DEMAM RUAM
Transcript of DEMAM RUAM
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CAMPAK PADA ANAK
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DEFINISI
- PENYAKIT AKUT YANG SANGAT MENULAR- DISEBABKAN OLEH INFEKSI VIRUS YANG UMUMNYA MENYERANG ANAK
EPIDEMIOLOGI
DI INDONESIA (SKRT) :- PERINGKAT KE-5 DLM URUTAN 10 PENYAKIT UTAMA
PADA BAYI- PERINGKAT KE-5 DLM URUTAN 10 PENYAKIT UTAMA
ANAK USIA 1-4 TAHUN
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CAMPAK :
- PENYAKIT ENDEMIS (NEGARA SEDANG BERKEMBANG)
- DITEMUKAN SEPANJANG TAHUN
- DAYA TAHAN TUBUH ↓ → INFEKSI SEKUNDER / PENYULIT :
1. BRONKOPNEUMONIA (75,2%)2. GASTROENTERITIS (7,1%)3. ENSEFALITIS (6,7%)4. LAIN-LAIN (7,9%)
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- MENURUT KELOMOK UMUR KASUS RANAP :
* 17,6% USIA < 1THN* 15,2% USIA 1 THN* 20,3% USIA 2 THN* 12,3% USIA 3 THN* 8,2% USIA 4 THN
- KLB :
* PEDESAAN (IMUNISASI ↓)* TRANSMIGRASI* DAERAH URBAN YG PADAT & KUMUH
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ETIOLOGI
VIRUS CAMPAK :- DI SEKRET NASOFARING & DARAH- SELAMA MASA TUNAS & DALAM WAKTU YG SINGKAT
SESUDAH RUAM (+)
VIRUS TETAP AKTIF : - 34 JAM PADA SUHU KAMAR- BEBERAPA HARI PADA SUHU 0◦C
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VIRUS CAMPAK : - Golongan paramyxovirus
- ORGANISME YG TDK MEMILIKI DAYA TAHAN TINGGI
- DI LUAR TUBUH MANUSIA TDK KEKAL
* SUHU KAMAR (3-5 HR) → 60% SIFAT INFEKTIVITAS (-) * MAMPU BERTAHAN DALAM KEADAAN DINGIN
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PATOGENESIS
- PENULARANNYA → SANGAT EFEKTIF
- VIRUS INFEKTIF → INFEKSI PADA MANUSIA
- PENULARAN → DROPLET MELALUI UDARA → 1-2 HARI SEBELUM TIMBUL GEJALA KLINIS s/d 4 HARI RUAM (+)
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Virus(penggandaan sgt minimal & jumlah virus ↓)
↓Limfatik lokal
↓Kgb regional
↓Virus memperbanyak diri
↓Penyebaran ke sel jaringan limforetikular (limpa)
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Infeksi awal 5-6 HARI ↓
masuk pembuluh darah & menyebar ke permukaan epitel ↓
orofaring, konjungtiva, saluran nafas, kulit, kandung kemih & usus 9-10 HARI ↓
fokus infeksi di epitel saluran nafas & konjungtiva ↓ nekrosis 1-2 lapis sel ↓ Virus >> → pembuluh darah ↓Manifestasi klinis saluran nafas (batuk pilek) & konjungtiva merah
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↓Demam tinggi
Tampak sakit beratUlsera kecil pada mukosa pipi (bercak koplik)
↓Daya tahan tubuh ↓
Ruam makulopapular (hari ke-14 infeksi)Daerah epitel yg nekrotik di nasofaring & sal nafas
↓Infeksi bakteri sekunder :
↓ Bronkopneumonia, otitis media dll
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GEJALA KLINIS KHAS :
1. STADIUM MASA TUNAS - 10-12 HARI
2. STADIUM PRODROMAL - GEJALA BATUK & PILEK YG ↑ - DITEMUKAN ERITEM PADA MUKOSA PIPI (BERCAK KOPLIK), FARING - PERADANGAN MUKOSA KONJUNGTIVA
3. STADIUM AKHIR - KELUARNYA RUAM (mulai dari belakang telinga → muka, badan, lengan & kaki) YG DIDAHULUI DGN ↑ SUHU → HIPERPIGMENTASI & DESKUAMASI
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DIAGNOSIS :
→ KELOMPOK GEJALA KLINIS
- KORIZA (PILEK)- MATA MERADANG- BATUK- DEMAM TINGGI BEBERAPA HARI
- RUAM KHAS
- HIPERPIGENTASI & MENGELUPAS
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RUAM KHAS :BELAKANG TELINGA
↓MENYEBAR :
↓MUKA → DADA → TUBUH → LENGAN & KAKI
↓BERSAMAAN DENGAN MENINGKATNYA SUHU TUBUH
↓HIPERPIGMENTASI
↓MENGELUPAS
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- TIDAK SEMUA KASUS MANIFESTASINYA SAMA & JELAS
- GIZI KURANG :* RUAM S/D BERDARAH DAN MENGELUPAS
* MENINGGAL SEBELUM RUAM TIMBUL
- DIAGNOSIS → KLINIS → IgM Spesifik
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DIAGNOSA BANDING :
1. EKSANTEM SUBITUM2. RUBELA3. DEMAM SKARLATINA4. INFEKSI STAFILOKOKUS
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EKSANTEM SUBITUM
- PENYAKIT VIRUS PADA BAYI & ANAK KECIL AKUT
- ETIOLOGI : human herpesvirus 6B (HHV-6B)
- KHAS : → RUAM & PERBAIKAN KLINIS HAMPIR SIMULTAN
- NAMA LAIN :> ROSEOLA INFANTUM> SIXTH DISEASE> THE ROSE RASH OF INFANTS> PSEUDORUBELLA
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- MASA INKUBASI 7-17 HARI
- PATOGENESI BELUM JELAS → Umumnya infeksi terjadi dari orang yg dekat dgn bayi (orang tua/keluarga, dokter, perawat)
> Horizontal : individu → individu (sekret oral) > Vertikal : ibu → bayi
- PROGNOSIS > penyakit akut & ringan
> sembuh sempurna
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DEMAM MENDADAK TINGGI (39,4C-41,2) (3-6 HARI)Limfadenopati servikal (Oksipital posterior) ±
Eksantema pada palatum molle & uvula↓
SETELAH PANAS TURUN ↓
TIMBUL RUAM DISELURUH TUBUH YG DIMULAI DI DADA(Makular, merah muda, Ф 1-3 mm) ≈ morbiliform / rubella-like
↓ LEHER, SEDIKIT PADA WAJAH & KAKI, LENGAN
↓RUAM MENGHILANG
(jarang menetap dlm 24 jam, deskuamasi & hiperpigmentasi ↓)
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Rubella (German measles)
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ETIOLOGI : RNA virus, genus Rubivirus, famili Togaviridae
PENULARAN : 7 hari sebelum s/d 5 hari sesudah erupsi → oral droplet dari nasofaring atau pernafasan→ plasenta
Erupsi di kulit ?
Virus (+) : - nasofaring s/d 6 hari setelah erupsi - kgb - urin - cairan serebrospinal - ASI - cairan sinovial - paru
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- PENYAKIT VIRUS PADA ANAK & DEWASA MUDA
- MASA INKUBASI : 14-21 HARI
- MASA PRODORMAL YG PENDEK :→ ERUPSI 2-3 HARI (tanpa keluhan sebelumnya)→ REMAJA : - DEMAM RINGAN (< 38,5C) , SAKIT KEPALA, NYERI TENGGOROK, KEMERAHAN PADA KONJUNGTIVA, PILEK, BATUK - LIMFADENOPATI SERVIKAL, SUBOKSIPITAL, POSTAURIKULAR
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MASA EKSANTEM :
MULAI DI RETROAURIKULER / MUKA ↓ MELUAS SECARA KRANIOKAUDAL KE BAGIAN LAIN TUBUH ↓ MAKULA BERBATAS TEGAS
↓ MELUAS & MENYATU ↓
morbilliform
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HARI KE-2 EKSANTEM DI MUKA MENGHILANG ↓
HARI KE-3 DI TUBUH ↓
HARI KE-4 DI ANGGOTA GERAK ↓ DESKUAMASI POSTEKSANTEMATIK (↓↓)
LIMFADENOPATI (5-8 HARI)
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Skarlatina
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DEMAM SKARLATINA
- DEMAM TINGGI- NYERI MENELAN- BATUK / PILEK
- LIDAH BERWARNA MERAH STRAWBERRY
- TONSILITIS EKSUDATIVA / MEMBRANOSA→ SANGAT SPESIFIK
- RUAM DALAM 12- 36 JAM
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Stafilokokus
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PENYULIT
A. LARINGITIS AKUTB. BRONKOPNEMONIAC. KEJANG DEMAMD. ENSEFALITISE. SSPE (Subacute Sclerosing Panensefalitis)F. OTITIS MEDIA AKUTG. ENTERITISH. KONJUNGTIVITISI. dll
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1. Laringitis akut
- Akibat edema hebat pada mukosa saluran nafas → yg bertambah parah saat demam ↑
- Gejala : → Distres pernapasan, sesak, sianosis dan stridor
- Demam ↓ : → keadaan membaik & gejala (-)
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2. Bronkopneumonia
- Dapat disebabkan : 1. virus campak 2. invasi bakteri
- Gejala : * batuk * takipne * ronki basah halus
- Suhu ↓ → gejala ↓ (kecuali batuk) → virus Suhu tidak ↓ → gejala tetap → invasi bakteri
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- Penunjang : * foto toraks → infiltrat * leukositosis
- Negara sedang berkembang → malnutrisi ↑→ Pneumoni > → bisa fatal jk antibiotik (-)
3. Kejang demam
- Periode demam → puncak demam (saat ruam keluar)
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4. Ensefalitis
- Penyulit neurologik yg paling sering- Timbul pada hari ke 4-7 setelah ruam (+)- Insidensi 1 dari 1000 campak- Mortalitas 30-40% Sebagai akibat : 1. imunologik 2. invasi langsung virus campak ke dlm otak
- Gejala : * kejang, letargi, koma, iritabel * nyeri kepala, takipne, disorientasi
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- Likuor : * pleositosis ringan * predominan sel mononuklear * protein ↑ ringan * glukosa normal
5. SSPE (Subacute Sclerosing Panensefalitis)
- Kelainan degeneratif SSP akibat infeksi virus campak persisten- Insidensi : 0,6-2,2 per 100.000 infeksi campak- Usia > muda → risiko > ↑- Masa inkubasi 7 tahun- Gangguan tingkah laku & intelektual yg progresif → Inkoordinasi motorik & kejang
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- Laboratorium : 1. Globulin (likuor) 2. Antibodi thd campak (serum)
- Terapi (-)- Dari timbul gejala s/d meninggal : 6-9 bulan
6. Otitis media
- Invasi virus ke telinga tengah (+)
- Invasi bakteri → otitis media purulenta mastoiditis
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7. Enteritis
- Muntah dan diare pada fase prodormal- Akibat invasi virus ke dalam sel mukosa usus
8. Konjungtivitis
- (+) pada hampir semua kasus campak- Gejala : * mata merah * kelopak mata bengkak * lakrimasi * fotofobia * kadang invasi bakteri
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- konjungtivitis dapat memburuk : * hipopion * pan-oftalmitis * kebutaan * ulkus kornea
9. Sistim Kardiovaskuler
- Perubahan gelombang T- Kontraksi aurikel- Perpanjangan interval A-V- Hanya sementara
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10. Lain-lain
a. Adenitis servicalb. Purpuran trombositopenikc. Bumil : abortus, partus prematurus, kelainan kongenitald. Aktivasi tuberkulosise. Gangguan gizi
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PENGOBATAN
A. TANPA PENYULIT → RAWAT JALAN
- CUKUP CAIRAN & KALORI
- PENGOBATAN SIMTOMATIK :
> DEMAM → ANTIPIRETIK> BATUK → ANTITUSIF> DAHAK → EKSPEKTORAN> KEJANG → ANTIKONVULSAN
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B. DENGAN PENYULIT → RAWAT INAP RUMAH SAKIT
- BANGSAL → ISOLASI
- PERBAIKAN KEADAAN UMUM : > KEBUTUHAN CAIRAN > DIET YANG MEMADAI
- VITAMIN A 100.000 IU 1 x (IDAI); 200.000 IU (WHO)
- JIKA MALNUTRISI (+) VITAMIN A 1500 IU / HARI
- PENYULIT (+) → TH/ SESUAI PENYULIT
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Bronkopneumonia :
- Ampisilin IV 100 mg/kgBB/hari : 4 dosis- Kloramfenikol IV 75 mg/kgBB/hari : 4 dosis
→ s/d sesak berkurang & pasien dpt per oral s/d 3 hari bebas demam
→ jika curiga infeksi spesifik uji tuberkulin setelah anak sehat kembali (3-4 minggu kemudian /anergi) Otitis media : infeksi sekunder >>
- Kotrimoksazol – sulfametoksazol (TMP 4 mg/kgBB/hari : 2 dosis)
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PENCEGAHAN→ IMUNISASI AKTIF PADA BAYI USIA 9 BULAN
Dosis 0,5 ml → SC; efektivitas 90-95%
Jenis vaksin :1. Tunggal2. Kombinasi dengan vaksin rubela dan parotitis epidemika
Kegagalan vaksinasi :1. Antibodi yg dibawa sejak lahir menetralisir virus vaksin campak2. Vaksin rusak3. Pemberian imunoglobulin bersama-sama
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GEJALA KIPI :
1. DEMAM > 39,5C- PADA 5-15% KASUS- MULAI HARI KE 5-6 PASCA IMUNISASI- BERLANGSUNG 2 HARI
2. KEJANG DEMAM3. RUAM :
- PADA 5% KASUS- TIMBUL HARI KE 7-10 PASCA IMUNISASI- BERLANGSUNG 2-4 HARI
4. ENSEFALITIS / ENSEFALOPATI PASCA IMUNISASI- 1 DARI 1 MILYAR DOSIS- TIMBUL 30 HARI PASCA IMUNISASI