Riset Kesehatan Dasar

5/24/2018 Riset Kesehatan Dasar

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Riset Kesehatan Dasar., 2013, Period Prev =-alence Pneumonia Balita, dan Prevalensi

Pneumonia Menurut Provinsi, Indonesia 2013, Badan Penelitian dan Pengembangan

Kesehatan Kementrian Kesehatan RI, Jakarta

Menurut Riset Kesehatan Dasar tahun 2013 periode prevalensi dan prevalensi

pneumonia tahun 2013 sebesar 1,8 persen dan 4,5 persen. Lima provinsi yang mempunyai

insiden dan prevalensi pneumonia tertinggi untuk semua umur adalah Nusa Tenggara Timur

(4,6% dan 10,3%), Papua (2,6% dan 8,2%), Sulawesi Tengah (2,3% dan 5,7%), Sulawesi

Barat (3,1% dan 6,1%), dan Sulawesi Selatan (2,4% dan 4,8%). Period prevalensi pneumonia

balita di Indonesia adalah 18,5 per mil. Balita dengan pneumonia yang berobat hanya 1,6 per

mil. Lima provinsi yang mempunyai insiden pneumonia balita tertinggi adalah Nusa

Tenggara Timur (38,5), Aceh (35,6), Bangka Belitung (34,8), Sulawesi Barat

(34,8), dan Kalimantan Tengah (32,7). Insidens tertinggi pneumonia balita terdapat pada

kelompok umur 12-23 bulan (21,7).

Bradley, John et al., 2011, The Management of Community-Acquired Pneumonia in Infants

and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric

Infectious Diseases Society and the Infectious Diseases Society of America, Infectious

Diseases Society of America: San Diego

1. Pemberian ASI eksklusif sampai usia 6 bulan dan dilanjutkan dengan pemberian

PASI hingga usia 2 tahun dapat menurunkan kejadian dan keparahan dari pneumonia

dan diare

2. Pemberian vaksin terhadap Streptococcus pneumoniae dan Haemophilus influenzae

tipe b, yang merupakan dua bakteri yang paling sering menyebabkan pneumonia pada

anak-anak.


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3. Pemberian vaksin campak dan pertusis secara nyata mengurangi angka kejadian

pneumonia dan kematian pada anak-anak.

4. Bayi dengan resiko tinggi diberikan profilaksis berupa antibodi monoklonal untuk

mencegah atau mengurangi resiko pneumonia berat yang disebabkan oleh respiratory

syncytial virus (RSV).

5. Menjaga kebersihan lingkungan, penyediaan air bersih, kebiasaan memasak air

sebelum diminum, kebiasaan mencuci tangan dengan sabun.

6. Mengurangi jumlah polusi udara disekitar tempat tinggal

Faktor Resiko

Pranatal Perinatal Postnatal

Gizi ibu saat hamil yang

buruk

Ibu perokok

Ibu alkoholik

Infeksi pada ibu

BBLR

Asfiksia

Penggunaan ventilator

Tidak mendapatkan ASI

dini

Malnutrisi

Polusi udara didalam

maupun diluar rumah

Tidak mendapatkan ASI

ekslusif

Tidak mendapatkan

Imunisasi

Sanitasi dan heigiene

lingkungan yang buruk

Jumlah penduduk yang

padat


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Don, Massimilliano., 2009,Community-Acquired Pneumonia,University of Tampere: Italy

Definite Risk Factor Likely Risk Factor Possible Risk Factor

Gizi ibu hamil yang buruk

Malnutrisi

BBLR

Tidak mendapatkan imunisasi

Polusi udara indor

Jumlah penduduk yang padat

Orang tua yang merokok

dan alkoholik

Defisiensi zink

Menderita penyakit lain

(diare, Penyakit jantung,

asma)

Defisiensi vitamin A

Polusi udara outdor

Curah hujan yang tinggi

Udara yang dingin

Sanitasi lingkungan yang

buruk

M, Korppi., 1993, White blood cell and differential counts in acute respiratory viral and

bacterial infections in children,Scand Journal Infection Disease, no. 25, vol. 4, hh.435-40.

WBC and granulocyte counts were higher in patients with bacterial infection than in those with viral

infection. Lymphocyte counts, by contrast, had no such aetiological association. The 95% confidence

limits for WBCs and granulocytes distinguished bacterial and pneumococcal cases completely from

viral cases with no bacterial involvement. The sensitivity of WBC counts, as well as granulocyte or

lymphocytes counts, for distinguishing bacterial from viral cases was low at all cut-off levels.

Specificity, in contrast, was 86% and 95% for WBCs at the cut-off levels 15.0 and 20.0 x 10(9)/l, and

84% and 97% for granulocytes at the cut-off levels 10.0 and 15.0 x 10(9)/l, respectively. It is

concluded that high WBC and granulocyte counts are clear evidence of the bacterial aetiology of

respiratory infection, but low or normal values do not rule it out. Lymphocyte counts are of no value for

distinguishing between viral and bacterial infections.

WBC count >15,000/mm3 revealed that neither a polymorphonuclear count of >10,000/mm3

(>66% segmented forms) nor a band count of >500/mm3 was associated with an increased

likelihood of occult bacterial infection. To improve the diagnostic utility of the CBC, other

studies have examined individual components of the white blood cell differential count

(TaBlE 1). In particular, the use of the absolute neutrophil count (ANC) has been proposed as

a superior marker of serious bacterial infection.
http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed/8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed/8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742


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A review of 6579 outpatients aged 3 to 36 months presenting to the emergency department

with temperatures of 39C or higher showed an ANC of >10,000/mm3 as more predictive of

occult pneumococcal bacteremia than an elevated WBC count (>15,000/mm3) alone.

Another retrospective review of more than 10,000 patients aged 3 to 36 months presenting to

the emergency department used logistic regression to identify predictors of bacteremia. In

this study, ANC (>9500/mm3) and WBC (>14,300/mm3) were of equal sensitivity (75%) and

specificity (75%) in identifying serious bacterial infection.

Finally, the band count alone does not accurately predict serious bacterial infection. In

summary, the CBC cannot be used in isolation to differentiate bacterial from viral illness. The

CBC can, however, augment clinical data from the history and physical examination to

predict the likelihood of serious bacterial illness. As a result, numerous diagnostic criteria,

each incorporating elements of the CBC, have been developed in an attempt to accurately

differentiate bacterial from viral illness in acutely febrile patients, most typically children

(TaBlE 2). These criteria differ by age of the patient, clinical testing recommendations,

indications for antibiotic therapy, as well as WBC cutoffs.

The American College of Emergency Physicians recommends considering antibiotic therapy

for previously healthy, well appearing children ages 3 to 36 months who present with a fever

with out a clinical source and a WBC count >15,000/mm3

The University of Cincinnati Evidence-Based Clinical Practice Guidelines for fever of

uncertain source in children ages 2 to 36 months recommends obtaining a CBC for any child

who is ill appear ing or at high risk for bacteremia (determined by the clinicians judgment).

A WBC of 15,000/mm3 or ANC >10,000/mm3 provide support for antibiotic therapy.


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The 1993 American Academy of Pediatrics guidelines for fever 39C with out a source in

children ages 3 months to 3 years recommends a CBC; if the WBC count 15,000/mm3, they

recommend a blood culture and treatment with antibiotics pending culture results.

It is important to note that in the age of Haemophilus influenza and Streptococcus pneumonia

vaccination, the rate of occult bacteremia in febrile children presenting without a source has

fallen from 3% to 10% to 1% or less.

A lower prevalence reduces the utility of routine CBC or blood culture in the evaluation of

immunized, febrile children. Parameters such as procalcitonin, interleukin-6, interleukin-8,

interleukin-1 receptor antagonist and C-reactive protein show future promise as biochemical

markers for identifying serious bacterial infections.


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WBC dan jumlah granulosit lebih tinggi pada pasien dengan infeksi bakteri dibandingkan

pada mereka dengan infeksi virus . Untuk leukosit dengan nilai cut-off 15,0 dan 20,0 x 103

memiliki spesifisitas 86% dan 95% , untuk granulosit di tingkat cut-off10,0 dan 15,0 x 103

memiliki spesifisitas 84 % dan 97 % sehingga dapat disimpulkan bahwa WBC tinggi dan

jumlah granulosit tinggi merupakan tanda infeksi bakteri saluran pernapasan. Jumlah limfosit

tidak dapat membedakan antara infeksi virus dan bakteri .

WBC lebih dari 15.000/mm3 dengan jumlah polimorfonuklear lebih dari 10.000/mm3 ( > 66

% tersegmentasi ) atau jumlah band > 500/mm3 dikaitkan dengan kemungkinan peningkatan

infeksi bakteri. Penggunaan jumlah neutrofil mutlak (ANC) telah diusulkan sebagai penanda

untuk infeksi bakteri yang serius . ANC lebih dari 10.000/mm3 merupakan penanda infeksi

bkteri dengan nilai sensitivitas (75%) dan spesifisitas (75%).

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