PBL blok 18 pneumonia pada anak

8/19/2019 PBL blok 18 pneumonia pada anak

1/14

Pneumonia pada Anak

Maria Amelia Goldie

102013119

FAKULTAS KEDOKTERAN UNIVERSITAS KRIDA WAANA

!l" Ar#$%a U&ara No" '( Ke)o% !er$* + !a*ar&a

,oldie-e%$r.,mail"/om

A)&ra*

%e$mo%ia adala i%e*i al$ra% 4er%aaa% a*$& )a,ia% )a-a 4are%*im 4ar$ 5a%, me%,e%ai #ari%,a%

4ar$64ar$ 5a%, meli4$&i al7eol$ da% #ari%,a% i%&er&iial 5a%, die)a)*a% ole )erma/am6ma/am e&iolo,i e4er&i

)a*&eri( 7ir$( #am$r da% )e%da ai%," ara 4e%$lara% melal$i 4er/i*a% l$da( *o%&a* la%,$%, le-a& m$l$& a&a$

*o%&a* &ida* la%,$%, melal$i 4erala&a% 5a%, &er*o%&ami%ai 4ada al$ra% 4er%aaa%" Ge#ala *li%i 4%e$mo%ia

a%&ara lai% demam( )a&$*( ea*( 4er%a4aa% da%,*al( re&ra*i ela i,a( 4er%a4aa% /$4i%, id$%,( %aa

me%de%,*$r( )a*a% ia%oi"

Ka&a K$%/i 8 %e$mo%ia( I%e*i Sal$ra% Naa

Abstract

Pneumonia is a respiration tract infection on down side lung parenchyma which contaminate lung tissues

such as alveoli and interstitial tissue caused by bacterias, viruses, parasitic fungi, and the other unknown objects.

The transmission through saliva splashed, direct contact through mouth and undirect contact through hospital

equipments which contaminated to respiration tract. The manifestation of pneumonia are fever, cough, asphyxiate,

shallow breath, costal retraction, snoring breath, even cyanosis.

ey !ord " Pneumonia, #espiratory Tract $nfection

1

mailto:[email protected]:[email protected]


2/14

Pendahuluan

%e$mo%ia adala $a&$ 4e%5a*i& i%e*i a&a$ 4erada%,a% 4ada or,a% 4ar$64ar$ 5a%,

die)a)*a% ole )a*&eri( 7ir$( #am$r a&a$4$% 4arai& di ma%a al7eol$ 5a%, )er&a%,,$%, #a-a)

me%5era4 o*i,e% dari a&moer &eri%lamai da% &erii ole /aira%" %e$mo%ia da4a& #$,a

die)a)*a% ole iri&ai *imia a&a$ ii* dari 4ar$64ar$ a&a$ e)a,ai a*i)a& dari 4e%5a*i& lai%%5a(

e4er&i *a%*er 4ar$64ar$ a&a$ &erlal$ )a%5a* mi%$m al*ool( %am$% 4e%5e)a) 5a%, 4ali%, eri%,

iala era%,a% )a*&eria %treptococcus pneumoniae( a&a$ 4%e$mo*o*$" Se)el$m 4e%em$a% dari

a%&i)io&i*6a%&i)io&i*( a&$ 4er &i,a dari em$a ora%,6ora%, 5a%, &ela me%,em)a%,*a%

4%e$mo%ia e$da i&$ me%i%,,al dari i%e*i" Saa& i%i( le)i dari &i,a #$&a ora%,6ora%,

me%,em)a%,*a% 4%e$mo%ia e&ia4 &a$% di Ameri*a" Le)i dari e&e%,a #$&a dari ora%,6ora%,

i%i dio4%ame die)$a r$ma a*i& $%&$* 4era-a&a%" Me*i4$% *e)a%5a*a% dari ora%,6ora%, i%i

em)$( *ira6*ira : a*a% me%i%,,al dari 4%e$mo%ia" %e$mo%ia adala 4emim4i% *e e%am

4e%5e)a) *ema&ia% di Ameri*a" %e$mo%ia eri%, *ali dideri&a e)a,ia% )ear ora%, 5a%, la%#$&

$ia da% mere*a 5a%, memili*i 4e%5a*i& *ro%i* e)a,ai a*i)a& r$a*%5a i&em *e*e)ala% &$)$

a*a% &e&a4i 4%e$mo%ia #$,a )ia me%5era%, *a$m m$da 5a%, )er&$)$ ea&" Saa& i%i di d$%ia

4e%5a*i& 4%e$mo%ia dila4or*a% &ela me%#adi 4e%5a*i& $&ama di *ala%,a% *a%a*6*a%a* da%

mer$4a*a% a&$ 4e%5a*i& eri$ 5a%, mere%,,$& %5a-a )eri)$6ri)$ -ar,a &$a e&ia4 &a$%"

Dia,%oi 4%e$mo%ia e/ara *li%i $m$m%5a m$da di&e,a**a%" Ta%da da% ,e#ala%5a a%,a&

*a 5a*%i )ila di&em$*a% demam( )a&$* )erdaa* ;4$&$m 5a%, 4rod$*&i< a&a$ %5eri dada"

Dia,%oi le)i me5a*i%*a% )ila dida4a&*a% i%il&ra& 4ada 4emeri*aa% o&o ro%&,e% 4ar$ da%

4e%em$a% mi*ro)a 4e%5e)a)%5a"1

Anamnesis

ada a%am%ei *a$ 4%e$mo%ia da4a& di&a%5a*a% ide%&i&a( *el$a% $&ama( ri-a5a&

4e%5a*i& e*ara%, ;RS


3/14

4er%a me%,alami a*i& er$4a a&a$ ri-a5a& ama da% aler,i( /erma&i ada &ida*%5a

,a&roeoa,eal rel$* ;&a%5a*a% a4a*a 4er%a ear&)$r%( eri%, m$al=m$%&a


4/14

>ia*a% dara ar$ dila*$*a% $%&$* me%e,a**a% dia,%oi da% me%e%&$*a% )a*&eri

4e%5e)a) 4%e$mo%ia" >ia*a% dara 4oi&i di&em$*a% 4ada 10620: 4%e$mo%ia )a*&erial da%

mer$4a*a% *o%irmai e)a,ai 4e%5e)a) 4%e$mo%ia a4a)ila ail%5a 4oi&i 4ada *$ma% 5a%,

di*e&a$i e)a,ai 4a&o,e% re4ira&ori"

Pemeriksaan Radiologi

Te 4e%&i%, $%&$* me%de&e*i 4%e$mo%ia 4ada *eadaa% 5a%, &ida* #ela iala

de%,a% o&o &ora*" Fo&o &ora* da4a& me%am4a*a% daera o4a* ;&erlia& 4$&i< 5a%,

me%,,am)ar*a% *o%olidai" %e$mo%ia &ida* elal$ dilia& ole i%ar ( elai% *are%a

4e%5a*i&%5a a%5a 4ada &i%,*a& 4erm$laa% a&a$ *are%a me%,e%ai )a,ia% 4ar$ &er&e%&$ 5a%,

$li& dilia& de%,a% i%ar " Dalam )e)era4a *a$ T &computed tomography' da4a&

me%$%#$*a% 4%e$mo%ia 5a%, &ida* &erlia& de%,a% o&o &ora i%ar " Si%ar da4a& *elir$(

*are%a maala lai%( e4er&i 4ar$& 4ada 4ar$ da% ,a,al #a%&$%, *o%,e&i da4a& me%5er$4ai

4%e$mo%ia 4ada o&o &ora i%ar " Fo&o &ora #$,a di,$%a*a% $%&$* e7al$ai ada%5a

*om4li*ai dari 4%e$mo%ia"

Pemeriksaan Serologi

Te $ri% a%&i,e% detection adala $a&$ /ara $%&$* me%de&e*i a%&i,e% (egionella

pneumophila ero,r$4 1" De&e*i i%i da4a& dila*$*a% 4ada ari *e 3 i%e*i am4ai 1 &a$%" Ole*are%a i&$ &ida* da4a& di,$%a*a% $%&$* de&e*i i%e*i )ar$ 4ada 4aie% de%,a% ri-a5a& 4er%a

i%e*i Le,io%ella" Se%i&i7i&a 4ada 4emeri*aa% i%i adala 9069B:( da% 4eii&a%5a adala

9C6100:"

$ndirect )luorescent Antibody ;IFA< dila*$*a% $%&$* melia& eeora%, &eri%e*i a&a$

&ida*" Dia,%oi di&e,a*a% #i*a *e%ai*a% &i&er B dari &i&er 1812 4ada aea*$& da% ae

*o%7alee% ;36' mi%,,$ *em$dia%


5/14

Diagnosis Kerja

%e$mo%ia adala $a&$ 4roe 4erada%,a% di ma%a &erda4a& *o%olidai 5a%,

die)a)*a% 4e%,iia% ro%,,a al7eoli ole e*$da&" er&$*ara% ,a &ida* da4a& )erla%,$%, 4ada

daera 5a%, me%,alami *o%olidai da% dara 5a%, dialir*a% *e e*i&ar al7eoli 5a%, &ida*

)er$%,i" ?i4o*emia da4a& &er#adi &er,a%&$%, )a%5a*%5a #ari%,a% 4ar$64ar$ 5a%, a*i&" ara

4e%$lara% 4%e$mo%ia da4a& melal$i 4er/i*a% l$da( *o%&a* la%,$%, le-a& m$l$& a&a$ *o%&a*

&ida* la%,$%, melal$i 4erala&a% 5a%, &er*o%&ami%ai de%,a% al$ra% 4er%aaa%" >iaa%5a

4e%$lara% or,a%ime &er#adi dari ora%, *e ora%,( %am$% 4e%$lara% melal$i *o%&a* eaa& eri%,

&er#adi" Maa i%*$)ai &ida* di*e&a$i 4a&i( m$%,*i% 163 ari"3

Diagnosis Banding

Bronkitis Akut

>ro%*i&i mer$4a*a% a*i)a& )e)era4a *eadaa% lai% al$ra% 4er%a4aa% a&a da% )a-a(

da% &ra*ea )iaa%5a &erli)a&" >ro%*i&i a*$& )iaa%5a dida$*$i ole i%e*i 4er%a4aa% a&a"

I%e*i e*$%der )iaa%5a dia*i)a&*a% ole %treptococcus pneumoniae, +oraxella catarrhalis,

aemophilus influen-ae da4a& &er#adi" Ka%5a 4ada a%a* iala da&a%, de%,a% )a&$* eri%,(

&ida* 4rod$*&i da% &im)$l%5a rela&i )er&aa4( m$lai 263 ari e&ela ri%i&i" >ro%*i&i laim

&er#adi 4ada )a5i da% a%a*6a%a*( da% $m$m%5a &er#adi di m$im di%,i% da% m$im emi"

Bronkiolitis

>ro%*ioli&i a*$& &er#adi a*i)a& o)&r$*i al$ra% 4er%a4aa% *e/il 4e%5a*i& i%i &er#adi

4ada $ia 2 &a$% 4er&ama" e%5a*i& i%i 4ali%, eri%, me%,a*i)a&*a% a%a* ar$ ra-a& i%a4"

>ro%*ioli&i di&a%dai de%,a% ada%5a o)&r$*i )ro%*iol$ 5a%, die)a)*a% ole edema da%

*$m4$la% m$*$ er&a *$m4$la% 4$i%,64$i%, el$ler da% ole i%7ai ole )a,ia%6)a,ia%

)ro%*$ 5a%, le)i *e/il ole 7ir$ ei%,,a &er#adi 4e%e)ala% 4ada di%di%, )ro%*iol$"

e%e)ala% eedi*i& a4a4$% 4ada 4ro%*iol$ 4ada )a5i da4a& a%,a& mem4e%,ar$i alira% $dara"

A%a* m$la6m$la me%deri&a i%e*i ri%,a% al$ra% %a4a a&a dier&ai de%,a% i%,$ da% )eri%"

Ge#ala i%i )iaa%5a )era*ir )e)era4a ari da% da4a& dier&ai de%,a% 4e%$r$%a% %a$ ma*a%

er&a demam 3(639o" er*em)a%,a% *e,a-a&a% )iaa%5a dier&ai de%,a% )a&$* 4ro*imal(

di4%ea( da% iri&a)ili&a"

5


6/14

Tuberkulosis Paru

T$)er*$loi 4ar$ adala 4e%5a*i& i%e*i 4ada al$ra% 4er%aaa% 5a%, die)a)*a% ole

)a*&eri +ycobacterium tuberculosis" >a*&eri i%i mer$4a*a% )a*&eri )ail 5a%, a%,a& *$a&

ei%,,a memerl$*a% -a*&$ lama $%&$* me%,o)a&i%5a" >a*&eri i%i le)i eri%, me%,i%e*i

or,a% 4ar$64ar$ ;90:< di)a%di%,*a% )a,ia% lai% &$)$ ma%$ia" e%deri&a 5a%, &eri%e*i

)iaa%5a a*a% me%,alami demam $)e)ri 5a%, )erla%,$%, lama( )iaa%5a diraa*a% malam

ari dier&ai *eri%,a& malam" Kada%,6*ada%, era%,a% demam e4er&i i%l$e%a da% )eria&

ila%, &im)$l" Ge#ala lai%( 4e%$r$%a% %a$ ma*a% da% )era& )ada%( )a&$*6)a&$* elama le)i

dari 3 mi%,,$ ;da4a& dier&ai de%,a% dara$*a% %e$mo%ia di&a%dai de%,a% )a&$* 4ile* )iaa" Seda%,*a% 4ada a%a* $ia 2 )$la% i%,,a

*$ra%, dari &a$% di)a,i me%#adi 4%e$mo%ia )era&( 4%e$mo%ia( da% )$*a% 4%e$mo%ia"

%e$mo%ia )era& di&a%dai de%,a% ada%5a ea* a&a$ &ari*a% di%di%, dada )a,ia% )a-a"

%e$mo%ia dier&ai de%,a% %aa /e4a&( )ila $ia 2 )$la% am4ai *$ra%, dari 1 &a$% 0 *ali 4er

me%i&( da% $%&$* $ia 1 i%,,a *$ra%, dari &a$% B0 *ali 4er me%i&" >$*a% 4%e$mo%ia di&a%dai

de%,a% )a&$* 4ile* )iaa( &ida* ada &ari*a% di%di%, dada )a,ia% )a-a *e dalam da% &ida* ada

%aa /e4a&"

>erdaar*a% *li%i da% e4idemiolo,i 4%e$mo%ia di)a,i me%#adi 4%e$mo%ia *om$%i&i

&communityacquired pneumonia'( 4%e$mo%ia %oo*omial &hospitalacquired

pneumonia/nosocomial pneumonia'( 4%e$mo%ia a4irai( da% 4%e$mo%ia 4ada 4e%deri&a

6


7/14

immunocompromised " %e$mo%ia %oo*omial di)a,i me%#adi &i,a #e%i 5ai&$ hospital acquired

pneumonia ;?A


8/14

di&a%dai )er/a*6)er/a*%i%e*i 4ada )er)a,ai &em4a& di 4ar$( )ai* di *a%a% Ma$4i% *iri 5a%,

die)a)*a% ole 7ir$ a&a$ )a*&eri da% eri%, &er#adi 4ada )a5i a&a$ ora%, &$a"163

Gejala Klinis

Demam da% )a&$* ;a-al%5a %o%4rod$*&i< mer$4a*a% ,e#ala $m$m" Da4a& #$,a &er#adi

%5eri dada da% ea* %a4a" Gam)ara% i&emi* ;le)i eri%, &er#adi %am$% &ida* 4eii* $%&$*

4%e$mo%ia a&i4i*< dia%&ara%5a adala %5eri *e4ala( confusion( mial,ia( da% malaie" Ada%5a

maa 4rodormal 5a%, lama le)i 4eii* )a,i or,a%im a&i4i*" ada 4emeri*aa% ii* )ia

di&em$*a% &a%da6&a%da *o%olidai lo*al da% ro%*i *aar &crackles' 4ada lo)$ 5a%, &er*e%a"

Ta*i4%ea( i4o&e%i( da% ia%oi mer$4a*a% &a%da )era&%5a 4e%5a*i&"B

tiologi

>ai* 4%e$mo%ia *om$%i&i ma$4$% 4%e$mo%ia %oo*omial *ed$a%5a memili*i e&ioo,i

5a%, ama 5ai&$ *$ma% 4a&o,e% e4er&i %treptokokus pneumonia( aemophilus influen-ae(

+oraxella catarrhalis da% )e)era4a )a*&eri a&i4i*al" e%5e)a) $&ama 4%e$mo%ia %oo*omial

adala )a*&eri ,ram %e,a&i aemophilus influen-a" Me*i demi*ia%( e*i&ar 1C: 4%e$mo%ia

%oo*omial die)a)*a% ole Pseudomonas aeruginosa 5a%, &er%5a&a me%#adi 4e%5e)a)

*ema&ia% da% *ea*i&a% 4ada 4%e$mo%ia %oo*omial" %e$mo%ia *are%a #am$r &ida* )a%5a*

di&em$*a% &e&a4i )iaa%5a &erda4a& 4ada 4aie% de%,a% ,a%,,$a% im$%olo,i* e4er&i AIDS da%

4ema*aia% o)a&6o)a&a% im$%o$4rea% 4ada 4aie% &ra%4la%&ai( *emo&era4i da% 4ada 4e%5a*i&

imunocompromised lai%%5a"

!am$r 5a%, eri%, me%im)$l*a% 4%e$mo%ia adala a%dida( A4er,ill$( ?i&o4lama

/a4$la&e$m( r54&o/o//$ %eoorma% da% o//idiode immi&i" %e$mo%ia 4ada 4aie%

imunocompromised diam4i%, 4e%5e)a)%5a adala )a*&eri da% #am$r o4o&$r%i&i* da4a& #$,a

die)a)*a% 7ir$ e4er&i 5&ome,alo7ir$ ;MVarr 7ir$( Ri%o7ir$( Ade%o7ir$(

aram5o7ir$( arai%l$e%a 7ir$( ?er4e im4le*( ?er4e 7ir$ ' da% ?er4e 7ir$ " U%&$* da4a& me%,e&a$i 4e%5e)a) lai%%5a da4a& dilia& 4ada &a)el 1"

Ta)el 1" A,e% I%e*i$ e%5e)a) %e$mo%ia"

Golongan Agen Pen!ebab Tipe Pneumonia

8


9/14

>a*&eri S&re4&o/o//$ 4%e$mo%ia %e$mo%ia )a/&erial

S&re4&o/o//$ 45o,e%e

S&a45lo/o//$ a$re$

Kle)iella 4%e$mo%ia

e$domo%a aer$,i%oa

E/eri/ia /oli

eri%ia 4e&i

Le,io%%aire )a/ill$ e%5a*i& Le,io%%aire

e4&o&re4&o/o//$( e4&o/o//$ %e$mo%ia a4irai ;a%aero)<

>a/&eroide

F$o)a/&eri$m

Veillo%ella

A/&i%om5/e&e A/&i%om5/e iraelii A*&i%omi*oi 4$lmo%ar

No/ardia &eroid No*ardioi 4$lmo%ar

F$%,i o//idioide immi&i Ko*idiomi*oi

?i&o4lama /a4$la&$m ?i&o4lamoi

>la&om5/e derma&idi&i >la&omi*oi

A4er,ill$ A4er,iloi

5/om5/e&e M$*omi*oi

Ri/*e&&ia iiella )$r%e&&i Demam

lam5dia lam5dia 4i&&a/i i&a*oi

Omi&oi

M5/o4lama M5/o4lama 4%e$mo%ia %e$mo%ia mi*o4lama

Vir$ I%l$e%a 7ir$( ade%o7ir$ %e$mo%ia 7iral

ro&ooa %e$mo/5&i /ari%ii %e$mo%ia 4%e$moi&i

pidemiologi

9


10/14

%e$mo%ia 5a%, dida4a& di ma5ara*a& a%,a& eri%, &er#adi" I%ide% di ma5ara*a&

adala 163=1000 ora%, de-aa" Se4erem4a& #$mla *a$ mem)$&$*a% 4era-a&a% di r$ma

a*i&" I%ide% *e#adia% 4ada la*i6la*i ama de%,a% 4erem4$a%( -ala$4$% 4e%5a*i& Le,io%aire

le)i eri%, dida4a&*a% 4ada la*i6la*i" %e$mo%ia %oo*omial le)i eri%, &er#adi 4ada ma%$la(

mer$4a*a 2(: *om4li*ai dari el$r$ 4era-a&a% di r$ma a*i& da% 1061: dari em$a *a$

i%e*i 5a%, dida4a& di r$ma a*i&" ada 4%e$mo%ia 4aie% de%,a% 5&em im$% re%da

me%i%,*a& a*i)a& i%ide% 4e%,,$%aa% o)a&6o)a&a% im$%o$4rei ;&ra%4la%&ai( 7a*$li&i


11/14

di&em$*a% i%e*i ole mi*roor,a%ime m$l&i4el" I%e*i 5a%, di$)$%,*a% de%,a% 5&em im$%

5a%, &er&e*a% adala %e$&ro4e%ia ;)a*&eri ,ram %e,a&i( %taphylococcus aureus( #am$r ;/a%dida(

a4er,ill$


12/14


13/14

e%,o)a&a% 4%e$mo%ia da4a& de%,a% 4em)eria% a%&i)io&i*a i%&ra7e%a ma$4$% oral mial

4e%iili%( a%&i)io&i* ,olo%,a% l$oro*$i%olo%( da% ,olo%,a% ealo4ori%" e%/e,aa%

4%e$mo%ia 4ada a%a* da4a& dila*$*a% de%,a% me%,i%dari aa4 ro*o* er&a 4em)eria% 7a*i%

ID ; $nvansive Pneumococcal *iseaseK" Ilm$ Keea&a% A%a*" Vol 2" Edii 1" !a*ar&a8 EG2012""103B6C"

2" S$do5o AW( >am)a%, S( d**" >$*$ A#ar Ilm$ e%5a*i& Dalam" Edii B #ilid 3"

!a*ar&a8 I%&er%a $)lii%,2009""220C610

3" Mi%adiarl5" e%5a*i& I%e*i Sal$ra% Na4a %e$mo%ia" !a*ar&a8 a5aa% O)or

I%do%eia2010""216B

B" Ma&o%da%, S( Waida5a& I( Sa&roamoro S" Dia,%oi Fii 4ada A%a*" 2%d Ed"

!a*ar&a 8 Sa,$%, Se&o200C""1''6C1

" !a-e&/ E( Mel%i/* !L( Adel)er, EA" Mi*ro)iolo,i *edo*&era%" Edii 20" !a*ar&a8

EG2009"(1CC69

'" Lea/ R . Acute and 0ritical 0are +edicine at a 2lance" Edii 2" Ne- or*8 !o% Wile5

a%d So%2010""C26

C" K$mar V( o&ra% RS( Ro))i% SL" >$*$ A#ar a&olo,i Ro))i%" Edii" !a*ar&a8EG200C

""9226

" Ro))i%( o&ra%( K$mar" >$*$ Sa*$ Daar a&olo,i e%5a*i&" Edii *e6"!a*ar&a8EG"2012"116B"

13


14/14

14

PBL blok 18 pneumonia pada anak

Documents

Transcript of PBL blok 18 pneumonia pada anak