Lymphomas in Children and Adolescents

Cancer can be divided into leukaemia (mainly in blood and bone marrow) and
solid tumours, where one or more lumps are the likely origin of disease.
Lymphomas are solid tumours which can involve many different parts of the
body and can present at different ages. Some lymphomas resemble
leukaemias in their pattern of spread and are treated with leukaemia-type
treatment protocols. Because the various types of lymphoma behave in
different ways it is best to consider them under individual groupings.

Hodgkins Disease:
Hodgkins Disease usually presents as enlargment of the lymph glands which
are distributed in the neck, chest, armpits and groins. It is rare in young
children and is most likely to be seen in older children and adolescents.
Patients may present with a lump only, or they may notice fevers, night
sweats, weight loss or itchiness of the skin.

To be sure of the diagnosis a piece of tissue needs to be biopsied by a surgeon

which, after processing, is examined by a pathologist under a microscope.
Both chemotherapy (drugs) and radiation therapy are effective in Hodgkins
disease. In order to work out the best choice or combination of treatments for
the individual it is necessary to do further tests to evaluate the extent of the
disease beyond that which can be seen by the naked eye. These tests are
referred to as "staging" and the result will allow your doctor to ascertain the
stage (extent) and express it as a number. For example if the disease is not
found anywhere outside the original lump it is called Stage 1. If two or more
lumps are found close to each other it becomes Stage 11. If disease involves
both the upper and lower half of the body it is Stage 111. If it has got into the
blood stream and has spread to organs other than the lymph glands and their
related structures it is called Stage IV. In addition, the letter A will be added if
the patient has no major symptoms and the letter B is added if the symptoms
are considered to be significant by your doctor. So one can be Stage 11A or
11B, for example.

The intensity and duration of treatment will to some extent depend on the
stage. We will also be guided by the findings of the pathologist, who will
recognise certain sub-types of this disease in the cells provided from the
biopsy. The usual duration of therapy is in the range of six months. There are a
number of drug combinations that can be effective and a specific outline of
the drugs chosen for each patient will be provided, as well as a schedule of
their frequency and method of administration. Both general side effects of
chemotherapy and specific side effects of the drugs used in your schedule will
also be provided in this booklet. If radiation therapy is included in your
schedule, the relevant information will again be provided and you will have the
opportunity to discuss these matters with our radiation therapy specialist.

Non-Hodgkins Lymphoma:
Non-Hodgkins Lymphomas (NHL) are more common than Hodgkins disease
and, although they are solid tumours, they have many features in common with
acute lymphatic leukaemia (the commonest cancer seen in childhood). The
cancer cell of Non-Hodgkins Lymphoma is very similar to the cell of acute
lymphatic leukaemia but, unlike leukaemia, it frequently presents as a lump in
some part of the body. The most likely place that lump may present is in the
abdomen. It often produces no symptoms in the patient until it becomes very
large. In some cases, however, it may interfere with bowel or kidney function.

Non-Hodgkins Lymphoma is very prone to spread via the blood stream and can
do so very early in the course of the disease. Therefore, the initial tests we do
(including scans and x-rays) delineate the lump (for example in the abdomen)
and also look for possible spread away from the original lump. For this reason
bone marrow tests, analysis of spinal fluid, and various total body scans may
be required. If the disease has spread and cells are obtained from one of these
sites through a needle, then it may not be necessary or appropriate to perform
an operation before starting any other form of treatment. If, however, the
disease is found to be localised to the abdomen with no spread beyond, then a
specialist cancer surgeon may attempt removal of a majority of the cancer.

Chemotherapy is the main form of treatment used for Non-Hodgkins

Lymphoma. The intensity and duration of treatment depends on the extent of
the disease at presentation and the amount of tumour that can be removed by
operation. Using all this information your doctor will design a treatment
programme (schedule) appropriate to your situation. Radiation therapy is not
usually included for this particular condition. If the disease has spread widely,
and this unfortunately is the case in about two thirds of the patients, a very
intensive course of chemotherapy may be required. This protocol may include
drugs given by vein or as tablets and also given through the spinal fluid to
protect the brain and spinal cord from cancer cells. It is clear that this is a
very serious cancer that can spread quickly and become difficult to cure.

The next most common place where Non-Hodgkins Lymphoma in children and
adolescents may present is in the centre of the chest, known as the
mediastinum. In this region there is a gland called the thymus gland which is
closely involved with the lymphatic system. This gland may enlarge without
any symptoms but when it becomes very big it can obstruct the air tubes as
well as the veins draining the head and neck. An x-ray of the chest will show
the enlarged thymus gland and also possibly fluid in the lining of the lung. This
form of Non-Hodgkins Lymphoma is also likely to spread to the bone marrow
and spinal fluid. It may also spread to the lymph glands in the neck. Biopsy
material can often be obtained from one of these three sites and the tests
required for staging may not be as numerous as in other forms of lymphomas.

Fortunately, despite the high propensity to spread early, the "mediastinum

type" Non-Hodgkins Lymphoma is especially responsive to chemotherapy
regimens. The chemotherapy programme is very similar to the one used in
some forms of leukaemia (acute lymphatic leukaemia) and will run for two
years. Special treatment to protect the brain and spinal cord from the cancer
cells is required and consists of injection of drugs into the spinal fluid and for
some patients radiation to the brain may also be required. Radiation is not
used for other parts of the body under normal circumstances. There is also no
further role for surgical operations other than the original biopsy and rarely for
complications.

Occasionally, Non-Hodgkins Lymphoma may present as a lump in a lymph

gland, as a lump in the bone, in skin, thyroid gland, or the tonsils. The
principles of diagnosis and treatment are similar as described for disease
arising in the mediastinum (chest), but the choice for chemotherapy
programme may differ and some aspects need to be highly individualised
according to the particular findings in that patient. In some situations, when
disease is localised and not advanced, the treatment does not need to be very
intensive or prolonged. This does not apply to the mediastinum, because
lymphoma arising there always requires two years of treatment.

During treatment, some tests need to be repeated at regular intervals to check

that the disease is remaining under control. In addition, many tests are
designed to recognise early signs of possible side-effects of treatment so that
adjustments can be made if necessary. After treatment is finished checks
continue and some tests may still be required but they are done less often as
time goes by.

http://www.kids-cancer.org/lymphomas.htm

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Treatment of cancer and blood disorders

When a family practitioner or paediatrician suspects a child or adolescent to
have either cancer or some serious blood disease it is customary to refer the
patient to a centre that specializes in the treatment of those diseases. The
Centre for Children's Cancer and Blood Disorders at the Sydney Children's
Hospital is a specialist unit where a large multidisciplinary team of doctors
and other health care professionals provide all aspects of care for children
with cancer and blood diseases, as well as their families.
Though there are a number of people concerned with the treatment of cancer
in children with cancer, one particular specialist (the
haematologist/oncologist) will act as leader of the team and will be identified
as your personal doctor, responsible for your child, providing information,
answering your questions, and introducing you to other members of the team.
He will also be assisted by qualified junior doctors who are in the process of
becoming paediatricians (Registrars and residents) and who carry out many of
the day-to-day tasks required.

One of the four consultants will be "on call" for each month and will be
responsible for each new admission. At weekends this consultant will cover all
children in hospital and any problems with children at home. For children in
hospital for transplant, the four consultants rotate monthly with the
consultant "on call" looking after the transplant patients for the month.

The initial tests necessary for diagnosis of cancer as well as the more
complex aspects of treatment of cancer are carried out in the
Haematology/Oncology Ward (C2W). However, the majority of visits and
treatments are performed in a clinic setting, in the Outpatients Department on
Tuesday and Wednesday mornings, or in the Day Only/Procedures Unit (C2N).
As with all members of the team, the Nursing staff in the
Haematology/Oncology and Day Only Wards and the Outpatients Department
are specialized in the care of children with cancer and blood diseases.

The various tests and procedures required for diagnosis and treatment of
cancer will involve doctors and other professionals from different departments
of our hospital. For example, specialists in surgery, radiotherapy, radiology,
nuclear medicine, pathology and other laboratory services may be involved in
your child's diagnosis and treatment. Your doctor will communicate with all
other experts and design a programme appropriate for your child's individual
needs. He will outline that programme to you and help you understand what is
happening at present and what can be expected in the future. He will also
explain the use of drugs (chemotherapy) which can be very effective in the
treatment of cancer in childhood. The team also includes a specialist
pharmacist.

An initial discussion (conference) is arranged at a time when immediate family

members are able to attend. It is understood that when a family is confronted
by a major crisis, it is difficult to absorb a lot of new information. For that
reason we attempt to provide written information and are also available for
questions and revisions of the original family conference, in order to assure
that you feel adequately informed and understand both the benefits and
possible complications of the treatment that is being planned. In our view,
proper care of child and family also includes provision of psycho-social
services concerned with the emotional, psychological, social and financial
needs which we know often arise at such a time of crisis. The team includes
Social Workers, home care nurses, play activity therapists for children in the
ward or Outpatients Department, a clinical psychologist and a bereavement
(life crisis) counsellor.

Your local family doctor or paediatrician, who may know both your child and
the family well, continues to be an important member of the team although he
has referred primary care to a specialist. Some regular checks, as well as
some of the treatments can be given by these doctors in their offices or local
hospitals. These issues are particularly relevant to families that come from
distant suburbs or country centres. While your haematologist/oncologist
remains "the captain of the ship", the method of providing total care for each
individual child and family is to co-ordinate the whole team and offer flexibility
according to particular needs.

You will notice that a specialist centre also has a responsibility to improve the
treatment for all children, including those whose disease will be diagnosed in
the future. Therefore, certain aspects of treatment may include a research
component designed to find answers to some important questions. This is
clinical research. We also have a very active laboratory Research Unit in
which scientists study the biology and behaviour of cancer cells in a variety of
ways.

It is important for you to clearly understand how to obtain information or

medical attention at all hours of the day and night. The hospital switchboard
number (shown on your appointment card) is 9382-1111. During normal working
hours the switchboard can put you through to the office of your specialist. If
he is not available, his secretary will take a message and he will return the
call. Alternatively, and often more efficiently, you will know the name of the
registrar working with your doctor. You can page the registrar through the
switchboard (or the specialist's secretary) and he will discuss the problem
with you. If he needs the assistance of the specialist it will be his or her
responsibility to find the specialist and provide the information to you. In the
same manner, if you call on evenings or weekends, there is always a registrar
on duty and available within the hospital. Although that particular registrar
may not be attached to your oncologist at the time, he or she will contact the
specialist either at home or by outside paging systems and make it his or her
responsibility to pass the information to you. In the meantime, if urgent action
is indicated, that may be initiated by the registrar while awaiting further
discussion with the specialist. In addition, your specialist may indicate that he
wishes you to call him at home at night or on weekends in particular
situations.

If your specialist is on leave or at a conference, he/she will arrange for one of

their other three colleagues to cover for them. The four specialists on staff are
Professor Glen Marshall, Dr Susan Russell, Dr Tracey O'Brien and Dr Richard
Cohn.

Many families wonder about the benefit or danger of engaging in "alternative"

or unconventional methods of treatment for cancer. Furthermore, when the
diagnosis becomes known amongst your friends and relatives, advice,
suggestions, criticisms, and referrals to non-medical treatment centres are
often offered. Firstly, one needs to acknowledge that these doubts and
considerations are normal given each family's intense desire to offer the very
best available to their child. We recommend that all ideas and possibilities
that come up in this way be discussed freely with the medical team, and in
particular, your paediatric oncologist. We have access to specialist advice
including expert nutritionists, cancer pharmacologists, and psychologists.

Unfortunately, one cannot assume that unconventional treatments for cancer

will "at least do no harm". On the other hand, it would be wrong to generalize
that all unconventional treatment is dangerous and counter productive. What
is important is to evaluate what is being offered, to consider it in the context
of the treatment programme designed by your doctor, and to discuss any
concerns. The clearest distinction between conventional and so called
"alternative" forms of therapies is the rigour with which they have been
tested, proven beneficial, and controlled in their delivery. Good intentions are
no substitute for a carefully designed, tested, and proven treatment
programme.

It is most accurate to regard unconventional offers as "unproven methods of

treatment". In some instances medical scientists have conducted studies to
evaluate the possible role of these treatments. The results have shown no
benefit and often significant dangers. If the patient or family wishes to read
further regarding the various aspects of "unproven methods of treatment", we
have in the "Patient and Family Information Library" several brochures
(reprints) available. However, in all instances frank and open discussion is the
best way to address your doubts and anxieties and offer the patient the best
and safest available treatment programme.

Diagnosis
The principle procedures that are carried out on patients with cancer and leukaemia as part of
their diagnosis and therapy, are lumbar punctures (spinal taps), bone marrow aspirations and
biopsies, and intravenous chemotherapy and blood tests.

Lumbar Punctures are undertaken for diagnostic purposes and to give treatment into the
cerebrospinal fluid (CSF). This is the fluid that surrounds the brain and spinal cord. In some
illnesses there may be cancerous or leukaemic cells in this fluid. It was also shown many years
ago that some malignant diseases, in particular leukaemia, remained hidden in the CSF and if
special treatment to kill these cells was not given, the disease might regrow from there.
Therefore, many treatment protocols include regular lumbar punctures (and sometimes also
radiation). Lumbar punctures are not much more painful than an intravenous injection, but they
cause a lot of anxiety in both the patients and the parents. A needle is inserted in the back,
between 2 vertebrae (bones in the back) and fluid is tapped quite easily.

Bone marrow aspirations and biopsies are usually done at the time of diagnosis of many
malignant diseases and from time to time during the treatment, to ensure that the patient is free of
disease in the marrow. This procedure is somewhat painful, but the principle pain is during the
suction of the marrow from inside the bone. A needle is inserted into the hip bone at the back in
order to get to the marrow.

To alleviate the pain, fear and anxiety, a number of measures are available:

1. Time the procedures with a general anaesthetic when possible. This is often not
practicable.
2. Sedation for the procedure. This usually involves the child taking a tablet then having
an intramuscular injection to achieve a calm, sleeping state, but not as deeply asleep as
with general anaesthetic. This is effective in many patients but some children keep
waking up. Even if half awake, the child does not usually remember the procedure that
has been undertaken.
3. Explaining the procedures. With older and co-operative children, we spend some time
explaining the procedures and give them details of everything that is to be done. When
appropriate we also demonstrate with the use of a small doll as a model. We then allow
the patient the opportunity to play with the doll and do the procedures on it. We explain
the importance of the child remaining still during the procedure and we also offer a
prize/gift to the child if he/she has been still during the procedure.
4. Local anaesthetic cream - a cream applied painlessly over the area of skin where the
procedure will be done on the patient. If necessary, we also inject local anaesthetic for
extra pain reduction.

Often, we have been able to do lumbar punctures on children down to the age of three without
sedation and we have had excellent co-operation. Other than some crying during the slightly
painful times the children have been excellent and very proud of themselves at the end because
they were so "good".

For many older children and adolescents the most suitable method of sedation is the use of
nitrous oxide (laughing gas). Again adequate preparation and explanations are important to
obtain co-operation during what are new and sometimes scary experiences.

Chemotherapy is one of the most important parts of a patient's treatment. This can be given
either by mouth or by intramuscular (deep into the skin) injection. Some of the medications can
also be given intravenously and must not be allowed to leak otherwise serious burns to the skin
and underlying tissue can occur. For this reason it is important that the child be very still for an
injection.

After a while the children become used to having their intravenous treatment and they do not
remain anxious about this. We do attempt to have experienced people giving the injections but
we also need understanding and co-operation in instances where the procedures have to be
repeated. This is for the patient's benefit and despite the distress it needs to be done.

We have available three video cassettes that describe the procedures. One is a parent's attitude,
the other is a young child's attitude and the third is an older child's view. We also have a
relaxation cassette tape for parents if they themselves feel anxious about the procedures and
need some help.

We are always very happy to spend time with a child and his/her parents and to explain the
procedures any number of times in order to allay their fears and worries. Parents and children are
welcome to come to the procedures unit in the Day Only Unit and we would be happy to give
explanations and assistance as required.
 Home

About Hodgkin's Disease

Hodgkin's disease is a type of lymphoma, which is a cancer of the lymphatic system.

(The disease is sometimes also referred to as Hodgkin's lymphoma.)

The lymphatic system helps the body's immune system to filter out bacteria, viruses, and
other unwanted substances. The lymphatic system includes the lymph nodes (which are
sometimes referred to as glands), thymus, spleen, tonsils, adenoids, and bone marrow, as
well as the channels (called lymphatics or lymph vessels) that connect them.

Most people don't notice the workings of their lymphatic systems; in fact, the only time
you may be aware of your lymphatic system is when your lymph nodes swell up. This
often happens when a person is sick — a sign that the lymphatic system is working hard
to filter an infection out of the body.

Lymphoma is a disease in which cancer cells form in a person's lymphatic system and
start to grow uncontrollably. There are several different types of lymphomas, and they are
divided into two broad categories: Hodgkin's disease and non-Hodgkin's lymphoma.

Lymphomas that involve a particular type of cell, called a Reed-Sternberg cell, are
classified under the heading Hodgkin's disease. There are several different subtypes of
Hodgkin's disease, based on how the cancerous tissue looks under a microscope.

Lymphomas that do not contain Reed-Sternberg cells are classified under the heading
non-Hodgkin's lymphomas.

No one really knows exactly what causes Hodgkin's disease. People who have a brother
or sister who has had Hodgkin's disease seem to be slightly more likely to get the disease,
as are people who have had an organ transplant or acquired immunodeficiency syndrome
(AIDS). But just because you've had an organ transplant or have a compromised immune
system doesn't mean you'll get Hodgkin's disease. Most people with Hodgkin's disease
don't have any of these risk factors.

Signs and Symptoms

The signs and symptoms of Hodgkin's disease vary from person to person. Some people
may not notice symptoms at all or they may think their symptoms are caused by
something else. Some of the more common signs and symptoms are:

 swollen lymph nodes in the neck, armpit, or groin area that don't go away
 fever
 night sweats
  weight loss over several months despite eating normally
 tiredness and weakness
 coughing or shortness of breath
 itching

The symptom that most people notice first is swollen lymph nodes. Of course, swollen
lymph nodes usually don't mean cancer — they're most often a sign of a common illness,
like an infection. In fact, all of the symptoms of Hodgkin's disease can also be caused by
other conditions, which is why only a doctor can determine what's really wrong.

Diagnosis

As with other health problems, a doctor will perform a physical exam and ask about a
person's medical history (such as diseases that you or your family members may have or
have had in the past). One of the things doctors might look for if they suspect lymphoma
is enlargement of the lymph nodes. Doctors may try to treat swollen lymph nodes with
antibiotics, because infections are the most common cause of swollen lymph nodes. But
if the lymph nodes remain swollen, the doctor may order a biopsy.

A biopsy is a type of test in which a doctor removes a tiny bit of tissue or fluid from the
body and sends it out to a laboratory for a specialist to examine under a microscope.
There are several kinds of biopsies. In the case of Hodgkin's disease, a doctor usually
orders one of two types:

 Fine needle aspiration. The doctor uses a very thin needle to suction out a small
amount of tissue from the lymph node.
 Excisional or incisional biopsy. The doctor opens the skin to remove the entire
enlarged lymph node (excisional) or only part of it (incisional).

A doctor may use either local anesthesia (where only a part of the body is numbed) or
general anesthesia (where a person is asleep) to ensure the person doesn't feel any pain
during these biopsies.

If your doctor suspects Hodgkin's disease, he or she will refer you to an oncologist, a
doctor who specializes in the treatment of cancer. The oncologist will do more tests to
find out whether the cancer has spread. This process is called staging. Some of these tests
are:

 blood tests
 a chest X-ray
 a computed tomography (CT or CAT) scan, a type of X-ray that rotates around
the patient and creates a picture of the inside of the body from different angles
 a magnetic resonance imaging (or MRI) scan, which use magnets and radio
waves to allow doctors to see inside the body (the person lies inside the machine
while it takes images)
 a bone marrow biopsy to check for cancer in the bone marrow
  a gallium scan, which uses the injection of a chemical called gallium to detect
tumors and inflammation
 a positron emission tomography (PET) scan, which can tell the difference
between normal and abnormal cells based on their metabolic activity

These tests don't usually hurt. If the tests will be uncomfortable, doctors give their
patients anesthesia or other pain-reducing medications. In some cases, doctors may
perform surgery to determine the stage of the cancer. One such surgical test is a
laparotomy, in which the person is put to sleep and a surgeon operates to examine the
internal organs. But these surgical procedures are becoming rare given the wide variety of
imaging technologies available today.

Treatment

Treatment for Hodgkin's disease is very effective for most people. The type and length of
treatment varies, depending on the stage and type of the disease; where the disease is
found in the body; and the person's age, physical maturity, and overall health.

The most common treatment for non-Hodgkin's lymphoma is chemotherapy.

Chemotherapy kills or stops the growth of cancer cells. Patients are also sometimes
treated with radiation therapy. In addition, some people may have surgery to remove
tumors.

For some patients who are getting very aggressive chemotherapy or radiation treatments,
doctors may perform bone marrow or stem cell transplants to replace cells that have been
damaged by the chemotherapy or radiation. These procedures involve taking the cells
from bone marrow or blood that has either been taken from the patient and treated to
remove cancerous cells or has been donated by another person. These cells are then
inserted into the patient's bloodstream to replace those that have been damaged or
destroyed.

Researchers are constantly working on new treatments for cancer. Some people decide to
participate in clinical trials, which are ways to test new cancer treatments or compare
their effectiveness with existing treatments. If you have Hodgkin's disease, your doctor
can tell you whether these are a good idea for the particular type you have.

What to Expect

Treatment for Hodgkin's disease is powerful. It destroys good cells along with bad, which
can create certain side effects.

Although the side effects depend on the individual and the medicine that a doctor
prescribes, the most common short-term side effects of chemotherapy are nausea,
vomiting, or a flu-like feeling. Some people feel weak or dizzy after their treatments, or
they run a fever. Others get sores in their mouths or suddenly don't feel much like eating.
It's also common for people to lose some or all of their hair.
The short-term side effects of radiation can be similar to those of chemotherapy, although
the side effects of radiation are usually more localized, meaning they affect only the area
that receives the radiation treatment. People can continue to feel side effects for weeks
after their treatment ends.

Chemotherapy and radiation treatments can weaken a person's immune system. If you're
getting one of these treatments, steer clear of friends and family with colds, the flu, or
other infections. You also need to avoid cuts and other injuries. It's best to put sports and
the more strenuous forms of physical activity on hold, but you can still stay active with
gentle forms of exercise, like walking.

Tell your doctor if you experience any side effects of treatment. Your doctor can also tell
you about possible long-term side effects of the type of treatment you are having.

It can be hard to deal with the side effects of treatment. Perhaps you feel tired and
nauseous, and you have to deal with losing your hair. It's important to lean on your
parents, other family, and friends. If you want, talk to a psychologist, who will listen to
your feelings privately and without judgment. You also can join a support group, where
you'll meet and talk to people who have Hodgkin's or other cancers and are dealing with
the same problems you are.

If you have or have had Hodgkin's disease, it's important to see your doctor regularly for
the years following treatment. Occasionally, cancer may return, and follow-up
appointments with your cancer specialist can help you catch it early if it does.

After Hodgkin's disease is gone, most people never get it again. However, some do. The
term "recurrent" describes Hodgkin's disease that returns after treatment to the same area
or a new one. If you have symptoms, tell your doctor. Some people can also develop
other cancers after being treated for Hodgkin's, which will require more treatments.

Most people survive Hodgkin's disease and go on to live normal, productive lives.

Reviewed by: Donna Patton, MD

Date reviewed: June 2007

http://kidshealth.org/college/diseases_conditions/cancer/hodgkins.html

PNEUMONIA

Pengertian Pnemonia
Pnemonia adalah proses infeksi akut yang mengenai jaringan paru-paru (alveoli).
Terjadinya pnemonia 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 permenit atau lebih pada anak usia 1 tahun sampai kurang dari 5
tahun. Pada anak dibawah usia 2 bulan, tidak dikenal diagnosis pnemonia.
Pneumonia Berat ditandai dengan adanya batuk atau (juga disertai) kesukaran bernapas,
napas sesak atau penarikan dinding dada sebelah bawah ke dalam (severe chest
indrawing) pada anak usia 2 bulan sampai kurang dari 5 tahun. Pada kelompok usia ini
dikenal juga Pnemonia sangat berat, dengan gejala batuk, kesukaran bernapas disertai
gejala sianosis sentral dan tidak dapat minum. Sementara untuk anak dibawah 2 bulan,
pnemonia berat ditandai dengan frekuensi pernapasan sebanyak 60 kali permenit atau
lebih atau (juga disertai) penarikan kuat pada dinding dada sebelah bawah ke dalam.
Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P2ISPA
(Pemberantasan Penyakit Infeksi Saluran Pernafasan Akut). Program ini mengupayakan
agar istilah Pnemonia lebih dikenal masyarakat, sehingga memudahkan kegiatan
penyuluhan dan penyebaran informasi tentang penanggulangan Pnemonia.
Program P2ISPA mengklasifikasikan penderita kedalam 2 kelompok usia:
Usia dibawah 2 bulan (Pnemonia Berat dan Bukan Pnemonia)
Usia 2 bulan sampai kurang dari 5 tahun (2 bulan - Pnemonia, Pnemonia Berat dan
Bukan Pnemonia )
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. Penyakit ISPA diluar pnemonia ini
antara lain: batuk-pilek biasa (common cold), pharyngitis, tonsilitis dan otitis.
Pharyngitis, tonsilitis dan otitis, tidak termasuk penyakit yang tercakup dalam program
ini.
Pneumonia merupakan masalah kesehatan di dunia karena angka kematiannya tinggi,
tidak saja dinegara berkembang, tapi juga di negara maju seperti AS, Kanada dan negara-
negara Eropah. Di AS misalnya, terdapat dua juta sampai tiga juta kasus pneumonia per
tahun dengan jumlah kematian rata-rata 45.000 orang.
Di Indonesia, pneumonia merupakan penyebab kematian nomor tiga setelah
kardiovaskuler dan tuberkulosis. Faktor sosial ekonomi yang rendah mempertinggi angka
kematian. Gejala Pneumonia 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 luman. Tapi akibatnya fungsi paru terganggu,
penderita mengalami kesulitan bernapas, karena tak tersisa ruang untuk oksigen.
Pneumonia yang ada di masyarakat umumnya, disebabkan oleh bakteri, virus atau
mikoplasma ( bentuk peralihan antara bakteri dan virus ). Bakteri yang umum adalah
streptococcus Pneumoniae, Staphylococcus Aureus, Klebsiella Sp, Pseudomonas sp,vIrus
misalnya virus influensa.

Mengobati Pneumonia
Anda mengalami tanda-tanda penumonia ?, Jangan khawatir, kesempatan sembuh masih
amat besar dengan syarat-syarat berikut ini; usia masih muda, dideteksi sejak dini, sistem
kekebalan tubuh bekerja dengan baik, infeksi belum menyebar, dan tidak ada infeksi lain.
Pengobatan awal biasanya adalah antibiotik, yang cukup manjur mengatasi penumonia
oleh bakteri, mikoplasma dan beberapa kasus rickettsia.
Untuk pneumonia oleh virus sampai saat ini belum ada panduan khusus, meski beberapa
obat antivirus telah digunakan. Kebanyakan pasien juga bisa diobati dirumah. Biasanya
dokter yang menangani peneumonia akan memilihkan obat sesuai pertimbangan masing-
masing, setelah suhu pasien kembali normal, dokter akan menginstruksikan pengobatan
lanjutan untuk mencegah kekambuhan. Soalnya, seranganberikutnya bisa lebih berat
dibanding yang pertama. Selain antibiotika, pasien juga akan mendapat pengobatan
tambahan berupa pengaturan pola makan dan oksigen untuk meningkatkan jumlah
oksigen dalam darah.
Pada pasien yang berusia pertengahan, diperlukan istirahat lebih panjang untuk
mengembvalikan kondisi tubuh. Namun, mereka yang sudah sembuh dari dari pneumonia
mikoplasma akan letih lesu dalam waktu yang panjang. Secara rutin, pasien yang sudah
sembuh dari pneumonia jangan dilarang kembali melakukan aktifitasnya. Namun mereka
perlu diingatkan untuk tidak langsung melakukan yang berat-berat. Soalnya, istirahat
cukup merupakan kunci untuk kembali sehat.
Untuk menangani pernapasan akut parah ( Severe Acute Respiratory Syndrom/SARS)
yang masih misterius, organisasi Kesehatan Dunia (WHO) menganjurkan para petugas
kesehatan untuk menerapkan Universal Precautions. Artinya, mereka harus mengenakan
sarung tangan, masker, sepatu boot dan jas yang melindungi seluruh tubuh dari kontak
langsung dengan penderita. Buat penderitanya juga dianjurkan untuk mengenakan masker
dan pelindung lain sampai SARS-nya ditanggulangi. Pasien yang dicurigai atau
kemungkinan besar terkena SARS harus diisolasi. Ruang perawatannya harus bertekanan
rendah dengan pintu tertutup rapat, tidak sharing dengan pasien lain ( termasuk dengan
pasien sindrom serupa ) dan punya fasilitas kamar mandi dan kloset sendiri.
Semua peralatan yang digunakan sebaiknya sekali pakai dan ruangan dibersihkan dengan
menggunakan desinfektans yang mengandung antibakteri, antivirus dan antijamur. Pasien
sebaiknya dijaga tidak banyak bergerak. Pasien maupun para petugas kesehatan yang
menangani dianjurkan untuk selalu mencuci tangan dengan sabun untuk menghindari
penyebaran. Karena antibiotika berspekturm luas tidak menunjukkan efektifitas
menangani SARS, WHO lebih menganjurkan untuk memanfaatkan suntikan intravena
ribavirin dan steroid untuk menstabilkan kondisi pasien yang sudah kritis.

Kenali Pneumonia biar tak Terlambat

PNEUMONIA sebenarnya bukan peyakit baru. American Lung Association misalnya,
menyebutkan hingga 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
dan menjadi penyebab kematian ketujuh di negara itu.
Pneumonia adalah infeksi yang menyebabkan paru ? paru meradang. Kantung-kantung
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. Gara ? gara 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 Oleh Bakteri
Pneumonia yang dipicu bakteri bisa menyerang siapa saja, dari bayi sampai usia lanjut.
Pencandu alkohol, pasien pasca-operasi, orang-orang dengan penyakit gangguan
pernapasan, sedang terinfeksi virus atau menurun kekebalan tubuhnya, adalah yang
paling berisiko. Sebenarnya bakteri penyebab pneumonia yang paling umum adalah
Streptococcus pneumoniae sudah ada di kerongkongan manusia sehat. Begitu pertahanan
tubuh menurun oleh sakit, usia tua, atau malnutrisi, bakteri segera memperbanyak diri
dan menyebabkan kerusakan.
Seluruh jaringan paru dipenuhi cairan dan infeksi dengan cepat menyebar ke seluruh
tubuh melalui aliran darah. Pasien yang terinfeksi pneumonia akan panas tinggi,
berkeringat, napas terengah-engah, dan denyut jantungnya meningkat cepat. Bibir dan
kuku mungkin membiru karena tubuh kekurangan oksigen. Pada kasus yang eksterm,
pasien akan mengigil, gigi bergemelutuk, sakit dada, dan kalau batuk mengeluarkan
lendir berwarna hijau. Sebelum terlambat, penyakit ini masih bisa diobati. Bahkan untuk
pencegahan vaksinnya pun sudah tersedia.

Pneumonia Oleh Virus

Setengah dari kejadian pneumonia diperkirakan disebabkan oleh virus. Saat ini makin
banyak saja virus yang berhasil diidentifikasi. Meski virus-virus ini kebanyakan
menyerang saluran pernapasan bagian atas-terutama pada anak-anak- gangguan ini bisa
memicu pneumonia. Untunglah, sebagian besar pneumonia jenis ini tidak berat dan
sembuh dalam waktu singkat.
Namun bila infeksi terjadi bersamaan dengan virus influensa, gangguan bisa berat dan
kadang menyebabkan kematian, Virus yang menginfeksi paru akan berkembang biak
walau tidak terlihat jaringan paru yang dipenuhi cairan.
Gejala Pneumonia oleh virus sama saja dengan influensa, yaitu demam, batuk kering
sakit kepala, ngilu diseluruh tubuh. Dan letih lesu, selama 12 ? 136 jam, napas menjadi
sesak, batuk makin hebat dan menghasilkan sejumlah lendir. Demam tinggi kadang
membuat bibir menjadi biru.

Pneumonia Mikoplasma
Pneumonia jenis ini berbeda gejala dan tanda-tanda fisiknya bila dibandingkan dengan
pneumonia pada umumnya. Karena itu, pneumonia yang diduga disebabkan oleh virus
yang belum ditemukan ini sering juga disebut pneumonia yang tidak tipikal ( Atypical
Penumonia ).
Pneumonia mikoplasma mulai diidentifikasi dalam perang dnia II. Mikoplasma adalah
agen terkecil dialam bebas yang menyebabkan penyakit pada manusia. Mikoplasma tidak
bisa diklasifikasikan sebagai virus maupun bakteri, meski memiliki karakteristik
keduanya.
Pneumonia yang dihasilkan biasanya berderajat ringan dan tersebar luas. Mikoplasma
menyerang segala jenis usia. Tetapi paling sering pada anak pria remaja dan usia muda.
Angka kematian sangat rendah, bahkan juga pada yang tidak diobati.
Gejala yang paling sering adalah batuk berat, namun dengan sedikit lendir. Demam dan
menggigil hanya muncul di awal, dan pada beberapa pasien bisa mual dan muntah. Rasa
lemah baru hilang dalam waktu lama.
Pneumonia Jenis Lain
Termasuk golongan ini adalah Pneumocystitis Carinii pnumonia ( PCP ) yang diduga
disebabkan oleh jamur, PCP biasanya menjadi tanda awal serangan penyakit pada
pengidap HIV/AIDS.
PCP bisa diobati pada banyak kasus. Bisa saja penyakit ini muncul lagi beberapa bulan
kemudian, namun pengobatan yang baik akan mencegah atau menundah kekambuhan.
Pneumonia lain yang lebih jarang disebabkan oleh masuknya makanan, cairan , gas, debu
maupun jamur.
Rickettsia- juga masuk golongan antara virus dan bakteri-menyebabkan demam Rocky
Mountain, demam Q, tipus, dan psittacosis. Penyakit-penyakit ini juga mengganggu
fungsi Paru, namun pneumonia tuberkulosis alis TBC adalah infeksi paru paling
berbahaya kecuali dioabati sejak dini.

Tanggal dibuat : 19/03/2005 @ 13:56

Revisi terakhir : 03/02/2007 @ 12:19
Kategori : PENYAKIT
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