,

+o%itin$, 'iare ata( syo.Canadian Pediatric surveillance program, 2002


27/96

Definisi Anafi&asis

! 2easi A&er$i siste%i a(t yan$

%en$enai #e#erapa siste% or$an

ter(ta%a Kar'io+as(&ar, 2espirasi, K(&it

'an Gastrointestina&, yan$ %er(paanreasi i%(no&o$is arena terpapar a&er$en

pa'a pen'erita yan$ tersensitisasi.

A##a I Terr, )**-


28/96

Syo Anafi&ati

'an 2easi Anafi&atoi'Syo Anafi&ati

! Anafi&asis 'isertai hipotensi 'en$an ata(tanpa pen(r(nan esa'aran

2easi Anfi&atoi'

! Kon'isi 'en$an tan'a 'an $ea&a

anafi&asis tanpa a'anya %eanis%ereasi anti$en0anti#o'i


29/96

:pi'e%io&o$i

! Ti'a 'ietah(i seara $eo$rafis, rasia&'an pre'i&esi ses

! *.5 as(s tiap se(ta pertah(n pa'a

pop(&asi (%(%! Di&aporan *.*-0*.*? per =*** pasien

M2S

! Men(n(an #ahwa pen$o#atan 'anpro'( #io&o$is yan$ a'i penye#a#nya

! Penye#a# @** e%atian pertah(n 'i AS


30/96

A&er$en Anafi&asis

! Maanan/ Ian, s(s(, te&(r, ('an$,

epitin$, eran$ serta aan$0aan$an

! O#at0o#atan/ Ana&$esi, opiat 'an ra'io

ontras

! Gi$itan ata( sen$atan seran$$a

! Lates


31/96

A&&er$en Mo'e of Ation


32/96

Foo' A&&er$en

! U'an$

! Kepitin$

! Te&(r

! Keran$

! S(s(

! Kaan$


33/96

Dr($s A&&er$en

! Protein 'an

Po&ipepti'a >etero&o$

! >or%on , :n9i%,

asin! >apten

! Anti#ioti, ita%in,

a$en Dia$nosti


34/96

Inset eno%

! Le#ah Ma'(

! Se%(t Merah ata(

Api

! Basp

! >ornet

! esp(&a


35/96

Lates


36/96

Patofisio&o$i Anafi&asis

! 2easi A&er$i

! Coo%# 'an Ge&& / >ypersensiti+ity Tipe =

! Se& Uta%a yan$ ter&i#at/ Mast Ce&& 'an"asophi&

! Prinsip / reasi A&er$en 4Anti#o'i

! Anti#o'i / I%(no$&o#(&in :


37/96

2easi A&er$i


38/96

Coo%# an' Ge&&

>ypersensiti+ity


39/96

Mast Ce&&


40/96


41/96


42/96


43/96

Anafi&asis

I+an M 2oitt 1)**-3 %e%#a$i proses Anafi&asis%ena'i - Fase/

! Fase Sensitisasi

%ast e&& #eriatan 'en$an a&&er$en perta%a a&i! Fase Ati+asi

Mast e&& terpapar a&&er$en e'(a a&i

De$ran(&asi Mast Ce&&

! Fase :fetor

:fe %e'iator pa'a or$an tar$et


44/96


45/96

De$ran(&asi Mast Ce&&


46/96


47/96


48/96


49/96

Tan'a 'an Gea&a Anafi&asis


50/96

Gea&a Awa& 'an K(&it

! Sait epa&a

! P(sin$

! Gata&

! 2asa Panas

Pa'a K(&it /

! :rite%a F&(shin$,%a(&opap(&ar rash

! Urtiaria

! An$ioe'e%a


51/96

An$ioe'e%a


52/96

Urtiaria


53/96

O(&ar

! Con(ti+itis

! Pr(rit(s

! inesi on(n$ti+a

! Lari%asi


54/96

Tan'a Kar'io+as(&ar

Kar'ioas(&ar! Tahyar'ia,

hypotension,

! syo, %yoar'ia&ishae%ia 7 infar,

! ar'ia arrest

! Diaphoresis! >iposia

! Arit%ia


55/96

2espirasi

! Sa&(ran Nafas Atas/Kon$esti nasa&, snee9in$,hoarseness, stri'or,orofarin$ 'an &arin$

e'e%a, #at( 'ano#str(si

! Sa&(ran Nafas "awah/Dyspnea, "ronhospas%,tahypnea, aesory

%(s&e (se, yanosis,respiratory arrest


56/96

Gastrointestina&

! M(a&

! M(ntah

! Cra%pPer(t

! Diare

! Uro$enita& / spas%e,

nyeri

! Sen'i/ arthra&$ia


57/96

Siste% Saraf P(sat

! Parestesi

! Kesa'aran %en(r(n

! Beaness

! Kon+(&si

! Ko%a

! Di99ines

! Synope


58/96

Dia$nosis

! Ana%nesa paparan A&er$en

! Gea&a K&inis

!Pe%erisaan Fisi! Pe%erisaan La#oratoris


59/96

Dia$nosa Diferensia&

! As%a Atta

! Syo #ent( &ain

! :'e%a par(

! Arit%ia ant(n$

! Kean$

! intosiasi o#at

! Urtiaria


60/96

Ko%p&iasi

! Ke%atian

! Ker(saan ota

per%anen

! Urtiaria an$ioe'e%a#er%in$$(

! Myoar' infar

! A#orsi! Ga$a& Gina&


61/96

Pre+ensi Anafi&asis

Ce$ah reasi (&an$

Ana%nesa penyait a&er$i

I'entifiasi 'an hin'ari a&er$en ata( penye#a# &ain.

Sin test (nt( o#at inesi

:neran o#at inesi

Catat ata( tanyaan P o#t y$ %enye#a#an a&er$i

"i&a %(n$in $(naan o#at seara perora& saa.

O#ser+asi pen'erita se&a%a -* %enit sete&ah pe%#erian

o#at yan$ #erisio tin$$i.


62/96

Pre+ensi Anafi&asis


63/96

Penyait A(toi%(n

! Anti#o'i ata( se& T %e&awan se&f anti$en

! Interasi anti#o'i ata(se& T terha'ap

arin$an #erpen$ar(h pa'a proses

penyait

! Tera'i 'isf(n$si i%(n

! Penyait #isa tertranfer %e&a&(i A" ata(

se& T


64/96

Penyait A(toi%(n

Or$an spesifi

! Gra+e 'isease

! DM tipe =

! Myasthenia $ra+is

Siste%i

! 2he(%atoi' arthritis

! S&ero'er%a siste%i

! SL:


65/96

I%(no'efisiensi

Pri%er

! Se& " 'efisiensi

! Se& T 'efisiensi

! Se& " T

Se(n'er

! O#at / ortiosteroi'7

sitostatia! Penyait %eta#o&i/

DM

! Infesi / AIDS! Kaner

! Diet0 Ma&n(trisi


66/96

AIDS

! Dise#a#an o&eh >(%an

I%%(no'efiieny ir(s 1>I3 yan$

%e%#erian $ea&a pen(r(nan ee#a&an

t(#(h! Perta%a a&i 'ietah(i tah(n =E6=

! >I 'ite%(an seara #ersa%aan o&eh 2.

Ga&&o 1AS3 'an L( Montainier 1Peranis3


67/96


68/96

Trans%isi >I

! Lewat sa&i+a, air %ata,(rine, CSF,ser(%,

se& 'arah, se%en, seresi +a$ina&

! Ati+itas ses(a&

! Ker(saan %e%#ran %(osa 1tra(%a,

infetion3

! Inesi 1I &ine3

! Transf(si


69/96

>I

! Mer(paan 2NA retro+ir(s 'apat

%e%#(at DNA 'ari 2NAnya arena

%e%i&ii RNA Reverse Trancriptase

! Me%i&i ) +arian/>I0= 'an >I0)

! >I0=, pre'o%inan, %en$infesi %an(sia

! >I0), 'ite%(an 'i Afria, trans%isi &ewat

heteroses(a&


70/96

>I


71/96

Geneti >I

Gen (ta%a! :n+0 en+e&op protein, $p=?*

$p=)* 'an $p5=

! Ga$0 ore protein, p)5,p=H, pE'an pH

! Po&0 en9y%e re+ersetranriptase, inte$rase 'anprotease

Gen re$(&ator

! tat0ati+asi tranripsi DNA

+ir(s! Nef0%e%#ant( rep&iasi +ir(s

! 2e+0 %e%#ant( re$(&asiati+itas %02NA


72/96

>I enter

! >I $p=)* #eriatan '$ CD5 'an [email protected]

! >I f(si 'an entry '$ %e'ia $p5=


73/96

>I enter


74/96

Asse%#&y +irion


75/96

Co 2eeptor >I


76/96

2o&e of Co reeptor >I


77/96

Pato$enesis >I

! Tar$et (ta%a 'a&ah se& Th CD5, 'i &ysis

o&eh +ir(s

! "e#erapa se& yan$ %e%i&ii CD 5 'apat

terinfesi 1Marofa$, strosit, 'en'ritiCe&&3ti'a &ysisreser+oir +ir(s &aten


78/96

Infesi >I


79/96

>I ' T > &


80/96

>I pa'a T >e&per

! Ati+itas nor%a&%en$hi&an$

! Dep&esi %onosit7%arofa$, se& ",ne(trofi&, anti#o'i, NKe&&s

! Pen(r(nan f(n$siADCC, fisasio%p&e%en,Inf&a%asi, Opsonisasi'an fa$ositosis


81/96

>I i f i t i ti


82/96

>I 4infesi oport(nisti

! T he&per %aa tera'i pen(r(nan sitoin

'an e%e%p(an %e&awan infesi

! Tera'i infesi a$en en'o$en 'an

nosoo%ia& antara &ain/ Pne(%oystis,CM, Toop&as%a, Can'i'a,

Myo#ateri(%, >erpes +ir(s 'an

Cryptoo(s! Tera'i KaposiJs saro%a,'an &y%pho%a

S t I f i >I


83/96

Spetr(% Infesi >I

! Infesi a(t

! Infesi asi%pto%ati

! Li%fa'enopati $enera&isata persisten

1PGL3

! AIDS0re&ate' Co%p&e 1A2C3

!AIDS


84/96

I f i A t >I


85/96

Infesi A(t >I

! Seroon+ersi ne$atif e Positif

! Gea&a %a&aise, 'e%a%, r(a%

%a(&opap(&ar, 'iare 'an &i%fo'enopati

! "e&&s pa&sy

! Monon(&eosis #e#erapa %in$$(

!Menin$itis0&ie

I f i i t ti >I


86/96

Infesi asi%pto%atis >I

! Seroon+ersi positif

! P ta%pa sehat se&a%a #ertah(n0tah(n

! D '$ #iaan ser(% 'an anti#o'i

! Para%eter i%(no&o$is Nor%a&

Li%fa'enopati Genera&isata


87/96

Li%fa'enopati Genera&isata

Persisten 1PGL3

! Li%fa'enopati &e#ih'ari = % pa'a &e#ih

'ari = e&enar,

se&a%a = #(&an

! Ter'apat 'e%a% 'an

%a&aise

AIDS & t ' C & 1A2C3


88/96

AIDS re&ate' Co%p&e 1A2C3

! Di tan'ai 'e%a%, %a&aise, e&e%ahan(%(%, erin$at %a&a%, 'iare 'an

pen(r(nan ""

! Para%eter i%(no&o$is ti'a #(r(

AIDS


89/96

AIDS

! A2C 'isertai pen(r(nan para%eteri%(no&o$is yan$ #(r(

! Ter'apat infesi oport(nisti 'an

e$anasan seperti Pne(%oystis,KaposiJsSaro%a,Toop&as%osis, Cyto%e$a&o+ir(s

! De%entia, '&&

C 'i' i


90/96

Can'i'osis

K iJ S


91/96

KaposiJs Saro%a

Pne %o stis arinii


92/96

Pne(%oystis arinii

Dia$nosa AIDS


93/96

Dia$nosa AIDS

! K&inis 1si$n 'ansi%pto%s3

! :LISA

! Bestern "&ot! PC2

Therapy


94/96

Therapy

Tar$et O#at

Pen$iatan reeptor Anti$en CD5, 2ANT:S,

Anti#o'i CD5

Transripsi 2NA e DNA AT, DDC, DDI, DDA,Fosarnet

Inhi#isi +irion0%2NA Interferon , Anti#o'i

Tar$et Teraphy


95/96

Tar$et Teraphy


96/96

Terima KasihAtas Perhatiannya

Semoga Bermanfaat

Wassalamualaikum wr wb

Imunopatofisiologi Kep

Documents

Transcript of Imunopatofisiologi Kep

FORMULA KEP

Proses kep

KEP penyuluhan

Supervisi Kep

Ketenagaan Kep.

Manajemen Kep Mengajar

Kep 431 Pb 2015 Perubahan Kelima KEP 157

Definisi KEp

Diagnosa Kep

KEP-115 PJ 2002_Perubahan Kep-533-PJ-2000

Makalah Kep Anak

Proses Kep Klg

MALNUTRISI - KEP

Kep Islami

Kep Arahan

Standar Kep

pp kep jiwa

Kep. Komunitas

Sejarah Kep

CV - ners.unair.ac.id · PDF filekualitas yan.kep rendah model – asuhan kep ... kep. maternitas kep. medikal-bedah kep. jiwa kep. komunitas p ardigm k eprw atn care p rev ... skenario