Pola Kuman Abses

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\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-573\slmult0 \fs40\cf0\f1\chars
calex100 {POLA KUMAN ABSES LEHER DALAM}\par\pard\li1960\ri0\sl-280\slmult0 \fs24
\cf0\f1\charscalex100 {Novialdi, M. Rusli Pulungan}\par\pard\li400\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li400\ri0\sl-386\slmult0 \fs24\cf0\f1\charscalex100 {B
agian THT-KL FK Univ. Andalas/RS. Dr. M. Djamil Padang}\par\pard\sect\sectd\sbkn
one\pard\li1760\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Latar belakang:.
Penatalaksanaan abses leher dalam memerlukan pemberian antibiotik}\par\pard\li10
26\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {secara empiris sebelum didapat
kan hasil kultur dan uji kepekaan. Antibiotik ini diberikan}\par\pard\li1026\ri0
\sl-306\slmult0 \*\tx6653\fs24\cf0\f1\charscalex100 {berdasarkan pola kuman peny
ebab abses leher dalam.}\tab \fs24\cf0\f1\charscalex100 {Tujuan: Mengetahui pola
kuman}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {penyebab
abses leher dalam dan kepekaannya terhadap antibiotik. Tinjauan Pustaka: Abses}\
par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {leher dalam pada
umumnya disebabkan oleh campuran beberapa kuman. Kuman penyebab}\par\pard\li1026
\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {abses leher dalam dapat berupa k
uman aerob, anaerob maupun fakultatif anaerob. Pemilihan}\par\pard\li1026\ri0\sl
-306\slmult0 \fs26\cf0\f1\charscalex100 {antibiotik berdasarkan hasil kultur dan
uji kepekaan antibiotik terhadap kuman penyebab.}\par\pard\li1026\ri0\sl-293\sl
mult0 \fs24\cf0\f1\charscalex100 {Kesimpulan: Kuman penyebab abses leher dalam a
dalah campuran kuman aerob dan anaerob.}\par\pard\li1026\ri0\sl-293\slmult0 \fs2
2\cf0\f1\charscalex100 {Kuman aerob yang paling dominan adalah stafilokokus dan
streptokokus. Kuman anaerob paling}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0
\f1\charscalex100 {banyak adalah kuman gram negatif anaerob. Antibiotik ceforazo
ne, ceforazone sulbactam,}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\chars
calex100 {moxyfloxacine, dan ceftriaxone masih sensitif terhadap kuman aerob pen
yebab abses leher}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100
{dalam. Metronidazole dan klindamisin sensitif terhadap kuman anaerob gram nega
tif.}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Kata Kunci:
Abses leher dalam, campuran beberapa kuman, pola kuman.}\par\pard\li1026\ri0\sl
-306\slmult0 \fs26\cf0\f1\charscalex100 {Absract}\par\pard\li1746\ri0\sl-293\slm
ult0 \fs26\cf0\f1\charscalex100 {Background: Management of deep neck abscess nee
d empiric antibiotical before}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\c
harscalex100 {the definite culture and sensitivity test result is available. Ant
ibiotic is given based on}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\chars
calex100 {microbial pattern of deep neck abscess. Purpose: To provide informatio
n about bacterial}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100
{pattern of deep neck abscess and sensitifity of bacterial to antibiotic. Revie
w: Deep neck}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {abs
cess is most common caused by polymicrobial. Aerob, anaerob and facultative anae
rob}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {bacterial ma
y be caused of deep neck abscess. To administer effectively antimicrobial}\par\p
ard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {agent to patien, based
on culture and sensitivity test. Concolusion: Deep neck abscess}\par\pard\li102

6\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {bacterial are mixed aerob, anae
rob and facultatif anaerob. Aerob bacterial predominant}\par\pard\li1026\ri0\sl293\slmult0 \fs26\cf0\f1\charscalex100 {are staphylococcus and streptococcus. An
aerob bacterial predominant is anaerob gram}\par\pard\li1026\ri0\sl-306\slmult0
\fs24\cf0\f1\charscalex100 {negatife. Ceforazone, ceforazone sulbactam, moxyflox
acine, and ceftriaxone antibiotic still}\par\pard\li1026\ri0\sl-293\slmult0 \fs2
6\cf0\f1\charscalex100 {sensitive to aerob microbial deep neck abscess. Metronid
azole and clindamisine are still}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f
1\charscalex100 {sensitive to anaerobic gram-negatif.}\par\pard\li1026\ri0\sl293\slmult0 \fs24\cf0\f1\charscalex100 {Key words: Deep neck abscess, polymicrob
ial, microbial pattern.}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1026\ri0\sl-386\slmult0 \fs28\cf0\f1\charscalex100 {Pendahuluan}\par\pard\li17
46\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Abses leher dalam adalah terku
mpulnya nanah (pus) di dalam ruang potensial di antara}\par\pard\li1026\ri0\sl-2
93\slmult0 \fs24\cf0\f1\charscalex100 {fasia leher dalam sebagai akibat penjalar
an dari berbagai sumber infeksi, seperti gigi, mulut,}\par\pard\li1026\ri0\sl-30
6\slmult0 \fs22\cf0\f1\charscalex100 {tenggorok, sinus paranasal, telinga dan le
her. Gejala dan tanda klinik biasanya berupa nyeri dan}\par\pard\li1026\ri0\sl-3
06\slmult0 \fs24\cf0\f1\charscalex100 {pembengkakan di ruang leher dalam yang te
rkena.}\fs20\cf0\f1\charscalex100 {1,2,3,4}\par\pard\li1746\ri0\sl-306\slmult0 \
fs24\cf0\f1\charscalex100 {Secara anatomi daerah potensial leher dalam merupakan
daerah yang sangat komplek.}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\ch
arscalex100 {Pengetahuan anatomi fasia dan ruang-ruang potensial leher secara ba
ik, serta penyebab abses}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charsc
alex100 {leher dalam mutlak diperlukan untuk dapat memperkirakan perjalanan peny
ebaran infeksi dan}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex10
0 {penatalaksanaan yang adekuat.}\fs20\cf0\f1\charscalex100 {1,2,3}\par\pard\li1
746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Tidak ada angka estimasi yang
diperoleh terhadap kejadian abses leher dalam. Namun}\par\pard\li9586\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-426\slmult0 \fs28\cf0\f1\charscalex10
0 {14}\par\pard\sect\sectd\sbknone\pard\sect\sectd\sbkpage
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3\margtsxn666\margbsxn293\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li10
26\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-453\slmult0 \fs
24\cf0\f1\charscalex100 {diperkirakan bahwa kejadian abses leher dalam menurun s
ecara bermakna sejak era pemakaian}\par\pard\li1026\ri0\sl-306\slmult0 \*\tx2266
\fs22\cf0\f1\charscalex100 {antibiotik.}\fs18\cf0\f1\charscalex100 {5,6}\tab \fs
22\cf0\f1\charscalex100 {Disamping itu higiene mulut yang meningkat juga berpera
n dalam hal ini.}\fs18\cf0\f1\charscalex100 {6}{ }\fs24\cf0\f1\charscalex100 {Se
belum}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {era antibi
otik, 70% infeksi leher dalam berasal dari penyebaran infeksi di faring dan tons
il ke}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {parafaring
. Saat ini infeksi leher dalam lebih banyak berasal dari tonsil pada anak, dan i
nfeksi gigi}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {pada
orang dewasa.}{\super \fs20\up4\cf0\f1\charscalex100 {4,5}}\par\pard\li1746\ri0
\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {Kuman penyebab abses leher dalam bia
sanya terdiri dari campuran kuman aerob,}\par\pard\li1026\ri0\sl-306\slmult0 \*\
tx4893\fs22\cf0\f1\charscalex100 {anaerob maupun fakultatif anaerob.}\fs18\cf0\f
1\charscalex100 {1,2,5,6}\tab \fs22\cf0\f1\charscalex100 {Asmar dikutip Murray d
kk,}{\super \fs18\up4\cf0\f1\charscalex100 {5}}\fs22\cf0\f1\charscalex100 {menda
patkan kultur dari}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex10
0 {abses retrofaring 90% mengandung kuman aerob, dan 50% pasien ditemukan kuman
anaerob.}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {Disamp
ing drainase abses yang optimal, pemberian antibiotik diperlukan untuk terapi}\p
ar\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {yang adekuat. Untu
k mendapatkan antibiotik yang efektif terhadap pasien, diperlukan}\par\pard\li10
26\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {pemeriksaan kultur kuman dan u
ji kepekaan antibiotik terhadap kuman. Namun ini memerlukan}\par\pard\li1026\ri0
\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {waktu yang cukup lama, sehingga dipe
rlukan pemberian antibiotik secara empiris. Berbagai}\par\pard\li1026\ri0\sl-293

\slmult0 \fs22\cf0\f1\charscalex100 {kepustakaan melaporkan pemberian terapi ant
ibiotik spektrum luas secara kombinasi. Kombinasi}\par\pard\li1026\ri0\sl-320\sl
mult0 \fs24\cf0\f1\charscalex100 {yang diberikan pun bervariasi.}{\super \fs20\u
p4\cf0\f1\charscalex100 {6}}\par\pard\li1026\ri0\sl-480\slmult0 \fs28\cf0\f1\cha
rscalex100 {Tinjauan Pustaka}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1026\ri0\sl-386\slmult0 \fs28\cf0\f1\charscalex100 {Anatomi Leher}\par\par
d\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Pada daerah leher terdap
at beberapa ruang potensial yang dibatasi oleh fasia servikal.}\par\pard\li1026\
ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Fasia servikal dibagi menjadi dua
yaitu fasia superfisial dan fasia profunda. Kedua fasia ini}\par\pard\li1026\ri
0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {dipisahkan oleh otot plastima yang
tipis dan meluas ke anterior leher. Otot platisma sebelah}\par\pard\li1026\ri0\s
l-293\slmult0 \fs26\cf0\f1\charscalex100 {inferior berasal dari fasia servikal p
rofunda dan klavikula serta meluas ke superior untuk}\par\pard\li1026\ri0\sl-320
\slmult0 \fs22\cf0\f1\charscalex100 {berinsersi di bagian inferior mandibula.}{\
super \fs20\up4\cf0\f1\charscalex100 {2,5}}\par\pard\li1026\ri0\sl-493\slmult0 \
fs24\cf0\f1\charscalex100 {Gambar 1. Potongan aksial leher setinggi orofaring}{\
super \fs20\up4\cf0\f1\charscalex100 {2}}\par\pard\li1026\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-426\s
lmult0 \fs24\cf0\f1\charscalex100 {Gambar 2. Potongan obliq leher}\fs20\cf0\f1\c
harscalex100 {2}\par\pard\li1386\ri0\sl-480\slmult0 \fs22\cf0\f1\charscalex100 {
Fasia superfisial terletak dibawah dermis. Ini termasuk sistem muskuloapenoureti
k, yang}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {meluas m
ulai dari epikranium sampai ke aksila dan dada, dan tidak termasuk bagian dari d
aerah}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {leher dala
m. Fasia profunda mengelilingi daerah leher dalam terdiri dari 3 lapisan, yaitu}
\fs20\cf0\f1\charscalex100 {2,4,7}\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1746\
fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {lapisan
superfisial}\par\pard\li1386\ri0\sl-293\slmult0 \*\tx1746\fs26\cf0\f2\charscalex
100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {lapisan tengah}\par\pard\li138
6\ri0\sl-306\slmult0 \*\tx1746\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24
\cf0\f1\charscalex100 {lapisan dalam.}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1026\ri0\sl-386\slmult0 \fs26\cf0\f1\charscalex100 {Ruang potensi
al leher dalam}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {R
uang potensial leher dalam dibagi menjadi ruang yang melibatkan daerah sepanjang
}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {leher, ruang su
prahioid dan ruang infrahioid. }\fs20\cf0\f1\charscalex100 {2,5,7}\par\pard\li13
4\cf0\f1\charscalex100 {Ruang yang melibatkan sepanjang leher terdiri dari:}\par
\pard\li2106\ri0\sl-306\slmult0 \*\tx2466\fs26\cf0\f2\charscalex100 {\uc1\u9679X
}\tab \fs24\cf0\f1\charscalex100 {ruang retrofaring}\par\pard\li2106\ri0\sl-293\
slmult0 \*\tx2466\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\chars
calex100 {ruang bahaya (danger space)}\par\pard\li2106\ri0\sl-306\slmult0 \*\tx2
466\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {ruan
g prevertebra.}\par\pard\li1386\ri0\sl-293\slmult0 \*\tx1746\fs26\cf0\f2\charsca
lex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {Ruang suprahioid terdiri da
ri:}\par\pard\li2106\ri0\sl-306\slmult0 \*\tx2466\fs26\cf0\f2\charscalex100 {\uc
1\u9679X}\tab \fs24\cf0\f1\charscalex100 {ruang submandibula}\par\pard\li9586\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li9586\ri0\sl-333\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\pard\sect\sectd\s
bkpage

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\pard\li2106\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2106\ri0\sl-453\slmult0 \*\
tx2466\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {r
uang parafaring}\par\pard\li2106\ri0\sl-293\slmult0 \*\tx2466\fs26\cf0\f2\charsc
alex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {ruang parotis}\par\pard\li
2106\ri0\sl-306\slmult0 \*\tx2466\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \f
s24\cf0\f1\charscalex100 {ruang mastikor}\par\pard\li2106\ri0\sl-293\slmult0 \*\
tx2466\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {r

uang peritonsil}\par\pard\li2106\ri0\sl-306\slmult0 \*\tx2466\fs26\cf0\f2\charsc
alex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {ruang temporalis.}\par\par
d\li1386\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1386\ri0\sl-386\slmult0 \*\tx17
46\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {Ruang
infrahioid:}\par\pard\li2186\ri0\sl-293\slmult0 \*\tx2546\fs26\cf0\f2\charscale
x100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {ruang pretrakeal.}\par\pard\l
i1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-280\slmult0
\fs24\cf0\f1\charscalex100 {Gambar 3. Potongan Sagital Leher}{\super \fs20\up4\c
f0\f1\charscalex100 {2}}\par\pard\li1026\ri0\sl-480\slmult0 \fs30\cf0\f1\charsca
lex100 {Kekerapan}\par\pard\li1746\ri0\sl-306\slmult0 \*\tx4720\fs24\cf0\f1\char
scalex100 {Ungkanot dikutip Murray dkk}\fs20\cf0\f1\charscalex100 {5}\tab \fs24\
cf0\f1\charscalex100 {mendapatkan 117 anak-anak yang tatalaksana sebagai}\par\pa
rd\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {abses leher dalam pada
rentang waktu 6 tahun. Abses peritonsil 49%, abses retrofaring 22%,}\par\pard\li
1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {abses submandibula 14%, abse
s bukkal 11%, abses parafaring 2%, lainnya 2%.}\par\pard\li1746\ri0\sl-320\slmu
lt0 \*\tx8040\fs24\cf0\f1\charscalex100 {Sakaguchi dkk,}{\super \fs20\up4\cf0\f1
\charscalex100 {8}}\fs24\cf0\f1\charscalex100 {melaporkan kasus infeksi leher da
lam sebanyak}\tab \fs24\cf0\f1\charscalex100 {91 kasus dari tahun}\par\pard\li10
26\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {1985 sampai 1994. Rentang usia
dari umur 1-81 tahun, laki-laki sebanyak 78% dan perempuan}\par\pard\li1026\ri0
\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {22%. Infeksi peritonsil paling banya
k ditemukan, yaitu 72 kasus, dikuti oleh parafaring 8 kasus,}\par\pard\li1026\ri
0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {submandibula, sublingual dan submak
sila masing-masing 7 kasus dan retrofaring
1 kasus.}\par\pard\li1746\ri0\sl-3
20\slmult0 \fs28\cf0\f1\charscalex100 {Huang dkk,}{\super \fs20\up4\cf0\f1\chars
calex100 {9}}\fs24\cf0\f1\charscalex100 {dalam penelitiannya pada tahun 1997 sam
pai 2002, menemukan kasus}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\chars
calex100 {infeksi leher dalam sebanyak 185 kasus. Abses submandibula (15,7%) mer
upakan kasus}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {ter
banyak ke dua setelah abses parafaring (38,4), dikuti oleh Ludwig\uc1\u8217Xs an
gina (12,4%), parotis}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscale
x100 {(7%) dan retrofaring (5,9%).}\par\pard\li1746\ri0\sl-320\slmult0 \fs26\cf0
\f1\charscalex100 {Yang dkk,}{\super \fs20\up4\cf0\f1\charscalex100 {6}}\fs24\cf
0\f1\charscalex100 {pada 100 kasus abses leher dalam yang diteliti April 2001 sa
mpai Oktober}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {200
6 mendapatkan perbandingan antara laki-laki dan perempuan 3:2. Lokasi abses lebi
h dari}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {satu ruan
g potensial 29%. Abses submandibula 35%, parafaring 20%, mastikator 13%, periton
sil}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {9%, sublingu
al 7%, parotis 3%, infra hyoid 26%, retrofaring 13%, ruang karotis 11%.}\par\par
d\li1746\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {Di Bagian THT-KL Rumah S
akit dr. M. Djamil Padang selama 1 tahun terakhir}\par\pard\li1026\ri0\sl-293\sl
mult0 \fs24\cf0\f1\charscalex100 {(Oktober 2009 sampai September 2010) didapatka
n abses leher dalam sebanyak 33 orang,}\par\pard\li1026\ri0\sl-306\slmult0 \fs24
\cf0\f1\charscalex100 {abses peritonsil 11 (32%) kasus, abses submandibula 9 (26
%) kasus, abses parafaring 6 (18%)}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0
\f1\charscalex100 {kasus, abses retrofaring 4 (12%) kasus, abses mastikator 3(9%
) kasus, abses pretrakeal 1}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\cha
rscalex100 {(3%) kasus.}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1026\ri0\sl-386\slmult0 \fs28\cf0\f1\charscalex100 {Patogenesis}\par\pard\li174
6\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Pembentukan abses merupakan has
il perkembangan dari flora normal dalam tubuh. Flora}\par\pard\li1026\ri0\sl-306
\slmult0 \fs24\cf0\f1\charscalex100 {normal dapat tumbuh dan mencapai daerah ste
ril dari tubuh baik secara perluasan langsung,}\par\pard\li1026\ri0\sl-293\slmul
t0 \fs24\cf0\f1\charscalex100 {maupun melalui laserasi atau perforasi. Berdasark
an kekhasan flora normal yang ada di bagian}\par\pard\li1026\ri0\sl-306\slmult0
\fs24\cf0\f1\charscalex100 {tubuh tertentu maka kuman dari abses yang terbentuk
dapat diprediksi berdasar lokasinya.}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\c

f0\f1\charscalex100 {Sebagian besar abses leher dalam disebabkan oleh campuran b
erbagai kuman, baik kuman}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\chars
calex100 {aerob, anaerob, maupun fakultatif anaerob.}\fs20\cf0\f1\charscalex100
{6,10}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Pada keban
yakan membran mukosa, kuman anaerob lebih banyak dibanding dengan}\par\pard\li10
26\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {kuman aerob dan fakultatif, de
ngan perbandingan mulai 10:1 sampai 10000:1. Bakteriologi dari}\par\pard\li1026\
ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {daerah gigi, oro-fasial, dan abse
s leher, kuman yang paling dominan adalah kuman anaerob}\par\pard\li9586\ri0\sl213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li95
86\ri0\sl-386\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\pard\sect\sectd\sbkpag
e
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{\shp{\*\shpinst\shpleft5000\shptop7133\shpright5026\shpbottom10280\shpfhdr0\shp
wr3\shpwrk0\shpfblwtxt1\shplid2042\shpz5\shpbxpage\shpbypage

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28\cf0\f1\charscalex100 {yaitu, Prevotella, Porphyromonas, Fusobacterium spp, da
n Peptostreptococcus spp.}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\chars
calex100 {Bakteri aerob dan fakultatif adalah Streptococcus pyogenic dan Stapy
lococcus aureus.}\fs20\cf0\f1\charscalex100 {10}\par\pard\li1746\ri0\sl-306\slmu
lt0 \fs26\cf0\f1\charscalex100 {Sumber infeksi paling sering pada abses leher da
lam berasal dari infeksi tonsil dan}\par\pard\li1026\ri0\sl-320\slmult0 \*\tx188
0\fs26\cf0\f1\charscalex100 {gigi.}\fs18\cf0\f1\charscalex100 {4,7,11}\tab \fs24
\cf0\f1\charscalex100 {Infeksi gigi dapat mengenai pulpa dan periodontal. Penyeb
aran infeksi dapat meluas}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\chars
calex100 {melalui foramen apikal gigi ke daerah sekitarnya. Apek gigi molar I ya
ng berada di atas}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100
{mylohyoid menyebabkan penjalaran infeksi akan masuk terlebih dahulu ke daerah
sublingual,}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {seda
ngkan molar II dan III apeknya berada di bawah mylohyoid sehingga infeksi akan l
ebih}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {cepat ke da
erah submaksila.}{\super \fs20\up4\cf0\f1\charscalex100 {7}}\par\pard\li1746\ri0
\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Parhischar dkk}{\super \fs18\up4\cf0
\f1\charscalex100 {12}}\fs22\cf0\f1\charscalex100 {mendapatkan, dari 210 abses l
eher dalam, 175 (83,3%) kasus dapat}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf
0\f1\charscalex100 {didentifikasi penyebabnya (tabel 1). Penyebab terbanyak infe
ksi gigi 43%. Tujuh puluh enam}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\
charscalex100 {persen Ludwig\uc1\u8217Xs angina disebabkan infeksi gigi, abses s
ubmandibula 61% disebabkan oleh}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1
\charscalex100 {infeksi gigi.}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn168
13\marglsxn666\margrsxn133\cols3\colno1\colw4840\colsr-0\colno2\colw4053\colsr-0
\colno3\colw2200\pard\li1746\ri0\sl-306\slmult0 \fs28\cf0\f1\charscalex100 {Yang
dkk}\fs20\cf0\f1\charscalex100 {5}{ }\fs24\cf0\f1\charscalex100 {melaporkan dar
i}\par\column\pard\li0\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {100 orang
abses leher dalam,}\par\column\pard\li0\ri0\sl-306\slmult0 \fs26\cf0\f1\charscal
ex100 {77 (77%)}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666
\margrsxn133\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {pasien d
apat didentifikasi sumber infeksi sebagai penyebab. Penyebab terbanyak berasal d
ari}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {infeksi orof
aring 35%, odontogenik 23%. Penyebab lain adalah infeksi kulit, sialolitiasis, t
rauma,}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {tuberkulo
sis, dan kista yang terinfeksi.}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1
\charscalex100 {Tabel 1. Sumber infeksi penyebab abses leher dalam.}\fs20\cf0\f1
\charscalex100 {12}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn
666\margrsxn133\cols2\colno1\colw3560\colsr-0\colno2\colw7533\pard\li1040\ri0\sl
-280\slmult0 \fs22\cf0\f1\charscalex100 {Penyebab}\par\column\pard\li0\ri0\sl-28
0\slmult0 \*\tx800\fs22\cf0\f1\charscalex100 {Jumlah}\tab \fs26\cf0\f1\charscale
x100 {%}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsx
n133\cols3\colno1\colw3853\colsr-0\colno2\colw506\colsr-0\colno3\colw6733\pard\l
i1040\ri0\sl-253\slmult0 \fs22\cf0\f1\charscalex100 {Gigi}\par\pard\li1040\ri0\s
l-240\slmult0 \fs22\cf0\f1\charscalex100 {Penyalahgunaan obat suntik}\par\pard\l

i1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Faringotonsilitis}\par\pard
\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Fraktur mandibula}\par\pa
rd\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Infeksi kulit}\par\pard
\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Tuberculosis}\par\pard\li
1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Benda asing}\par\pard\li1040
\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Peritonsil abses}\par\pard\li104
0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Trauma}\par\pard\li1040\ri0\sl240\slmult0 \fs22\cf0\f1\charscalex100 {Sialolitiasis}\par\pard\li1040\ri0\sl-24
0\slmult0 \fs22\cf0\f1\charscalex100 {Parotis}\par\pard\li1040\ri0\sl-240\slmult
0 \fs22\cf0\f1\charscalex100 {Lain-lain}\par\pard\li1040\ri0\sl-240\slmult0 \fs2
2\cf0\f1\charscalex100 {Tidak diketahui}\par\column\pard\li0\ri0\sl-253\slmult0
\fs26\cf0\f1\charscalex100 {77}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\cha
rscalex100 {21}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {12}\
par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {10}\par\pard\li53\ri
0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {9}\par\pard\li53\ri0\sl-240\slmult0
\fs26\cf0\f1\charscalex100 {9}\par\pard\li53\ri0\sl-240\slmult0 \fs26\cf0\f1\ch
arscalex100 {7}\par\pard\li53\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {6}\
par\pard\li53\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {6}\par\pard\li53\ri
rscalex100 {10}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {35}\
par\column\pard\li0\ri0\sl-253\slmult0 \fs26\cf0\f1\charscalex100 {43}\par\pard\
li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {12}\par\pard\li0\ri0\sl-240\s
lmult0 \fs22\cf0\f1\charscalex100 {6,7}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf
0\f1\charscalex100 {5,6}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex
100 {5,1}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {5,1}\par\p
ard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {3,9}\par\pard\li0\ri0\sl240\slmult0 \fs22\cf0\f1\charscalex100 {3,4}\par\pard\li0\ri0\sl-240\slmult0 \fs
22\cf0\f1\charscalex100 {3,4}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\chars
calex100 {2,8}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,7}\
par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {5,6}\par\pard\sect\s
ectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\pard\li1746\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex
100 {Pola kuman penyebab abses leher dalam berbeda sesuai dengan sumber infeksin
ya.}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {Infeksi yang
berasal dari orofaring lebih banyak disebabkan kuman flora normal di saluran na
fas}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {atas seperti
streptokokus dan stafilokokus. Infeksi yang berasal dari gigi biasanya lebih do
minan}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {kuman anae
rob seperti, Prevotella, Fusobacterium spp,.}\fs18\cf0\f1\charscalex100 {10,13}\
par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Penyebaran abses
leher dalam dapat melalui beberapa jalan yaitu hematogen, limfogen,}\par\pard\li
1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {dan celah antar ruang leher
dalam. Beratnya infeksi tergantung dari virulensi kuman, daya tahan}\par\pard\li
1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {tubuh dan lokasi anatomi.}\f
s18\cf0\f1\charscalex100 {2,10,13}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\
f1\charscalex100 {Infeksi dari submandibula dapat meluas ke ruang mastikor kemud
ian ke parafaring.}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex10
0 {Perluasan infeksi ke parafaring juga dapat langsung dari ruang submandibula.
Selanjutnya infeksi}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex1
00 {dapat menjalar ke daerah potensial lainnya.(gambar 4).}\fs20\cf0\f1\charscal
ex100 {2,10}\par\pard\li1026\ri0\sl-480\slmult0 \fs26\cf0\f1\charscalex100 {Geja
la Klinis}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Gejala
klinis abses leher dalam secara umum sama dengan gejala infeksi pada umumnya}\p
ar\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {yaitu, demam, nyer
i, pembengkakan, dan gangguan fungsi.}{\super \fs20\up4\cf0\f1\charscalex100 {13}}\fs24\cf0\f1\charscalex100 {Abshirini H, dkk}{\super \fs20\up4\cf0\f1\charsca
lex100 {4}}\fs24\cf0\f1\charscalex100 {melaporkan gejala}\par\pard\sect\sectd\sb
knone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols2\colno1\colw4666\cols
r-0\colno2\colw6426\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {k
linis dari abses leher dalam pada}\par\column\pard\li0\ri0\sl-293\slmult0 \fs24\
cf0\f1\charscalex100 {147 kasus didapatkan: bengkak pada leher 87%, trismus}\par
18\cf0\par\pard\li4920\ri0\sl-280\slmult0 \fs26\cf0\f1\charscalex100 {14}\par\pa
rd\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\pard\sect\
sectd\sbkpage
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24\cf0\f1\charscalex100 {53%, disfagia 45%, dan odinofagia 29,3%. Berdasarkan ru
ang yang dikenai akan menimbulkan}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\
f1\charscalex100 {gejala spesifik yang sesuai dengan ruang potensial yang terl
ibat.}\fs20\cf0\f1\charscalex100 {1-3}\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1
746\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {Abse
s peritonsil}\par\pard\li1746\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {Abs
es peritonsil merupakan abses yang paling banyak ditemukan, dan biasanya}\par\pa
rd\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {merupakan lanjutan dari
infeksi tonsil. Pada abses peritonsil didapatkan gejala demam,}\par\pard\li1746
\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {nyeri tenggorok, nyeri menelan,
hipersalivasi, nyeri telinga dan suara bergumam. Pada}\par\pard\li1746\ri0\sl-30
6\slmult0 \fs24\cf0\f1\charscalex100 {pemeriksaan fisik didapatkan arkus faring
tidak simetris, pembengkakan di daerah}\par\pard\li1746\ri0\sl-293\slmult0 \fs22
\cf0\f1\charscalex100 {peritonsil, uvula terdorong ke sisi yang sehat, dan trism
us. Tonsil hiperemis, dan kadang}\par\pard\li1746\ri0\sl-320\slmult0 \fs24\cf0\f
1\charscalex100 {terdapat detritus. Abses ini dapat meluas ke daerah parafaring.
}\fs18\cf0\f1\charscalex100 {1,2,5,14}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\
cf0\f1\charscalex100 {Untuk memastikan diagnosis dapat dilakukan pungsi aspirasi
dari tempat yang paling}\par\pard\li1746\ri0\sl-320\slmult0 \fs22\cf0\f1\charsc
alex100 {fluktuatif.}{\super \fs20\up4\cf0\f1\charscalex100 {3,5}}\par\pard\li13
4\cf0\f1\charscalex100 {Abses retrofaring}\par\pard\li1746\ri0\sl-293\slmult0 \f
s24\cf0\f1\charscalex100 {Merupakan abses leher dalam yang jarang terjadi, terut
ama terjadi pada anak dan}\par\pard\li1746\ri0\sl-320\slmult0 \*\tx7933\fs24\cf0
\f1\charscalex100 {merupakan abses leher dalam yang terbanyak pada anak.}\fs18\c
f0\f1\charscalex100 {1,2,3,15}\tab \fs24\cf0\f1\charscalex100 {Pada anak biasany
a}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {abses terjadi
mengikuti infeksi saluran nafas atas dengan supurasi pada kelenjar getah}\par\pa
rd\li1746\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {bening yang terdapat pa
da daerah retrofaring. Kelenjar getah bening ini biasanya}\par\pard\li1746\ri0\s
l-306\slmult0 \*\tx6253\fs26\cf0\f1\charscalex100 {mengalami atropi pada usia 34 tahun.}\fs18\cf0\f1\charscalex100 {3,14,15,16}\tab \fs24\cf0\f1\charscalex100
{Pada orang dewasa abses retrofaring}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\c
f0\f1\charscalex100 {sering terjadi akibat adanya trauma tumpul pada mukosa fari
ng, perluasan abses dari}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charsc
alex100 {struktur yang berdekatan.}\fs18\cf0\f1\charscalex100 {4,14,16,17}\par\p
ard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Gejala klinis berupa d
emam, nyeri tenggorok, pergerakan leher terbatas, sesak nafas,}\par\pard\li1746\
ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {odinofagi maupun disfagi. Pada pe
meriksaan didapatkan pembengkakan dinding}\par\pard\li1746\ri0\sl-320\slmult0 \f
s24\cf0\f1\charscalex100 {posterior faring.}{\super \fs20\up4\cf0\f1\charscalex1
00 {4}}\par\pard\li1386\ri0\sl-293\slmult0 \*\tx1746\fs26\cf0\f2\charscalex100 {
\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {Abses Parafaring}\par\pard\li1746\r
i0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Abses parafaring dapat terjadi set
elah infeksi faring, tonsil, adenoid, gigi, parotis, atau}\par\pard\li1746\ri0\s
l-293\slmult0 \fs24\cf0\f1\charscalex100 {kelenjar limfatik. Pada banyak kasus a
bses parafaring merupakan perluasan dari abses}\par\pard\li1746\ri0\sl-306\slmul
t0 \fs26\cf0\f1\charscalex100 {leher dalam yang berdekatan seperti; abses perito
nsil, abses submandibula, abses}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1
\charscalex100 {retrofaring maupun mastikator. Gejala abses parafaring berupa de
mam, trismus, nyeri}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex1

00 {tenggorok, odinofagi dan disfagia. Pada pemeriksaan fisik didapatkan pembeng
kakan di}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {daerah
parafaring, pendorongan dinding lateral faring ke medial, dan angulus mandibula}
\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {tidak teraba. Pa
da abses parafaring yang mengenai daerah prestiloid akan memberikan}\par\pard\li
1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {gejala trismus yang lebih je
las.}\fs18\cf0\f1\charscalex100 {4,5,14}\par\pard\li1386\ri0\sl-306\slmult0 \*\t
x1746\fs26\cf0\f2\charscalex100 {\uc1\u9679X}\tab \fs24\cf0\f1\charscalex100 {Ab
ses Submandibula}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100
{Pasien biasanya akan mengeluh nyeri di rongga mulut, air liur banyak, Pada peme
riksaan}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {fisik di
dapatkan pembengkakan di daerah submandibula, fluktuatif, lidah terangkat ke}\pa
r\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {atas dan terdorong
ke belakang, angulus mandibula dapat diraba. Pada aspirasi}\par\pard\li1746\ri0\
sl-306\slmult0 \fs22\cf0\f1\charscalex100 {didapatkan pus. Ludwig\uc1\u8217Xs an
gina merupakan selulitis di daerah sub mandibula, dengan}\par\pard\li1746\ri0\sl
-293\slmult0 \fs22\cf0\f1\charscalex100 {tidak ada fokal abses. Biasanya akan me
ngenai kedua sisi submandibula, air liur yang}\par\pard\li1746\ri0\sl-306\slmult
0 \fs22\cf0\f1\charscalex100 {banyak, trismus, nyeri, disfagia, massa di submand
ibula, sesak nafas akibat sumbatan}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0
\f1\charscalex100 {jalan nafas oleh lidah yang terangkat ke atas dan terdorong k
e belakang.}\fs20\cf0\f1\charscalex100 {5,14}\par\pard\li1026\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1026\ri0\sl-386\slmult0 \fs26\cf0\f1\charscalex100 {Pemeri
ksaan Penunjang}\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1746\fs26\cf0\f1\charsc
alex100 {1.}\tab \fs24\cf0\f1\charscalex100 {Rontgen servikal lateral}\par\pard\
li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Dapat memberikan gambaran
adanya pembengkakan jaringan lunak pada daerah}\par\pard\li1746\ri0\sl-306\slmul
t0 \fs22\cf0\f1\charscalex100 {prevertebra, adanya benda asing, gambaran udara d
i subkutan, air fluid levels, erosi dari}\par\pard\li9586\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li9586\ri0\sl-426\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\pa
rd\sect\sectd\sbkpage
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3\margtsxn666\margbsxn293\cols2\colno1\colw1746\colsr-0\colno2\colw9346\pard\li1
106\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1106\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1106\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1106\ri0\sl-213\slmult0 \f
t0 \fs18\cf0\par\pard\li1106\ri0\sl-213\slmult0 \fs22\cf0\f1\charscalex100 {Umur
}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li0\ri0\sl-453\slmult0 \fs24\cf0\f1\charscalex100 {kor
pus vertebre. Penebalan jaringan lunak pada prevertebre setinggi servikal II (C2
),}\par\pard\li0\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {lebih 7mm, dan s
etinggi servikal VI yang lebih 14mm pada anak, lebih 22mm pada}\par\pard\li0\ri0
\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {dewasa dicurigai sebagai suatu abses
retrofaring.}\fs20\cf0\f1\charscalex100 {2,3,4,5}\par\pard\li0\ri0\sl-453\slmul
t0 \fs24\cf0\f1\charscalex100 {Tabel 2. Tebal jaringan lunak posterior faring be
rdasarkan umur pada Rontgen servikal}\par\pard\li0\ri0\sl-306\slmult0 \fs26\cf0\
f1\charscalex100 {lateral}\fs18\cf0\f1\charscalex100 {18}\par\pard\li466\ri0\sl280\slmult0 \*\tx1653\fs22\cf0\f1\charscalex100 {Setinggi C4}\tab \fs22\cf0\f1\c
harscalex100 {Setinggi C6}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\m
arglsxn666\margrsxn133\cols3\colno1\colw1746\colsr-0\colno2\colw1653\colsr-0\col
no3\colw7693\pard\li1040\ri0\sl-280\slmult0 \fs22\cf0\f1\charscalex100 {0-1}\par
\pard\li1040\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {1-2}\par\pard\li1040
\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {2-3}\par\pard\li1040\ri0\sl-240\
slmult0 \fs20\cf0\f1\charscalex100 {3-6}\par\pard\li1040\ri0\sl-240\slmult0 \fs2
0\cf0\f1\charscalex100 {6-14}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\ch
arscalex100 {Dewasa}\par\column\pard\li466\ri0\sl-280\slmult0 \fs20\cf0\f1\chars

calex100 {1,5.C}\par\pard\li466\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {0
,5.C}\par\pard\li466\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {0,5.C}\par\p
ard\li466\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {0,4.C}\par\pard\li466\r
i0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {0,3.C}\par\pard\li466\ri0\sl-240\s
lmult0 \fs18\cf0\f1\charscalex100 {Lk
pr}\par\pard\li466\ri0\sl-240\slmu
lt0 \fs20\cf0\f1\charscalex100 {0,3C 0,3C}\par\pard\li0\ri0\sl-253\slmult0 \fs
22\cf0\f1\charscalex100 {C= corpus servikal}\par\column\pard\li0\ri0\sl-280\slmu
lt0 \fs20\cf0\f1\charscalex100 {2,0.C}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0
\f1\charscalex100 {1,5.C}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f1\charscale
x100 {1,2.C}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {1,2.C}\
par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {1,2.C}\par\pard\li0\
ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {Lk
pr}\par\pard\li0\ri0\s
l-240\slmult0 \fs20\cf0\f1\charscalex100 {0,7C 0,6C}\par\pard\sect\sectd\sbkno
ne\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\pard\li1386\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1746\fs26\cf0\f1\charscalex1
00 {2.}\tab \fs24\cf0\f1\charscalex100 {Rontgen Panoramiks}\par\pard\li1746\ri0\
sl-320\slmult0 \fs24\cf0\f1\charscalex100 {Dilakukan pada kasus abses leher dala
m yang dicurigai berasal dari gigi.}{\super \fs20\up4\cf0\f1\charscalex100 {5}}
\par\pard\li1386\ri0\sl-306\slmult0 \*\tx1746\fs26\cf0\f1\charscalex100 {3.}\tab
\fs24\cf0\f1\charscalex100 {Rontgen toraks}\par\pard\li1746\ri0\sl-293\slmult0
\fs24\cf0\f1\charscalex100 {Perlu dilakukan untuk evaluasi mediastinum, empisema
subkutis, pendorongan saluran}\par\pard\li1746\ri0\sl-320\slmult0 \fs24\cf0\f1\
charscalex100 {nafas, pneumonia yang dicurigai akibat aspirasi dari abses.}{\sup
er \fs20\up4\cf0\f1\charscalex100 {5}}\par\pard\li1386\ri0\sl-293\slmult0 \*\tx1
746\fs26\cf0\f1\charscalex100 {4.}\tab \fs24\cf0\f1\charscalex100 {Tomografi Kom
puter (TK)}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Tomog
rafi komputer dengan kontras merupakan pemeriksaan baku emas pada abses}\par\par
d\li1746\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {leher dalam. Berdasarkan
penelitian Crespo dkk, seperti dikutip Murray AD dkk,}{\super \fs20\up4\cf0\f1\
charscalex100 {5}}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100
{bahwa dengan hanya pemeriksaan klinis tanpa tomografi komputer mengakibatkan}\
par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {estimasi terhadap
luasnya abses yang terlalu rendah pada 70% pasien. TK memberikan}\par\pard\li17
46\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {gambaran abses berupa lesi den
gan hipodens (intensitas rendah), batas yang lebih jelas,}\par\pard\li1746\ri0\s
l-306\slmult0 \fs24\cf0\f1\charscalex100 {kadang ada air fluid levels. Kirse dan
Robenson}\fs20\cf0\f1\charscalex100 {17}\fs24\cf0\f1\charscalex100 {, mendapatk
an ada hubungan antara}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscal
ex100 {ketidakteraturan dinding abses dengan adanya pus pada rongga tersebut. Pe
meriksaan}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {TK tor
aks diperlukan jika dicurigai adanya perluasan abses ke mediastinum.}\fs20\cf0\f
1\charscalex100 {5}\par\pard\li1026\ri0\sl-480\slmult0 \fs26\cf0\f1\charscalex10
0 {Bakteriologi}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri
0\sl-386\slmult0 \fs26\cf0\f1\charscalex100 {Pemeriksaan Bakteriologi}\par\pard\
li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Pemeriksaan bakteriologi p
us dari lesi yang dalam atau tertutup harus meliputi biakan}\par\pard\li1026\ri0
\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {metoda anaerob. Setelah desinfeksi k
ulit, pus dapat diambil dengan aspirasi memakai jarum}\par\pard\li1026\ri0\sl-30
6\slmult0 \fs24\cf0\f1\charscalex100 {aspirasi atau dilakukan insisi. Pus yang d
iambil sebaiknya tidak terkontaminasi dengan flora}\par\pard\li1026\ri0\sl-293\s
lmult0 \fs22\cf0\f1\charscalex100 {normal yang ada di daerah saluran nafas atas
atau rongga mulut. Aspirasi dilakukan dari daerah}\par\pard\li1026\ri0\sl-320\sl
mult0 \fs24\cf0\f1\charscalex100 {yang sehat dan dilakukan lebih dalam.}{\super
\fs20\up4\cf0\f1\charscalex100 {19}}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf
0\f1\charscalex100 {Spesimen yang telah diambil dimasukkan ke dalam media transf
ortasi yang steril. Untuk}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\chars
calex100 {pembiakan kuman anaerob diperlukan media transfortasi yang suasana ana
erob.}\par\pard\li1746\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {Biakan cai
r yang dianjurkan untuk kuman aerob dan anerob adalah thioglukonat.}\par\pard\li
1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Formulasi ini berisi substan

si reduksi yang akan menciptakan lingkungan anaerob. Suasana}\par\pard\li1026\ri
0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {anaerob terdapat di bagian bawah ta
bung.}\fs20\cf0\f1\charscalex100 {19}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\c
f0\f1\charscalex100 {Biakan kuman aerob dan fakultatif dapat dilakukan dengan me
nggunakan agar darah,}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscale
x100 {agar coklat, eosin-methilene blue (EMB). Tempat pembiakan ini dinkubasi pa
da suhu 37}\fs20\cf0\f1\charscalex100 {0}\fs26\cf0\f1\charscalex100 {C, 5%}\par\
pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li9586\ri0\sl-373\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\par
d\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\pard\sect\s
ectd\sbkpage
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{\shp{\*\shpinst\shpleft0\shptop-100893\shpright11906\shpbottom168160\shpfhdr0\s
hpwr3\shpwrk0\shpfblwtxt1\shplid2095\shpz1\shpbxpage\shpbypage
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30\cf0\f1\charscalex100 {CO}{\sub \fs20\cf0\f1\charscalex100 {2}}\fs24\cf0\f1\ch
arscalex100 {dan dinilai 48-72 jam. Untuk kuman anaerob dapat dinkubasi pada aga
r darah anaerob}\par\pard\li1026\ri0\sl-280\slmult0 \fs26\cf0\f1\charscalex100 {
yang mengandung tryptic soy agar, ekstrak ragi, vitamin K3, hemin, 5% darah domb
a.}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {Dinkubasi dal
am suasana anaerob dan dinilai 72-120 jam.}{\super \fs20\up4\cf0\f1\charscalex10
0 {6}}\par\pard\li1026\ri0\sl-480\slmult0 \fs28\cf0\f1\charscalex100 {Pola kuman
}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Pada umumnya ab
ses leher dalam disebabkan oleh infeksi campuran beberapa kuman.}\par\pard\li102
6\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {Baik kuman aerob, anaerob maupu
n kuman fakultatif anaerob. Kuman aerob yang sering}\par\pard\li1026\ri0\sl-293\
slmult0 \fs26\cf0\f1\charscalex100 {ditemukan adalah stafilokokus, Streptococcus
sp, , Haemofilus influenza, Streptococcus}\par\pard\li1026\ri0\sl-306\slmult0 \
fs22\cf0\f1\charscalex100 {Peneumonia, Moraxtella catarrhalis, Klebsiell sp, Nei
sseria sp. Kuman anaerob yang sering}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\c
f0\f1\charscalex100 {adalah Peptostreptococcus, Fusobacterium dan bacteroides sp
. Pseudomanas aeruginosa}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charsc
alex100 {merupakan kuman yang jarang ditemukan}\fs20\cf0\f1\charscalex100 {7,17}
\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Genus stafilokok
us yang memiliki kepentingan klinis adalah Staphylococcus aureus,}\par\pard\li10
26\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Staphylococcus epidermidis, St
aphylococcus saprophyticus. Staphylococcus aureus bersifat}\par\pard\li1026\ri0\
sl-306\slmult0 \fs22\cf0\f1\charscalex100 {patogen utama pada manusia dan bersif
at koagulase-positif. Dengan sifat koagulase ini memiliki}\par\pard\li1026\ri0\s
l-293\slmult0 \*\tx6360\fs24\cf0\f1\charscalex100 {potensi menjadi patogen invas
if. Beberapa strain dari}\tab \fs24\cf0\f1\charscalex100 {S aureus mempunyai kap
sul sehingga}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {men
yulitkan tubuh untuk melakukan fagositosis. Infeksi S aureus dapat bersifat heba
t, terlokalisir,}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100
{nyeri membentuk supurasi dan cepat sembuh dengan drainase pus.}{\super \fs20\up
4\cf0\f1\charscalex100 {19}}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\cha
rscalex100 {Staphylococcus epidermidis bersifat koagulase-negatif dan bersifat f
lora normal pada}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100
{tubuh manusia seperti di saluran nafas atas. Infeksi dapat terjadi akibat adany
a trauma atau}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {in
flantasi alat-alat, pada daya tahan tubuh yang rendah. Supurasi lokal merupakan
ciri khas infeksi}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100
{stafilokokus baik koagulase-positif maupun koagulase negatif. Dari fokus manap
un, organisme}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {da
pat menyebar melalui vena maupun limfatik ke bagian tubuh lain. Supurasi dalam v
ena yang}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {menimbu
lkan trombosis merupakan gambaran umum penyebaran tersebut.}{\super \fs20\up4\cf
0\f1\charscalex100 {19}}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charsca
lex100 {Streptokokus mempunyai berbagai group sesuai dengan sifat dari kuman ter
sebut dan}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {tidak
ada satu sistem yang bisa mengklasifikasikannya secara sempurna. Yang banyak ber
peran}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {pada abses
leher dalam adalah Streptococcus viridan, Streptococcus \uc1\u945X-haemolyticus
,}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {Streptococcus
\uc1\u946X-haemolyticus, dan Streptococcus pneumonia. Temuan klinis akibat infek
si}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {streptokokus
ini sangat bervariasi tergantung sifat biologi organisme penyebab, respon imun}\
par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {penjamu, dan temp
at infeksi. Salah satu yang ditakutkan akibat infeksi streptokokus group A}\par\
pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {adalah terjadinya glo
merulonefritis dan demam reumatik akibat reaksi hipersensitivitas terhadap}\par\
pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {kuman tersebut.}{\sup
er \fs20\up4\cf0\f1\charscalex100 {19}}\par\pard\li1746\ri0\sl-306\slmult0 \fs28
\cf0\f1\charscalex100 {Entrobacteriaceae merupakan batang gram negatif yang besa
r dan heterogen.}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100
{Pembiakan pada agar MacConkey, dapat tumbuh secara aerob maupun anaerob ( fakul
tatif}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {anaerob).
Yang termasuk dalam famili ini antara lain Klebsiella sp, Proteus sp, E coli.}\p
ar\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Klebsiella pneumon
ia terdapat dalam saluran nafas pada sekitar 5% individu normal. Proteus}\par\pa
rd\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {sp menimbulkan infeksi
pada manusia hanya bila kuman keluar dari saluran cerna.}{\super \fs20\up4\cf0\f
1\charscalex100 {19}}\par\pard\li1746\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex
100 {Pseudomonas aeruginosa merupakan patogen oportunistik dalam tubuh manusia,}
\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {bersifat invasif
dan patogen nasokomial yang penting. Menimbulkan penyakit jika daya tahan}\par\
pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {tubuh penjamu lemah.
Abses yang dibentuk akibat pseudomas merupakan pus yang hijau}\par\pard\li1026\r
i0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {kebiruan.}{\super \fs20\up4\cf0\f1
\charscalex100 {19}}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex1
00 {Kuman anaerob yang sering ditemukan pada abses leher dalam adalah kelompok b
atang}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {gram negat
if, seperti Bacteroides, Prevotella, maupun Fusobacterium. Gejala klinis yang}\p
ar\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {menandakan adanya
infeksi anaerob adalah: 1. Sekret yang berbau busuk akibat produk asam}\par\pard
\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {lemak rantai pendek dari
metabolisme anaerob. 2. Infeksi di proksimal permukaan mukosa. 3.}\par\pard\li95
\pard\li9586\ri0\sl-346\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\pard\sect\se
ctd\sbkpage
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24\cf0\f1\charscalex100 {Adanya gas dalam jaringan. 4. Hasil biakan aerob negati
f.}{\super \fs20\up4\cf0\f1\charscalex100 {19}}\par\pard\li1746\ri0\sl-320\slmul
t0 \fs24\cf0\f1\charscalex100 {Infeksi yang penting secara klinis akibat kuman a
naerob sering terjadi. Infeksi sering}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\
cf0\f1\charscalex100 {bersifat polimikroba yaitu bersamaan dengan kuman anaerob
lainnya, fakultatif anaerob, dan}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f
1\charscalex100 {aerob. Bakteri anaerob ditemukan hampir disemua bagian tubuh. I
nfeksi terjadi ketika bakteri}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\c
harscalex100 {anaerob dan bakteri flora normal lainnya mengontaminasi yang secar
a normal steril.}{\super \fs20\up4\cf0\f1\charscalex100 {19}}\par\pard\li1746\ri
0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Bacteroides termasuk kelompok besar
basilus gram negatif dan tampak seperti batang}\par\pard\li1026\ri0\sl-293\slmu
lt0 \fs22\cf0\f1\charscalex100 {yang tipis atau kokobasilus. Spesies bacteroides
merupakan flora normal di dalam usus dan}\par\pard\li1026\ri0\sl-306\slmult0 \f
s24\cf0\f1\charscalex100 {bagian tubuh lainnya. Pada infeksi bactroides sering d
ihubungkan dengan kuman-kuman lainnya.}\par\pard\li1746\ri0\sl-293\slmult0 \fs22
\cf0\f1\charscalex100 {Spesies Prevotella juga termasuk kelompok basilus gram ne
gatif dan tampak seperti}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charsc

alex100 {batang yang tipis atau kokobasilus. Pada infeksi kuman ini sering bersa
maan dengan anaerob}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex1
00 {lainnya terutam peptostreptococcus.}\par\pard\li1746\ri0\sl-306\slmult0 \fs2
4\cf0\f1\charscalex100 {Fusobacterium merupakan bakteri batang pleomorfik gram n
egatif. Sebagian besar}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscal
ex100 {spesies menghasilkan asam butirat dan merubah treonin menjadi asam propio
nat. Kuman ini}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {s
ering disolasi dari mukasa yang terinfeksi. Kadang kuman ini menjadi satu-satuny
a kuman yang}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {dis
olasi dari infeksi atau abses yang ada.}{\super \fs20\up4\cf0\f1\charscalex100 {
19}}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Spesies pept
ostreptococcus merupakan spesies kokus gram positif dengan ukuran dan}\par\pard\
li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {bentuk yang bervariasi. Di
temukan di kulit dan merupakan flora normal di mukosa.}\par\pard\li1746\ri0\sl-3
06\slmult0 \fs24\cf0\f1\charscalex100 {Berbagai penelitian tentang kuman penyeba
b abses leher dalam telah banyak dilakukan.}\par\pard\li1026\ri0\sl-306\slmult0
\fs30\cf0\f1\charscalex100 {Botin dkk}{\super \fs20\up4\cf0\f1\charscalex100 {20
}}\fs28\cf0\f1\charscalex100 {mendapatkan Peptostreptococus, Streptococus virida
n, Streptococus}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {
intermedius berkaitan dengan infeksi gigi sebagai sumber infeksi abses leher dal
am. El-Sayed}\par\pard\li1026\ri0\sl-306\slmult0 \*\tx2800\*\tx3973\fs24\cf0\f1\
charscalex100 {dan Al-daurosy,}\fs20\cf0\f1\charscalex100 {21}\tab \fs26\cf0\f1\
charscalex100 {Botin dkk}\fs20\cf0\f1\charscalex100 {20}\tab \fs24\cf0\f1\charsc
alex100 {mendapatkan kuman aerob terbanyak adalah stafilokokus dan}\par\pard\li1
026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {streptokokus.}\par\pard\li102
6\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f1\c
harscalex100 {Tabel. 3. Kuman Penyebab Abses leher dalam}{\super \fs20\up4\cf0\f
1\charscalex100 {12}}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\margls
xn666\margrsxn133\cols4\colno1\colw3546\colsr-0\colno2\colw720\colsr-0\colno3\co
lw5320\colsr-0\colno4\colw1506\pard\li1666\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1666\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Jenis Kuman}\par\pard\li1
040\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Streptococcus viridans}\par\p
ard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Staphylococcus epiderm
idis}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Staphylococ
cus aureus}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Bactr
oides Sp}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Strepto
coccus}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {\uc1\u946
X-haemolyticus}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {K
lebsiella pneumonia}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex1
00 {Streptococcus pneumonia}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\cha
rscalex100 {Mycobacterium tb}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\c
harscalex100 {Anaerob gram negatif}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0
\f1\charscalex100 {Neisseria sp}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1
\charscalex100 {Peptostreptococcus}\par\pard\li1040\ri0\sl-240\slmult0 \fs24\cf0
\f1\charscalex100 {Jamur}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charsc
alex100 {Enterobacter}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscale
x100 {Bacillus sp}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{Propionibacterium}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex1
00 {Acinetobacter}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{Actinimicosis israelii}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charsc
alex100 {Proteus sp}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex1
00 {Klepsiella sp}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{Bifidobacterium}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{Microaerophilic}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{streptococcus}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex1
00 {Jumlah}\par\pard\li13\ri0\sl-266\slmult0 \fs24\cf0\f1\charscalex100 {pasien}
\par\pard\li186\ri0\sl-253\slmult0 \fs26\cf0\f1\charscalex100 {63}\par\pard\li18
6\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {46}\par\pard\li186\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li186\ri0\sl-266\slmult0 \fs26\cf0\f1\charscalex100 {3
5}\par\pard\li186\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {22}\par\pard\li

186\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {34}\par\pard\li186\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li186\ri0\sl-266\slmult0 \fs26\cf0\f1\charscalex100
{11}\par\pard\li186\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {10}\par\pard\
li186\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {10}\par\pard\li240\ri0\sl-2
40\slmult0 \fs26\cf0\f1\charscalex100 {9}\par\pard\li240\ri0\sl-240\slmult0 \fs2
6\cf0\f1\charscalex100 {8}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\charsc
alex100 {8}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {8}\par
\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {7}\par\pard\li240\ri0
\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {6}\par\pard\li240\ri0\sl-240\slmult0
\fs26\cf0\f1\charscalex100 {6}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\c
harscalex100 {5}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {3
}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {3}\par\pard\li24
0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {3}\par\pard\li240\ri0\sl-240\sl
mult0 \fs26\cf0\f1\charscalex100 {3}\par\pard\li240\ri0\sl-240\slmult0 \fs26\cf0
\f1\charscalex100 {3}\par\column\pard\li0\ri0\sl-266\slmult0 \fs22\cf0\f1\charsc
alex100 {% kultur +}\par\pard\li306\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li306\
ri0\sl-280\slmult0 \fs26\cf0\f1\charscalex100 {39}\par\pard\li306\ri0\sl-240\slm
ult0 \fs26\cf0\f1\charscalex100 {28}\par\pard\li306\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li306\ri0\sl-266\slmult0 \fs26\cf0\f1\charscalex100 {22}\par\pard\li30
6\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {14}\par\pard\li306\ri0\sl-240\s
lmult0 \fs26\cf0\f1\charscalex100 {21}\par\pard\li293\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li293\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {6,8}\par\pard\l
i293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {6,2}\par\pard\li293\ri0\sl-2
40\slmult0 \fs22\cf0\f1\charscalex100 {6,2}\par\pard\li293\ri0\sl-240\slmult0 \f
s22\cf0\f1\charscalex100 {5,5}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\ch
arscalex100 {4,9}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {
4,9}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {4,9}\par\pard
\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {4,3}\par\pard\li293\ri0\sl
-240\slmult0 \fs22\cf0\f1\charscalex100 {3,7}\par\pard\li293\ri0\sl-240\slmult0
\fs22\cf0\f1\charscalex100 {3,7}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\
charscalex100 {3,1}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{1,9}\par\pard\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,9}\par\pa
rd\li293\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,9}\par\pard\li293\ri0\
sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,9}\par\pard\li293\ri0\sl-240\slmult
0 \fs22\cf0\f1\charscalex100 {1,9}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs28\cf0\f1\charscalex100
{14}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn13
3\pard\sect\sectd\sbkpage

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3\margtsxn666\margbsxn293\cols3\colno1\colw3786\colsr-0\colno2\colw773\colsr-0\c
olno3\colw6533\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li104
0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li1040\ri0\sl-213\slmult0 \fs22\cf0\f1\charscalex100 {Enterococcus sp}\par\
pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Moraxtella catarrhali
s}\par\pard\li1040\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {Dan lain-lain}
\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult
3\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {
3}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {2}\par\column\par
d\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,9}\par\pard\l
i0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1,2}\par\pard\li0\ri0\sl-240\s
lmult0 \fs22\cf0\f1\charscalex100 {6,8}\par\pard\sect\sectd\sbknone\pgwsxn11893\
pghsxn16813\marglsxn666\margrsxn133\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1746\ri0\sl-333\slmult0 \fs24\cf0\f1\charscalex100 {Abshirini H dkk,}{\s
uper \fs20\up4\cf0\f1\charscalex100 {4}}\fs24\cf0\f1\charscalex100 {pada 40 hasi
l kultur dari abses leher dalam mendapatkan; stafilokokus}\par\pard\li1026\ri0\s
l-306\slmult0 \*\tx1786\*\tx3413\*\tx5133\*\tx6080\*\tx7520\fs24\cf0\f1\charscal
ex100 {77%,}\tab \fs22\cf0\f1\charscalex100 {Streptococcus}\tab \fs24\cf0\f1\cha
rscalex100 {\uc1\u946X-haemolitycus}\tab \fs24\cf0\f1\charscalex100 {12,5%,}\tab
\fs26\cf0\f1\charscalex100 {Entrobacter}\tab \fs26\cf0\f1\charscalex100 {12,5%,
Streptococcus}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {\
uc1\u945X-haemolyticus 7,5%, Klebsiella sp 5%, Streptococcus non haemolyticus 5%
, Pseudomonas}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {ae
ruginosa 2,5%. Parhiscar dkk,}{\super \fs20\up4\cf0\f1\charscalex100 {12}}\fs24\
cf0\f1\charscalex100 {dari 210 pasien abses leher dalam (1981-1998), dilakukan}\
par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {kultur terhadap 1
86 (88%) pasien, dan pada 162 (87%) pasien ditemukan pertumbuhan kuman,}\par\par
d\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {24(13%) pasien tidak ter
dapat pertumbuhan kuman. Kuman terbanyak Streptococcus viridan}\par\pard\li1026\
ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {39%, Staphylococcus epidermidis 2
8%. Kuman anaerob terbanyak adalah bacteroides sp}\par\pard\li1026\ri0\sl-306\sl
mult0 \fs24\cf0\f1\charscalex100 {14%. ( tabel 3.)}\par\pard\li1746\ri0\sl-306\s
lmult0 \*\tx2586\fs24\cf0\f1\charscalex100 {Brook}\fs18\cf0\f1\charscalex100 {10
}\tab \fs22\cf0\f1\charscalex100 {menemukan kuman yang tumbuh pada 201 spesimen
dari abses kepala dan}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscale
x100 {leher, hanya kuman aerob sebanyak 65 spesimen, hanya kuman anaerob 65 spes
imen, dan}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {campur
an keduanya 71 spesimen. Yang dkk}\fs18\cf0\f1\charscalex100 {6}{ }\fs22\cf0\f1\
charscalex100 {dari 100 pasien abses leher dalam yang dilakukan}\par\pard\li1026
\ri0\sl-306\slmult0 \*\tx4386\fs24\cf0\f1\charscalex100 {kultur kuman didapatkan
89%,}\tab \fs24\cf0\f1\charscalex100 {ada pertumbuhan kuman. Kuman aerob domina
n ialah}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {Streptoc
occus viridan, Klebsiella pneumonia, Stapylococcus aureus. Kuman anaerob}\par\pa
rd\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {dominan Prevotella, Pep
tostreptococcus, dan Bacteroides. (Tabel 4).}\par\pard\li1026\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs22\cf0\f1\charscalex100 {Tabel.
4 Pola kelompok kuman pada abses leher dalam}{\super \fs18\up4\cf0\f1\charscalex
100 {6}}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1040\ri0\sl-280
\slmult0 \fs24\cf0\f1\charscalex100 {Hasil
jum
lah kasus}\par\pard\li1040\ri0\sl-266\slmult0 \fs18\cf0\f1\charscalex100 {Positi
f kuman
89}\par\pard\li1040\ri0\sl-240\slmult0
\fs18\cf0\f1\charscalex100 {
Kuman tunggal
38(42,7
%)}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {
Gr
am positif aerob
14}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\
f1\charscalex100 {
Gram negatif aerob
21}\par\pard\li1040
\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {
Anaerob
3}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex10
0 {
Kuman campuran
51 (57,3%)}\par\pard\li1040\ri0\sl-24
0\slmult0 \fs18\cf0\f1\charscalex100 {
Aerob saja
13}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {
Gram positif saja
5}\par\pard\li1040\ri0\sl-240\slmult0 \fs1
8\cf0\f1\charscalex100 {
Gram negatif saja
1}\par\pard\
li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {
Kedua gram
7}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscale
x100 {
Anaerob saja
2}\par\pard\li1040\ri0\sl-2
40\slmult0 \fs18\cf0\f1\charscalex100 {
Campuran aerob-anaerob
36}\
\fs22\cf0\f1\charscalex100 {Di Bagian THT-KL Rumah Sakit dr. M. Djamil Padang, p
eriode April 2010 sampai}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charsc
alex100 {dengan Oktober 2010 terdapat sebanyak 22 pasien abses leher dalam dan d
ilakukan kultur}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {
kuman penyebab, didapatkan 16 (73%) spesimen tumbuh kuman aerob, 6 (27%) tidak t
umbuh}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {kuman aero
b dan 2 (9%) tumbuh jamur yaitu Candida sp. Kuman aerob yang tumbuh yaitu;}\par\
pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols2\co
lno1\colw6480\colsr-0\colno2\colw4613\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f
1\charscalex100 {Streptocccus \uc1\u945X haemoliticus 6 (37%), Klepsiella sp}\pa
r\column\pard\li0\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {4 (25%), Entero
bacter sp 3 (19%),}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn
666\margrsxn133\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {Staph
ylococcus aureus 2 (12,5%), Staphilococcus epidermidis 1 (6%). E. Coli 1 (6%),}\

par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {Proteus vulgaris
1 (6%). Dua spesimen tumbuh 2 macam kuman aerob yaitu campuran}\par\pard\li1026\
ri0\sl-306\slmult0 \*\tx4866\fs24\cf0\f1\charscalex100 {Streptocccus \uc1\u945X
haemoliticus dengan}\tab \fs22\cf0\f1\charscalex100 {Klepsiella sp. Pada pemerik
saan ini tidak dilakukan}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charsc
alex100 {kultur pada kuman anaerob. (tabel 5)}\par\pard\li1746\ri0\sl-306\slmult
0 \fs26\cf0\f1\charscalex100 {infeksi leher dalam ditemukan 88 (74,6%) spesimen
mengandung kuman anaerob.}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\chars
calex100 {Kuman anaerob saja 19,5%, kuman aerob dan fakultatif saja 16,9%, campu
ran kuman aerob}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {
dan anaerob 55,1%, dan 8,5% tidak tumbuh kuman. Dari kuman anaerob tumbuh didapa
tkan}\par\pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-413\sl
mult0 \fs28\cf0\f1\charscalex100 {14}\par\pard\sect\sectd\sbknone\pgwsxn11893\pg
hsxn16813\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage
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26\cf0\f1\charscalex100 {gram negatif anaerob 50,8%, yaitu; Bacteroides fragilli
s 3,9%, Fusobacterium sp 9,4%,}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\
charscalex100 {Prevotella spp 30,5%, lain-lain 7%, gram positif anaerob 49,2%, y
aitu: Actinomycess spp}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscal
ex100 {11,7%, Eubacterium spp 11,7%, lactobacillus spp 6,2%, propionibacterium s
pp 4,7%,}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {kokus g
ram positif 10,9%.}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026
\ri0\sl-360\slmult0 \fs24\cf0\f1\charscalex100 {Tabel 5. Hasil kultur abses lehe
r dalam Bagian THT-KL dr. M.Djamil Padang periode April}\par\pard\li1026\ri0\sl266\slmult0 \fs22\cf0\f1\charscalex100 {2010-Oktober 2010}\par\pard\sect\sectd\s
bknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols3\colno1\colw3560\col
sr-0\colno2\colw1040\colsr-0\colno3\colw6493\pard\li1040\ri0\sl-280\slmult0 \fs2
2\cf0\f1\charscalex100 {Jenis Kuman}\par\pard\li1040\ri0\sl-253\slmult0 \fs22\cf
0\f1\charscalex100 {Streptocccus \uc1\u945X haemoliticus}\par\pard\li1040\ri0\sl
-240\slmult0 \fs22\cf0\f1\charscalex100 {Klepsiella sp}\par\pard\li1040\ri0\sl-2
40\slmult0 \fs22\cf0\f1\charscalex100 {Enterobacter sp}\par\column\pard\li0\ri0\
sl-280\slmult0 \*\tx853\fs22\cf0\f1\charscalex100 {Jumlah}\tab \fs26\cf0\f1\char
scalex100 {%}\par\pard\li373\ri0\sl-253\slmult0 \fs26\cf0\f1\charscalex100 {6}\p
ar\pard\li373\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {4}\par\pard\li373\r
i0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {3}\par\column\pard\li0\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs26\cf0\f1\charscalex100 {37
}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {25}\par\pard\li0\r
i0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {19}\par\pard\sect\sectd\sbknone\pg

wsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols3\colno1\colw3933\colsr-0\coln
o2\colw600\colsr-0\colno3\colw6560\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\c
harscalex100 {Staphylococcus aureus}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf
0\f1\charscalex100 {Staphilococcus epidermidis}\par\pard\li1040\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {E. Coli}\par\pard\li1040\ri0\sl-240\slmult0 \fs22
\cf0\f1\charscalex100 {Proteus vulgaris}\par\column\pard\li0\ri0\sl-240\slmult0
\fs26\cf0\f1\charscalex100 {2}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\char
scalex100 {1}\par\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {1}\par
\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex100 {1}\par\column\pard\li0\
ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {12,5}\par\pard\li106\ri0\sl-240\s
lmult0 \fs26\cf0\f1\charscalex100 {6}\par\pard\li106\ri0\sl-240\slmult0 \fs26\cf
0\f1\charscalex100 {6}\par\pard\li106\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex
100 {6}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn
133\pard\li1746\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1746\ri0\sl-333\slmult0
\fs24\cf0\f1\charscalex100 {Boyanova L, dkk.}{\super \fs20\up4\cf0\f1\charscalex
100 {13}}\fs24\cf0\f1\charscalex100 { pada tahun 2002 sampai 2005, dari 118 pasi
en}\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-386\slmu
lt0 \fs26\cf0\f1\charscalex100 {Uji Kepekaan Antibiotik}\par\pard\li1746\ri0\sl306\slmult0 \fs24\cf0\f1\charscalex100 {Untuk mendapatkan jenis antibiotik yang
sesuai dengan kuman penyebab, uji kepekaan}\par\pard\li1026\ri0\sl-293\slmult0 \
fs24\cf0\f1\charscalex100 {perlu dilakukan. Jenis kuman yang bervariasi menyulit
kan dalam pemberian antibiotik tanpa}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\c
f0\f1\charscalex100 {adanya uji kepekaan tersebut.}\par\pard\li1746\ri0\sl-293\s
lmult0 \fs24\cf0\f1\charscalex100 {Pada uji kepekaan yang dilakukan di RS. Dr. M
. Djamil Padang periode April 2010}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0
\f1\charscalex100 {sampai dengan Oktober 2010 dari 16 spesimen yang terdapat per
tumbuhan kuman didapatkan}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\chars
calex100 {hasil seperti terlihat pada tabel 6.}\par\pard\li1026\ri0\sl-266\slmul
t0 \fs20\cf0\f1\charscalex100 {Tabel 6. Hasil uji kepekaan antibiotik terhadap k
uman penyebab abses leher dalam di RS. M. Djamil}\par\pard\li1026\ri0\sl-306\slm
ult0 \fs24\cf0\f1\charscalex100 {Padang }\fs24\cf0\f1\charscalex100 {periode }\f
s22\cf0\f1\charscalex100 {April 2010 sampai dengan Oktober 2010}\par\pard\sect\s
ectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols10\colno1\colw2
306\colsr-0\colno2\colw280\colsr-0\colno3\colw200\colsr-0\colno4\colw373\colsr-0
\colno5\colw653\colsr-0\colno6\colw453\colsr-0\colno7\colw666\colsr-0\colno8\col
w440\colsr-0\colno9\colw693\colsr-0\colno10\colw5026\pard\li1040\ri0\sl-266\slmu
lt0 \fs22\cf0\f1\charscalex100 {Antibiotik}\par\pard\li1040\ri0\sl-280\slmult0 \
fs22\cf0\f1\charscalex100 {Ampicillin}\par\pard\li1040\ri0\sl-240\slmult0 \fs20\
cf0\f1\charscalex100 {Ampicillin}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f
1\charscalex100 {sulbactam}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\char
scalex100 {Eritromicin}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs24\cf0\f1\
charscalex100 {+}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-333\slmult0 \fs22\cf0\f1\charscalex100 {17}\par\pard\li0\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {16}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li0\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {17}\par\column\pard\li0
\ri0\sl-266\slmult0 \fs24\cf0\f1\charscalex100 {\uc1\u8721X}\par\column\pard\li0
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs22\cf0\f1\chars
calex100 {6(35}\par\pard\li120\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)
}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {6(37}\par\pard\li1
20\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\column\pard\li0\ri0\sl
-266\slmult0 \fs24\cf0\f1\charscalex100 {S}\par\column\pard\li0\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs22\cf0\f1\charscalex100 {3(18}\p
ar\pard\li120\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\pard\li0\ri
0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {5(31}\par\pard\li120\ri0\sl-240\slm
ult0 \fs22\cf0\f1\charscalex100 {%)}\par\column\pard\li0\ri0\sl-266\slmult0 \fs2
4\cf0\f1\charscalex100 {I}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li0\ri0\sl-333\slmult0 \fs22\cf0\f1\charscalex100 {8(47}\par\pard\li120\ri0
\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\pard\li0\ri0\sl-240\slmult0
\fs22\cf0\f1\charscalex100 {5(31}\par\pard\li120\ri0\sl-240\slmult0 \fs22\cf0\f1

\charscalex100 {%)}\par\column\pard\li0\ri0\sl-266\slmult0 \fs24\cf0\f1\charscal
ex100 {R}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrs
xn133\cols6\colno1\colw2586\colsr-0\colno2\colw573\colsr-0\colno3\colw1106\colsr
-0\colno4\colw1106\colsr-0\colno5\colw4213\colsr-0\colno6\colw1506\pard\li1040\r
i0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {Cefixime}\par\pard\li1040\ri0\sl-2
40\slmult0 \fs18\cf0\f1\charscalex100 {Chloramphenicl}\par\pard\li1040\ri0\sl-24
0\slmult0 \fs18\cf0\f1\charscalex100 {Kotrimoxazole}\par\pard\li1040\ri0\sl-240\
slmult0 \fs18\cf0\f1\charscalex100 {Cefotaxime}\par\pard\li1040\ri0\sl-240\slmul
t0 \fs20\cf0\f1\charscalex100 {Gentamycin}\par\pard\li1040\ri0\sl-240\slmult0 \f
s18\cf0\f1\charscalex100 {Cifrofloxacin}\par\pard\li1040\ri0\sl-240\slmult0 \fs1
8\cf0\f1\charscalex100 {Ceftriaxone}\par\pard\li1040\ri0\sl-240\slmult0 \fs20\cf
0\f1\charscalex100 {Ceftazidime}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1
\charscalex100 {Ceforazone}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\char
scalex100 {Ceforazone}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscale
x100 {sulbactam +}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100
{M eropenem}\par\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {M o
xyfloxacine}\par\column\pard\li93\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100
{9}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {16}\par\pard\li9
3\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {8}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs22\cf0\f1\charscalex100 {16}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1
\charscalex100 {17}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {
17}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {17}\par\pard\li0
\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {18}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs22\cf0\f1\charscalex100 {14}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1
\charscalex100 {10}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\s
l-266\slmult0 \fs22\cf0\f1\charscalex100 {16}\par\pard\li0\ri0\sl-240\slmult0 \f
s22\cf0\f1\charscalex100 {12}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li0\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {6(35}\par\pard\li120\
ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\pard\li0\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {5(56}\par\pard\li120\ri0\sl-240\slmult0 \fs22\cf0
\f1\charscalex100 {%)}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex10
0 {9(56}\par\pard\li120\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\p
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sl-240\slmult0 \fs22\cf0\f1\charscalex100 {%)}\par\pard\li0\ri0\sl-240\slmult0 \
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I= intermediate
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rd\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {terhadap gram negatif a
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r\column\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {M etronidazole}
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{m sp}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Amoksi
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4\cf0\f1\charscalex100 {0}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\c
harscalex100 {11}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {15
}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {15}\par\par
d\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {15}\par\pard\sect\sectd\sbk
none\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols5\colno1\colw4160\colsr
-0\colno2\colw360\colsr-0\colno3\colw333\colsr-0\colno4\colw413\colsr-0\colno5\c
olw5826\pard\li1040\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {Gram negatif}
\fs20\cf0\f1\charscalex100 {Klindamisin}\par\column\pard\li0\ri0\sl-240\slmult0
\fs24\cf0\f1\charscalex100 {1}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\
f1\charscalex100 {0}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charsca
lex100 {13}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {1
4}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\c
ols6\colno1\colw2000\colsr-0\colno2\colw2160\colsr-0\colno3\colw360\colsr-0\coln
o4\colw333\colsr-0\colno5\colw413\colsr-0\colno6\colw5826\pard\li1040\ri0\sl-240
\slmult0 \fs22\cf0\f1\charscalex100 {lain}\par\column\pard\li0\ri0\sl-240\slmult
0 \fs20\cf0\f1\charscalex100 {Ampisilin/sulbaktam}\par\pard\li0\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {Amoksilin}\par\column\pard\li0\ri0\sl-240\slmult0
rscalex100 {2}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100
{0}\par\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {0}\par\column\p
ard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {15}\par\pard\li80\ri0\sl240\slmult0 \fs22\cf0\f1\charscalex100 {5}\par\column\pard\li0\ri0\sl-240\slmult
0 \fs22\cf0\f1\charscalex100 {15}\par\pard\li93\ri0\sl-240\slmult0 \fs24\cf0\f1\
charscalex100 {7}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn66
6\margrsxn133\cols5\colno1\colw4160\colsr-0\colno2\colw360\colsr-0\colno3\colw41
3\colsr-0\colno4\colw426\colsr-0\colno5\colw5733\pard\li1040\ri0\sl-240\slmult0
\fs22\cf0\f1\charscalex100 {Gram positif}\fs18\cf0\f1\charscalex100 {M etronidaz
ole}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {2}\par\c
olumn\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {1}\par\column\pard
\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {5}\par\column\pard\li0\ri0\s
l-240\slmult0 \fs24\cf0\f1\charscalex100 {8}\par\pard\sect\sectd\sbknone\pgwsxn1
1893\pghsxn16813\marglsxn666\margrsxn133\cols6\colno1\colw2000\colsr-0\colno2\co
lw2160\colsr-0\colno3\colw360\colsr-0\colno4\colw413\colsr-0\colno5\colw426\cols
r-0\colno6\colw5733\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {l
ain}\par\column\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Klindami
sin}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Ampisilin/sulba
ktam}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {0}\par\
pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {0}\par\column\pard\li0\r
i0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {0}\par\pard\li0\ri0\sl-240\slmult0
\fs24\cf0\f1\charscalex100 {0}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0
\f1\charscalex100 {7}\par\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100
{5}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {7}\par\p
ard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {5}\par\pard\sect\sectd\sb
knone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols5\colno1\colw4160\cols
r-0\colno2\colw360\colsr-0\colno3\colw333\colsr-0\colno4\colw413\colsr-0\colno5\
colw5826\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Gram positif
}{ }\fs18\cf0\f1\charscalex100 {M etronidazole}\par\column\pard\li0\ri0\sl-240\s
lmult0 \fs24\cf0\f1\charscalex100 {1}\par\column\pard\li0\ri0\sl-240\slmult0 \fs
24\cf0\f1\charscalex100 {0}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\
charscalex100 {13}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscale
x100 {14}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrs
xn133\cols6\colno1\colw2000\colsr-0\colno2\colw2066\colsr-0\colno3\colw453\colsr
-0\colno4\colw333\colsr-0\colno5\colw413\colsr-0\colno6\colw5826\pard\li1040\ri0
\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {non spora}\par\column\pard\li0\ri0\s
l-240\slmult0 \fs20\cf0\f1\charscalex100 {Klindamisin}\par\pard\li0\ri0\sl-240\s
lmult0 \fs20\cf0\f1\charscalex100 {Ampisilin/sulbaktam}\par\pard\li0\ri0\sl-240\
slmult0 \fs18\cf0\f1\charscalex100 {M etronidazole}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs20\cf0\f1\charscalex100 {Klindamisin}\par\pard\li0\ri0\sl-240\slmult0 \fs
20\cf0\f1\charscalex100 {Ampisilin/sulbaktam}\par\column\pard\li93\ri0\sl-240\sl
mult0 \fs24\cf0\f1\charscalex100 {0}\par\pard\li93\ri0\sl-240\slmult0 \fs24\cf0\
f1\charscalex100 {0}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{40}\par\pard\li93\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {3}\par\pard\li
93\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {0}\par\column\pard\li0\ri0\sl240\slmult0 \fs24\cf0\f1\charscalex100 {1}\par\pard\li0\ri0\sl-240\slmult0 \fs24
\cf0\f1\charscalex100 {0}\par\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscale
x100 {0}\par\pard\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {2}\par\pard
\li0\ri0\sl-240\slmult0 \fs24\cf0\f1\charscalex100 {0}\par\column\pard\li0\ri0\s
l-240\slmult0 \fs22\cf0\f1\charscalex100 {11}\par\pard\li0\ri0\sl-240\slmult0 \f
s22\cf0\f1\charscalex100 {14}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\chars
calex100 {17}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {48}\pa
r\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {56}\par\column\pard\li
0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {12}\par\pard\li0\ri0\sl-240\slm
ult0 \fs22\cf0\f1\charscalex100 {14}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f
1\charscalex100 {57}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100
{53}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {56}\par\pard\se
ct\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols2\colno1\co
lw9586\colsr-0\colno2\colw1506\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1026\ri0\sl-280\slmult0 \fs20\cf0\f1\charscalex100 {S= sensitif
I= inter
mediate R= resisiten}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-400\slmult0 \fs28\cf0\
f1\charscalex100 {14}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\margls
xn666\margrsxn133\pard\sect\sectd\sbkpage

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18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-266\s
lmult0 \fs26\cf0\f1\charscalex100 {Komplikasi}\par\pard\li1746\ri0\sl-293\slmult
0 \fs24\cf0\f1\charscalex100 {Kejadian komplikasi abses leher dalam menurun seja
k pemakaian antibiotik yang lebih}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\
f1\charscalex100 {luas. Walau demikian tetap harus waspada terhadap tanda-tanda
komplikasi yang muncul, yang}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\ch

arscalex100 {mungkin sangat berbahaya. Obstruksi jalan nafas dan asfiksia merupa
kan komplikasi yang}\par\pard\li1026\ri0\sl-320\slmult0 \fs22\cf0\f1\charscalex1
00 {potensial terjadi pada abses leher dalam terutama Ludwig\uc1\u8217Xs angina.
}{\super \fs18\up4\cf0\f1\charscalex100 {7}}\fs22\cf0\f1\charscalex100 {Ruptur a
bses, baik spontan}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex10
0 {atau akibat manipulasi, dapat mengakibatkan terjadinya pneumonia, abses paru
maupun}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {empiema.}
\fs20\cf0\f1\charscalex100 {7,22}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f
1\charscalex100 {Komplikasi vaskuler seperti trombosis vena jugularis dan ruptur
arteri karotis. Trombosis}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\char
scalex100 {vena jugularis ditandai dengan adanya demam, menggigil, nyeri dan ben
gkak sepanjang otot}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex1
00 {sternokleidomastoideus pada saat badan membungkuk atau rukuk. Dapat terjadi
bakteremia}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {maupu
n sepsis. Kejadian emboli paru mencapai 5% pada kasus pasien dengan trombosis ve
na}\par\pard\li1026\ri0\sl-293\slmult0 \fs28\cf0\f1\charscalex100 {jugularis. Pe
nyebab terbanyak adalah bakteri Fusobacterium necroforum, dan pada}\par\pard\li1
026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {penyalahgunaan obat suntik pe
nyebab terbanyak adalah stafilokokus.}{\super \fs20\up4\cf0\f1\charscalex100 {7}
}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Ruptur arteri k
arotis merupakan komplikasi yang jarang terjadi. Ini biasanya terjadi pada}\par\
pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {abses parafaring bagi
an poststiloid, infeksi meluas ke bungkus karotis. Mediastinitis dapat terjadi}\
par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {akibat perluasan
infeksi melalui viseral anterior, vaskuler viseral, maupun daerah retrofaring da
n}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {danger space.
Pasien akan mengeluhkan nyeri dada dan sukar bernafas.}{\super \fs20\up4\cf0\f1\
charscalex100 {7}}\par\pard\li1026\ri0\sl-480\slmult0 \fs28\cf0\f1\charscalex100
{Penatalaksanaan}\par\pard\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100
{Penatalaksanaan abses leher dalam adalah dengan evakuasi abses baik dilakukan
dengan}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {anestesi
lokal maupun dengan anestesi umum. Antibiotik dosis tinggi terhadap kuman aerob
dan}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {anaerob haru
s diberikan secara parenteral. Hal yang paling penting adalah terjaganya saluran
}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {nafas yang adek
uat dan drainase abses yang baik.}\fs18\cf0\f1\charscalex100 {3,11,17}\par\pard\
li1746\ri0\sl-320\slmult0 \fs26\cf0\f1\charscalex100 {Menurut Poe dkk}{\super \f
s20\up4\cf0\f1\charscalex100 {22}}\fs24\cf0\f1\charscalex100 {penatalaksanaan ab
ses leher dalam meliputi operasi untuk evakuasi}\par\pard\li1026\ri0\sl-293\slmu
lt0 \fs26\cf0\f1\charscalex100 {dan drainase abses, identifikasi kuman penyebab
dan pemberian antibiotik. Hal ini akan}\par\pard\li1026\ri0\sl-306\slmult0 \fs24
\cf0\f1\charscalex100 {mengurangi komplikasi dan mempercepat perbaikan.}\par\par
d\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Beberapa hal yang perlu
diperhatikan dalam pemilihan antibiotika adalah efektifitas obat}\par\pard\li102
6\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {terhadap kuman target, risiko p
eningkatan resistensi kuman minimal, toksisitas obat rendah,}\par\pard\li1026\ri
0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {stabilitas tinggi dan masa kerja ya
ng lebih lama.}{\super \fs20\up4\cf0\f1\charscalex100 {10}}\par\pard\li1746\ri0\
sl-480\slmult0 \*\tx3933\fs24\cf0\f1\charscalex100 {Pemberian antibiotik}\tab \f
s26\cf0\f1\charscalex100 {berdasarkan hasil biakan kuman dan tes kepekaan antibi
otik}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {terhadap ku
man penyebab infeksi. Biakan kuman membutuhkan waktu yang lama untuk}\par\pard\l
i1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {mendapatkan hasilnya, sedan
gkan pengobatan harus segera diberikan. Sebelum hasil kultur}\par\pard\li1026\ri
0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {kuman dan uji sensitifitas keluar,
diberikan antibiotik kuman aerob dan anaerob secara empiris.}\par\pard\li1026\ri
0\sl-306\slmult0 \*\tx2706\fs28\cf0\f1\charscalex100 {Yang SW, dkk}\fs20\cf0\f1\
charscalex100 {6}\tab \fs24\cf0\f1\charscalex100 {melaporkan pemberian antibioti
k kombinasi pada abses leher dalam, yaitu;}\par\pard\li1026\ri0\sl-306\slmult0 \
fs24\cf0\f1\charscalex100 {Kombinasi penesilin G, klindamisin dan gentamisin, ko

mbinasi ceftriaxone dan klindamisin,}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\c
f0\f1\charscalex100 {kombinasi ceftriaxone dan metronidazole, kombinasi cefuroxi
me dan klindamisin, kombinasi}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\c
harscalex100 {pinisilin dan metronidazole, masing-masing didapatkan angka perlin
dungan (keberhasilan) 67,4%,}\par\pard\li1026\ri0\sl-306\slmult0 \*\tx5653\fs30\
cf0\f1\charscalex100 {76,4%, 70,8%, 61,9%. Avest ET, dkk,}\fs20\cf0\f1\charscale
x100 {23}\tab \fs26\cf0\f1\charscalex100 {memberikan antibiotik empiris, kombina
si}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {metronidazole
dengan ceftriaxone.}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex
100 {Penesilin G merupakan obat terpilih untuk infeksi kuman streptokokus dan st
afilokokus}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {yang
tidak menghasilkan enzim penecilinase. Gentamisin menunjukkan efek sinergis deng
an}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {pinisilin. Kl
indamisin efektif terhadap streptokokus, pneumokokus dan stafilokokus yang resis
ten}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {terhadap pen
isilin. Lebih khusus pemakaian klindamisin pada infeksi polimicrobial termasuk}\
\fs28\cf0\f1\charscalex100 {14}\par\pard\sect\sectd\sbkpage
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24\cf0\f1\charscalex100 {Bacteroides sp maupun kuman anaerob lainnya pada daerah
oral.}\fs18\cf0\f1\charscalex100 {6,19.}\par\pard\li1746\ri0\sl-293\slmult0 \fs
26\cf0\f1\charscalex100 {Berbagai kombinasi pemberian antibiotik secara empiris
sebelum didapatkan hasil}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charsc
alex100 {kepekaan terhadap kuman penyebab, dianjurkan berbagai ahli seperti terl
ihat pada tabel 8.}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex10
0 {Pada kultur didapatkan kuman anaerob, maka antibiotik metronidazole, klindami
sin,}\par\pard\li1026\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {carbapenem,
sefoxitin, atau kombinasi penisilin dan \uc1\u946X-lactam inhibitor merupakan o
bat}\par\pard\li1026\ri0\sl-320\slmult0 \fs22\cf0\f1\charscalex100 {terpilih.}{\
super \fs20\up4\cf0\f1\charscalex100 {10}}\par\pard\li1746\ri0\sl-293\slmult0 \f
s20\cf0\f1\charscalex100 {Metronidazole juga efektif sebagai amubisid. Aminoglik
osida, quinolone atau cefalosforin}\par\pard\li1026\ri0\sl-320\slmult0 \*\tx8640
\fs22\cf0\f1\charscalex100 {generasi ke III dapat ditambahkan jika terdapat kuma
n enterik gram negatif.}\fs18\cf0\f1\charscalex100 {6,10}\tab \fs22\cf0\f1\chars
calex100 {Cefalosporin}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscal
ex100 {generasi III mempunyai efektifitas yang lebih baik terhadap gram negatif
enterik. Dibanding}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex10
0 {dengan cefalosporin generasi I, generasi III kurang efektif terhadap kokus gr
am positif, tapi}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100
{sangat efektif terhadap Haemofillus infeluenza, Neisseria sp dan Pneumokokus. C
eftriaxone}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {dan c
efotaxime mempunyai efektifitas terhadap streptokokus. Ceftriaxone sangat efekti
f terhadap}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {gram
negatif dan Haemofillus sp, kebanyakan Streptococcus pneumonia dan Neisseriae sp
}\par\pard\li1026\ri0\sl-320\slmult0 \fs22\cf0\f1\charscalex100 {yang resisiten
terhadap penesilin.}{\super \fs20\up4\cf0\f1\charscalex100 {6}}\par\pard\li1026\
ri0\sl-493\slmult0 \fs22\cf0\f1\charscalex100 {Tabel 8. Antibiotik yang dianjurk
an beberapa penulis secara empiris}\fs32\cf0\f1\charscalex100 {.}{\super \fs20\u
p4\cf0\f1\charscalex100 {6}}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813
\marglsxn666\margrsxn133\cols3\colno1\colw2280\colsr-0\colno2\colw2413\colsr-0\c
olno3\colw6400\pard\li1040\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {Penuli
s}\par\column\pard\li0\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {Antibiotik
}\par\column\pard\li0\ri0\sl-266\slmult0 \fs22\cf0\f1\charscalex100 {Umur}\par\p
ard\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols2\col
no1\colw4693\colsr-0\colno2\colw6400\pard\li1040\ri0\sl-253\slmult0 \fs22\cf0\f1
\charscalex100 {Sakaguchi dkk}{ }\fs22\cf0\f1\charscalex100 {Penesilin & Klindam
isin}\par\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {(97)}\par\c
olumn\pard\li0\ri0\sl-253\slmult0 \fs26\cf0\f1\charscalex100 { D}\par\pard\sect\

sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols3\colno1\colw2
280\colsr-0\colno2\colw2413\colsr-0\colno3\colw6400\pard\li1040\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {Parhischar,}\par\pard\li1040\ri0\sl-240\slmult0 \
fs18\cf0\f1\charscalex100 {Har-El (01)}\par\pard\li1040\ri0\sl-240\slmult0 \fs20
\cf0\f1\charscalex100 {Gates (83)}\par\pard\li1040\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1040\ri0\sl-266\slmult0 \fs20\cf0\f1\charscalex100 {Chen dkk (98)}\pa
r\pard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Plaza, Mayor}\par\p
ard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {(01)}\par\pard\li1040\
ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Simo dkk (98)}\par\pard\li1040\ri
0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {Nagy dkk}\par\pard\li1040\ri0\sl-24
0\slmult0 \fs22\cf0\f1\charscalex100 {(97)}\par\pard\li1040\ri0\sl-240\slmult0 \
fs20\cf0\f1\charscalex100 {Mc Clay dkk}\par\pard\li1040\ri0\sl-240\slmult0 \fs22
\cf0\f1\charscalex100 {(03)}\par\column\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1
\charscalex100 {Penesilin G & Oxacillin atau}\par\pard\li0\ri0\sl-240\slmult0 \f
s22\cf0\f1\charscalex100 {Nafcilin}\par\pard\li0\ri0\sl-240\slmult0 \fs22\cf0\f1
\charscalex100 {Penesilin, \uc1\u946X lactamase}\par\pard\li0\ri0\sl-240\slmult0
\fs22\cf0\f1\charscalex100 {resistant drug}\par\pard\li0\ri0\sl-240\slmult0 \fs
22\cf0\f1\charscalex100 {penesilinG, Klindamisin,}\par\pard\li0\ri0\sl-240\slmul
t0 \fs22\cf0\f1\charscalex100 {Gentamisin}\par\pard\li0\ri0\sl-240\slmult0 \fs20
\cf0\f1\charscalex100 {Cefotaxime, Metronidazole}\par\pard\li0\ri0\sl-240\slmult
0 \fs22\cf0\f1\charscalex100 {Flucloxacine, Metronidazole}\par\pard\li0\ri0\sl-2
40\slmult0 \fs22\cf0\f1\charscalex100 {Ceftriaxone , Klindamisin}\par\pard\li0\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f1\charsca
lex100 {Cefuroxime, Klindamisin}\par\column\pard\li0\ri0\sl-240\slmult0 \fs24\cf
0\f1\charscalex100 {A&D}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-266\slmult0 \fs24\cf0\f1\charscalex100 {DTV}\par\pard\li0\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs26\cf0\f1\charscalex100 {D}\par
\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs26\cf0
\f1\charscalex100 {D}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0
\sl-266\slmult0 \fs26\cf0\f1\charscalex100 {A}\par\pard\li0\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs24\cf0\f1\charscalex100 {A&D}\par\pa
rd\sect\sectd\sbknone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\cols2\coln
o1\colw4693\colsr-0\colno2\colw6400\pard\li1040\ri0\sl-240\slmult0 \fs20\cf0\f1\
charscalex100 {Sichel dkk (02)}{ }\fs22\cf0\f1\charscalex100 {Amoksillin-Asam kl
avulanik}\par\pard\li1040\ri0\sl-240\slmult0 \*\tx2280\fs22\cf0\f1\charscalex100
{Brondbo dkk}\tab \fs22\cf0\f1\charscalex100 {Penesilin G, Metronidazole}\par\p
ard\li1040\ri0\sl-240\slmult0 \fs22\cf0\f1\charscalex100 {(83)}\par\pard\li1026\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1026\ri0\sl-306\slmult0 \fs18\cf0\f1\charscalex100 {A=Anak, D=Dewasa DTV=Da
ta tidak valid}\par\column\pard\li0\ri0\sl-240\slmult0 \fs26\cf0\f1\charscalex10
0 {A}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0
\fs24\cf0\f1\charscalex100 {A&D}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-266\slmult0 \fs26\cf0\f1\charscalex100 {A}\par\pard\sect\sectd\sb
knone\pgwsxn11893\pghsxn16813\marglsxn666\margrsxn133\pard\li1746\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Di
Bagian THT-KL RS. Dr. M. Djamil Padang pemberian antibiotik secara empiris}\par
\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {diberikan berupa ant
ibiotik kombinasi ceftriaxone, dan metronidazole. Ini berdasarkan kuman}\par\par
d\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {penyebab terbanyak abses
leher dalam yaitu jenis streptokokus, stafilokokus dan kuman}\par\pard\li1026\r
i0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {anaerob. Penambahan gentamisin (am
inoglikosid) dapat diberikan jika dicurigai kuman penyebab}\par\pard\li1026\ri0\
sl-293\slmult0 \fs24\cf0\f1\charscalex100 {termasuk kuman entrik seperti Klebsie
lla, proteus, Enterobacter.}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\cha
rscalex100 {Setelah keluar hasil uji kepekaan antibiotik terhadap kuman penyebab
diberikan}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\charscalex100 {antib
iotik yang sesuai. Pada pemberian kombinasi antibiotik secara empiris jika terda
pat}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {perbaikan, a
ntibiotik dapat diteruskan, jika tidak maka antibiotik diganti sesuai uji kepeka
an.}\fs20\cf0\f1\charscalex100 {2.3,4}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\

cf0\f1\charscalex100 {Evakuasi abses dapat dilakukan dalam anastesi lokal untuk
abses yang dangkal dan}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscal
ex100 {terlokalisasi atau eksplorasi dalam narkose umum bila letak abses dalam d
an luas.}\fs20\cf0\f1\charscalex100 {2,3,4}\par\pard\li9586\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-440
\slmult0 \fs28\cf0\f1\charscalex100 {14}\par\pard\sect\sectd\sbknone\pgwsxn11893
\pghsxn16813\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage
7;32768}}
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26\cf0\f1\charscalex100 {Adanya trismus menyulitkan untuk masuknya pipa endotrak
ea peroral. Pada kasus}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscal
ex100 {demikian diperlukan tindakan trakeostomi dalam anastesi lokal. Jika terda
pat fasilitas}\par\pard\li1026\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {br
onkoskop fleksibel, intubasi pipa endotrakea dapat dilakukan secara intranasal.}
{\super \fs20\up4\cf0\f1\charscalex100 {2,5}}\par\pard\li1026\ri0\sl-480\slmult0
\fs28\cf0\f1\charscalex100 {Diskusi}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\c
f0\f1\charscalex100 {Abses leher dalam adalah terkumpulnya nanah (pus) di dalam
ruang potensial di antara}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\chars
calex100 {fasia leher dalam sebagai akibat penjalaran dari berbagai sumber, sepe
rti gigi, mulut, tenggorok,}\par\pard\li1026\ri0\sl-293\slmult0 \fs26\cf0\f1\cha
rscalex100 {sinus paranasal, telinga dan leher. Gejala dan tanda klinik biasanya
berupa nyeri dan}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100
{pembengkakan di ruang leher dalam yang terlibat.}\par\pard\li1746\ri0\sl-306\s
lmult0 \fs24\cf0\f1\charscalex100 {Sumber infeksi abses leher dalam saat ini pal
ing banyak berasal dari tonsil pada anak,}\par\pard\li1026\ri0\sl-306\slmult0 \f
s24\cf0\f1\charscalex100 {dan dari gigi pada orang dewasa. Berdasarkan sumber in
feksi dapat diperkirakan kuman}\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\
charscalex100 {penyebab pada abses leher dalam. Infeksi yang berasal dari gigi l
ebih banyak disebabkan kuman}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\ch
arscalex100 {anaerob dan infeksi yang berasal dari saluran nafas atas atau tonsi
l lebih banyak disebabkan oleh}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\
charscalex100 {kuman aerob seperti stafilokokus dan streptokokus.}\par\pard\li17
46\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {Pembentukan abses merupakan ha
sil perkembangan dari flora normal dalam tubuh. Flora}\par\pard\li1026\ri0\sl-29
3\slmult0 \fs22\cf0\f1\charscalex100 {normal di dalam rongga mulut dapat masuk k
e daerah steril dari tubuh secara langsung ataupun}\par\pard\li1026\ri0\sl-306\s
lmult0 \fs22\cf0\f1\charscalex100 {karena adanya laserasi atau perforasi. Sumber
infeksi abses leher dalam pada umumnya berasal}\par\pard\li1026\ri0\sl-293\slmu
lt0 \fs22\cf0\f1\charscalex100 {dari infeksi tonsil, gigi, dan faring.}\par\pard
\li1746\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Gejala klinis yang muncul
secara umum memberikan gambaran radang akut, seperti}\par\pard\li1026\ri0\sl-29
3\slmult0 \fs24\cf0\f1\charscalex100 {demam, nyeri, pembengkakan, ditambah denga
n gejala khas dari masing-masing abses leher}\par\pard\li1026\ri0\sl-306\slmult0
\fs22\cf0\f1\charscalex100 {dalam sesuai daerah yang dikenai. Pemeriksaan penun
jang diperlukan untuk diagnosis, perluasan}\par\pard\li1026\ri0\sl-293\slmult0 \
fs24\cf0\f1\charscalex100 {abses maupun melihat komplikasi.}\par\pard\li1746\ri0
\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {Kuman penyebab abses leher dalam dar
i berbagai penelitian merupakan campuran dari}\par\pard\li1026\ri0\sl-293\slmult
0 \fs22\cf0\f1\charscalex100 {berbagai macam kuman, baik aerob, anaerob, maupun
fakultatif anaerob. Kuman aerob dominan}\par\pard\li1026\ri0\sl-306\slmult0 \fs2
6\cf0\f1\charscalex100 {Streptococcus viridan, Klebsiella pneumonia, Staphylococ
cus aureus. Kuman anaerob}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\chars
calex100 {dominan Prevotella, Peptostreptococcus, Fusobacterium dan Bacteroides.
Di Rumah Sakit}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {
Dr. Djamil Padang pola kuman yang ditemukan hampir sama dengan berbagai peneliti
an diatas.}\par\pard\li1746\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {Penat
alaksanaan abses leher dalam adalah dengan evakuasi abses baik dilakukan dengan}
\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100 {anestesi lokal m
aupun dengan anestesi umum. Antibiotik diberikan sesuai dengan hasil kultur dan}
\par\pard\li1026\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {uji sensitifitas
. Sebelum keluar hasil kultur perlu diberikan antibiotik secara empiris, dengan}
\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {memberikan antib
iotik untuk kuman aerob dan anaerob.}\par\pard\li1746\ri0\sl-293\slmult0 \fs24\c
f0\f1\charscalex100 {Pemberian antibiotik kombinasi merupakan pilihan yang tepat
mengingat kuman}\par\pard\li1026\ri0\sl-306\slmult0 \fs22\cf0\f1\charscalex100
{penyebab dari abses leher dalam adalah campuran berbagai kuman. Berdasarkan uji
kepekaaan}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {terha
dap ceforazone sulbactam, moxyfloxacine, ceforazone, ceftriaxone, angka sensitif
itasnya}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {terhadap
kuman aerob yaitu lebih dari 70%. Metronidazole dan klindamisin angka sensitifi
tasnya}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {masih tin
ggi terutama untuk kuman anaerob gram negatif. Secara empiris kombinasi ceftriax
one}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {dengan metro
nidazole masih cukup baik.}\par\pard\li1746\ri0\sl-306\slmult0 \fs24\cf0\f1\char
scalex100 {Disimpulakan bahwa kuman penyebab terbanyak abses leher dalam adalah
kuman aerob}\par\pard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {yait
u; Streptococcus viridan, Klebsiella pneumonia, Staphylococcus aureus, dan kuman
}\par\pard\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {anaerob adalah
Prevotella, Peptostreptococcus, Fusobacterium dan Bactoroides. Antibiotik}\par\p
ard\li1026\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {seperti ceforazone sul
bactam, moxyfloxacine, ceforazone, ceftriaxone masih sensitif terhadap}\par\pard
\li1026\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {kuman aerob penyebab abse
s leher dalam. Metronidazole dan klindamisin sensitif terhadap}\par\pard\li1026\
ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {kuman anaerob gram negatif.}\par\
pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li9586\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li9586\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li9586\ri0\sl-320\slmult0 \fs28\cf0\f1\charscalex100 {1
4}\par\pard\sect\sectd\sbkpage
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28\cf0\f1\charscalex100 {Daftar Pustaka}\par\pard\li1026\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1026\ri0\sl-386\slmult0 \*\tx1386\fs26\cf0\f1\charscalex100 {1.
}\tab \fs24\cf0\f1\charscalex100 {Balenger JJ. Infection of the facial space of
neck and floor of the mouth. In: Balenger JJ}\par\pard\li1386\ri0\sl-306\slmult0
\fs22\cf0\f1\charscalex100 {editors. Diseases of the nose, throat, ear, head an
d neck.15}\fs18\cf0\f1\charscalex100 {th}{ }\fs22\cf0\f1\charscalex100 {ed. Phil
adelphia, London: Lea}\par\pard\li1386\ri0\sl-306\slmult0 \fs24\cf0\f1\charscale
x100 {and Febiger. 1991:p.234-41}\par\pard\li1026\ri0\sl-293\slmult0 \*\tx1386\f

s24\cf0\f1\charscalex100 {2.}\tab \fs22\cf0\f1\charscalex100 {Gadre AK, Gadre KC
. Infection of the deep Space of the neck. In: Bailey BJ, Jhonson JT,}\par\pard\
li1386\ri0\sl-320\slmult0 \*\tx8586\fs26\cf0\f1\charscalex100 {editors. Otolaryn
gology Head and neck surgery. 4}{\super \fs20\up4\cf0\f1\charscalex100 {th}}\fs2
6\cf0\f1\charscalex100 {ed. Philadelphia:}\tab \fs24\cf0\f1\charscalex100 {JB.Li
ppincott}\par\pard\li1386\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {Company
2006.p.666-81}\par\pard\li1026\ri0\sl-306\slmult0 \*\tx1386\fs24\cf0\f1\charsca
lex100 {3.}\tab \fs22\cf0\f1\charscalex100 {Fachruddin D. Abses leher dalam. Dal
am: Iskandar M, Soepardi AE editor. Buku ajar ilmu}\par\pard\li1386\ri0\sl-293\s
lmult0 \fs24\cf0\f1\charscalex100 {penyakit telinga hidung tenggorok. Edisi ke 6
. Jakarta: Balai Penerbit FK-UI. 2007:p. 185-8}\par\pard\li1026\ri0\sl-306\slmul
t0 \*\tx1386\fs26\cf0\f1\charscalex100 {4.}\tab \fs24\cf0\f1\charscalex100 {Absh
irini H, Alavi SM, Rekabi H, Ghazipur A, Shabab M. Predisposing factors for the}
\par\pard\li1386\ri0\sl-293\slmult0 \fs24\cf0\f1\charscalex100 {complications of
deep neck infection. The Iranian J of otorhinolaryngol 2010;22 (60):}\par\pard\
li1386\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {139-45.}\par\pard\li1026\r
i0\sl-293\slmult0 \*\tx1386\fs26\cf0\f1\charscalex100 {5.}\tab \fs24\cf0\f1\char
scalex100 {Murray A.D. MD, Marcincuk M.C. MD. Deep neck infections. [update July
2009; cited}\par\pard\li1386\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {Jun
e 16}{\super \fs18\up4\cf0\f1\charscalex100 {th}}\fs22\cf0\f1\charscalex100 {, 2
010] Available from:}{ }\fs20\cf1\f1\charscalex100 {http://www.eMedicine Special
ties//Otolaringology and facial}\par\pard\li1386\ri0\sl-293\slmult0 \fs24\cf1\f1
\charscalex100\ul {plastic surgery.com}\ul0 \par\pard\li1026\ri0\sl-306\slmult0
\*\tx1386\fs24\cf0\f1\charscalex100 {6.}\tab \fs22\cf0\f1\charscalex100 {Yang S.
W, Lee M.H, See L.C, Huang S.H, Chen T.M, Chen T.A. Deep neck abscess: an}\par\p
ard\li1386\ri0\sl-293\slmult0 \fs22\cf0\f1\charscalex100 {analysis of microbial
etiology and effectiveness of antibiotics. Infection and Drug Resistance.}\par\p
ard\li1386\ri0\sl-306\slmult0 \fs26\cf0\f1\charscalex100 {2008;1:1-8.}\par\pard\
li1026\ri0\sl-293\slmult0 \*\tx1386\fs24\cf0\f1\charscalex100 {7.}\tab \fs22\cf0
\f1\charscalex100 {Rosen EJ. Deep neck spaces and infections. Grand rounds prese
ntation, UTMB, Dept. Of}\par\pard\li1386\ri0\sl-306\slmult0 \fs24\cf0\f1\charsca
lex100 {Otolaryngology. 2002.}\par\pard\li1026\ri0\sl-293\slmult0 \*\tx1386\fs26
\cf0\f1\charscalex100 {8.}\tab \fs24\cf0\f1\charscalex100 {Sakaguchi M, Sato S,
Ishiyama T, Katsuno T, Taguchi K. characterization and management}\par\pard\li13
86\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {of deep neck infection. J. Ora
l Maxilofac Surg 1997;26:131-134}\par\pard\li1026\ri0\sl-293\slmult0 \*\tx1440\f
s26\cf0\f1\charscalex100 {9.}\tab \fs24\cf0\f1\charscalex100 {Huang T, chen T, R
ong P, Tseng F, Yeah T, Shyang C. Deep neck infection: analysis of 18}\par\pard\
li1440\ri0\sl-306\slmult0 \fs24\cf0\f1\charscalex100 {cases. Head and neck. Ockt
2004.860-4}\par\pard\li1026\ri0\sl-293\slmult0 \*\tx1386\fs22\cf0\f1\charscalex
100 {10.}\tab \fs24\cf0\f1\charscalex100 {Brook I, Microbiology of polymicrobial
abscess and implication for therapy. J antimicrob}\par\pard\li1386\ri0\sl-306\s
lmult0 \fs24\cf0\f1\charscalex100 {chemother 2002;50:805-10}\par\pard\li1026\ri0
\sl-293\slmult0 \*\tx1386\fs22\cf0\f1\charscalex100 {11.}\tab \fs24\cf0\f1\chars
calex100 {Chuang YC, Wang HW. A deep neck abscess presenting as a hypopharyngeal
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on culture and sensitivity test. Concolusion: Deep neck abscess}\par\pard\li102

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