PNEUMONIA Tia_Sabrina (06-038

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Pneumonia Defininisi Pneumonia Pneumonia adalah peradangan paru yang disebabkan oleh mikroorganisme, baik oleh bakteri, virus, jamur, dan parasit. Adapun pneumonia yang disebabkan oleh Mycobacterium tuberculosis tidak termasuk. Klasifikasi Pneumonia Tipe pneumonia berdasarkan sumber kuman, yaitu: Pneumonia komuniti, pneumonia yang didapat di masyarakat (Community Acquired Pneumonia) Pneumonia nosokomial (Hospital Acquired Pneumonia) Pneumonia Aspirasi Pneumonia Imunocompromised Klasifikasi pneumonia berdasarkan penyebabnya, yaitu: Pneumonia bakterial / tipikal : staphylococcus, streptococcus, Hemofilus influenza, klebsiella, pseudomonas, dll Pneumonia atipical : mycoplasma, legionella, dan chlamydia Pneumonia virus Pneumonia jamur Klasifikasi pneumonia berdasarkan predileksi, yaitu: Pneumonia lobaris, lobularis Bronkopneumonia Pleuropneumonia Pneumonia interstitiel Patogenesis Pneumonia Dalam keadaan sehat, tidak terjadi pertumbuhan mikroorganisme di paru karena adanya aktivitas mekanisme pertahanan paru. Apabila terjadi ketidakseimbangan antara daya tahan tubuh, mikroorganisme dan lingkungan, maka mikroorganisme dapat berkembangbiak menimbulkan pernyakit. Mikroorganisme masuk saluran napas, dengan cara: Inokulasi langsung Penyebaran melalui pembuluh darah Inhalasi bahan aerosol Kolonisasi di permukaan mukosa Bakteri masuk ke alveoli menyebabkan reaksi radang, sehingga timbullah edema di seluruh alveoli, infiltrasi sel-sel PMN (polimorfonuclear), dan diapedesis eritrosit. Sel-sel PMN mendesak bakteri ke permukaan alveoli. Dengan bantuan lekosit yang lain melalui psedopodosis sitoplasmik mengelilingi bakteri tersebut kemudian di fagosit. Terdapat 4 zona pada daerah reaksi inflamasi, antara lain: Zona luar: alveoli yang terisi bakteri dan cairan edema. Zona permulaan konsolidasi: terdiri dari PMN dan beberapa eksudasi sel darah merah. Zona konsolidasi luar: daerah tempat terjadi fagositosis yang aktif dengan jumlah PMN yang banyak. Zona resolusi: daerah tempat terjadi resolusi dengan banyak bakteri yang mati, lekosit dan alveolar makrofag. Sehingga, terlihat adanya 2 gambaran, yaitu: Red hepatization: daerah perifer yang terdapat edema dan perdarahan Gray hepatization: daerah konsolidasi yang luas Diagnosis Pneumonia Anamnesis Demam menggigil Suhu tubuh meningkat Batuk berdahak mukoid atau purulen Sesak napas Kadang nyeri dada Pemeriksaan Fisik Tergantung luas lesi paru Inspeksi: bagian yang sakit tertinggal Palpasi: fremitus dapat mengeras Perkusi: redup Auskultasi: suara dasar bronkovesikuler sampai bronkial, suara tambahan ronki basah halus sampai ronki basah kasar pada stadium resolusi. Pemeriksaan Penunjang Gambaran radiologis: foto toraks PA/ lateral, gambaran infiltrat sampai gambaran konsolidasi (berawan), dapat disertai air bronchogram. Pemeriksaan laboratorium: terdapat peningkatan jumlah lekosit lebih dari 10.000/ul kadang dapat mencapai 30.000/ul. Untuk menentukan diagnosis etiologi dilakukan pemeriksaan biakan dahak, biakan darah, dan serologi. Analisis gas darah menunjukkan hipoksemia; pada stadium lanjut asidosis respiratorik. Penilaian Derajat Keparahan Pneumonia Sistem skor pada pneumonia komuniti berdasarkan Patient Outcome Research Team (PORT). Penilaian skor PORT ini meliputi Faktor demografi Usia Laki-laki, nilainya = umur (tahun) – 10 Perempuan, nilainya = umur (tahun) Perawatan di rumah, nilainya 10 Adanya penyakit penyerta berupa: Keganasan, nilainya 30 Penyakit hati, nilainya 20 Gagal jantung kongestif, nilainya 10 Penyakit CV, nilainya 10 Penyakit ginjal, nilainya 10 Pemeriksaan fisis Perubahan status mental, nilainya 20 Pernapasan lebih dari atau sama dengan 30 kali per menit, nilainya 20 Tekanan darah sistolik kurang dari atau sama dengan 90 mmHg, nilainya 20 Suhu tubuh kurang dari 35°C atau lebih dari atau sama dengan 40°C, nilainya 15 Nadi lebih dari atau sama dengan 125 kali per menit, nilainya 10 Hasil laboratorium / radiologi Analisis gas darah arteri didapatkan pH sebesar 7,35, nilainya 30 BUN lebih dari 30 mg/dl, nilainya 20 Natrium kurang dari 130 mEq/liter, nilainya 20 Glukosa lebih dari 250 mg/dl, nilainya 10 Hematokrit kurang dari 30 %, nilainya 10 PO2 kurang dari atau sama dengan 60 mmHg, nilainya 10 Efusi pleura, nilainya 10 Penatalaksanaan Pneumonia Indikasi rawat inap penderita pneumonia, antara lain: Skor PORT lebih dari 70 Bila skor PORT kurang dari 70, dengan kriteria seperti pada kriteria minor. Pneumonia pada pengguna NAPZA Penilaian derajat keparahan penyakit pneumonia berdasarkan ATS. Kriteria pneumonia berat bila dijumpai salah satu atau lebih dari kriteria di bawah ini. Kriteria Minor Pneumonia Frekuensi pernapasan lebih dari 30 kali per menit PaO2/FiO2 kurang dari 250 mmHg Foto toraks paru menunjukkan adanya kelainan bilateral Foto toraks paru melibatkan lebih dari 2 lobus Tekanan sistolik kurang dari 90 mmHg Tekanan diastolik kurang dari 60 mmHg Kriteria Mayor Pneumonia Membutuhkan ventilasi mekanik Infiltrat bertambah lebih dari 50 % Membutuhkan vasopressor lebih dari 4 jam Kreatinin serum lebih dari sama dengan 2 mg/dl; atau, peningkatan lebih dari sama dengan 2 mg/dl pada penderita riwayat penyakit ginjal atau gagal ginjal yang membutuhkan dialisis. Kriteria perawatan intensif penderita pneumonia, antara lain:

PNEUMONIA Tia_Sabrina (06-038)
Paling sedikit 1 dari 2 gejala minor tertentu, yaitu membutuh ventilasi mekanik; atau, membutuhkan vasopresor lebih dari 4 jam. Atau 2 dari 3 gejala minor tertentu, yaitu nilai PaO2/FiO2 kurang dari 250 mmHg; foto toraks menunjukkan adanya kelainan bilateral; dan, tekanan sistolik kurang dari 90 mmHg. Pengobatan Pneumonia Pengobatan terdiri atas antibiotik dan pengobatan suportif. Pemberian antibiotik sebaiknya berdasarkan data mikroorganisme dan hasil uji kepekaannya. Karena beberapa alasan, yaitu: Penyakit yang berat dapat mengancam jiwa Bakteri patogen yang berhasil di isolasi belum tentu sebagai penyebab pneumonia Hasil pembiakan bakteri memerlukan waktu maka, pemberian antibiotika dilakukan secara empiris. Untuk Penisilin Sensitif Streptococcus Pneumoniae (PSSP), dapat diberikan: Golongan penisilin TMP-SMZ Makrolid Untuk Penisilin Resisten Streptococcus Pneumoniae (PRSP), dapat diberikan: Betalaktam oral dosis tinggi (untuk rawat jalan) Sefotaksim, Sefriakson dosis tinggi Makrolid baru dosis tinggi Fluorokuinolon respirasi Untuk Pseudomonas aeruginosa, dapat diberikan: Aminoglikosid Seftazidim, Sefoperason, Sefepim Tikarsilin, Piperasilin Karbapenem : Meropenem, Imipenem Siprofloksasin, levofloksasin Untuk Methicillin Resistent Staphylococcus Aureus (MRSA), dapat diberikan: Vankomisin Teikoplanin Linezolid Untuk Hemophilus influenza, dapat diberikan: TMP-SMZ Azithromisin Sefalosporin gen.2 atau 3 Fluorokuinolone respirasi Untuk Legionella, dapat diberikan: Makrolid Fluorokuinolone Rafampicin Untuk Mycoplasma pneumoniae, dapat diberikan: Doksisiklin Makrolid Fluorokuinolone Untuk Chlamydia pneumoniae, dapat diberikan: Doksisiklin Makrolid Fluorokuinolone Komplikasi Penumonia Komplikasi yang dapat terjadi pada pneumonia, antara lain: Efusi pleura Empiema Abses paru Pneumothoraks Gagal napas Sepsis oOOo Pneumonia sebenarnya bukan peyakit baru. Tahun 1936 pneumonia menjadi penyebab kematian nomor satu di Amerika. Penggunaan antibiotik, membuat penyakit ini bisa dikontrol beberapa tahun kemudian. Namun tahun 2000, kombinasi pneumonia dan influenza kembali merajalela. Di Indonesia, pneumonia merupakan penyebab kematian nomor tiga setelah kardiovaskuler dan TBC. Faktor sosial ekonomi yang rendah mempertinggi angka kematian. Kasus pneumonia ditemukan paling banyak menyerang anak balita. Menurut laporan WHO, sekitar 800.000 hingga 1 juta anak meninggal dunia tiap tahun akibat pneumonia. Bahkan UNICEF dan WHO menyebutkan pneumonia sebagai penyebab kematian anak balita tertinggi, melebihi penyakitpenyakit lain seperti campak, malaria, serta AIDS. Pneumonia adalah infeksi yang menyebabkan paruparu meradang. Kantong-kantong udara dalam paru yang disebut alveoli dipenuhi nanah dan cairan sehingga kemampuan menyerap oksigen menjadi kurang. Kekurangan oksigen membuat sel-sel tubuh tidak bisa bekerja. Karena inilah, selain penyebaran infeksi ke seluruh tubuh, penderita pneumonia bisa meninggal. Sebenarnya pneumonia bukanlah penyakit tunggal. Penyebabnya bisa bermacam-macam dan diketahui ada 30 sumber infeksi dengan sumber utama bakteri, virus, mikroplasma, jamur, berbagai senyawa kimia maupun partikel. Pneumonia adalah proses infeksi akut yang mengenai jaringan paru-paru (alveoli). Terjadinya pneumonia pada anak seringkali bersamaan dengan proses infeksi akut pada bronkus (biasa disebut bronchopneumonia). Gejala penyakit ini berupa napas cepat dan napas sesak, karena paru meradang secara mendadak. Batas napas cepat adalah frekuensi pernapasan sebanyak 50 kali per menit atau lebih pada anak usia 2 bulan sampai kurang dari 1 tahun, dan 40 kali per menit atau lebih pada anak usia 1 tahun sampai kurang dari 5 tahun. Pada anak dibawah usia 2 bulan, tidak dikenal diagnosis pneumonia. Pneumonia berat ditandai dengan adanya batuk atau (juga disertai) kesukaran bernapas, napas sesak atau penarikan dinding dada sebelah bawah ke dalam pada anak usia 2 bulan sampai kurang dari 5 tahun. Pada kelompok usia ini dikenal juga pneumonia sangat berat dengan gejala batuk, kesukaran bernapas disertai gejala sianosis sentral dan tidak dapat minum. Sementara untuk anak dibawah 2 bulan, pneumonia berat ditandai dengan frekuensi pernapasan sebanyak 60 kali per menit atau lebih atau (juga disertai) penarikan kuat pada dinding dada sebelah bawah ke dalam. Menurut dokter spesialis paru dari RSIA Hermina Jatinegara, Dr. Bambang Supriyatno SpA(K), perbedaan mendasar antara pneumonia dengan TBC terletak pada jenis mikroorganisme yang menginfeksi. ‘’Pneumonia yang ada di masyarakat umumnya, disebabkan oleh bakteri, virus atau mikoplasma (bentuk peralihan antara bakteri dan virus ),’’ katanya. Bambang menyebutkan, bakteri yang umum adalah streptococcus Pneumoniae, Staphylococcus Aureus, Klebsiella Sp, Pseudomonas sp. Sedangkan, vIrus misalnya virus influensa. “Pada TBC, jenis mikroorganisme yang menginfeksinya adalah mikrobakterium tuberculosis,’’ sambungnya. Rentannya anak terkena penyakit pneumonia umumnya dikarenakan lemahnya atau belum sempurnanya sistem kekebalan tubuh balita. Oleh sebab itu, mikrorganisme atau kuman lebih mudah menembus pertahanan tubuh. Jenis bakteri pneumococcus atau pneumokok belakangan semakin populer seiring kian dikenalnya jenis penyakit Invasive Pneumococcal Disease (IPD). Selain pneumonia, yang termasuk IPD adalah radang selaput otak (meningitis) atau infeksi darah (bakteremia). "Pada pneumonia yang disebabkan oleh bakteri pneumokok, kerap menimbulkan komplikasi dan mengakibatkan penderita juga terkena meningitis atau bakteremia," kata Bambang. Dokter spesialis anak dari RSAB Harapan Kita, Dr. Attila Dewanti SpA menjelaskan bahwa bakteri pneumokok ini dapat masuk melalui infeksi pada daerah mulut dan tenggorokan, menembus jaringan mukosa lalu masuk ke pembuluh darah, mengikuti aliran darah sampai ke paru-paru dan selaput otak. “Akibatnya, timbul peradangan pada paru dan daerah selaput otak,” tambahnya. Gejala khususnya adalah demam, sesak napas, napas dan nadi cepat, dahak berwarna kehijauan atau seperti karet, serta gambaran hasil ronsen memperlihatkan kepadatan pada bagian paru. Kepadatan terjadi karena paru dipenuhi sel radang dan cairan yang sebenarnya merupakan reaksi tubuh untuk mematikan kuman. Tapi akibatnya fungsi paru terganggu, penderita mengalami kesulitan bernapas, karena tak tersisa ruang untuk oksigen.

usia dibawah 2 bulan (Pnemonia Berat dan Bukan Pnemonia) dan usia 2 bulan sampai kurang dari 5 tahun.” paparnya. Mikoplasma menyerang segala jenis usia. Bahkan kawasan Asia dinyatakan sebagai hot zone. Gejala yang paling sering adalah batuk berat. pasien bisa mendapatkan istirahat dan pengobatan yang lebih intensif.PNEUMONIA Tia_Sabrina (06-038) Namun. Bambang tetap meyakinkan bahwa anak dengan pneumonia juga bisa sembuh total dan hidup dengan normal. Soalnya. Sebenarnya bakteri penyebab pneumonia yang paling umum adalah Streptococcus pneumoniae sudah ada di kerongkongan manusia sehat. sehingga memudahkan kegiatan penyuluhan dan penyebaran informasi tentang penanggulangannya. PCP biasanya menjadi tanda awal serangan penyakit pada pengidap HIV/AIDS. Cairan ini bisa diperoleh dengan cara banyak minum air putih maupun melalui infus. Karenanya dokter spesialins bagian neurologi anak ini menyatakan sebaiknya bila anak sakit panas tinggi dan batuk. tonsilitis dan otitis. termasuk pneumonia. Pneumonia yang dihasilkan biasanya berderajat ringan dan tersebar luas. Umumnya pengobatan dengan pemberian antibiotik. Menurut Atilla yang juga bertugas di klinik khusus tumbuh kembang anak RSAB Harapan kita. MMR maupun Hepatitis B. batuk kering sakit kepala. dan kalau batuk mengeluarkan lendir berwarna hijau. pasien juga akan mendapat pengobatan tambahan berupa pengaturan pola makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. Atilla menguatkan bahwa vaksin itu aman dan dapat diberikan bersamaan dengan vaksin lain seperti Hib. Ungkapan klasik bahwa “mencegah lebih baik daripada mengobati” benar-benar relevan dengan penyakit pneumonia ini. gigi bergemelutuk. Oleh sebab itu apabila pneumonia yang dialami cukup parah. Demam dan menggigil hanya muncul di awal. Pasien yang terinfeksi pneumonia akan panas tinggi. Selain imunisasi. atau bahkan terapi oksigen sebagai penunjang. yaitu demam. pharyngitis. 6 bulan dan diulang lagi pada usia 12 bulan. Pneumonia oleh Bakteri Pneumonia yang dipicu bakteri bisa menyerang siapa saja. Angka kematian sangat rendah. Walaupun demikian. napas menjadi sesak. penyakit ini masih bisa diobati. namun pengobatan yang atas-terutama pada anak-anak. bila infeksi terjadi bersamaan dengan virus influensa. atau malnutrisi. Rasa lemah baru hilang dalam waktu lama. Penanganan pneumonia pun dapat dilakukan dengan beberapa cara. Selain itu penderita pneumonia juga membutuhkan banyak cairan untuk mencegahnya dari dehidrasi. meski memiliki karakteristik keduanya. Pada beberapa kasus. Pneumonia Jenis Lain Termasuk golongan ini adalah Pneumocystitis Carinii pnumonia ( PCP ) yang diduga disebabkan oleh jamur. pasien akan mengigil. Pneumonia oleh virus Setengah dari kejadian pneumonia diperkirakan disebabkan oleh virus. dokter akan menginstruksikan pengobatan lanjutan untuk mencegah kekambuhan. Bisa saja penyakit ini muncul lagi beberapa bulan kemudian. Meski virus-virus ini kebanyakan menyerang saluran pernapasan bagian Pneumonia jenis ini berbeda gejala dan tanda-tanda fisiknya bila dibandingkan dengan pneumonia pada umumnya. penanganannya juga dilakukan dengan cara opname. napas terengah-engah. antara lain dengan cara cukup istirahat juga olahraga. Mengingat pengobatannya yang semakin sulit. sebagian besar pneumonia jenis ini tidak berat dan sembuh dalam waktu singkat. Selain antibiotika. Yaitu. bila sudah sesak baru dibawa ke dokter. segeralah ke dokter untuk dicari tahu penyebabnya. Pada kasus yang eksterm. 4 bulan. terutama terkait dengan meningkatkan resistensi bakteri pneumokokus. pneumonia yang diduga disebabkan oleh virus yang belum ditemukan ini sering juga disebut pneumonia yang tidak tipikal ( Atypical Penumonia ). Karena gejala awal panas dan batuk. “Anak dapat mengalami berbagai efek samping seperti gangguan kecerdasan. Dan letih lesu. Mikoplasma tidak bisa diklasifikasikan sebagai virus maupun bakteri. selama 12 . Penyakit ISPA diluar pneumonia ini antara lain batuk-pilek biasa. Biasanya dokter yang menangani pneumonia akan memilihkan obat sesuai pertimbangan masingmasing.” papar Atilla. Klasifikasi Bukan-pnemonia mencakup kelompok balita penderita batuk yang tidak menunjukkan gejala peningkatan frekuensi nafas dan tidak menunjukkan adanya penarikan dinding dada bagian bawah ke dalam. orang tua sering mengobati sendiri dirumah dengan obat biasa. Seluruh jaringan paru dipenuhi cairan dan infeksi dengan cepat menyebar ke seluruh tubuh melalui aliran darah. setelah suhu pasien kembali normal. Untuk pneumonia oleh virus sampai saat ini belum ada panduan khusus. pencegahan pneumonia menurut Bambang adalah dengan menjaga keseimbangan nutrisi anak. bakteri segera memperbanyak diri dan menyebabkan kerusakan.” jelasnya. Kebanyakan pasien juga bisa diobati dirumah. yakni pada saat bayi berusia 2 bulan. Untunglah. Dengan perawatan khusus di rumah sakit. ngilu diseluruh tubuh. gangguan perkembangan motorik. gangguan pendengaran dan keterlambatan bicara. Namun. Begitu pertahanan tubuh menurun oleh sakit. Setelah itu ada pula pemeriksaan penunjuang seperti rontgen paru dan pemeriksaan darah. dan denyut jantungnya meningkat cepat. dari bayi sampai usia lanjut. Adapun mengenai waktu ideal pemberian vaksin IPD. bahkan juga pada yang tidak diobati. Tetapi paling sering pada anak pria remaja dan usia muda. Bibir dan kuku mungkin membiru karena tubuh kekurangan oksigen. batuk makin hebat dan menghasilkan sejumlah lendir. Namun. Virus yang menginfeksi paru akan berkembang biak walau tidak terlihat jaringan paru yang dipenuhi cairan. sakit dada. “Selain itu. dapat dilakukan dengan cara vaksinasi pneumokokus atau sering juga disebut sebagai vaksin IPD.136 jam. maka tindakan pencegahan sangatlah dianjurkan. gangguan bisa berat dan kadang menyebabkan kematian. gejala awalnya yang tergolong sederhana seringkali membuat orangtua kurang waspada terhadap penyakit ini.gangguan ini bisa memicu pneumonia. “Orang tua sering datang terlambat membawa anaknya ke dokter. menurut penjelasan Atilla adalah sebanyak 4 kali. peluang mencegah Pneumonia dengan vaksin IPD adalah sekitar 80-90%. Pencegahan Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P2ISPA (Pemberantasan Penyakit Infeksi Saluran Pernafasan Akut). Atilla menerangkan bahwa pneumonia yang sudah mengalami komplikasi tersebut bisa meninggalkan berbagai efek samping. yakni daerah dengan tingkat resistensi tinggi untuk bakteri pneumokok. serangan berikutnya bisa lebih berat dibanding yang pertama. Saat ini makin banyak saja virus yang berhasil diidentifikasi. PCP bisa diobati pada banyak kasus. Pertama dengan pemeriksaan fisik secara umum. hanya saja perlu dosis tinggi dan waktu yg lama. usia tua. upayakan agar anak memiliki daya tahan tubuh yang baik. Program ini mengupayakan agar istilah pneumonia lebih dikenal masyarakat. berkeringat. “Penderita pneumonia dapat sembuh bila diberikan antibiotik yg sesuai dengan jenis kumannya. Bahkan untuk pencegahan vaksinnya pun sudah tersedia. Karena itu. Sebelum terlambat. Demam tinggi kadang membuat bibir menjadi biru. dan pada beberapa pasien bisa mual dan muntah. ” jelas Atilla. namun dengan sedikit lendir. meski beberapa obat antivirus telah digunakan. Gejala Pneumonia oleh virus sama saja dengan influensa. Pneumonia mikoplasma . Pencegahan penyakit IPD. Program P2ISPA mengklasifikasikan penderita kedalam 2 kelompok usia. bakteri Streptococcus pneumoniae mulai resisten atau kebal terhadap beberapa jenis antibiotik. Diagnosa dan Pengobatan Diagnosis pneumonia dilakukan dengan berbagai cara.

lalu kian berkurang pada remaja dan dewasa." tandas Dr Soedjatmiko SpA(K) MSi. batuk basah dan berlendir. Kuman pneumokokus dapat menyerang paru-paru. hingga kematian. angka kematian anak akibat pneumonia lebih banyak dibandingkan jumlah total kematian karena AIDS. sakit di dada atau perut. cairan. dia butuh antibiotika sesegera mungkin oOOo Pneumonia is a general term that refers to an infection of the lungs. tipus. tapi kalaupun sudah lewat tidak masalah. bakteri ini kebal terhadap antibiotik sehingga menyulitkan pengobatan. hidung meler. Vaksin ini masih dapat diberikan hingga usia 9 tahun. Hanya. Adapun cara penularan bakteri pneumokokus. suara dengik ketika anak bernapas. Pneumonia adalah bagian dari penyakit infeksi pneumokokus invasif (IPD) yang merupakan sekelompok penyakit karena bakteri streptococcus pneumoniae. Kapan harus menghubungi dokter : Bila bayi anda sulit bernapas. Menurut Peter Salama. atau masuk ke pembuluh darah hingga mampu menginfiltrasi organ lainnya.juga masuk golongan antara virus dan bakteri-menyebabkan demam Rocky Mountain. Some common symptoms include: fever chills cough unusually rapid breathing breathing with grunting or wheezing sounds labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath) vomiting chest pain abdominal pain decreased activity loss of appetite (in older children) or poor feeding (in infants) Croup Gejala: Batuk menggonggong di malam hari. Pada kasus yang serius. depending on the age of the child and the cause of the pneumonia. Asetaminofen atau ibu protein bisa membantu meredakan rasa nyeri dan demam. antara lain melalui percikan ludah melalui udara saat bersin. debu maupun jamur. Oleh karena itu. atau obat. menggigil. dan ada suara dengik saat dia mengambil napas. Imunisasi dianjurkan sedini mungkin supaya lebih efektif sehingga unsur perlindungannya mencapai level optimal. bacteria. terutama di negara dengan angka kematian balita yang tinggi. dan sesak napas. Peter Salama. gejala pilek yang bertahan lebih dari seminggu dan terus memburuk. kelumpuhan. "Itulah sebabnya. "Indonesia dengan 58 kematian per 1. symptoms of pneumonia begin after 2 or 3 days of a cold or sore throat. Tercatat lebih dari satu juta bayi dan balita meninggal setiap tahun akibat pneumonia. batuk. Lebih baik telat daripada tidak diberikan sama sekali." sahut Soedjatmiko seraya mengungkapkan bahwa IDAI juga telah menerbitkan rekomendasi dan petunjuk pemakaian vaksin pneumokokus sejak bulan Juni 2006. Penanganan : Antibiotika ( jika disebabkan bakteri). Ditandai dengan gejala demam tinggi." sebut Ketua Divisi Tumbuh Kembang-Pediatri Sosial Departemen Ilmu Kesehatan Anak FKUI/RSCM Dr Soedjatmiko SpA(K) MSi. IPD dapat menyerang siapa saja dan di mana saja. Namun kembali meninggi lagi di usia lanjut. dan dengik berdana tinggi ketika anak menarik napas. sementara pneumonia yang . dan psittacosis. "Bakteri pneumokokus dulu bisa dimatikan dengan antibiotik. Periksa dulu dengan gejala lain yang menyerupai berikut ini . satu dari lima kematian anak dan balita disebabkan pneumonia. hilang selera makan. demam. batuk." kata Kepala Divisi Kesehatan UNICEF. Dengan angka kematian total 6 juta anak. Bronchiolitis ( RSV) Gejalanya: hidung meler. Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). Padahal vaksinasi bisa mencegah penyakit itu. Kapan harus menghubungi dokter: Segera setelah anda mencurigai anak menderita pneumonia." papar dokter yang juga menjabat Sekretaris Satgas Imunisasi Ikatan Dokter Anak Indonesia (PP IDAI) ini. Rickettsia. tidak aktif seperti biasanya atau menolak menyusu. IPD bisa berdampak pada kecacatan permanen berupa ketulian. Soedjatmiko mengemukakan. Tingginya angka kematian akibat pneumonia sekaligus membuktikan masih rendahnya kesadaran masyarakat akan pentingnya imunisasi sebagai langkah pencegahan. Signs and Symptoms Symptoms of pneumonia vary. kelelahan. (sindo//tty) oOOo Banyak gejala batuk dan pilek yang mirip dengan gejala penyakit lain.000 kematian balita per tahun. demam Q. Penyakit-penyakit ini juga mengganggu fungsi paru.000 kelahiran hidup. istirahat. gangguan mental. lalu diberikan satu dosis lagi pada usia 12-15 bulan sebagai penguat. Anak anda mungkin butuh Xray untuk diagnosa. setiap tahun sekitar 3 juta orang meninggal akibat berbagai penyakit yang sebenarnya bisa dicegah dengan imunisasi. selaput otak. When this happens. 4 bulan. juga proteksi bagi anggota keluarga lain. Bila dia berusia lebih tua. Batuk rejan ( pertusis) Gejala: Batuk yang bertahan lebih dari satu menit dalam pernapasan di antara batuk. Dengan kata lain. fungi. Kapan harus menghubungi dokter: Sesegera mungkin. Kapan harus menghubungi dokter: Bila anak benar-benar sulit bernapas atau dengik berlanjut lebih dari 5 menit atau malah lebih buruk. dan cacar air. 6 bulan. Kasus kejadiannya amat tinggi pada usia kurang dari dua tahun. "Itu adalah jadwal idealnya. namun pneumonia tuberkulosis alis TBC adalah infeksi paru paling berbahaya kecuali dioabati sejak dini. dan gangguan saraf. batuk atau berbicara. lendir yang kental. kemunduran intelegensi.000 kelahiran hidup anak balita. serta pelembab udara untuk mengencerkan lendir serta melegakan jalur pernapasan. Pnaeumonia Gejala: Demam. kelompok usia paling rentan menderita IPD adalah bayi dan anak-anak usia kurang dari dua tahun. terutama akibat pneumonia pada anak. cairan. masuk kategori direkomendasikan. ada tanda-tanda dehidrasi. Penanganan : Antibiotika. bayi disarankan diimunisasi PCV mulai usia bayi 2 bulan. including viruses. Penanganan: Banyak cairan dan istirahat. maupun negara dengan lebih dari 50. disebabkan virus dibiarkan saja. Pneumonia lain yang lebih jarang disebabkan oleh masuknya makanan. Belakangan. Sekitar tiga per empat jumlah kasus pneumonia balita terdapat di 15 negara. Hal itu merujuk pada negara dengan lebih dari 50 kematian per 1. gas. imunisasi PCV tak hanya melindungi si bayi yang diimunisasi. termasuk Indonesia yang menempati urutan ke-6. demam penanganan: Duduk di kamar mandi dan berikan air hangat melalui shower selama 15-20 menit akan membantunya bernapas. malaria.PNEUMONIA Tia_Sabrina (06-038) baik akan mencegah atau menundah kekambuhan. which can be caused by a variety of microorganisms. oOOo ORGANISASI Kesehatan Dunia atau World Health Organization (WHO) mengungkap. "Pneumonia menjadi masalah signifikan di banyak negara. lekas marah. and parasites. napas tersengal-sengal. Anak dibawah 6 bulan mungkin perlu dirawat dirumah sakit. negara dengan angka kematian balita yang tinggi. anak-anak ( khususnya bayi) mungkin dirawat di rumah sakit untuk menerima oksigen. menggigil. menjadi prioritas utama.

blood tests. The flu vaccine is strongly recommended for children with chronic illnesses such as chronic heart or lung disorders or asthma. and (sometimes) bacterial cultures of mucus produced by coughing when making a diagnosis. (The pertussis immunization is the "P" part of the routine DTaP injection. if they are vomiting so much that they cannot take medicine by mouth. but there may be fever and abdominal pain or vomiting. Doctors may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in children who have been exposed to someone with certain types of pneumonia. When pneumonia is caused by viruses. and parasites. Wheezing may be more common in viral pneumonia. which may not be helpful in some types of pneumonia. Antiviral medication is now available. regular tuberculosis screening is performed yearly in some high-risk areas because early detection will prevent active tuberculosis infection including pneumonia. Check your child's lips and fingernails to make sure that they are rosy and pink. symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. or above 100. which is a sign that your child's lungs are not getting enough oxygen. Illness can spread when an infected person coughs or sneezes on a person. there may be no breathing problems at all. bluish or gray color of the lips and fingernails Sometimes a child's only symptom is rapid breathing. Incubation The incubation period for pneumonia varies. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely.4 degrees Fahrenheit (38 degrees Celsius) in an infant under 6 months of age. and parainfluenza virus (the virus that causes croup). Because they are at higher risk for serious complications. a common cause of bacterial pneumonia.PNEUMONIA Tia_Sabrina (06-038) in extreme cases. Children usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. not bluish or gray.9 degrees Celsius). In addition. Lebih dari 30 tahun. If your child has chest pain. When pneumonia is due to whooping cough (pertussis). and wash your hands frequently. by sharing drinking glasses and eating utensils. but especially if your child: is having trouble breathing or is breathing abnormally fast has a bluish or gray color to the fingernails or lips has a fever of 102 degrees Fahrenheit (38. In general. try a heating pad or warm compress on the chest area. depending on the type of virus or bacteria causing the infection. the child may have long coughing spells. Duration With treatment. rhinovirus. such as pertussis. give the medicine on schedule for as long as the doctor directs. ia menekuni bidang . When pneumonia is caused by bacteria. Ask your child's doctor before you use a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus. turn blue from lack of air. Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. infants who were born prematurely may be given treatments that temporarily protect against RSV. especially if fever is present.Dr. especially if you are handling used tissues or dirty handkerchiefs. or make a classic "whoop" sound when trying to take a breath. keep his or her drinking glass and eating utensils separate from those of other family members. The type of antibiotic used depends on the type of pneumonia. Don't force a child who's not feeling well to eat. if they have chronic illnesses that affect the immune system. Mardjanis Said SpA(K).) Vaccines are now also given against the pneumococcus organism (PCV). and can be used to prevent some types of viral pneumonia or to make symptoms less severe. influenza. most types of bacterial pneumonia can be cured within 1 to 2 weeks. respiratory syncytial virus (RSV). When to Call Your Child's Doctor Call your child's doctor immediately if your child has any of the signs and symptoms of pneumonia. too. fungi. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen. an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. which can lead to pneumonia in younger children. Although different types of pneumonia tend to affect children in different age groups. pneumonia is most commonly caused by viruses. In infants. Children with HIV infection may also receive prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii. if they have lung infections that may have spread into the bloodstream. or if they have recurrent episodes of pneumonia.9 degrees Celsius) in an older infant or child. For example. This will help your child recover faster and will decrease the chance that infection will spread to other household members. in older children and adolescents. Prevention There are vaccines to prevent infections by viruses or bacteria that cause some types of pneumonia. Description Pneumonia is a lung infection that can be caused by different types of germs. so it is best to keep your child away from anyone who has an upper respiratory tract infection. pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. including bacteria. who are at special risk for other types of pneumonia. or above 100. influenza virus (flu). and when a person touches the used tissues or handkerchiefs of an infected person. viruses. pneumonia can be treated with oral antibiotics given to your child at home. The doctor may possibly use a chest X-ray. Home Treatment If your child's doctor has prescribed antibiotics for bacterial pneumonia. as well as otherwise healthy children. If someone in your home has a respiratory infection or throat infection. and call the doctor if it goes above 102 degrees Fahrenheit (38. but encourage your child to drink fluids. Vaksinasi merupakan upaya terpenting untuk menurunkan mortalitas dan morbiditas akibat penyakit ini . Perkembangan kesehatan respirasi anak di negeri ini tak luput dari perhatian Prof. termasuk Indonesia.4 degrees Fahrenheit (38 degrees Celsius) in infants under 6 months of age Professional Treatment Doctors usually make the diagnosis of pneumonia after a physical examination. Some viruses that cause pneumonia are adenoviruses. Contagiousness The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Take your child's temperature at least once each morning and each evening. 18 to 72 hours. Children with chronic illnesses. pneumonia is not contagious. pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia. 4 to 6 days. Pneumonia merupakan penyebab kematian terbesar balita dan menjadi masalah kesehatan di negara berkembang . Children may be hospitalized for treatment if they have pneumonia caused by pertussis or other bacterial pneumonia that causes high fevers and respiratory distress. In most cases. Viral pneumonia may last longer. Some common incubation periods are: respiratory syncytial virus. They may also be hospitalized if supplemental oxygen is needed. but the upper respiratory viruses that lead to it are. may receive additional vaccines or protective immune medication.

sesak napas. pneumoniae dan Hib merupakan bakteri yang selalu ditemukan pada dua pertiga hasil isolasi. diagnosis dan prognosis pneumonia pada bayi dan balita dipengaruhi oleh berbagai faktor. prevalensi pneumonia pada balita cenderung meningkat. retraksi dada. Selama itu pula penyakit infeksi pernapasan terutama pneumonia menjadi masalah kesehatan anak dan penyebab kematian balita terbesar di Indonesia. Protein-karier yang digunakan dapat berasal dari toksoid tetanus. Walaupun prevalensi pneumokokus resistensi penisilin makin berkembang namun studi bakteriologi klugman masih memberi harapan. tapi juga menjadi persoalan negera berkembang yang kondisi lingkungannya buruk dan malnutrisi" kata Prof. 89 persen efektif dalam mencegah semua kasus infeksi invasif akibat pneumokokus dari berbagai serotype pada anak yang telah mendapat satu kali atau lebih dosis vaksinasi. Pneumonia tergolong penyakit Infeksi Saluran Pernapasan Akut (ISPA)." tegas Prof. termasuk infeksi . 770. Penelitian di beberapa negara berkembang menunjukan bahwa S. Sebagai referensi. dan pneumonia). efektifitasnya ternyata sama. Vaksin Hib konjugat dikembangkan dengan mengkonjugasikan protein-karier pada kapsul polisakarida Hib. Vaksin ini telah terbukti cukup poten. meningitis.Pneumonia Kode ICD-10: J12-J18. pneumoniae). Pasien pneumonia rawat jalan. air hunger dan sianosis. Persentase ini terbesar bahkan bila dibandingkan dengan diare (17 persen) dan malaria (8 persen). Mardjanis. Langsung ke: navigasi. Prof.8 persen. Beberapa studi menunjukan vaksin pneumokokus konjugat heptavalen memberikan efektivitas sangat tinggi dalam mencegah penyakit pneumokokus invasif (bakteriemia. Sebagai perbandingan. amoksisilin (25 mg/kg/BB) dan kotrimoksazol (4 mg/kg BB TMP. gejala klinis yang kadang-kadang tidak khas terutama pada bayi.5 -38. Di samping itu. 23F ) yang bertanggung jawab terhadap 83 persen penyakit pneumokokus invasif pada anak usia di bawah 5 tahun. P23 Kode ICD-9: 480-486.2 juta. timbul juga efek herd immunity. di Aula FKUI. Program Pengembangan Imunisasi (PPI) yang dicanangkan di seluruh dunia. lihat pneumonia (non-manusia). keterbatasan penggunaan prosedur diagnosis invasif. terbukti menurunkan angka kematian balita. Dimana sekitar 70 persennya terjadi di negara-negara berkembang. diberi antibiotik seperti kortrimoksazol atau amoksisilin yang diberikan secara oral. etiologi non infeksi yang relatif lebih sering dan faktor patogenesis. Studi lain pada 2003 memperlihatkan penurunan jumlah bayi penderita infeksi invasif akibat pneumokokus sebanyak 78 persen setelah divaksinasi saat berusia 2 tahun. S.20 mg/kg BB sulfametaksazol) 2 kali sehari adalah samasama efektif.24 bulan dengan pneumonia berat antara penisilin G intravena (25 000 U/kg BB setiap empat jam plus kloramfenikol (15 mg/kg BB setiap 6 jam) dibandingkan dengan seftriakson intravena (50 mg/kg BB setiap 6 jam) yang diberikan selama 10 hari. yaitu anak yang tidak divaksinasi akan terproteksi akibat anak-anak lain diimuniasi. terutama pada masa neonatus. gejala infeksi umum seperti demam . Begitu pula dengan program imunisasi terhadap penyakit infeksi pernapasan akut memberikan kontribusi cukup besar dalam menurunkan angka kematian balita. Di Amerika Serikat telah dikenal 7 serotipe ( 4. dan Staphilococcus aureus (S. gelisah. Sebab etiologi bakterilogiknya berbeda dengan pneumonia anak usia di atas dua bulan. aureus). ensiklopedia bebas berbahasa Indonesia. Dilaporkan bahwa antibiotik beta-laktam dosis tinggi masih mampu mengatasi aktivitas bakteri gram positif resisten-penisilin. Mardjanis memaparkan perkembangan pneumonia di Indonesia. Berdasarkan keefektifan vaksin tersebut dalam mencegah pneumonia. atau protein membran luar N meningitides. pada pidato pengukuhannya sebagai Guru Besar Tetap dalam Ilmu Kesehatan Anak pada Fakultas Kedokteran Universitas Indonesia. takipnu. Eropa dan Australia serta telah digunakan lebih dari 100 juta dosis di seluruh dunia.0 Pneumonia adalah sebuah penyakit pada paru-paru di mana pulmonary alveolus (alveoli) yang bertanggung jawab menyerap oksigen dari atmosfer menjadi "inflame" dan terisi oleh cairan. Pneumonia merupakan 'predator ' balita nomor satu di negara berkembang. gejala gastrointestinal seperti mual. Tetapi di Indonesia vaksin ini dimulai pada usia 2 bulan. Pada beberapa studi melaporkan bahwa pada anak usia 2 bulan sampai 5 tahun bakteri utama penyebab pneumonia adalah Streptococcus pneumoniae (S. Di negara maju. Untuk membaca tentang pneumonia dalam hewan lainnya. Sementara pada pneumonia rawat inap diberikan antibiotik beta-laktam intravena atau kombinasi antibiotik beta-laktam dan kloramfenikol intravena . Pemberian antibiotik merupakan salah satu kunci terapi pneumonia. Pertama. Badan Kesehatan Dunia (WHO) tahun 2005 memperkirakan kematian balita akibat pneumonia diseluruh dunia sekitar 19 persen atau berkisar 1. terutama Afrika dan Asia Tenggara. Saat ini. serta menurunkan angka kejadian otitis media akut dan prevalensi kolonisasi di nasofaring.6 – 2. Atas dasar itu. berkisar 18. sebuah penelitian multisenter di Pakistan yang membuktikan bahwa pada pneumonia rawat jalan. cari Artikel ini tentang pneumonia pada manusia. malaise. pneumonia sukar dibedakan dengan sepsis dan meningitis. Di negara maju penyebab terbanyak adalah Sterptococcus grup B sedangkan di negara berkembang dilaporkan sering disebabkan oleh bakteri gram negatif seperti Enterobacter sp. Klebsilla sp. menurut British Thoracic Society. 6B. Gambaran klinis pneumonia diklasifikasikan menjadi dua kelompok. nafsu makan berkurang. pneumonia berbeda dengan Hib yang hanya memiliki satu serotipe. dan Coli sp. vaksin pneumokokus ini telah tersedia.000 bayi di California Utara menunjukan vaksin pneumokokus memiliki tingkat keampuhan: 97 persen efektif dalam mencegah serotype spesifik dari bakteri pneumokokus pada bayi yang telah divaksinasi penuh. Di Departemen IKA FKUI/RSCM pneumonia berat yang diberikan kombinasi amoksisilin dan kloramfenikol intravena. "Upaya pencegahan dengan pemberian vaksin merupakan komponen penting dalam menurunkan mortalitas. dikembangkan vaksin heptavalen yang berasal dari 7 serotipe tersebut dan masing-masing serotipe dikonjugasikan dengan protein-karier yang berasal dari mutan non toksis difteri CRM 197. di Indonesia. 20-60 persen etiologi pneumonia tidak terindentifikasi. Di Indonesia. Tapi etiologi pasti mikrobiologisnya sukar didapat. Pada bayi usia kurang dari dua bulan. Hemophilus influenzae tipe b (Hib). toksin difteri.1 persen dari spesimen darah. sejauh ini efektifitasnya cukup memuaskan. Pneumonia dapat disebabkan oleh beberapa penyebab. Oleh karena itu antibiotik beta-laktam masih merupakan antibiotik pilihan untuk pengobatan pneumonia Cegah dengan Imunisasi Imunisasi menjadi pengalaman sukses dunia kedokteran. 19F. sakit kepala. meningitis dan bakteremia maka vaksin ini menjadi vaksin yang diwajibkan di Amerika Serikat. 18C. Dalam orasinya yang bertema "Pneumonia Penyebab Utama Mortalitas Anak Balita: Tantangan dan Harapan".9 persen dari aspirat baru dan 69. napas cuping hidung. muntah atau diare. gejala gangguan respiratorik seperti batuk. S. Pneumonia Dari Wikipedia Indonesia. aman dan efektif sejak usia enam minggu ke atas. Gambaran klinis. "Hal ini tidak hanya terjadi di Indonesia.PNEUMONIA Tia_Sabrina (06-038) kesehatan anak khususnya respirologi. 14. 29 April lalu. pneumonia mempunyai lebih dari 90 serotipe yang sebagian besar menjadi penyebab penyakit pada anak. Antara lain faktor imaturitas anatomis dan imunologis. Sekarang ini telah dikembangkan vaksin untuk mengatasi Hib dan pneumokokus. dr. Mardjanis Said SpA. yaitu 73. Kedua. Penyakit ini dipicu oleh berbagai mikroorganisme terutama bakteri dan virus pada saluran pernafasan. Berdasarkan Survei Kesehatan Rumah Tangga (SKRT) tahun 2001 kematian balita akibat pneumonia meningkat. 9V.. Studi klinis pada 37. suatu penelitian terapi antibiotik pada anak usia 2. jaringan paru dan adneksanya.

or who have cyanosis (blue-tinged skin) require immediate attention. or parasites. either because the disease is only in its initial stages. Salah satu kasus Pneumonia yang mempunya tingkat kematian tinggi pada saat ini adalah kasus Pneumonia yang disebabkan oleh Flu burung. the appropriate treatment. a culture of the person's sputum may be requested. Infants with pneumonia may have many of the symptoms above. in studies it has been shown that two doctors can arrive at different findings on the same patient. leading to falls. viruses. left side of image). chest CT (computed tomography) can reveal pneumonia that is not seen on chest x-ray. indicating the presence of an infection or inflammation. or phlegm and a high fever that may be accompanied by shaking chills. mood swings. while the alveolus on the right is full of fluid from pneumonia. or a low oxygen saturation.) Pneumonia can result from a variety of causes. moreover. They may develop a new or worsening confusion or may experience unsteadiness. fever. demam. virus. further investigations are needed to confirm the diagnosis. in a community setting (general practice).[2] While these signs are relevant. vomiting. Treatment depends on the cause of pneumonia. dan kesehatan orang tersebut.[3] [4] [edit] Diagnosis If pneumonia is suspected on the basis of a patient's symptoms and findings from physical examination. or if the health care provider has concerns about the diagnosis. the white blood cell count may appear deceptively normal. seperti kanker paru-paru atau terlalu banyak minum alkohol.[1] Frequently. Any bacteria identified are then tested to see which antibiotics will be most effective. bronchial breathing on auscultation with a stethoscope (harsher sounds from the larger airways transmitted through the inflamed and consolidated lung). Respiratory secretions can also be tested for the presence of viruses such as influenza.[2] Symptoms of pneumonia need immediate medical evaluation. it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid. oOOo Pneumonia From Wikipedia. Physical examination of the lungs may be normal. and the person's underlying health. fatigue. Other possible symptoms are loss of appetite. low blood pressure. jamur. komplikasin lainnya. dan merupakan penyebab kematian peringkat atas di antara orang tua dan orang yang sakit secara kronik. In some cases. sakit dada. perawatan yang cocok. Prognosis untuk individu tergantung dari jenis pneumonia. and adenovirus. Liver function tests should be carried out to test for damage caused by sepsis. Gejala yang berhubungan dengan pneumonia termasuk batuk. and chemical or physical injury to the lungs. Low blood sodium in pneumonia is thought to be due to extra anti-diuretic hormone produced when the lungs are diseased (SIADH). blueness of the skin.) If antibiotics fail to improve the patient's health. can mimic pneumonia on x-ray. The alveolus on the left is normal. and is a leading cause of death among the elderly and people who are chronically and terminally ill. In elderly people manifestations of pneumonia may not be typical. especially those who have other illnesses. Xrays can be misleading. experience headaches. Sputum cultures generally take at least two to three days. However. Pneumonia is not always seen on x-rays. [edit] Investigations Pneumonia as seen on chest x-ray. A complete blood count may show a high white blood cell count. Shortness of breath is also common. including infection with bacteria.PNEUMONIA Tia_Sabrina (06-038) oleh bakteria. A: Normal chest xray. which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. Alat diagnosa termasuk sinar-x dan pemeriksaan sputum. Pneumonia is a common illness which occurs in all age groups. like lung scarring and congestive heart failure. People with pneumonia may cough up blood. as is pleuritic chest pain. keeping oxygen from reaching the bloodstream. In some people with immune system problems. for instance. (See below. bacterial pneumonia is treated with antibiotics. atau parasit. but increased rather than decreased vocal resonance (which distinguishes it from a pleural effusion). Less common forms of pneumonia can cause other symptoms. Diagnosing pneumonia can be difficult in some people. a sharp or stabbing pain. and difficulty in breathing. Signs and symptoms Pneumonia fills the lung's alveoli with fluid. respiratory syncytial virus. An important test for pneumonia in unclear situations is a chest x-ray. Blood tests may be used to evaluate kidney function (important when prescribing certain antibiotics) or to look for low blood sodium. People with infectious pneumonia often have a cough producing greenish or yellow sputum. fungi. but often shows decreased expansion of the chest on the affected side. so they are mainly used to confirm that the infection is sensitive to an antibiotic that has already been started. any complications. People who are struggling to breathe. Diagnostic tools include x-rays and examination of the sputum. B: Abnormal chest x-ray with shadowing from pneumonia in the right lung (white area. Specific blood serology tests for other bacteria (Mycoplasma. an increased respiratory rate. who are confused. Physical examination by a health care provider may reveal fever or sometimes low body temperature. yang terjadi di seluruh kelompok umur. a fast heart rate. or because it involves a part of the lung not easily seen by x-ray. Information from a chest X-ray and blood tests are helpful. Vaksin untuk mencegah beberapa jenis pneumonia tersedia. and sputum cultures in some cases. Vaccines to prevent certain types of pneumonia are available. the free encyclopedia Pneumonia is an inflammatory illness of the lung. Its cause may also be officially described as idiopathic—that is. unknown—when infectious causes have been excluded. pneumonia is usually diagnosed based on symptoms and physical examination alone. The chest X-ray is typically used for diagnosis in hospitals and some clinics with X-ray facilities. either experienced during deep breaths or coughs or worsened by it.[2] [edit] Combining findings One study created a prediction rule that found the five following signs best predicted infiltrates on the chest . pneumonia caused by Legionella may cause abdominal pain and diarrhea. chest pain. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. and joint pains or muscle aches. oOOo Pneumonia adalah penyakit umum. while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. but in many cases they are simply sleepy or have a decreased appetite. pneumonia disebabkan bakteri dirawat dengan antibiotik. The prognosis depends on the type of pneumonia. dan kesulitan bernafas. nausea. Typical symptoms associated with pneumonia include cough. Legionella and Chlamydophila) and a urine test for Legionella antigen are available. and rales heard over the affected area. they are insufficient to diagnose or rule out a pneumonia. or develop sweaty and clammy skin. Percussion may be dulled over the affected lung. Pneumonia dapat juga disebabkan oleh iritasi kimia atau fisik dari paru-paru atau sebagai akibat dari penyakit lainnya.[5] Chest x-rays are also used to evaluate for complications of pneumonia. because other problems. Perawatan tergantung dari penyebab pneumonia. (The alveoli are microscopic air-filled sacs in the lungs responsible for absorbing oxygen from the atmosphere. A blood sample may similarly be cultured to look for infection in the blood (blood culture). Occasionally a chest CT scan or other tests may be needed to distinguish pneumonia from other illnesses.

Pseudomonas aeruginosa and Moraxella catarrhalis. Bacteria can also travel to the area between the lungs and the chest wall (the pleural cavity) causing a complication called an empyema. Less common causes of infectious pneumonia are fungi and parasites.14% to 24% 1 findings . As well as damaging the lungs. When the immune system responds to the viral infection. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Viral pneumonia is commonly caused by viruses such as influenza virus. Pulmonary edema can be mistaken for pneumonia due to it's ability to show a third heart sound and present with an abnormal ECG. The neutrophils engulf and kill the offending organisms. Although more than one hundred strains of microorganism can cause pneumonia. Strongyloides stercoralis. Viruses can also make the body more susceptible to bacterial infections. with Streptococcus agalactiae being an important cause of pneumonia in newborn babies. even more lung damage occurs. Herpes simplex virus is a rare cause of pneumonia except in newborns. Klebsiella pneumoniae. Mycoplasma pneumoniae. and coccidioidomycosis in the southwestern United States. either when the virus directly kills the cells. Cryptococcus neoformans. When pneumonias are grouped this way. bacteria may invade the spaces between cells and between alveoli through connecting pores. as in other cases of pneumonia.PNEUMONIA Tia_Sabrina (06-038) radiograph of 1134 patients presenting to an emergency room:[6] Temperature > 100 degrees F (37. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. [edit] Viruses Main article: Viral pneumonia Viruses invade cells in order to reproduce. The white spaces are alveoli that contain air. Once inside. often called "pneumococcus". and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation. This invasion triggers the immune system to send neutrophils. and heart. and also release cytokines. activate certain chemical cytokines which allow fluid to leak into the alveoli.58% to 85% 3 findings . and respond to different antibiotics than other bacteria. a common cause of pneumonia. The symptoms of infectious pneumonia are caused by the invasion of the lungs by microorganisms and by the immune system's response to the infection. only a few are responsible for most cases. The most common causes of bacterial pneumonia are Streptococcus pneumoniae. with low blood pressure and damage to multiple parts of the body including the brain. One type of white blood cell. Many bacteria live in parts of the upper respiratory tract. and fatigue common in bacterial and fungal pneumonia.2% to 3% A subsequent study[7] comparing four prediction rules to physician judgment found that two rules. bacteria. for which reason bacterial pneumonia often complicates viral pneumonia. The bacterium Streptococcus pneumoniae. or other medical problems. the one above[6] and also[8] were more accurate than physician judgment because of the increased specificity of the prediction rules. cause generally less severe pneumonia. and metapneumovirus. Another important Gram-positive cause of pneumonia is Staphylococcus aureus. blastomyces. but can also reach the lung through the bloodstream when there is an infection in another part of the body. Once in the lungs. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. adenovirus. Other diseases to be taken into consideration include bronchiectasis. kidneys. White blood cells. respiratory syncytial virus (RSV). Once inside. Pneumonia can be caused by microorganisms. and can easily be inhaled into the alveoli. a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. The terms "Gram-positive" and "Gram-negative" refer to the bacteria's color (purple or red. lung cancer and pulmonary emboli. The most common parasites causing pneumonia are Toxoplasma gondii. photographed through an electron microscope. thus complicating the underlying parasitic pneumonia. usually through the blood. respectively) when stained using a process called the Gram stain. or through a type of cell controlled self-destruction called apoptosis. the virus invades the cells lining the airways and alveoli. and Coccidioides immitis. Pneumocystis jiroveci. infectious causes are the most common type. Eosinophils in the lungs can lead to eosinophilic pneumonia. a combination of cellular destruction and immune response causes disruption of oxygen transportation. chills. This invasion often leads to cell death.[2] [edit] Pathophysiology Upper panel shows a normal lung under a microscope. immunosuppresive drugs. many viruses affect other organs and thus disrupt many body functions.5% to 9% 0 findings . such as the nose. Histoplasmosis is most common in the Mississippi River basin. causing a general activation of the immune system. responds vigorously to parasite infection. Streptococcus pneumoniae. is the most common bacterial cause of pneumonia in all age groups except newborn infants. [edit] Idiopathic Main article: Idiopathic interstitial pneumonia .84% to 91% probability 4 findings . Typically. Chronic obstructive pulmonary disease (COPD) or asthma can present with a polyphonic wheeze. There. and Legionella pneumophila. This leads to the fever. Lower panel shows a lung with pneumonia under a microscope. The most common causes of pneumonia are viruses and bacteria. These parasites typically enter the body through the skin or by being swallowed. causing serious or even fatal illness such as septic shock. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenzae. the eosinophil. Gram-positive bacteria and "atypical" bacteria. The term "atypical" is used because atypical bacteria commonly affect healthier people. Escherichia coli.35% to 51% 2 findings .8 degrees C) Pulse > 100 beats/min Crackles Decreased breath sounds Absence of asthma The probability of an infiltrate in two separate validations was based on the number of findings: 5 findings . [edit] Differential diagnosis Several diseases and/or conditions can present with similar clinical features to pneumonia and as such care must be taken in the proper diagnosis of the disease. The types of Gram-positive bacteria that cause pneumonia can be found in the nose or mouth of many healthy people. to the lungs. a type of defensive white blood cell. [edit] Fungi Main article: Fungal pneumonia Fungal pneumonia is uncommon. [edit] Bacteria Main article: Bacterial pneumonia Bacteria typically enter the lung when airborne droplets are inhaled. The alveoli are filled with inflammation and debris. they travel to the lungs. Bacteria often travel from an infected lung into the bloodstream. but it may occur in individuals with immune system problems due to AIDS. The neutrophils. irritants and unknown causes. and Ascariasis. Fungal pneumonia is most often caused by Histoplasma capsulatum. similar to that of pneumonia. People with immune system problems are also at risk of pneumonia caused by cytomegalovirus (CMV). [edit] Parasites Main article: Parasitic pneumonia A variety of parasites can affect the lungs. mouth and sinuses. mainly lymphocytes. "Atypical" bacteria which cause pneumonia include Chlamydophila pneumoniae.

the presence of underlying lung disease and underlying systemic disease. including mechanical ventilation. Chlamydophila) or viral pneumonia using the location. Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. either by direct inspection at autopsy or by its appearance under a microscope. fungal. prolonged malnutrition. e. Interstitial pneumonia involves the areas in between the alveoli. viruses. [edit] Treatment . Sputum cultures. Aspiration is a leading cause of death among hospital and nursing home patients. a particular kind of white blood cell.PNEUMONIA Tia_Sabrina (06-038) Idiopathic interstitial pneumonias (IIP) are a class as diffuse lung diseases. Eosinophilic pneumonia often occurs in response to infection with a parasite or after exposure to certain types of environmental factors. Early investigators distinguished between typical lobar pneumonia and atypical (e. Chemical pneumonia Chemical pneumonia (usually called chemical pneumonitis) is caused by chemical toxins such as pesticides. In some types of IIP. New cases of SARS have not been seen since June 2003. microbiology. classification based upon the causative microorganism became possible. Pseudomonas. A lobar pneumonia is an infection that only involves a single lobe.g. The most common causes of CAP vary depending on a person's age. and whether the person has recently been hospitalized. a microbiologic classification arose. desquamative interstitial pneumonia is caused by smoking. is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission. The resulting lung inflammation is not an infection but can contribute to one. tests on respiratory secretions. With the advent of modern microbiology. [edit] Early classification schemes Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of the lung. or section. [edit] Hospital-acquired pneumonia Main article: Hospital-acquired pneumonia Hospital-acquired pneumonia. but they include Streptococcus pneumoniae. Aspiration pneumonia Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating foreign objects which are usually oral or gastric contents. and it often causes a more severe illness. When the toxic substance is an oil. of a lung. Certain x-ray findings can be used to help predict the course of illness. a radiological classification. also called nosocomial pneumonia. risk factors for certain microorganisms. and Haemophilus influenzae. and appearance of the opacities they saw on chest x-rays. decreased amounts of stomach acid. A recently introduced type of healthcare-associated pneumonia (in patients living outside the hospital who have recently been in close contact with the health care system) lies between these two categories. some types of usual interstitial pneumonia. dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. Another important system of classification is the combined clinical classification. Pathologists originally classified them according to the anatomic changes that were found in the lungs during autopsies. [edit] Other types of pneumonia Severe acute respiratory syndrome (SARS) SARS is a highly contagious and deadly type of pneumonia which first occurred in 2002 after initial outbreaks in China. and Serratia. and it may be called "interstitial pneumonitis. As more became known about the microorganisms causing pneumonia. blood cultures. There are two broad categories of pneumonia in this scheme: community-acquired pneumonia and hospital-acquired pneumonia. Multilobar pneumonia involves more than one lobe. now the most commonly used classification scheme. The advantage of this classification scheme over previous systems is that it can help guide the selection of appropriate initial treatments even before the microbiologic cause of the pneumonia is known. the cause. Bronchiolitis obliterans organizing pneumonia (BOOP) BOOP is caused by inflammation of the small airways of the lungs. underlying heart and lung diseases. Because such laboratory testing typically takes several days. [edit] Combined clinical classification Traditionally. since they often cannot adequately protect their airways and may have otherwise impaired defenses. VAP is pneumonia which occurs after at least 48 hours of intubation and mechanical ventilation. distribution. An outdated term. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia worldwide. microbiologic classification is usually not possible at the time of initial diagnosis. Walking pneumonia is usually caused by a virus or by atypical bacteria. Hospitalized patients may have many risk factors for pneumonia. and specific blood tests are used to determine the microbiologic classification. The discovery of x-rays made it possible to determine the anatomic type of pneumonia without direct examination of the lungs at autopsy and led to the development of a radiological classification. walking pneumonia. has been used to describe a type of communityacquired pneumonia of less severity (hence the fact that the patient can continue to "walk" rather than require hospitalization). In some types of IIP the cause of the pneumonia is known." It is more likely to be caused by viruses or by atypical bacteria. Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria. SARS is caused by the SARS coronavirus. and the aspiration pneumonia syndromes. which combines factors such as age. It is also known as cryptogenic organizing pneumonitis (COP). or mycobacterial.g. Gramnegative bacteria cause CAP in certain at-risk populations. [edit] Classification Pneumonias can be classified in several ways. or mixed bacterial infections caused by airway obstruction.g. Enterobacter. e. Hospital-acquired microorganisms may include resistant bacteria such as MRSA. CAP is the most common type of pneumonia. it tends to be more deadly than community-acquired pneumonia. attempts to identify a person's risk factors when he or she first comes to medical attention. [edit] Community-acquired pneumonia Main article: Community-acquired pneumonia Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not recently been hospitalized. Overall. Additionally. and with the advent of x-rays. This is useful because chronic pneumonias tend to be either non-infectious. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as Streptococcus pneumoniae). indeed. Eosinophilic pneumonia Eosinophilic pneumonia is invasion of the lung by eosinophils. and immune disturbances. Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonia. since the material aspirated may contain anaerobic bacteria or other unusual causes of pneumonia. which may enter the body by inhalation or by skin contact. a previously unknown pathogen. the atypical bacteria. is unknown or idiopathic. treatment and prognosis are different from those of community-acquired pneumonia. the atypical pneumonias (such as the interstitial pneumonitis of Mycoplasma pneumoniae or Chlamydia pneumoniae). Determining which microorganism is causing an individual's pneumonia is an important step in deciding treatment type and length. although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone. the pneumonia may be called lipoid pneumonia. or after reflux or vomiting which results in bronchopneumonia. The combined clinical classification. and the name is a misnomer. clinicians have classified pneumonia by clinical characteristics. CAP is the fourth most common cause of death in the United Kingdom and the sixth in the United States. the microorganisms a person is exposed to in a hospital are often different from those at home . The causes. Lobar pneumonia is often due to Streptococcus pneumoniae. either while eating.

The B arrow indicates the width of the right lung. and aminoglycosides. limited access to x-rays. complete drainage of the fluid may be necessary. a specific cause for pneumonia is identified in only 50% of people. carbapenems. the person will often have to be hospitalized. When pleural fluid is present in a person with pneumonia. and heart damage. If the microorganisms themselves are present in the pleural cavity. Appropriately treating underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia. Chest x-ray showing a pleural effusion. while viral pneumonia caused by influenza A or B may be treated with oseltamivir or zanamivir. because antibiotics do not penetrate well into the pleural cavity. azithromycin. In severe cases of empyema. adenovirus. sometimes with added clarithromycin. [edit] Complications Sometimes pneumonia can lead to additional complications. fluids. often requiring a chest tube. People who have difficulty breathing due to pneumonia may require extra oxygen. rest. [edit] Prognosis and mortality Clinical prediction rules have been developed to more objectively prognosticate outcomes in pneumonia. The volume of useful lung is reduced because of the collection of fluid around the lung. but also because cigarette smoke interferes with many of the body's natural defenses against pneumonia. In the United Kingdom. Pleural effusion. However. combined with severe difficulties extracting oxygen due to the alveolar fluid. However. and abscess [edit] Clinical prediction rules Occasionally. most types of bacterial pneumonia can be cleared within two to four weeks. pneumonia is even deadlier. Multiple antibiotics may be administered in combination in an attempt to treat all of the possible causative microorganisms.and fourth-generation cephalosporins. patients allergic to penicillins are given erythromycin instead of amoxicillin. These treatments are beneficial only if they are started within 48 hours of the onset of symptoms. Many strains of H5N1 influenza A. and the fluoroquinolones have displaced amoxicillin as first-line treatment. The most important complications include: [edit] Respiratory and circulatory failure Because pneumonia affects the lungs. empiric treatment is usually started well before laboratory reports are available. the fluid can often be collected with a needle (thoracentesis) and examined. Individuals with sepsis or septic shock need hospitalization in an intensive care unit. and mycoplasmal pneumonia may take four to six weeks to resolve completely. also known as avian influenza or "bird flu. antibiotics are not useful for viral pneumonia. bacteria in the lung will form a pocket of infected fluid called an abscess. They often require intravenous fluids and medications to help keep their blood pressure from dropping too low. If the fluid is not drained. Testing pregnant With treatment. about half of the people who develop methicillin-resistant Staphylococcus aureus (MRSA) pneumonia while on a ventilator will die. Streptococcus pneumoniae is the most common cause. but there is increasing evidence that shorter courses (as short as three days) are sufficient. even after extensive evaluation. and a ventilator may be used to help the person breathe. and the elderly may need more advanced treatment. Typically. Antibiotics are used to treat bacterial pneumonia. Lung abscesses can usually be seen with a chest x-ray or chest CT scan. However. Complications are more frequently associated with bacterial pneumonia than with viral pneumonia.[9][10] [11] Antibiotics for hospital-acquired pneumonia include vancomycin. Sepsis most often occurs with bacterial pneumonia. the most common microorganisms causing pneumonia in the local geographic area. often including intubation and artificial ventilation. empyema. These rules can be helpful in deciding whether or not to hospitalize the person.[12] In cases where the pneumonia progresses to blood poisoning (bacteremia). people with other medical problems. This stiffness. which takes into account the severity of symptoms. and age[16] online calculator [edit] Prevention There are several ways to prevent infectious pneumonia. and the immune status and underlying health of the individual. but sometimes the abscess must be drained by a surgeon or radiologist. The antibiotic choice depends on the nature of the pneumonia. Rarely. microorganisms infecting the lung will cause fluid (a pleural effusion) to build up in the space that surrounds the lung (the pleural cavity).[14] In regions of the world without advanced health care systems. or complications occur. In contrast. and it often causes death." have shown resistance to rimantadine and amantadine. among other problems. Antibiotics are usually adequate to treat a lung abscess. Limited access to clinics and hospitals. and because of differences in the microorganisms' abilities to resist various antibiotic treatments. such as with a bi-level positive airway pressure machine. where the "atypical" forms of communityacquired pneumonia are becoming more common. [edit] Pleural effusion. Pneumonia severity index (or PORT Score)[15] online calculator CURB-65 score. Sepsis occurs when microorganisms enter the bloodstream and the immune system responds by secreting cytokines. kidney. Extremely sick individuals may require intensive care treatment. The A arrow indicates "fluid layering" in the right chest. and it may not be possible for them to breathe well enough to stay alive without support. If the symptoms get worse.[12] Viral pneumonia may last longer. In other cases. . There are no known effective treatments for viral pneumonias caused by the SARS coronavirus. Because treatment should generally not be delayed in any person with a serious pneumonia. people with pneumonia who are having trouble breathing. or parainfluenza virus. placement of an endotracheal tube (breathing tube) may be necessary. The lungs quickly fill with fluid and become very stiff. oral antibiotics. Sepsis can cause liver. clarithromycin. In North America. Non-invasive breathing assistance may be helpful. although they sometimes are used to treat or prevent bacterial infections that can occur in lungs damaged by a viral pneumonia. third. Pneumonia can also cause respiratory failure by triggering acute respiratory distress syndrome (ARDS). These antibiotics are usually given intravenously. and home care are sufficient for complete resolution. often people with pneumonia have difficulty breathing. is associated with little mortality. surgery may be needed. the fluid collection is called an empyema. for instance. amoxicillin is the antibiotic selected for most patients with community-acquired pneumonia. fluoroquinolones. create a need for mechanical ventilation. the pneumonia does not improve with home treatment. Antibiotic choices vary from hospital to hospital because of regional differences in the most likely microorganisms. which results from a combination of infection and inflammatory response.[13] The death rate (or mortality) also depends on the underlying cause of the pneumonia. Smoking cessation is important not only because it helps to limit lung damage. Sepsis and septic shock are potential complications of pneumonia. just over 20% of sufferers will die. limited antibiotic choices. Treatment for pneumonia should ideally be based on the causative microorganism and its known antibiotic sensitivity. Viral pneumonia caused by influenza A may be treated with rimantadine or amantadine. the infection may persist. The duration of treatment has traditionally been seven to ten days. Abscesses typically occur in aspiration pneumonia and often contain several types of bacteria. and inability to treat underlying conditions inevitably leads to higher rates of death from pneumonia. Research shows that there are several ways to prevent pneumonia in newborn infants. Pneumonia caused by Mycoplasma. Depending on the results of this examination.PNEUMONIA Tia_Sabrina (06-038) Most cases of pneumonia can be treated without hospitalization. any underlying diseases. hantavirus.

and if expiration be if cough be present. emphysema. Yang ada pneumonia. It is a major cause of death among all age groups. lho!"Yang ditegur pun menurut. Banyak orang menganggap. reduces pneumonia in infants. In the United Kingdom. In the U. respectively. Bila lingkungan di sekitar ada orang atau anak yang terinfeksi. Namun. tobacco smoking. sticking [pleuritic] pain in the side. or in both." The symptoms of pneumonia were described by Hippocrates (c. for such sweats are bad. terutama pada bayi. lembabnya udara dari lantai atau yang kita hirup bisa menyebabkan paru-paru basah." appreciated the morbidity and mortality of pneumonia. and if there be pains on either side. and urine that is thin and acrid. cystic fibrosis. Hippocrates referred to pneumonia as a disease "named by the ancients. jangan tiduran begitu.[18] When an influenza outbreak is occurring. dan adenovirus merupakan yang paling kerap menyebabkan pneumonia. medications such as amantadine. When pneumonia is at its height. Bacteria were first seen in the airways of individuals who died from pneumonia by Edwin Klebs in 1875. and pleuritic affections. The World Health Organization estimates that one in three newborn infant deaths are due to pneumonia[21] and WHO also estimates that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria Streptococcus pneumoniae.. [26] Initial work identifying the two common bacterial causes Streptococcus pneumoniae and Klebsiella pneumoniae was performed by Carl Friedländer[27] and Albert Fränkel[28] in 1882 and 1884. Benarkah? Apa sebenarnya paru-paru basah itu? 30 Sumber Infeksi Dalam dunia kedokteran. lalu pindah ke sofa atau tempat tidur. Roughly 20-40% of individuals who contract pneumonia require hospital admission of which between 5-10% are admitted to a critical care unit..[23] These individuals are also more likely to have repeated episodes of pneumonia. and oseltamivir can help prevent influenza. sehingga kemampuan menyerap oksigen berkurang. Vaccination is important for preventing pneumonia in both children and adults. and it reflected the extent of medical knowledge through the Middle Ages into the 19th century. People who are hospitalized for any reason are also at high risk for pneumonia. Kantong-kantong udara dalam paru (alveoli) dipenuhi nanah dan cairan. Dr.S. "Eh. In addition. influenzae. Friedländer's initial work introduced the Gram stain. and florid. A repeat vaccination may also be required after five or ten years. a fundamental laboratory test still used to identify and categorize bacteria. cirrhosis of the liver. Vaccination of infants against Haemophilus influenzae type b began in 1988 and led to a dramatic decline in cases shortly thereafter. [17] Influenza vaccines should be given yearly to the same individuals who receive vaccination against Streptococcus pneumoniae. alcoholism. resulting in a similar decline. serrated pulse and cough. are at particular risk for pneumonia and associated mortality. or those who do not have a spleen. Pneumonia occurs more commonly in males than females. known as "the father of modern medicine. Similarly. and the violence of the disease which is obtaining the upper hand. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia. as proceeding from the suffocation. and pregnant women should receive the vaccine. and intensive care in the twentieth century. jamur. Perkuat tubuh rales. risiko tertular sangat besar. or having any other character different from the common. Ketika seorang anak atau orang dewasa berbaring di lantai tanpa alas. rimantadine. mortality from pneumonia dropped precipitously in the developed world. frothy. Peripneumonia. yaitu infeksi yang menyebabkan paru-paru meradang. With the advent of penicillin and other antibiotics. Virus sinsitial pernapasan (respiratory syncitial virus atau RSV). the case is beyond remedy if he is not purged.PNEUMONIA Tia_Sabrina (06-038) women for Group B Streptococcus and Chlamydia trachomatis. nanti kena paru-paru basah. the majority of deaths occur in the newborn period. nursing home residents. Christian Gram's paper describing the procedure in 1884 helped differentiate the two different bacteria and showed that pneumonia could be caused by more than one microorganism. the mortality rate in the UK is around 510%. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced their role in pneumonia in children.[24] However. are to be thus observed: If the fever be acute. short rapid breaths. alcoholism. penyebab utamanya adalah bakteri. and 90% of these deaths take place in developing countries. congestive heart failure.[29] dengan gizi seimbang dan menjaga lingkungan adalah langkah terbaik nmnghindarinya. Prajna Paramita. Meski kasus pneumonia akibat bakteri tidak terlalu banyak. virus. FCCP.[19][20] [edit] Epidemiology Pneumonia is a common illness in all parts of the world. diabetes mellitus. modern surgical techniques. and then giving antibiotic treatment if needed. berbagai senyawa kimia. mikroplasma. the annual incidence of pneumonia is approximately 6 cases for every 1000 people for the 18-39 age group."[25] This clinical description is quite similar to those found in modern textbooks. or immune system problems are at increased risk for pneumonia. it is currently recommended for all healthy individuals older than 65 and any adults with emphysema. the ancient Greek physician known as the "father of medicine. kerap muncul seruan. However. . and it is bad if he has dyspnoea. and the sputa expectorated be of a blond or livid color. this rises to 75 cases for every 1000 people. Individuals with underlying illnesses such as Alzheimer's disease.[30] Vaccination against Streptococcus pneumoniae in adults began in 1977 and in children began in 2000. In children. Maimonides (1138–1204 AD) observed "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever. or likewise thin. 460 BC–370 BC): Sir William Osler. apalagi bila daya tahan tubuh sedang tidak baik. [edit] History Hippocrates." He also reported the results of surgical drainage of empyemas. painfluenzae. Dan RSV yang paling umum menjadi penyebab pneumonia. dan partikel. Elderly individuals. however. Sulit Bernapas Pneumonia muncul karena kuman penyakit terhirup hidung dan mulut. menyebutkan bahwa penyakit ini disebabkan oleh sekitar 30 macam sumber infeksi.. MD. and if sweats come out about the neck and head. [22] Mortality from pneumonia generally decreases with age until late adulthood. and more often in Blacks than Caucasians. Vaccinating children against Streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. jenis ini cenderung menimbulkan infeksi lebih berat daripada yang disebabkan oleh nonbakteri.[2] More cases of pneumonia occur during the winter months than during other times of the year. with over two million deaths a year worldwide. tidak dikenal istilah paruparu basah. describing it as the "captain of the men of death" in 1918. A vaccine against Streptococcus pneumoniae is also available for adults. health care workers. Pneumonia yang kerap disebut paru-paru basah termasuk jenis penyakit berbahaya. several key developments in the 1900s improved the outcome for those with pneumonia. For those over 75 years of age. Umumnya infeksi virus saluran pernapasan bawah berlangsung selama musim dingin atau hujan. zanamivir. cerebrospinal fluid leaks.

dahak. demam. Pada anak. Dr. bahkan menyebabkan kematian. Bakteri penyebab pneumonia paling sering adalah Streptococcus pneumoniae (pneumokokus). Letih lesu selama 12-136 jam. Tanda klinis yang bisa ditemui biasanya flek pada paru. tendiri dari pencegahan melalui imunisasi dan upaya pencegahan non-imunisasi. usia tua. Program Pengembangan Imunisasi (PPI) yang meliputi imunisasi DPT dan campak yang telah dilaksanakan pemerintah selama ini dapat menurunkan proporsi kematian balita akibat pneumonia. Sebelum terlambat. bisa diketahui ada masalah di paru. infeksi lebih sering mengenai laki-laki dibanding anak perempuan. Menujuk angka-angka di atas bisa dimengerti para ahli menyebut pneumonia sebagai The Forgotten Pandemic atau "wabah raya yang terlupakan" karena begitu banyak korban yang meninggal karena pneumonia tetapi sangat sedikit perhatian yang diberikan kepada masalah pneumonia. Jika infeksi terjadi berbarengan dengan virus influenza. * Lakukan imunisasi. Untungnya. atau 1 balita setiap 5 menit. mikroplasma. penderita bisa meninggal. Demikian pidato Prof. Diperkirakan 75% pneumonia pada anak balita di negara berkembang termasuk di Indonesia disebabkan oleh pneumokokus dan Hib. Bila penyebabnya bakteri. napas sesak batuk makin hebat dan menghasilkan sejumlah lendir juga bisa dialami. Pasien yang terinfeksi pneumonia akan panas tinggi. dan kepadatan penduduk. hidrokarbon. sakit kepala. rentan terkena penyakit ini. Sumber: Senior Pneumonia Penyebab Utama Mortalitas Anak Balita di Indonesia. Pada kasus berat. biasanya antibiotika ini cukup manjur. Vaksin Hb sudah banyak dipakai untuk menangkal pneumonia. sedang terinfeksi virus atau kekebalan tubuh menurun. Puncak serangan infeksi antara usia 2 dan 3 tahun dan sesudahnya akan menurun sedikit demi sedikit. ngilu di seluruh tubuh. asap dapur dIl. Pneumonia ditandai oleh batuk disertai sulit bernapas. akibat obat. pemberian nutrisi yang baik. Gejala sulit bernapas bisa juga disertai gejala sianosis (kebiruan di bagian kulit dan mukosa karena hemoglobin berkurang dalam darah kapiler) sentral dan tidak dapat minum. Mita ini. perbaikan lingkungan hidup dan sikap hidup sehat. Namun. benda asing. meski beberapa obat antivirus telah digunakan. Akibatnya suara berubah serak karena di sekitar pita suara banyak terdapat lendir. tanda klinis ini tidak mencukupi sebab tuberkulosis pun ditandai oleh flek ini. meski tak tampak di jaringan paru yang penuh cairan. Hal ini dapat dimengerti karena campak. selain meningitis. gigi bergemelutuk. Bisa 60 kali permenit atau lebih tarikan napas. Sudah Ada Vaksinnya Pneumonia Bakteri Jenis ini bisa menyerang bayi sampai usia lanjut. Tidak heran bila melihat kontribusinya yang besar terhadap kematian balita pneumonia dikenal juga sebagai "pembunuh balita nomor satu". penghindaran pajanan asap nokok. oksigen di selsel tubuh pun berkurang dan tidak bisa bekerja. Prof. H. jenis kelemin. Bibir dan kuku bisa membiru karena tubuh kekurangan oksigen. Sp. Hemophilus influenzae tipe b (Hib) dan Staphylococcus aureus (S aureus). Karena itu. penderita penyakit pernapasan. * Hindari rokok dan penderita batuk. selain penyebaran infeksi ke seluruh tubuh. dan kalau batuk mengeluarkan lendir berwarna hljau. bakteri segera memperbanyak diri dan merusak tubuh. Langkah untuk Mencegah Jenis dan parahnya penyakit ini disebabkan oleh beberapa faktor. Lewat pemeriksaan rontgen dada. berkeringat. Gejala lain adalah radang tenggorokan (laringitis). Ini berarti bahwa pneumonia menyebabkan kematian lebih dari 100. Di samping itu. * Mengusahakan sirkulasi udara yang baik. dengan penarikan kuat pada dinding dada sebelah bawah ke dalam. pasien juga akan mendapat terapi tambahan berupa pengaturan makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. Kebanyakan virus menyerang saluran pernapasan atas. sampai saat ini belum ada panduan khusus. Demam tinggi kadang membuat bibir membiru. pemeriksaan penunjang seperti pemeriksaan darah. dan rickettsia. pasien pasca operasi. Pneumonia Virus sebagian besar kasus pneumonia disebabkan oleh virus. Upaya pencegahan merupakan komponen strategis dalam pemberantasan pneumonia pada anak. Gejala pneumonia ini mirip influenza. sebagian besar pneumonia ini tidak berat dan sembuh dalam waktu singkat. serta kondisi lingkungan. Gara-gara nanah dan cairan memenuhi paru-paru. musim. terutama untuk anak. Agar terhindar dari pneumonia perlu beberapa langkah strategis seperti: * Menjaga kebersihan lingkungan tempat tinggal. Istirahat panjang diperlukan untuk mengembalikan kondisi tubuh. Yang tidak kalah penting sebenarnya adalah upaya pencegahan non-imunisasi yang meliputi pemberian ASI eksklusif. bahan lipoid. Pecandu alkohol. sekarang telah tersedia vaksin Hib dan vaksin pneumokokus konjugat untuk pencegahan terhadap infeksi bakteri penyebab pneumonia dan penyakit berat lain seperti meningitis. pada tanggal 29 April 2006. atau hampir 300 balita setiap hari. yang kesemuanya itu dapat menghindarkan terhadap . Di seluruh dunia setiap tahun diperkirakan terjadi lebih 2 juta kematian balita karena pneumonia. Perlu Mengatur Makan Pengobatan awal untuk pneumonia biasanya berupa antibiotika." ujar spesialis paru dari RSPAD Gatot Subroto yang akrab disapa Dr. serta gejala sangat penting untuk menentukan flek ini pertanda TBC atau pneumonia. penyakit ini bisa diobati. Namun vaksin ini belum masuk dalam Program Pengembangan Imunisasi (PPI) Pemerintah. Mardjanis Said. Dr. napas terengah-engah. Pada anak usia di bawah 2 bulan. radiasi. Selain antibiotika.A(K) Pnumonia adalah penyakit infeksi akut paru yang disebabkan terutama oleh bakteri. Di Indonesia menurut Survei Kesehatan Rumah Tangga tahun 2001 kematian balita akibat pneumonia 5 per 1000 balita per tahun.PNEUMONIA Tia_Sabrina (06-038) "Pneumonia termasuk penyakit yang serius dan berbahaya. dan denyut jantung meningkat cepat. merupakan penyakit Infeksi Saluran Pernapasan Akut (ISPA) yang paling sering menyebabkan kematian pada bayi dan anak balita. batuk kering. gangguan bisa berat. reaksi hipersensitivitas dari saluran napas. Tandanya.000 balita setiap tahun. Vaksin ini untuk menangkal serangan bakteri Haemophyllus influenzae tipe B yang bisa menyebabkan kedua jenis penyakit itu. napas sesak. sakit dada. Virus penginfeksi paru akan berkembang biak. pneumonia berat ditandai kerapnya frekuensi bernapas. Akibatnya. Saat kekebalan tubuh menurun. Seluruh jaringan paru dipenuhi cairan dan infeksi terjadi cepat menyebar ke seluruh tubuh lewat darah. dan sudah ada di kerongkongan manusia sehat. Untuk pneumonia akibat virus. atau kurang gizi. Beberapa kasus pneumonia tidak disebabkan infeksi mikroorganisme. Vaksin pencegahannya pun sudah tersedia. pasien akan menggigil. * Makanlah dengan gizi seimbang. Bisa juga akibat aspirasi makanan atau asam lambung. Bakteri penyebab pneumonia yang paling umum adalah Streptococcus pneumoniae. pertusis dan juga difteri bisa juga menyebabkan pneumonia atau merupakan penyakit penyerta pada pneumonia balita. termasuk usia. atau terjadi penarikan dinding dada sebelah bawah ke dalam (severe chest indrawing). Mardjanis Said SpA(K) dan Departemen Ilmu Kesehatan Anak FKUI sebagai Guru Besar Tetap dalam Ilmu Kesehatan Anak di Fakultas Kedokteran Universitas Indonesia Jakarta.

virus atau bakteri penyebab infeksi paru mudah sekali menular lewat udara. bisa menjadi berat dan menyebabkan kematian dengan tanda napas cepat dan/atau napas sesak. sebaiknya kita memang mencegah terjadinya infeksi pada paru. perlu antibiotik dan/atau perawatan di rumah sakit). Udara ini berasal dari alveolus yang pecah karena penuh dengan udara. dan lainnya. antara lain vaksin influenza. mengatur sirkulasi udara di dalam rumah secara baik. pembakaran sampah. staf IKA dan para kolega Divisi Respirologi daerah berbagai senter di tanah air. yaitu demam. Penelitian klinis. Bila hal ini sering terjadi. Bisa juga karena infeksi virus atau bakteri yang masuk dari vagina ke dalam rahim. peradangan pada jaringan paru disebut pneumonia. Pneumonia lobaris merupakan peradangan pada sebagian paru atau salah satu lobus paru. dan vaksin PCV. Pasalnya. peradangannya mengenai saluran napas kecil dan jaringan paru yang terjadi pada sebagian besar atau keseluruhan lapangan paru kiri dan kanan. Seperti halnya gangguan yang lain. Beliau juga memberikan usulan untuk institusi pendidikan yaitu untuk mengatasi kesenjangan antara ilmu yang didapat saat kuliah dan strategi pelaksanaan di lapangan. selesma). Sedangkan bronkopneumonia duplex. pada anak yang memilik bakat alergi. (HG) Batuk oOOo Secara umum. juga melakoni gaya hidup sehat. beliau mengusulkan agar istilah ISPA yang sering disalahtafsirkan sebagai Infeksi Saluran Pernapasan Atas dipakai sebagai pengganti istilah batuk-pilek biasa (common cold. * Perkecil Risiko Tertular Di usia bayi. saluran pernapasan atas merupakan pintu masuk udara. sehingga sesak napas. Istilah "bukan pneumonia" dalam Pedoman Tatalaksana Baku diganti dengan ISPA sehingga di masyarakat terdapat 2 istilah populer yaitu ISPA (penyakit saluran napas atas. mungkin saja akan menjadi pneumonia. acara syukuran diadakan di Departemen IKA FKUI RSCM. tidak merokok di dalam ruangan. kontrol teratur ke dokter kandungan dan dokter lain bila ada penyakit khusus. Bila ia tersedak. Sedangkan jamur sangat jarang terjadi. Bila anak menderita batuk dan pilek. secara garis besar pneumonia dapat dikelompokkan menjadi 3. Hal ini perlu dilakukan mengingat pneumonia paling sering menyerang anak di bawah usia 2 tahun. biasanya ringan sebagian besar disebabkan oleh virus dan tidak perlu antibiotik) dan pneumonia (penyakit paru. debu kotor. penyebab infeksi paru adalah virus dan bakteri seperti Streptococcus pneumoniae dan Haemophylus influenzae. 2. maka mudah terjadi peradangan pada saluran pernapasan dan tak mustahil terjadi pula infeksi di paru-parunya. tidak kontak dekat dengan penderita pneumonia. Di kota-kota besar seperti Jakarta. Bila saat itu daya tahan tubuhnya lemah. yang paling utama dan sering terjadi adalah pneumonia lobaris dan bronkopneumonia duplex. Bila terus-menerus terjadi. membersihkan kamar tidur dari debu setiap hari. Infeksi saluran pernapasan atas seperti batuk dan flu bisa menjadi awal terjadinya infeksi paru. yaitu: 1. Caranya dengan menjaga asupan nutrisi yang baik supaya daya tahan tubuh baik. daya tahan tubuh si kecil sangat rendah sehingga mudah tertular penyakit. Hal ini bisa disebabkan penularan dari ibu yang memiliki kuman penyebab pneumonia sehingga masuk ke janin lewat plasenta. yang masuk biasanya karena ia tersedak air ketuban ibu yang bercampur kotoran bayi itu sendiri. Dua KOMPLIKASI Infeksi paru dapat menimbulkan komplikasi pneumothorax dan empyema (terjadi pengumpulan nanah di antara paru dan dinding dada). Buang sampah di tempatnya kemudian menutupnya. Sekali lagi selamat Prof. maka Program Pemberantasan Pneumonia termasuk Pedoman Tatalaksana Baku rekomendasi WHO dimasukkan ke dalam kurikulum pendidikan di FK. polusi udara sering kali terjadi. Artinya. kita harus memerhatikan betul kesehatan diri dan janin. dan thorax = dada. Umumnya di Indonesia. vaksin HiB. Segera bawa ke dokter bila flu dan batuk tak juga sembuh dalam waktu 3-5 hari. Pecahnya alveolus disebabkan adanya sumbatan atau peradangan di saluran bronkioli yang membuat udara bisa masuk namun tak bisa keluar. komplikasi ini harus segera diatasi supaya bisa tertangani dengan baik. Untuk ISPA yang lama digunakan istilah IRA atay lnfeksi Respirasi Akut. Pada bayi baru lahir. atau jamur. menjaga kebersihan tubuh. batuk. Karenanya. Idealnya dilakukan penelitian berbasis masyarakat berskala luas. Terjadi bila bayi tersedak dan ada cairan/makanan yang masuk ke paru-paru. Bila kemudian tak diobati dengan baik. Gejala yang muncul umumnya sama dengan gangguan paru lainnya. bisa berkembang menjadi infeksi di saluran pernapasan. ada udara di dalam rongga dada. disarankan untuk diberikan vaksinasi. hindari risiko tertular dengan tidak terlalu sering berada di keramaian. Bila udara yang dihirup kotor atau berdebu. Akibatnya akan timbul pilek. Pneumonia akibat faktor lingkungan. Juga terus berikan ASI supaya daya tahan tubuhnya tetap terjaga. Mardjanis. frekuensi napas cepat. Asap kendaraan bermotor. Pneumonia karena infeksi virus. MENCEGAH Lebih EFEKTIF Mengingat pengobatan yang butuh waktu lama dan dananya pun cukup besar. akan sering bersin-bersin. Dengan melakukan hal-hal ini diharapkan kehamilan berjalan normal dan janin pun sehat hingga saat kelahirannya tiba. sehingga kemudian janin seakan berkubang dalam air ketuban yang mengandung kuman. sesak napas. Aspirasi pneumonia. membersihkan sofa dan lantai rumah secara berkala. Udara kemudian masuk ke dalam rongga antara paru dan tulang dada. 3. jangan dibiarkan berlarut-larut. para undangan. mikrobiologis maupun lapangan yang berhubungan dengan pemberantasan pneumonia kiranya dapat dilakukan. tentu harus segera ditangani. Lambat laun alveolus menjadi penuh sehingga tak kuat menampung udara dan pecah. maka di . bakteri. asap buangan pabrik. Berikut adalah langkah-langkah yang perlu dilakukan: Ada bayi yang baru lahir terkena pneumonia. Setelah upacara pidato pengukuhan. Kedua komplikasi ini sangat berbahaya karena lambat laun dapat mengganggu dan merusak paru-paru. Ada beberapa jenis peradangan pada paru. Untuk Program/Subdit P2-ISPA Depkes. Untuk itu. Kalau tidak. Sebab. bayi akan sesak napas atau bahkan tak bisa bernapas sehingga jiwanya pun tak tertolong. sebagian besar disebabkan oleh bakteri.PNEUMONIA Tia_Sabrina (06-038) risiko terinfeksi penyakit menular termasuk penghindaran terhadap pneumonia. 1. flu. Infeksi ini bisa menyebabkan pneumonia lobaris maupun bronkopneumonia duplex. terutama mereka yang berbakat alergi. * Menjaga Kebersihan Lingkungan Menjaga kebersihan lingkungan penting dilakukan supaya udara yang kita hirup bersih dan menyehatkan. batuk. Hadir dalam kesempatan tersebut. belum lagi dengan tingkat keberhasilan yang terkadang sulit dicapai. * Menjaga Kesehatan Sewaktu Hamil Berdasarkan penyebabnya. flu. Pneumothorax Berasal dari kata pneumo = udara. Di usia beberapa hari atau bulan bisa karena tersedak ASI yang bukan masuk ke saluran cerna melainkan ke saluran pernapasan. dapat membuat hidup kita lebih sehat. bisa menyebabkan sesak napas. * Berikan Vaksin Supaya anak lebih kebal terhadap serangan infeksi paru. virus dan kuman ke dalam tubuh. Pemberiannya dapat dilakukan sejak bayi. saat mengandung si kecil.

akan terdengar suara ronki. Mungkin perlu diberikan oksigen tambahan. oOOo Definisi Pneumonia adalah infeksi akut pada paru-paru. cairan intravena dan alat bantu nafas mekanik. Selain itu. Pneumonia yang didapat di rumah sakit cenderung bersifat lebih serius karena pada saat menjalani perawatan di rumah sakit. ketika paru-paru terisi oleh cairan sehingga terjadi ganguan pernapasan. oOOo Pneumonia is characterized by inflammation of the alveoli and terminal airspaces in response to invasion by an infectious agent introduced into the lungs through hematogenous spread or inhalation. Empiyema (peradangan di paru) Peradangan terjadi karena kuman atau bakteri berhasil dilokalisasi oleh pertahanan tubuh namun tak dapat dibasmi. Pada kelompok usia ini dikenal juga Pnemonia sangat berat. pneumonia adalah penyebab kematian nomor tiga setelah kardiovaskuler dan tuberkulosis. stres. This is in contrast to pneumonitis. Dahak berwarna kehijauan atau seperti karet. Salah satu diantaranya adalah berdasarkan cara diperolehnya. resulting in air loss and consolidation. 2. harus dirawat dan antibiotik diberikan melalui infus.PNEUMONIA Tia_Sabrina (06-038) rongga tersebut akan penuh dengan udara. yaitu "community-acquired" (diperoleh diluar institusi kesehatan) dan "hospital-acquired" (diperoleh di rumah sakit atau sarana kesehatan lainnya). Diagnosa Pada pemeriksaan dada dengan menggunakan stetoskop. Virus: virus influenza. bisa diberikan antibiotik per-oral (lewat mulut) dan tetap tinggal di rumah. kemungkinannya terjadinya infeksi oleh bakteri yang resisten terhadap antibiotik adalah lebih besar. Penderita yang lebih tua dan penderita dengan sesak nafas atau dengan penyakit jantung atau paru-paru lainnya. Pneumonia pada anak-anak paling sering disebabkan oleh virus pernafasan. Gejala Pada anak usia 2 bulan sampai kurang dari 5 tahun Pneumonia Berat ditandai batuk atau (juga disertai) kesulitan bernapas. The nonimmune mechanisms include aerodynamic filtering of inhaled . Pencegahan Untuk orang-orang yang rentan terhadap pneumonia. Kadang bayi tiba-tiba menjadi sakit yang disertai dengan turun naiknya suhu tubuh oOOo Definisi Pneumonia adalah peradangan paru yang disebabkan oleh infeksi bakteri. Pneumonia juga bisa terjadi setelah pembedahan (terutama pembedahan perut) atau cedera (terutama cedera dada). Yang sering menjadi penyebabnya adalah Staphylococcus aureus. Pada usia sekolah. kehijauan atau seperti nanah) nyeri dada (bisa tajam atau tumpul dan bertambah hebat jika penderita menarik nafas dalam atau terbatuk) menggigil demam mudah merasa lelah sesak nafas sakit kepala nafsu makan berkurang mual dan muntah merasa tidak enak badan kekakuan sendi kekakuan otot. Bakteri (paling sering menyebabkan pneumonia pada dewasa): Streptococcus pneumoniae 2. Gejala Gejala-gejala yang biasa ditemukan adalah: batuk berdahak (dahaknya seperti lendir.penerima organ cangkokan) Gangguan sistem kekebalan karena penyakit (penderita AIDS). dengan gejala batuk dan kesukaran bernapas karena tidak ada ruang tersisa untuk oksigen di paru-paru. yang tersering yaitu bakteri Streptococcus pneumoniae pneumococcus). Pemeriksaan penunjang: Rontgen dada Pembiakan dahak Hitung jenis darah Gas darah arteri. Organisme mirip bakteri: Mycoplasma pneumoniae (terutama pada anak-anak dan dewasa muda) 4. Di Indonesia. napas sesak atau penarikan dinding dada sebelah bawah ke dalam (severe chest indrawing). pneumokokus. akan tampak bahwa jumlah lendir meningkat. dibagi menjadi 2 kelompok. Akhirnya muncul nanah dan mengumpul di antara paru-paru dan dinding dada. sistem pertahanan tubuh penderita untuk melawan infeksi seringkali terganggu. Jika bayi bernapas dengan bantuan ventilator. Adapun cara mikroorganisme itu sampai ke paru-paru bisa melalui: Inhalasi (penghirupan) mikroorganisme dari udara yang tercemar Aliran darah. Pneumonia yang didapat diluar institusi kesehatan paling sering disebabkan oleh Streptococcus pneumoniae. Hemophilus influenzae atau kombinasi ketiganya. virus maupun jamur. Lambat-laun paru-paru menjadi kempis karena terdesak oleh udara. Pneumonia pada orang dewasa paling sering disebabkan oleh bakteri. sebagai akibat dari dangkalnya pernafasan. Gejala lainnya yang mungkin ditemukan: kulit lembab batuk darah pernafasan yang cepat cemas. tegang nyeri perut. Pada anak di bawah 2 bulan Pnemonia berat ditandai frekuensi pernapasan sebanyak 60 kali per menit atau lebih atau (juga disertai) penarikan kuat pada dinding dada sebelah bawah ke dalam. pneumonia paling sering disebabkan oleh bakteri Mycoplasma pneumoniae. Vaksinasi bisa membantu mencegah beberapa jenis pneumonia pada anak-anak dan orang dewasa yang beresiko tinggi: Vaksin pneumokokus (untuk mencegah pneumonia karena Streptococcus pneumoniae) Vaksin flu Vaksin Hib (untuk mencegah pneumonia karena Haemophilus influenzae type b). Kebanyakan penderita akan memberikan respon terhadap pengobatan dan keadaannya membaik dalam waktu 2 minggu. latihan bernafas dalam dan terapi untuk membuang dahak. Pengobatan Kepada penderita yang penyakitnya tidak terlalu berat. Penyebab pneumonia adalah: 1. Staphylococcus aureus Legionella Hemophilus influenzae Pneumonia dikelompokkan berdasarkan sejumlah sistem yang berlainan. Jamur tertentu. dan puncaknya terjadi pada umur 2-3 tahun. bisa membantu mencegah terjadinya pneumonia. akibat kemampuan paru-paru menyerap oksigen berkurang. gangguan terhadap kemampuan batuk dan lendir yang tertahan. An inhaled infectious organism must bypass the host's normal nonimmune and immune defense mechanisms in order to cause pneumonia. Beberapa orang yang rentan (mudah terkena) pneumonia adalah: Peminum alkohol Perokok Penderita diabetes Penderita gagal jantung Penderita penyakit paru obstruktif menahun Gangguan sistem kekebalan karena obat tertentu (penderita kanker. The inflammatory cascade triggers the leakage of plasma and the loss of surfactant. chicken-pox (cacar air) 3. dari infeksi di organ tubuh yang lain Migrasi (perpindahan) organisme langsung dari infeksi di dekat paru-paru. which is caused by noninfectious agents such as radiation or chemicals.

1 Mortality/Morbidity The United Nations Children's Fund (UNICEF) estimates that 3 million children die worldwide from pneumonia each year. tachypnea. • Newborns o Newborns with pneumonia rarely cough. The patient must increase his or her respiratory rate to maintain adequate ventilation. Physical Because pneumonia is common and is associated with significant morbidity and mortality. This inflammatory response differs according to the type of infectious agent. patients with AIDS. the cough reflex. defensins). tachypnea. complement. retractions. and eosinophils carry out the immunemediated host defense. Grunting suggests a lower respiratory tract disease. Wheezing is less common than in viral infections. cough (productive or nonproductive). Patients with these infections present with wheezing and crackles. viral infection. cough (productive or nonproductive). Different age groups tend to be infected by different pathogens. irritability. and certain chemical agents: These conditions create disruption in the mucociliary blanket. which triggers a brisk influx of RBCs and polymorphonuclear cells (red hepatization) followed by the deposition of fibrin and the degradation of inflammatory cells (gray hepatization). The signs and symptoms of pneumonia are often nonspecific and widely vary based on the patient’s age and the infectious organisms involved. tubular breath o . they more commonly present with tachypnea. 2 cases per 100 children aged 5-9 years. resulting in partial obstruction of the airway. patients who have undergone chemotherapy. lysozymes. however. although it is more common in younger children. diminished breath sounds. which increases airflow to respiratory surfaces. In a large communitybased study conducted by Denny and Clyde. o • o These infections are characterized by the accumulation of mononuclear cells in the submucosa and perivascular space. • • • • Grunting in a newborn is due to vocal cord approximation as they try to provide increased positive end-expiratory pressure (PEEP) and keep their lower airways open. sequestrations). and appropriately treating patients is important. They may have some posttussive emesis. Tachypnea and hypoxia are common. o The inflammation and pulmonary edema that result from these infections cause the lungs to become stiff and less distensible. intra-alveolar debris is ingested and removed by the alveolar macrophages. or (3) a rub caused by pericardial effusion in patients with lower lobe pneumonia due to Haemophilus influenzae infection. dehydration. retractions. Frequency United States Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years. All children o Many children present with nasal flaring. Inflammation in the small airways leads to crackles. and hypoxemia. • Anatomic abnormalities (eg. altered pulmonary blood flow. o Auscultation of the lung fields may yield rales.PNEUMONIA Tia_Sabrina (06-038) particles based on size. and decreased feeding. and electrostatic charges. and hypoxemia are common and may be accompanied by a persistent cough. Macrophages. lymphocytes. and 1 case per 100 children aged 9-15 years. gastric fluid aspiration or other causes of noninfectious inflammation. Patients often appear ill and may have more subtle physical findings than their overall clinical appearance may suggest. correctly recognizing any complications or underlying conditions. pneumonia remains a significant cause of morbidity in industrialized nations. impaired cough reflex. • Immunodeficiency and immunosuppression: These conditions increase predisposition for pneumonia. congestion. and several secreted substances (eg. the annual incidence rate of pneumonia was 4 cases per 100 children in the preschool-aged group. o During resolution. congestion. and aspiration: These conditions provide infectious organisms with easier access to the alveoli and terminal airspaces. and congestion. See Causes for specific details. neutrophils. Although most fatalities occur in developing countries. and pulmonary edema develops. newborn infants). and pulmonary edema: These conditions increase the predisposition for pneumonia. Disease progresses when the alveolar type II cells lose their • o • Fungal infections are unusual and are typically found in patients with inadequate immune function (eg. cigarette smoke. tracheostomy. This consolidation leads to decreased air entry and dullness to percussion. resulting in ventilation/perfusion (V/Q) mismatch and hypoxemia. shape. and lethargy. a hyaline membrane forms. Pathophysiology Inoculation of the respiratory tract by infectious organisms leads to an acute inflammatory response in the host that typically lasts 1-2 weeks. o Poorly ventilated areas of the lung may remain well perfused. o Extrapulmonary signs and symptoms include (1) abdominal pain or an ileus accompanied by emesis in patients with lower lobe pneumonia. bronchial obstruction. fever. properly diagnosing pneumonia. Bacterial infections The alveoli fill with proteinaceous fluid. • Ciliary dyskinesia. grunting. Fungal infections o o • o • The pathology may be a diffuse infiltrate of organisms or focal areas of fungal growth. thereby decreasing tidal volume. which affects diagnostic and therapeutic decisions. Toddlers and preschoolers: These children most often present with fever. wheezing. (2) nuchal rigidity in patients with right upper lobe pneumonia. Retractions result from the effort to increase intrathoracic pressure to compensate for decreased compliance. • Viral infections structural integrity and surfactant production is diminished. chest pain. mucociliary clearance. Age Pneumonia can occur at any age. Conditions that allow pneumonia-causing infectious organisms to circumvent the upper airway defense mechanisms include the following: • Intubation. Older infants: Grunting may be less common. Older children and adolescents o This group may also present with fever.

or by postnatal contact with other people or contaminated equipment. o If TB is not treated during the early stages of infection. Parainfluenza type 3 infection occurs in the spring. The affected lung field may be dull to percussion. and the treatments widely vary. or Staphylococcus aureus. accounting for approximately 90% of all lower respiratory infections. Klebsiella pneumoniae) are a common cause of bacterial pneumonia. 1621% of cases in older children. Infants infected with these organisms present between age 4-11 weeks with an afebrile pneumonia characterized by a staccato cough. or consolidation of a segment or lobe (usually right upper lobe). fungal. o RSV is the most common viral pathogen. basic laboratory and radiologic testing is often not helpful in determining the etiology of pneumonia. Ureaplasma urealyticum. o Some organisms acquired perinatally may not cause illness until later in infancy. cavitary lesions (in adolescents and adults only). contacts with persons in the penal system. o Children with TB usually do not present with symptoms until 1-6 months after primary infection. although predominantly in infants who have not completed their vaccinations or in children who did not receive vaccinations. and 30-50% of cases in college students and military recruits. Bacterial. In addition. o Other viruses that cause pneumonia less frequently in infants include adenovirus. hypotonia. with associated hyperreactive airways. coronavirus.PNEUMONIA Tia_Sabrina (06-038) sounds. A recent addition to this list is human metapneumovirus. acidosis. • Newborns (aged 0-30 d) o Infections with group B Streptococcus.8-2% of all pertussis cases and 16-20% of hospitalized cases. followed by parainfluenza types 1. or hypoxia that is out of proportion to ausculatory findings. To complicate matters. including Chlamydia pneumoniae. o Evidence suggests that breastfeeding has a protective effect against invasive pneumococcus. • School-aged children and adolescents: Bacterial pneumonia (10%) is common. Escherichia coli. These children may present with fever. and mycobacterial infections are relatively common and have similar presentations. However. premature infants may have chronic lung disease of prematurity. RSV infection occurs in the winter and early spring. rhinovirus. approximately 25% of children younger than 15 years develop extrapulmonary disease. immigrants from Africa. Community-acquired viral infections occur in newborns. irritability. o Children younger than 5 years. herpesvirus. They are often treated with an antibiotic within a month of contracting pneumonia. cough (which may include hemoptysis). Listeria monocytogenes. with gradual onset of malaise. via aspiration of organisms present in the birth canal. complicating clinical diagnosis. The most commonly isolated virus is respiratory syncytial virus (RSV). pleural effusion. although less commonly than in older infants. close contact with known individuals with TB). children enrolled in daycare. viral. or those with frequent ear infections are at increased risk for invasive pneumococcal disease and infection with resistant pneumococcal strains. making premature infants (who may not have benefited from sufficient transfer of transplacental immunoglobulin G [IgG]) especially vulnerable to lower-tract disease. headache. Decreased tactile and vocal fremitus. and baseline increased oxygen requirements. hypoxia. chlamydial. and 3 and influenza A or B. Children aged 5 years (ready to start school) o o Mycoplasma pneumoniae is the most common cause of community-acquired pneumonia and accounts for 20% of pneumonia cases in the general population. may be appreciated over the area of pneumonia. o Chest radiography findings may include hilar or mediastinal lymphadenopathy. certain parts of Asia. and. 2. and types 1 and 2 occur in the fall. cytomegalovirus. or gram-negative rods (eg. 9-16% of cases in early-school–aged children. or pleural friction rub. o A history of exposure to possible sources should be obtained (eg. fewer functional alveoli. The survival rate with this complication is much lower than in pneumonia attributed to other causes. which causes an illness similar to RSV and may be o • • responsible for one third to one half of non-RSV bronchiolitis. Infants or toddlers with bacterial pneumonia may present with lethargy. Causes Various organisms cause pneumonia. H influenzae type B (less common in immunized children). atelectasis. o Tuberculosis (TB) pneumonia in children warrants special mention. certain age trends in the etiology of pneumonia can aid in decision-making. and Pneumocystis carinii. These pathogens can be acquired in utero. tachypnea. even before testing is complete. Chlamydia pneumoniae is also fairly common in this age group and presents in a similar fashion. The transfer of maternal antibodies is important in protecting newborns and young infants from such infections. o Infants and postpubertal adolescents are at increased risk of disease progression. o Bacterial infections in this age group are uncommon and are attributable to Streptococcus pneumoniae. A study conducted in the United Kingdom showed that 59% of . and cytomegalovirus. Mycoplasma hominis. Influenza occurs in the winter. night sweats. Bronchopneumonia occurs in 0. as well as egophony. chills. Infants and toddlers o Viruses are the most common cause of pneumonia. and cough. mycoplasmal. Mycoplasma infections are indolent. occasionally. and weight loss. enterovirus. or miliary disease. and Eastern Europe. low-grade fever. Bordetella pertussis also causes pneumonia. and these children are often febrile and appear ill.

Because of the possible risks associated with lung aspiration. In these studies. suggesting that a blood culture may not always accurately reveal the lung pathogen. In addition. although a Gram stain may help.PNEUMONIA Tia_Sabrina (06-038) deaths from pertussis are associated with pneumonia. or are immunocompromised and an exact etiology is needed. and samples are always contaminated by oral flora. A blood culture is still recommended in complicated cases of pneumonia. The organisms obtained in the blood and lung aspirate differed in 4 of the 8 children in whom both culture results were positive. However. 2 infants with RSV infection may share a room. whereas such patients would normally need isolation and may unnecessarily tie up a bed. poor feeding. In general. malaise. including cultures. Therefore. in most patients with community-acquired pneumonia who are treated on an outpatient basis. For example. by definition. several diagnostic studies aimed at identifying the infectious culprit are warranted. performing a nasal wash for RSV and influenza enzyme-linked immunoassay (ELISA) and viral culture can help to establish a rapid diagnosis. Blood culture Although blood cultures are technically easy to obtain and relatively noninvasive and nontraumatic. and staphylococcal secondary infections are all relatively common. o In a study of 168 patients with known pneumonia. the patient has an empyema. Lung aspirate aspirate. Clinical presentation includes coryza. Candida species. Sputum culture Sputum is rarely produced in children younger than 10 years. For these reasons. Unfortunately.2 Blood culture implicated an organism in 18% of the patients compared with 52% with lung o • o o This test is performed for diagnostic and therapeutic purposes in children with pleural effusions. If the Gram stain or the culture result from the pleural fluid is positive or the WBC is higher than 1000 cells/mL. Thoracentesis • o • • o • • • • o • o • Although antiviral therapies are not often used. which may be helpful in excluding other diagnoses. treatment is empiric and based primarily on patient age and clinical presentation. quantitative cultures can help distinguish contamination from infection.7-3% had transient small hemoptysis complicating their lung aspirations. the results are rarely positive in the presence of pneumonia and even less so in cases of pretreated pneumonia. Viral pneumonias are common in this age group and are usually mild and self-limited. o o Flexible fiberoptic bronchoscopy is occasionally useful to obtain lower airway secretions for culture or cytology.59% of patients had a pneumothorax and 0. Lab Studies Identifying the causative infectious agent is the most valuable step in managing a complicated case of pneumonia. blood culture results are positive in 1015% of patients with streptococcal pneumonia (Media file 1). sputum cultures are not useful in most children with pneumonia. fever. or in patients suspected of having an infection with Pneumocystis. McCracken and associates found only sterile blood cultures. o The common agents that cause pneumonia may be normal oral flora. with or without aerobes. apnea. viral pneumonias are occasionally severe and can rapidly progress to respiratory failure. Other therapeutic decisions can be made based on the properties of the effusion (see Complications). Careful consideration of the diagnostic possibilities is o o • This test is underused and is a significantly more efficient method of obtaining a culture. 1. Group A streptococcal. . The numbers are even less in patients with Staphylococcus infection. and a CBC count with the differential and acute-phase reactants (erythrocyte sedimentation rate [ESR]. and cytomegalovirus can occur. opportunistic infections with organisms such as Aspergillus species. have not improved with previous empiric treatment. serology. o Viral cultures can be obtained in 12 days using newer cell culture techniques and may permit discontinuation of unnecessary antibiotics. Bronchoscopy necessary to send the samples for the appropriate tests. Pneumocystis species. o Contamination of the bronchoscopic aspirate with upper airway secretions is common. paroxysms of cough occasionally accompanied by emesis. An adequate sputum culture should contain more than 25 polymorphonuclear (PMN) cells per field and fewer than 10 squamous cells per field. if necessary. it should be reserved for patients who are ill enough to require hospitalization. patients with a bleeding diathesis. is the most common etiologic agent. o Other studies have demonstrated lung aspirate results to be positive in 50-60% of patients with known pneumonia. and cyanosis. C-reactive protein [CRP]). pneumococcal. Oral anaerobic flora. either as a primary manifestation of viral infection or as a consequence of subsequent bacterial infection. A study that compared the incidence of (1) positive culture results obtained with blood culture with (2) positive culture results obtained with lung aspiration in 100 children aged 3-58 months with pneumonia merits mention. as in adults. • Direct antigen detection correct diagnosis allows for appropriate placement of patients in the hospital. In patients with complicated pneumonia who have not responded to treatment or who require admission to the hospital. In immunosuppressed individuals. other fungi) or in patients who are severely ill. Aspiration pneumonia is more common in children with neurological impairment and swallowing abnormalities. This procedure is most useful in immunocompromised patients who are believed to be infected with unusual organisms (Pneumocystis. an etiologic agent can be difficult to identify. which may require drainage for complete resolution. o A lung aspirate should not be performed in patients who are on ventilators.

50% positive using PCR. Imaging Studies • Radiography o This is the primary imaging study used to confirm the diagnosis of pneumonia. Using an IgM-capture test in acute-phase serum. CRP.3 Acute and convalescent serum samples were collected and tested using enzyme immunoassay for M pneumoniae immunoglobulin M (IgM) and IgG antibodies. pleural fluid. The total WBC and differential may aid in determining if an infection is bacterial or viral. which may be larger) is 15 mm or larger. grunting. Arterial blood gas: This test is indicated in any patient with significant respiratory distress to determine the degree of respiratory insufficiency. however. and the results may not return until after the patient has already completed a course of antibiotics. or respiratory distress. malnutrition. chest radiography and ESR can be useful in monitoring the course of pneumonia. results are positive if the induration is 10 mm or larger. or biopsy specimen. PCR is noninvasive. All 24 cases had positive results with IgM-capture test with convalescent-phase serum. and. Positive results were confirmed with Southern hybridization of PCR products and an IgM test with solid-phase antigen. sputum. A total of 24 (9%) confirmed diagnoses of Mycoplasma infection were made. the best test for diagnosis is an early-morning gastric aspirate sent for acid-fast bacilli (AFB) stain. urine. Chest radiography helps to confirm the diagnosis of a child with positive Mantoux test results. together with clinical symptoms. which are more commonly used to aid in the diagnosis of Mycoplasma infection and demonstrate positive results in only 50% of cases. Among children younger than 4 years. Mantoux test results should be interpreted using the criteria outlined above. IgM serology is much more sensitive than cold agglutinin • assessments. This should be repeated on 3 consecutive mornings. o Chest radiography is indicated in an infant or toddler who presents with fever and any of the following: tachypnea. Nasopharyngeal aspirates were tested using PCR and cultured with a Pneumofast kit. In a Finnish study. or both) and sedimentation rate. Mantoux skin test (intradermal inoculation of 5 TU of purified protein derivative) results should be read 48-72 hours after placement. a sample is aspirated first thing the following morning. test results are positive if the induration is 5 mm or larger. they are not widely available. PCR. o Chest radiography is indicated primarily in complicated cases in . Although new serologic and PCR tests for common lung pathogens hold definite promise for making rapid. o o • Skin tests o o • These tests are used in diagnosing TB. are widely available and have proven to be of considerable benefit in the treatment of hospitalized patients. they are not always necessary or useful in determining the etiology of the infection. renal failure). In a child with suspected pulmonary TB. retractions. CBC count: Testing should include a CBC count with differential and evaluation of acute-phase reactants (ESR. as well as a PCR test for TB. accurate. cerebrospinal fluid. the cough may be scarce or nonproductive. however. C pneumoniae infection is diagnosed more readily with PCR than with culture. rales. Gastric aspirates should be obtained by first placing a nasogastric (NG) tube the night before sample collection. If the chest radiography findings are positive or if the child has other symptoms consistent with the diagnosis of TB. culture. and. In older children and adolescents. 278 patients diagnosed with communityacquired pneumonia underwent extensive testing for Mycoplasma infection. the diagnosis of pneumonia is often based on clinical presentation. before ambulation and feeding. decreased breath sounds. and 47% positive using culture. Similarly. an attempt should be made to isolate the tubercle bacilli from early-morning gastric aspirates. Therefore. Even if the child has received the Bacillus Calmette-Guérin (BCG) vaccine. more efforts are underway to develop quick and accurate serologic tests for common lung pathogens. In immunosuppressed children or those in close contact with others who have known or suspected cases of TB. Direct fluorescent antibody and serologic tests for RSV and influenza. positive test results must correlate with acute symptoms to have any validity because 2-5% of the population may be asymptomatically infected with C pneumoniae. those who have an increased environmental exposure to TB or other medical risk factors (eg. if • • available. lymphoma. 79% of results were positive. The authors of this study concluded that IgM serologic studies for Mycoplasma infection were not only quick but also sensitive and were the most valuable tools for diagnosis of M pneumoniae infection in any age group. diabetes mellitus. nasal flaring. Physicians often obtain radiographs when diagnosing pneumonia. test results are positive if the induration (not the area of erythema.PNEUMONIA Tia_Sabrina (06-038) • Serology o • o o o Because of the relatively low yield of cultures. an advantage over lung aspirate or bronchoalveolar lavage (BAL) cultures. and noninvasive diagnosis. 79% were positive using IgG serology. In children older than 4 years without any risk factors. such as M pneumoniae. Polymerase chain reaction o o o • o o This test shows promise of being useful in diagnosing streptococcal pneumonia.

In a study of children whose effusions were characterized as high grade based on ultrasonography findings. however. 2 radiologists who independently evaluated all chest radiographs were unable to distinguish whether the agent involved was bacterial. • Antibiotic administration must be targeted to the likely organism. Medical Care • Treatment decisions in children with pneumonia are dictated based on the likely etiology of the infectious organism and the age and clinical status of the patient. acid-fast bacilli are present and can be detected using the ZiehlNeelsen stain or can be grown on the Lowenstein-Jensen medium. and mucous plugging that results in atelectasis. Aspergillus and Zygomycetes species may be seen using simple hematoxylin and eosin staining. or unidentified. o In patients with bacterial pneumonia. Sputum. viral. no definitive studies have been performed in children. o Fungal elements may be seen using Gomori methenamine silver staining or periodic acidSchiff staining. Procedures • Bronchoscopy with BAL • Lung biopsy (guided with CT scanning or ultrasonography. viral pneumonias are associated with a patchy perihilar infiltrate. Early in the infection. Although these patterns are typical.PNEUMONIA Tia_Sabrina (06-038) which treatment fails to elicit a response. o Findings of foamy alveolar casts are practically diagnostic for Pneumocystis jiroveci pneumonia. In addition to a pleural effusion or empyema. • In young infants with bronchiolitis. Although trends in radiographic findings may prove useful. hospital stay was reduced by nearly 50% after surgery. gram-negative. particularly early in the course. bearing in mind the age of the patient. culture or immunostaining is required. particularly in cases in which the clinical examination findings are equivocal. whether to perform surgical debridement of organized empyemas or loculated effusions) and in outlining the projected course of the patient's illness. the history of exposure. o The radiographic appearance of Mycoplasma infection varies. This information is beneficial when making treatment decisions (eg. the etiology cannot be reliably identified based solely on chest radiography findings. Ultrasonography o These studies are indicated primarily in children with complications such as pleural effusions and in those in whom antibiotic treatment fails to elicit a response. o Ultrasonography is used to effectively differentiate between a low-grade (nonfibrinopurulent) effusion and one that is high-grade (fibrinopurulent and organizing). other suppurative complications of pneumonia include cavitary necrosis or abscess and purulent pericarditis. o Except for patients with sickle cell disease (SCD). o In general. • Contrast CT scanning o This test is also indicated in children with complications such as pleural effusions and in those in whom antibiotic treatment fails to elicit a response. Although most children do not expectorate sputum. depending on local resistance patterns). Caseating granulomas are highly suspicious. obtain a chest radiograph 6 weeks after treatment to verify resolution of the pneumonia and to screen for any underlying predisposing conditions. may be observed in numerous disease processes. o Ultrasonography may also prove useful for guidance in thoracentesis of a loculated effusion. but. as part of a video-assisted thorascopic surgery [VATS] procedure. such as sequestration. even in the absence of detectable organisms. A lobar infiltrate can be seen with viral infections. they are able to clear it from their lungs and to swallow it. and atelectasis on chest radiography. along with hilar adenopathy and pleural effusions. Furthermore. the possibility of resistance (which may vary. or complicated pneumococcal pneumonia. or biopsy material may yield diagnostic findings. chest percussion can be helpful in moving mucus and improving air entry (postpercussion auscultation often results in increased o o • . Pneumatoceles and abscesses are less commonly found but may indicate an S aureus. chest radiography findings frequently do not correlate with the infectious agent involved. Given the frequency of nonspecific findings obtained with imaging. although usually parapneumonic (80%). or during bronchoscopy) to assist in the diagnosis of infection with rare or unusual organisms Histologic Findings No specific histologic findings are reported in most patients with pneumonias beyond evidence of inflammation and cellular infiltration and exudation into alveolar spaces and the interstitium. Obtain both frontal and lateral radiographs. patchy and segmental areas of consolidation are noted. • Chest percussion is usually unnecessary in children with pneumonia. A significant number of these complications are not evident using radiography. Studies in adults have not shown benefit. Several studies have demonstrated that chest radiography is 42-73% accurate in predicting the etiology of a case of pneumonia. lavage. the pattern tends to be reticular and interstitial. as the infection progresses. In complicated cases of pneumonia. in patients respiratory distress. o Contrast CT scanning is often more sensitive and demonstrates changes typical for these complications. clinical presentation and other laboratory findings must be considered in the diagnosis of pneumonia and the determination of the etiologic agent. foreign body aspirations. or in those who require hospitalization. pleural effusions. o In patients with TB. a significant pleural effusion usually indicates a bacterial etiology. occasionally. hyperinflation. typical findings include a lobar consolidation with air bronchograms occasionally accompanied by a pleural effusion (Images 2-3). The specific morphology of the organisms may be diagnostic. In one study of 168 children with pneumonia. and other pertinent history. and the cup-shaped organisms are often found using Gomori methenamine silver staining or direct immunofluorescence. Chest radiography findings may be negative in the presence of pneumonia.

The role of steroids in this situation is controversial. respectively. degree of hydration. which responds to bronchodilators. administered as a nasal spray. it should still be considered in unvaccinated persons. However. younger than 2 months. or both and is not bronchodilator responsive. in years when vaccine strains have been mismatched with the circulating influenza strains. consideration of an anatomic abnormality is appropriate. o The vaccine exists in 2 forms: inactivated vaccine (various products). anorexia is commonly associated with inflammatory conditions. • VATS procedure may be performed for decortication of organized empyema or loculated effusions. the few studies that have involved children have not shown shortened hospital stays. can be trusted to limit their own activity when necessary. o Clinical trials are ongoing to lower the age of administration of Fluzone (made by Aventis Pasteur). Prevnar) contains epitopes to 7 different strains. Unless they are vomiting. degree of hypoxia. the most important tasks are resolving the symptoms and clearing the infiltrate. School-aged children o Many of these children do not require hospitalization and respond well to oral antibiotics. the whole treatment approach must be reconsidered. to 2 months (currently approved for • • • Transfer • • • • o Usually. the use of FluMist is cautioned in persons with known asthma because of reports of transient increases in wheezing episodes in the weeks after administration. However. and a resolution of the disease process. However. cough. which is currently licensed only for persons aged 2-49 years. and a cold-adapted attenuated vaccine (FluMist [made by MedImmune]). Influenza vaccine is recommended for children aged 6 months and older. the rates of HIB pneumonia have significantly declined. Conjugated and unconjugated polysaccharide vaccines for S pneumoniae have been developed for infants and children. even if that entails a slightly longer wait. Severe respiratory compromise may require intubation and transfer to a suitable ICU for more intensive monitoring and therapy. Diet • No specific dietary considerations are recommended. In a study of adults with pneumococcal pneumonia. Extra humidification of inspired air (eg. A parapneumonic effusion that Indications for transfer include refractory hypoxia. hypercapnia). administered as an intramuscular injection. most childhood pneumonias have complete radiologic clearing. decompensated respiratory distress (eg. Although some pneumonias are destructive (eg. they do not require intravenous fluids or antibiotics. • Children younger than 5 years: These children are hospitalized more often. as decompensation may be rapid. o Transfer may need to be initiated at a lower threshold for infants or young children. infants or children with reactive airway disease or asthma may react to a viral infection with bronchospasm. requires drainage usually dictates a hospital admission. vaccination is the primary mode of prevention. the infiltrate did not completely resolve in all patients until 8 weeks after therapy (although it was sooner in most patients). adenovirus) and can cause permanent changes. Macrolide antibiotics are useful in this age group because they cover the most common bacteriologic and atypical agents. mucus plugging. • Chest tube placement for drainage of an effusion or empyema may be performed. and systemic complications such as sepsis. Gentle activity should be encouraged. increasing levels of resistance to macrolides among streptococcal isolates should be considered (depending on local resistance rates). these patients are not toxic or hypoxic enough to require supplemental oxygen. tissue plasminogen activator [TPA]) may be indicated. o Although the vaccine is especially recommended for children at high risk. or asthma.PNEUMONIA Tia_Sabrina (06-038) wheezes and crackles because of the better air entry) and oxygenation. in general. and the wheezing that is sometimes heard in patients with pneumonia is usually caused by airway inflammation. With successful therapy. and steroids should probably not be initiated as routine because of the lack of evidence that they are beneficial and because of the risk of immunosuppression. • After initiating therapy. but their clinical status. who have not received their first shot. lessening tachypnea due to fatigue. even when the inactivated vaccine was entirely useless. cystic fibrosis. However. Activity • Activity stimulates mucus mobilization. o Transfer of very sick infants or young children to a pediatric ICU is best done with a specialist pediatric transfer team. follow-up radiography should be performed after 8 weeks. If a significant abnormality persists. Bronchodilators should not be routinely used. Even very young infants can benefit from repositioning to help shift mucus. Bacterial lower respiratory tract infections rarely trigger asthma attacks. However. The pneumococcal 7-valent conjugate vaccine (diphtheria CRM197 protein. although supplemental oxygen is frequently humidified for patient comfort. one of the inactivated intramuscular vaccines. Pneumococcal vaccine polyvalent (Pneumovax) covers 23 different strains. symptoms resolve much sooner that the infiltrate. Further Outpatient Care • If therapy fails to elicit a response. However. Deterrence/Prevention • Aside from avoiding infectious contacts (difficult for many families who use daycare facilities). and need for intravenous therapy dictate this decision. In a patient who is clinically doing well. such as those with bronchopulmonary dysplasia (BPD). FluMist has provided good protection (approximately 70%). including those o • . • Since the introduction of the conjugated H Influenzae type B (HIB) vaccine. compared with conventional medical transport or even air transport. • Children usually do not participate in vigorous activity if they are ill and. Surgical Care • Drainage of parapneumonic effusions with or without intrapleural instillation of a fibrinolytic agent (eg. room humidifiers) is also not useful.

Numax remains an investigational drug at this time with no plans for licensure for the 2007-2008 RSV season. Batuk kronis berulang yang sering menyerang anakanak adalah karena asma. and immunosuppression. In addition. Batuk akut adalah batuk yang berlangsung kurang dari 14 hari. palivizumab (Synagis [made by MedImmune]) at a dose of 15 mg/kg (maximum volume 1 mL per injection. CBC count with differential. Kemudian reseptor akan mengalirkan lewat syaraf ke pusat batuk yang berada di otak. visit eMedicine's Pneumonia Center. also made by MedImmune]) is in phase III clinical trials for similar indications and. [sunting] Akut dan Kronis Batuk dapat dibedakan menjadi dua jenis yaitu batuk akut dan batuk kronis. Prognosis • Overall. if approved. the prognosis is good. o Synagis has no role in the treatment of RSV infection. Clinical studies to evaluate the safety and efficacy of Numax in the setting of treating RSV infection in hospitalized children are ongoing. • Significant sequelae occur with adenoviral disease. dan pertusis (batuk rejan/batuk 100 hari). This pleural fluid is produced at 100 mL/h. Di sini akan memberi sinyal kepada otot-otot tubuh untuk mengeluarkan benda asing tadi. These may or may not require treatment depending on the size of the pneumothorax and whether it is under tension and compromising ventilation and cardiac output. Synagis has not been shown to reduce upper-respiratory infections with RSV. misalnya debu di reseptor batuk (hidung. Pertussis dapat dicegah dengan imunisasi DPT. and 10% is reabsorbed by the lymphatics. but unvaccinated. Amylase and lactase dehydrogenase (LDH) levels can also be measured but are less useful in a parapneumonic effusion than effusions of other etiologies. Bila batuk sudah lebih dari 14 hari atau terjadi dalam 3 episode selama 3 bulan berturut-turut. Monthly injections during the RSV season approximately halve the rate of serious RSV disease that leads to hospitalization. Pleural fluid accumulates when the balance between production and reabsorption is disrupted. Ninety percent of the fluid is reabsorbed on the visceral surface. hingga terjadilah batuk. especially in the context of necrotizing pneumonias or bullae formation. see eMedicine's patient education articles Viral Pneumonia and Bacterial Pneumonia. keduanya dikelompokkan berdasarkan waktu. A transudate accumulates in the pleural cavity when changes in the hydrostatic or oncotic pressures are not accompanied by changes in the membranes. Preliminary results from animal and small-scale human studies suggest that Numax may be effective in reducing RSV viral load in the upper and lower airways. The results help the physician determine if the effusion is a transudate or exudate and help to determine the best course of management for the effusion. Batuk ini banyak diakibatkan karena masalah emosi dan psikologis. . o A new monoclonal antibody (motavizumab [Numax. RSV prophylaxis consists of monthly intramuscular injections of a monoclonal humanized antibody. even in children with pneumonia that has been complicated by empyema or lung abscess. • • • A thin layer of fluid (approximately 10 mL) is usually found between the visceral and parietal pleura and helps prevent friction.PNEUMONIA Tia_Sabrina (06-038) children 6 months or older) to help protect this high-risk. Alergi Asma atau tuberculosis Benda asing yang masuk kedalam saluran napas Tersedak akibat minum susu Menghirup asap rokok dari orang sekitar Batuk Psikogenik. tuberkolosis (TB). population. Infeksi saluran pernafasan bagian atas (ISPA). Patient Education • For excellent patient education resources. • Pneumothorax: Severe coughing. Also. It reduces only the serious complications of infection. makanan. Batuk merupakan mekanisme pertahanan tubuh di saluran pernafasan dan merupakan gejala suatu penyakit atau reaksi tubuh terhadap iritasi di tenggorokan karena adanya lendir. and children with significant congenital heart disease. Numax showed a 26% improvement in preventing hospitalizations due to RSV and a 52% reduction in outpatient medically attended lower-tract RSV infections compared with Synagis. and protein assessment should be performed. Long-term alteration of pulmonary function is rare. serta dalam 1 episode. disebut batuk kronis atau batuk kronis berulang. oOOo • Batuk bukanlah suatu penyakit. Complications • Pleural effusions and empyemas When a child with pneumonia develops a pleural effusion. such as children younger than 2 years with chronic lung disease of prematurity. One study of intubated patients showed a reduction in viral titers but no change in clinical status. In an worldwide comparison between Numax and Synagis during the 2004-2006 RSV seasons. • Death occurs almost exclusively in children with underlying conditions. multiple injections may be required per dose). Pertusis adalah batuk kronis yang disebabkan oleh kuman Bordetella pertussis. saluran pernafasan. The pleural fluid should be obtained to assess pH and glucose levels and a Gram stain and culture. perhaps reflective of a large inflammatory component to the disease process. bahkan telinga). The safety and efficacy of this approach remains unknown. including bronchiolitis obliterans. congenital heart disease. asap dan sebagainya. [sunting] Penyebab batuk Ada beberapa macam penyebab batuk : Umumnya disebabkan oleh infeksi di saluran pernafasan bagian atas yang merupakan gejala flu. thoracentesis should be performed for diagnostic and therapeutic purposes. premature infants younger than 6 months (or with other risk factors). will likely replace Synagis. may lead to spontaneous pneumothoraces. o This expensive therapy is generally restricted to infants at high-risk. such as chronic lung disease of prematurity. Increased membrane permeability and hydrostatic pressure often result from inflammation and result in a subsequent loss of protein from the capillaries and an accumulation of exudates in the pleural cavity. Batuk terjadi karena rangsangan tertentu. debu.

Satu hal yang perlu diingat adalah bahwa batuk hanyalah merupakan gejala. yakni batuk produktif (biasa disebut batuk berdahak) dan batuk tidak produktif (lebih dikenal sebagai batuk kering). Your little one's forehead feels warm. even infants . can make a child Batuk kering yang kronis mungkin menjadi tanda asma ringan. You immediately suspect a fever. enalapril maleate. because fevers in newborns can indicate a serious infection. Asma. Hal ini dapat menyebabkan batuk produktif atau perasaan bahwa anda harus batuk terus-menerus untuk membersihkan tenggorokan anda. Sedangkan berdasarkan waktu berlangsungnya. But it's easy to learn how to correctly take a child's temperature when it's a little higher than usual. or some other cause. Batuk produktif memiliki ciri khas yaitu dada terasa penuh atau berbunyi. fever itself causes no harm and can actually be a good thing — it's often the body's way of fighting off infections. how to measure and treat them. Although it can be frightening when your child's temperature rises. hot. Batuk memiliki ciri khas. ensiklopedia bebas berbahasa Indonesia. batuk akut dan batuk kronis. Asam lambung yang kembali ke kerongkongan. gastroesophageal reflux. Penghambat ACE termasuk captopril. why does the hypothalamus tell the body to change to a new temperature? Researchers believe turning up the heat is the body's way of fighting the germs that cause infections and making the body a less comfortable place for them. asap. Perokok atau pengguna tembakau. Batuk produktif sebaiknya tidak ditekan karena batuk ini membantu membersihkan lendir di paru-paru. Gejala biasanya bertambah berat ketika terjaga dan berbicara. batuk kering mungkin bertahan selama beberapa minggu lebih panjang daripada gejala lain dan sering menjadi lebih buruk pada malam hari. may get fevers if they're overbundled or in a hot environment because they don't regulate their body temperature as well as older children. and when to call your child's doctor. High fever. Berdasarkan produktivitasnya. Batuk jenis ini biasanya disebabkan oleh bronkitis. Alergi. batuk ada 2 jenis. What Is Fever? Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level. Bronkospasme. Infeksi paru-paru atau saluran pernapasan bagian atas dapat menyebabkan batuk. Gejala lain mungkin termasuk mengi (napas berbunyi). Anak yang memiliki suhu tinggi karena suhu tinggi berkepanjangan dapat menyebabkan sawan. Most people's body temperatures even change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can fluctuate as kids run around. atau tuberkulosis. dikenal ada 2 jenis batuk. Demam adalah suatu keadaan di mana suhu badan melebihi 370C yang disebabkan oleh penyakit atau radang. though. disebut batuk kronis atau batuk kronis berulang. fevers usually don't indicate anything serious. Batuk produktif yang menyertai flu merupakan hal yang normal. but are unsure of what to do next. yaitu: Virus. Demam yang melebihi 3 hari mungkin merupakan malaria atau penyakit yang disebabkan oleh nyamuk lainnya. Most parents have experienced this scenario: You wake up in the middle of the night to find your child standing by your bed. however. and sweaty. Fever has several potential causes: Infection: Most fevers are caused by infection or other illness. especially newborns. Batuk produktif dapat merupakan tanda penyakit seperti Penyakit Paru Obstruktif Kronik (PPOK) yang bertambah buruk atau sebagai tanda bahwa anda telah terinfeksi. uncomfortable and aggravate problems such as dehydration. Common cold. Jenis batuk ini mungkin merupakan gejala gastroesophageal reflux dan mungkin dapat membangunkan anda saat tertidur. bronkitis. Ada beberapa penyebab batuk tidak produktif. Batuk produktif pada orang yang merokok atau menggunakan tembakau sering merupakan tanda kerusakan paru-paru atau iritasi tenggorokan atau kerongkongan. sinusitis. Setelah terserang flu. Batuk baru dapat ditentukan sebagai tanda suatu penyakit jika ada gejala lain yang muncul. baik oleh perokok aktif maupun pasif. illness. sehingga dapat dikenali. Jika batuk berlangsung lebih dari 3 minggu atau terjadi dalam 3 episode selama 3 bulan berturut-turut. and exercise. Fever helps the body fight infections by stimulating natural defense mechanisms. Infeksi. Should you get out the thermometer? Call the doctor? In healthy kids. dan bahan kimia di lingkungan kerja. bahan iritan. Terjadinya batuk sering dipicu oleh lendir yang mengalir sepanjang tenggorokan. And not all fevers need to be treated. The hypothalamus knows what temperature your body should be (usually around 98. mungkin menunjukkan kejang (spasme) di bronkial yang disebabkan oleh iritasi. bukan suatu penyakit. sesak napas.PNEUMONIA Tia_Sabrina (06-038) oOOo Hampir setiap orang pernah mengalami batuk. dapat membantu anda mengambil langkah yang tepat untuk mengatasi keluhan anda. Batuk Produktif Batuk produktif menghasilkan dahak atau lendir (sputum) sehingga lebih dikenal dengan sebutan batuk berdahak. Batuk jenis ini biasanya disebabkan oleh flu dan alergi. bentuk batuk yang sering ditemui merupakan jenis batuk akut ringan yang disertai demam ringan dan pilek. Ada beberapa penyebab batuk produktif. dan perubahan temperatur.6° Fahrenheit. atau rasa sakit di dada. seperti makanan atau pil. dan lisinopril. or about 37° Celsius) and will send messages to your body to keep it that way. Batuk tidak produktif. Batuk Akut atau Kronis? Batuk akut merupakan batuk yang berlangsung kurang dari 3 minggu serta terjadi dalam 1 episode. Obat pengontrol tekanan darah tinggi golongan penghambat ACE (Angiotensin Converting Enzyme). Kontak dengan debu. What Causes Fever? It's important to remember that fever by itself is not an illness — it's usually a symptom of an underlying problem. tuberkulosis. postnasal drip syndrome. Batuk ini sering dipicu oleh inhalasi partikel makanan. This thermostat is found in the part of the brain called the hypothalamus. asap rokok. Overdressing: Infants. Batuk tidak produktif sering membuat tenggorokan terasa gatal sehingga menyebabkan suara menjadi serak atau hilang. the hypothalamus will "reset" the body to a higher temperature in response to an infection. Dengan mengenali jenis batuk anda. So. Batuk semacam ini dapat merupakan gejala sisa dari infeksi virus atau flu. oOOo Demam Dari Wikipedia Indonesia. play. Lendir yang mengalir ke bagian belakang tenggorokan (postnasal drip syndrome). Read on for more about fevers. Mereka yang mengalami batuk produktif umumnya kesulitan bernapas dan disertai pengeluaran dahak. flushed. asma. Hambatan saluran udara karena benda yang dihirup. yaitu: Virus. dan pertusis (batuk rejan/batuk 100 hari). Sometimes. Batuk Tidak Produktif Batuk tidak produktif merupakan batuk yang tidak menghasilkan sputum sehingga disebut juga batuk kering. terutama malam hari. Penyakit paru-paru kronis. Batuk produktif dapat merupakan gejala dari pneumonia. Sering bersin juga gejala umum dari alergi radang selaput lendir hidung (allergic rhinitis). However.

Electronic ear thermometers measure the tympanic temperature — the temperature inside the ear canal. armpit. you can usually use a digital thermometer to take an oral temperature if your child will cooperate.5° Fahrenheit (37. Kids whose temperatures are lower than 102° Fahrenheit (38. If your child is between 3 months and 3 years old and has a fever of 102.2° Celsius) measured in an axillary position (under the arm) But how high a fever is doesn't tell you much about how sick your child is. call the doctor to see if he or she needs to see your child. If you need to know your child's exact temperature. Although they're quick and easy to use in older babies and children. The method you choose to take your child's temperature will depend on his or her age and how cooperative your child is. and are available in a range of prices. How Do I Know if My Child Has a Fever? A gentle kiss on the forehead or a hand placed lightly on your child's skin is often enough to give you a hint that your child has a fever. or continues to breathe fast after the fever comes down. However. but again. But now they recommend considering both the temperature and the child's overall condition. but the American Academy of Pediatrics (AAP) now says they should not be used because of concerns about possible exposure to mercury. They also require the child to keep the pacifier in the mouth for several minutes without moving. Glass mercury thermometers were once common. but they aren't reliable for taking an exact measurement. you'll get the most reliable reading by using a digital thermometer to take a rectal temperature.) As any parent knows. In these cases. If your child is between 3 months to 4 years old. When Can a Fever Be a Sign of Something Serious? In the past. Forehead thermometers also may be able to tell you if your child has a fever. Pacifier thermometers may seem convenient. you can use the tympanic method (with an electronic ear thermometer) or axillary method (with a digital thermometer). You need to know how the thermometer signals that the reading is complete (usually. (If you still have a mercury thermometer. are available at most supermarkets and pharmacies. However.4° Fahrenheit (38° Celsius) measured rectally (in the bottom) 99. be sure you know how to use it correctly to get an accurate reading. plastic strip thermometers are not the way to go. it's probably not the cause if a child's temperature is higher than 100° Fahrenheit (37. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104° Fahrenheit / 38. electronic ear thermometers aren't as accurate for infants 3 months or younger as digital thermometers and are more expensive. read the directions thoroughly. You could also use a digital thermometer to take an axillary temperature. not eating as much as usual is OK. Watching how your child behaves will give you a pretty good idea whether a minor illness is the cause or if your child should be seen by a doctor. Use a reliable thermometer to tell if your child has a fever when his or her temperature is at or above one of these levels: 100. especially in infants. many digital thermometers can be used for the following temperature-taking methods: oral (in the mouth) rectal (in the bottom) axillary (under the arm) Digital thermometers usually have a plastic. The child may sweat as the body releases extra heat when the temperature starts to drop.4° Fahrenheit (38° Celsius) or higher. or rectum. you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. it's a beep or a series of beeps or the . How to Use a Digital Thermometer A digital thermometer offers the quickest. especially in infants and very young children. Different Types of Thermometers Whichever type of thermometer you choose. do not simply throw it in the trash where the mercury can leak out. flexible probe with a temperature sensor at the tip and an easyto-read digital display on the opposite end. although this is a less accurate method. You should call the doctor if your child is having difficulty breathing. The illness is probably not serious if your child: is still interested in playing is eating and drinking well is alert and smiling at you has a normal skin color looks well when his or her temperature comes down And don't worry too much about a child with a fever who doesn't want to eat. And serious infections may cause no fever or even an abnormally low body temperature. Plastic strip thermometers (small plastic strips that you press against your child's forehead) may be able to tell you whether your child has a fever. doctors advised treating a fever on the basis of temperature alone. which is an environmental toxin. Although teething may cause a slight rise in body temperature. Although you should read the manufacturer's instructions to determine what method or methods the thermometer is designed for. is breathing faster than normal. which is a nearly impossible task for most babies and toddlers. taking a squirming child's temperature can be challenging. Digital thermometers usually provide the quickest. but are not as accurate as oral or rectal digital thermometers.9°–40° Celsius range). Sometimes kids with a fever breathe faster than usual and may have a higher heart rate. this method of taking a temperature (called tactile temperature) is dependent on the person doing the feeling and doesn't give an accurate measure of temperature.5° Celsius) measured orally (in the mouth) 99° Fahrenheit (37.PNEUMONIA Tia_Sabrina (06-038) who are overdressed must be evaluated by a doctor if they have a fever. If your child is younger than 3 months. They come in many sizes and shapes. Because fevers may rise and fall. take behavior and activity level into account. There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100. Even a slight fever can be a sign of a potentially serious infection in very young infants. Talk to your doctor or your local health department about how and where to dispose of a mercury thermometer. Immunizations: Babies and children sometimes get a low-grade fever after getting vaccinated. For kids who still drink and urinate normally.8° Celsius). But it's one of the most important tools doctors have to determine if a child has an illness or infection. call your doctor or go to the emergency department immediately. Before you use one. but this doesn't usually indicate a serious problem. their readings are less reliable than rectal temperatures and shouldn't be used in infants younger than 3 months. a child with fever might experience chills as the body tries to generate additional heat as its temperature begins to rise. This is very common with infections that cause fever. For older kids. kids who have frequent coughs or are breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. most accurate readings. most accurate way to take a child's temperature and can be used in the mouth.2° Fahrenheit (39° Celsius) or higher. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small.9° Celsius) often don't require medication unless they're uncomfortable. Keep and follow the manufacturer's recommendations for any thermometer. If your child is 4 years or older.

Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. cancer. Write down the number on the screen. You can find these solutions at pharmacies and supermarkets. not clothing). If your child also is vomiting and/or has diarrhea.4° Fahrenheit (38° Celsius) or higher older child with a temperature of higher than 102. Never use alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that may raise body temperature). (Unless instructed by a doctor. But don't worry — it's a simple process: Lubricate the tip of the thermometer with a lubricant. not all fevers need to be treated. Remind your child not to bite down or talk. Fever: A Common Part of Childhood . and make sure there's no gum or candy in your child's mouth. limit your child's intake of fruits and apple juice. which actually raises body temperature. Soothe your child and speak quietly as you hold the thermometer in place. noting the time of day that you took the reading. turn on the thermometer and make sure the screen is clear of any old readings. And in most cases. If your child has any medical problems. Remember that fever medication will usually temporarily bring a temperature down.e. a rare but potentially fatal disease. In general. or nails infant's soft spot on the head seems to be bulging outward or sunken inwards stiff neck severe headache limpness or refusal to move difficulty breathing that doesn't get better when the nose is cleared leaning forward and drooling seizure abdominal pain Also. flat surface and keep your palm along the lower back .PNEUMONIA Tia_Sabrina (06-038) temperature flashes in the digital window on the front of the thermometer). Stop if you feel any resistance.. lupus. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature. Remember to discard the sleeve after each use and to clean the thermometer according to the manufacturer's instructions before putting it back in its case. Fold your child's arm across the chest to hold the thermometer in place. insert the lubricated thermometer into the anal opening about ½ inch to 1 inch (about 1. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise. ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. such as petroleum jelly. First. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. cool water may cause shivering. Make sure your child gets plenty of rest. and place the thermometer under an armpit (it must be touching skin only. never give aspirin to a child due to its association with Reye syndrome. Whatever method you choose. sore throat or earache) still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older) has recurrent fevers. let your child eat what he or she wants (in reasonable amounts) but don't force eating if your child doesn't feel like it. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. To take an axillary temperature: This is a convenient way to take a child's temperature. Place your child: . the illness.5 centimeters). Write down the number on the screen. To take a rectal temperature: Before becoming parents. cooperative child. Don't offer sports drinks — they're not designed for younger children. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen. When to Call the Doctor The exact temperature that should trigger a call to the doctor depends on the age of the child. Giving a sponge bath can make your child more comfortable and help bring the fever down. Avoid drinks containing caffeine. Make sure your child's room is a comfortable temperature — not too hot or too cold. tongue. keep these additional tips in mind: Never take a child's temperature right after a bath or if he or she has been bundled tightly for a while — this can affect the temperature reading. Helping Kids Feel Better Again. soup. Although not as accurate as a rectal or oral temperature in a cooperative child. but it will not return it to normal — and it won't treat the underlying reason for the fever. If you don't know the recommended dose or your child is younger than 2 years. It's best to keep a child with a fever home from school or child care. a fever should be treated only if it's causing a child discomfort. If your thermometer uses disposable plastic sleeves or covers. Most doctors feel that it's safe to return when the temperature has been normal for 24 hours. or sickle cell anemia has a rash has pain with urination Seek emergency care if your child shows any of the following signs along with a fever: inconsolable crying extreme irritability lethargy and difficulty waking rash or purple spots that look like bruises on the skin (that were not there before the child got sick) blue lips.) Infants under 2 months old should not be given any medication for fever without being evaluated by a doctor. you can give acetaminophen or ibuprofen based on the package recommendations for age or weight.belly-down across your lap or on a firm. put one on according to the manufacturer's instructions. Staying in bed all day isn't necessary. Remove your child's shirt and undershirt. especially for kids who can't hold a thermometer in their mouths.or face-up with legs bent toward the chest with your hand against the back of the thighs With your other hand. noting the time of day that you took the reading. because they can cause increased urination.2° Fahrenheit (39° Celsius) Call the doctor if an older child has a fever of less than 102. not having tears when crying. noting the time of day that you took the reading. including colas and tea. most people cringe at the thought of taking a rectal temperature. call the doctor to find out how much to give. check with the doctor to see which medication is best to use. less alert and less active than usual) has a specific complaint (i. and the added sugars may make diarrhea worse. some parents may prefer to take an axillary temperature.25 to 2. ice pops. Here are ways to alleviate symptoms that often accompany a fever: If your child is fussy or appears uncomfortable. and to relax and breathe normally through the nose. but a sick child should take it easy. Water. Use only lukewarm water. even if they only last a few hours each night has a chronic medical problem such as heart disease. Never leave a child unattended while taking a temperature. Also. ask your child's doctor for his or her specific guidelines on when to call about a fever. and whether the child has other symptoms with the fever. Offer plenty of fluids to avoid dehydration — a fever will cause a child to lose fluids more rapidly.2° Fahrenheit (39° Celsius) but also: refuses fluids or seems too ill to drink adequately has persistent diarrhea or repeated vomiting has any signs of dehydration (urinating less than usual. and flavored gelatin are all good choices. Dress your child in lightweight clothing and cover him or her with a light sheet or blanket. Call your doctor if you have an: infant younger than 3 months with a temperature of 100. To take an oral temperature: This process is easy in an older.

always call your doctor for advice. and in the majority of cases.PNEUMONIA Tia_Sabrina (06-038) All kids get fevers. For older infants and children (but not necessarily for infants younger than 3 months). most are completely back to normal within a few days. . But if you're ever in doubt about what to do or what a fever might mean. Everyone gets cranky when they have a fever. the way they act is far more important than the reading on your thermometer. or if your child is acting ill in a way that concerns you even if there's no fever. This is normal and should be expected.

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