PBL blok 18 pneumonia pada anak

Pneumonia pada Anak 

Pneumonia pada Anak 

Maria Amelia Goldie Maria Amelia Goldie

102013119 102013119 FAKUL

FAKULTTAS KEDOKAS KEDOKTERAN TERAN UNIVERSUNIVERSITAS KRIDA WAITAS KRIDA WAANAANA !l" A

!l" Ar#$%a U&ara No" '( Ke)or#$%a U&ara No" '( Ke)o% !er$* + !a*ar&a% !er$* + !a*ar&a ,oldie-e%$r.,mail"/om

,oldie-e%$r.,mail"/om

A)&ra*  A)&ra* 

%e$mo%ia adala i%e*i al$ra% 4er%aaa% a*$& )a,ia% )a-a 4are%*im 4ar$ 5a%, me%,e%ai #ari%,a% %e$mo%ia adala i%e*i al$ra% 4er%aaa% a*$& )a,ia% )a-a 4are%*im 4ar$ 5a%, me%,e%ai #ari%,a%  4ar$64ar$ 5a%,

 4ar$64ar$ 5a%, meli4$&i al7eol$ meli4$&i al7eol$ da% da% #ari%,a% i%&er&iial 5a%, #ari%,a% i%&er&iial 5a%, die)a)*a% ole die)a)*a% ole )erma/am6ma/am e&iolo,i e4er&i)erma/am6ma/am e&iolo,i e4er&i  )a*&eri(

 )a*&eri( 7ir$( 7ir$( #am$r #am$r da% da% )e%da )e%da ai%," ai%," ara ara 4e%$lara% 4e%$lara% melal$i melal$i 4er/i*a% 4er/i*a% l$da( l$da( *o%&a* *o%&a* la%,$%, la%,$%, le-a& le-a& m$l$& m$l$& a&a$a&a$ *o%&a* &ida* la%,$%, melal$i 4erala&a% 5a%, &er*o%&ami%ai 4ada al$ra% 4er%aaa%" Ge#ala *li%i 4%e$mo%ia *o%&a* &ida* la%,$%, melal$i 4erala&a% 5a%, &er*o%&ami%ai 4ada al$ra% 4er%aaa%" Ge#ala *li%i 4%e$mo%ia a%&

a%&ara ara lailai% % demdemam( am( )a&)a&$*( $*( eea*( a*( 4er4er%a4%a4aaaa% % da%da%,*a,*al( l( rere&ra&ra*i *i elela a i,ai,a( ( 4er4er%a4%a4aaaa% % /$4/$4i%, i%, idid$%,$%,( ( %a%aaa me%de%,*$r( )a*a% ia%oi"

me%de%,*$r( )a*a% ia%oi"

Ka&a K$%/i 8

Ka&a K$%/i 8 %e$mo%ia( I%e*i Sal$ra% Naa%e$mo%ia( I%e*i Sal$ra% Naa

 Abstract   Abstract 

 Pneumonia is a

 Pneumonia is a respirarespiration tract infection on tion tract infection on down side lung down side lung parenchymparenchyma which a which contaminate lung tissuescontaminate lung tissues  such as

 such as alveoli and interstitial tissue alveoli and interstitial tissue caused by caused by bacterias, viruses, parasitic fungi, bacterias, viruses, parasitic fungi, and the and the other unknown objects.other unknown objects. The transmission through saliva splashed, direct contact through mouth and undirect contact through hospital  The transmission through saliva splashed, direct contact through mouth and undirect contact through hospital  equipments which contaminated to respiration tract. The manifestation of pneumonia are fever, cough, asphyxiate, equipments which contaminated to respiration tract. The manifestation of pneumonia are fever, cough, asphyxiate,  shallow br

 shallow breath, costal eath, costal retractretraction, snoring brion, snoring breath, even ceath, even cyanosis.yanosis.

 ey !

Pendahuluan

%e$mo%ia adala $a&$ 4e%5a*i& i%e*i a&a$ 4erada%,a% 4ada or,a% 4ar$64ar$ 5a%, die)a)*a% ole )a*&eri( 7ir$( #am$r a&a$4$% 4arai& di ma%a al7eol$ 5a%, )er&a%,,$%, #a-a) me%5era4 o*i,e% dari a&moer &eri%lamai da% &erii ole /aira%" %e$mo%ia da4a& #$,a die)a)*a% ole iri&ai *imia a&a$ ii* dari 4ar$64ar$ a&a$ e)a,ai a*i)a& dari 4e%5a*i& lai%%5a( e4er&i *a%*er 4ar$64ar$ a&a$ &erlal$ )a%5a* mi%$m al*ool( %am$% 4e%5e)a) 5a%, 4ali%, eri%, iala era%,a% )a*&eria %treptococcus pneumoniae( a&a$ 4%e$mo*o*$" Se)el$m 4e%em$a% dari a%&i)io&i*6a%&i)io&i*( a&$ 4er &i,a dari em$a ora%,6ora%, 5a%, &ela me%,em)a%,*a%  4%e$mo%ia e$da i&$ me%i%,,al dari i%e*i" Saa& i%i( le)i dari &i,a #$&a ora%,6ora%, me%,em)a%,*a% 4%e$mo%ia e&ia4 &a$% di Ameri*a" Le)i dari e&e%,a #$&a dari ora%,6ora%, i%i dio4%ame die)$a r$ma a*i& $%&$* 4era-a&a%" Me*i4$% *e)a%5a*a% dari ora%,6ora%, i%i em)$( *ira6*ira : a*a% me%i%,,al dari 4%e$mo%ia" %e$mo%ia adala 4emim4i% *e e%am  4e%5e)a) *ema&ia% di Ameri*a" %e$mo%ia eri%, *ali dideri&a e)a,ia% )ear ora%, 5a%, la%#$& $ia da% mere*a 5a%, memili*i 4e%5a*i& *ro%i* e)a,ai a*i)a& r$a*%5a i&em *e*e)ala% &$)$ a*a% &e&a4i 4%e$mo%ia #$,a )ia me%5era%, *a$m m$da 5a%, )er&$)$ ea&" Saa& i%i di d$%ia  4e%5a*i& 4%e$mo%ia dila4or*a% &ela me%#adi 4e%5a*i& $&ama di *ala%,a% *a%a*6*a%a* da%

mer$4a*a% a&$ 4e%5a*i& eri$ 5a%, mere%,,$& %5a-a )eri)$6ri)$ -ar,a &$a e&ia4 &a$%" Dia,%oi 4%e$mo%ia e/ara *li%i $m$m%5a m$da di&e,a**a%" Ta%da da% ,e#ala%5a a%,a& *a 5a*%i )ila di&em$*a% demam( )a&$* )erdaa* ;4$&$m 5a%, 4rod$*&i< a&a$ %5eri dada" Dia,%oi le)i me5a*i%*a% )ila dida4a&*a% i%il&ra& 4ada 4emeri*aa% o&o ro%&,e% 4ar$ da%  4e%em$a% mi*ro)a 4e%5e)a)%5a"1

Anamnesis

ada a%am%ei *a$ 4%e$mo%ia da4a& di&a%5a*a% ide%&i&a( *el$a% $&ama( ri-a5a&  4e%5a*i& e*ara%, ;RS<( ri-a5a& 4e%5a*i& da$l$ ;RD<( ri-a5a& 4e%5a*i& *el$ar,a ;RK<

ri-a5a& 4erali%a% i)$( ri-a5a& 4er*em)a%,a% a%a* da% ri-a5a& oial e*o%omi 4aie%"

ada a%am%ei ide%&i&a /erma&i alama& $%&$* &a$ a4a*a a%a* &i%,,al di daera  )er4ol$i a&a$ &ida*" ada a%am%ei KU &a%5a*a% a4a*a a%a* &erda4a& )a&$*=ea =demam" ada a%am%ei RS &a%5a*a%( a4a*a e)el$m%5a a%a* &ereda*" ada a%am%ei RK  &a%5a*a% ada*a *el$ar,a 5a%, me%,alami a*i& er$4a" ada a%am%ei RD &a%5a*a% a4a*a

 4er%a me%,alami a*i& er$4a a&a$ ri-a5a& ama da% aler,i( /erma&i ada &ida*%5a ,a&roeoa,eal rel$* ;&a%5a*a% a4a*a 4er%a ear&)$r%( eri%, m$al=m$%&a<" ada a%am%ei ri-a5a& 4erali%a% /erma&i a4a*a a%a* lair >>LR ;)era& )ada% )a5i lair re%da<( a4a*a ada *elai%a% a%a&omi )a-aa%" ada a%am%ei ri-a5a& 4er*em)a%,a% &a%5a*a% a4a*a a%a* mi%$m ASI e**l$i da% a4a*a a%a* r$&i% im$%iai" ada ri-a5a& oial + e*o%omi &a%5a*a% a4a*a a%a* &i%,,al di r$ma 5a%, em4i& a&a$ &ida*"1

Pemeriksaan Fisik 

emeri*aa% 4ada 4%e$mo%ia $m$m%5a dila*$*a% de%,a% /ara TTV ;&a%da6&a%da 7i&al<( i%4e*i( 4al4ai( 4er*$i( da% a$*$l&ai" ada TTV )iaa%5a dida4a&*a% $$ $)e)ril a&a$ &i%,,i( &a*i*ardi( da% 4e%i%,*a&a% re*$e%i %aa" ada i%4e*i ar$ di4era&i*a% )e%&$*  &ora* da% 4er,era*a%%5a( *eadaa% ela i,a ;4ada 4%e$mo%ia ela i,a a*a% me%/e*e$%,=re&ra*i<" Selai% i&$ #$,a 5a%, )ia *i&a i%4e*i adala a4a*a 4aie% me%,alami ea* %a4a( )a&$*6)a&$* a&a$ ia%oi da% #$,a melia& a4a*a %a4a 4aie% /e4a& a&a$ lam)a&" ada 4al4ai &ora* a%&erior da% 4o&erior 4aie%( ra)a ela i,a ;%ormal( me%/em)$%,=me%/e*$%,< da% mela*$*a% 4emeri*aa% 7o*al remi&$ 4ada &ora* a%&erior da%  4o&erior" ada 4er*$i 4emeri*a me%,e&$* di%di%, dada da% me%de%,ar ail%5a a4a*a  4e*a* ;ada%5a maa &$mor=/aira%<( i4ero%or ;4ada emiema<( red$4 ;ada%5a i%il&ra&e<( da% &im4a%i ;4ada 4e%5a*i& 4%e$mo&orak). ada a$*$l&ai 4emeri*a me%de%,ar*a% $ara  4ar$64ar$" ?ila%,%5a $ara %aa %ormal( ada%5a $ara re&a*( a&a$ 4e%i%,*a&a% $ara )ii*a% &whispered pectoryloqui' da4a& me%,e%ali daera 4ada 4ar$ 5a%, *era da% 5a%, 4e%$ /aira% 5a%, di%ama*a% *o%olidai"2

Pemeriksaan Penunjang Pemeriksaan Laboratorium

ada 4emeri*aa% la) dara ail 4emeri*aa% 5a%, )erma*%a adala &erda4a&%5a le$*oi&oi e)a,ai 4e%a%da ada%5a i%e*i" ?i&$%, #e%i le$*oi& 4ada 4%e$mo%ia 7iral eri%,*ali %ormal a&a$4$% edi*i& me%i%,*a&( de%,a% limoi& 4redomi%a%( eda%,*a% 4ada  4%e$mo%ia )a*&erial i&$%, #e%i le$*oi& me%,alami 4e%i%,*a&a% ;@20"000=mm3_{< de%,a%}

>ia*a% dara ar$ dila*$*a% $%&$* me%e,a**a% dia,%oi da% me%e%&$*a% )a*&eri  4e%5e)a) 4%e$mo%ia" >ia*a% dara 4oi&i di&em$*a% 4ada 10620: 4%e$mo%ia )a*&erial da% mer$4a*a% *o%irmai e)a,ai 4e%5e)a) 4%e$mo%ia a4a)ila ail%5a 4oi&i 4ada *$ma% 5a%, di*e&a$i e)a,ai 4a&o,e% re4ira&ori"

Pemeriksaan Radiologi

Te 4e%&i%, $%&$* me%de&e*i 4%e$mo%ia 4ada *eadaa% 5a%, &ida* #ela iala de%,a% o&o &ora*" Fo&o &ora* da4a& me%am4a*a% daera o4a* ;&erlia& 4$&i< 5a%, me%,,am)ar*a% *o%olidai" %e$mo%ia &ida* elal$ dilia& ole i%ar ( elai% *are%a  4e%5a*i&%5a a%5a 4ada &i%,*a& 4erm$laa% a&a$ *are%a me%,e%ai )a,ia% 4ar$ &er&e%&$ 5a%, $li& dilia& de%,a% i%ar " Dalam )e)era4a *a$ T &computed tomography'  da4a& me%$%#$*a% 4%e$mo%ia 5a%, &ida* &erlia& de%,a% o&o &ora i%ar " Si%ar  da4a& *elir$( *are%a maala lai%( e4er&i 4ar$& 4ada 4ar$ da% ,a,al #a%&$%, *o%,e&i da4a& me%5er$4ai  4%e$mo%ia 4ada o&o &ora i%ar " Fo&o &ora #$,a di,$%a*a% $%&$* e7al$ai ada%5a

*om4li*ai dari 4%e$mo%ia" Pemeriksaan Serologi

Te $ri% a%&i,e% detection adala $a&$ /ara $%&$* me%de&e*i a%&i,e%  (egionella  pneumophila ero,r$4 1" De&e*i i%i da4a& dila*$*a% 4ada ari *e 3 i%e*i am4ai 1 &a$%" Ole *are%a i&$ &ida* da4a& di,$%a*a% $%&$* de&e*i i%e*i )ar$ 4ada 4aie% de%,a% ri-a5a& 4er%a i%e*i Le,io%ella" Se%i&i7i&a 4ada 4emeri*aa% i%i adala 9069B:( da% 4eii&a%5a adala 9C6100:"

 $ndirect )luorescent Antibody ;IFA< dila*$*a% $%&$* melia& eeora%, &eri%e*i a&a$ &ida*" Dia,%oi di&e,a*a% #i*a *e%ai*a% &i&er B dari &i&er 1812 4ada aea*$& da% ae *o%7alee% ;36' mi%,,$ *em$dia%<" Se%i&i7i&a C60: da% 4eii&a 906100:"

 *irect )luorescent Antiboody Test  da4a& me%de&e*i e*i&ar 10B610 )a*&eri=ml 4eime%" Me%,,$%a*a% la)el fluorescein isothiocyanate ;FIT<" ri%i4 4emeri*aa% i%i adala me%,i*a& a%&i,e% 4ada el mem)ra% )a*&eri 5ai&$ *om4le* a%&i,e% a%&i)odi" De&e*i de%,a% me%,,$%a*a% mi*ro*o4 l$ore%i" Se%i&i7i&a 260: da% 4eii&a 9B699:"2

Diagnosis Kerja

%e$mo%ia adala $a&$ 4roe 4erada%,a% di ma%a &erda4a& *o%olidai 5a%, die)a)*a% 4e%,iia% ro%,,a al7eoli ole e*$da&" er&$*ara% ,a &ida* da4a& )erla%,$%, 4ada daera 5a%, me%,alami *o%olidai da% dara 5a%, dialir*a% *e e*i&ar al7eoli 5a%, &ida*   )er$%,i" ?i4o*emia da4a& &er#adi &er,a%&$%, )a%5a*%5a #ari%,a% 4ar$64ar$ 5a%, a*i&" ara  4e%$lara% 4%e$mo%ia da4a& melal$i 4er/i*a% l$da( *o%&a* la%,$%, le-a& m$l$& a&a$ *o%&a* 

&ida* la%,$%, melal$i 4erala&a% 5a%, &er*o%&ami%ai de%,a% al$ra% 4er%aaa%" >iaa%5a  4e%$lara% or,a%ime &er#adi dari ora%, *e ora%,( %am$% 4e%$lara% melal$i *o%&a* eaa& eri%,

&er#adi" Maa i%*$)ai &ida* di*e&a$i 4a&i( m$%,*i% 163  ari"3

Diagnosis Banding Bronkitis Akut

>ro%*i&i mer$4a*a% a*i)a& )e)era4a *eadaa% lai% al$ra% 4er%a4aa% a&a da% )a-a( da% &ra*ea )iaa%5a &erli)a&" >ro%*i&i a*$& )iaa%5a dida$*$i ole i%e*i 4er%a4aa% a&a" I%e*i e*$%der )iaa%5a dia*i)a&*a% ole %treptococcus pneumoniae, +oraxella catarrhalis,  aemophilus influen-ae da4a& &er#adi" Ka%5a 4ada a%a* iala da&a%, de%,a% )a&$* eri%,(

&ida* 4rod$*&i da% &im)$l%5a rela&i )er&aa4( m$lai 263 ari e&ela ri%i&i" >ro%*i&i laim &er#adi 4ada )a5i da% a%a*6a%a*( da% $m$m%5a &er#adi di m$im di%,i% da% m$im emi"

Bronkiolitis

>ro%*ioli&i a*$& &er#adi a*i)a& o)&r$*i al$ra% 4er%a4aa% *e/il 4e%5a*i& i%i &er#adi  4ada $ia 2 &a$% 4er&ama" e%5a*i& i%i 4ali%, eri%, me%,a*i)a&*a% a%a* ar$ ra-a& i%a4"

>ro%*ioli&i di&a%dai de%,a% ada%5a o)&r$*i )ro%*iol$ 5a%, die)a)*a% ole edema da% *$m4$la% m$*$ er&a *$m4$la% 4$i%,64$i%, el$ler da% ole i%7ai ole )a,ia%6)a,ia%  )ro%*$ 5a%, le)i *e/il ole 7ir$ ei%,,a &er#adi 4e%e)ala% 4ada di%di%, )ro%*iol$" e%e)ala% eedi*i& a4a4$% 4ada 4ro%*iol$ 4ada )a5i da4a& a%,a& mem4e%,ar$i alira% $dara" A%a* m$la6m$la me%deri&a i%e*i ri%,a% al$ra% %a4a a&a dier&ai de%,a% i%,$ da% )eri%" Ge#ala i%i )iaa%5a )era*ir )e)era4a ari da% da4a& dier&ai de%,a% 4e%$r$%a% %a$ ma*a% er&a demam 3(639o_{" er*em)a%,a% *e,a-a&a% )iaa%5a dier&ai de%,a% )a&$* 4ro*imal(}

Tuberkulosis Paru

T$)er*$loi 4ar$ adala 4e%5a*i& i%e*i 4ada al$ra% 4er%aaa% 5a%, die)a)*a% ole  )a*&eri  +ycobacterium tuberculosis" >a*&eri i%i mer$4a*a% )a*&eri )ail 5a%, a%,a& *$a& ei%,,a memerl$*a% -a*&$ lama $%&$* me%,o)a&i%5a" >a*&eri i%i le)i eri%, me%,i%e*i or,a% 4ar$64ar$ ;90:< di)a%di%,*a% )a,ia% lai% &$)$ ma%$ia" e%deri&a 5a%, &eri%e*i  )iaa%5a a*a% me%,alami demam $)e)ri 5a%, )erla%,$%, lama( )iaa%5a diraa*a% malam ari dier&ai *eri%,a& malam" Kada%,6*ada%, era%,a% demam e4er&i i%l$e%a da% )eria& ila%, &im)$l" Ge#ala lai%( 4e%$r$%a% %a$ ma*a% da% )era& )ada%( )a&$*6)a&$* elama le)i dari 3 mi%,,$ ;da4a& dier&ai de%,a% dara<( 4eraaa% &ida* e%a* ;malaie<( da% lema" Ge#ala lai% a%&ara lai% daa* )er/am4$r dara=)a&$* dara( ea* %aa da% raa %5eri 4ada dada( demam=meria%, le)i dari e)$la%( )er*eri%,a& 4ada malam ari &a%4a 4e%5e)a) 5a%, #ela(  )ada% lema da% le$( %a$ ma*a% me%$r$% da% &er#adi 4e%$r$%a% )era& )ada%"B

Klasifikasi

Terda4a& 3 *laii*ai 4%e$mo%ia( )erdaar*a% re%&a%, $ia( *li%i da% e4idemiolo,i( a,e% 4e%5e)a)( da% 4redile*i i%e*i"

>erdaar*a% re%&a%, $ia( 4%e$mo%ia di)a,i me%#adi 4%e$mo%ia 4ada a%a* *$ra%, dari 2  )$la% da% a%a* 2 )$la% am4ai *$ra%, dari  &a$%" ada a%a* *$ra%, dari 2 &a$% 4%e$mo%ia

di)a,i me%#adi 4%e$mo%ia )era& da% )$*a% 4%e$mo%ia ;)a&$* )iaa<" %e$mo%ia )era& di&a%dai de%,a% ada%5a %aa /e4a& 5ai&$ re*$e%i 4er%aaa% e)a%5a* '0 *ali 4er me%i& a&a$ le)i" >$*a% %e$mo%ia di&a%dai de%,a% )a&$* 4ile* )iaa" Seda%,*a% 4ada a%a* $ia 2 )$la% i%,,a *$ra%, dari  &a$% di)a,i me%#adi 4%e$mo%ia )era&( 4%e$mo%ia( da% )$*a% 4%e$mo%ia" %e$mo%ia )era& di&a%dai de%,a% ada%5a ea* a&a$ &ari*a% di%di%, dada )a,ia% )a-a" %e$mo%ia dier&ai de%,a% %aa /e4a&( )ila $ia 2 )$la% am4ai *$ra%, dari 1 &a$% 0 *ali 4er  me%i&( da% $%&$* $ia 1 i%,,a *$ra%, dari  &a$% B0 *ali 4er me%i&" >$*a% 4%e$mo%ia di&a%dai de%,a% )a&$* 4ile* )iaa( &ida* ada &ari*a% di%di%, dada )a,ia% )a-a *e dalam da% &ida* ada %aa /e4a&"

>erdaar*a% *li%i da% e4idemiolo,i 4%e$mo%ia di)a,i me%#adi 4%e$mo%ia *om$%i&i &communityacquired pneumonia'( 4%e$mo%ia %oo*omial &hospitalacquired   pneumonia/nosocomial pneumonia'( 4%e$mo%ia a4irai( da% 4%e$mo%ia 4ada 4e%deri&a

immunocompromised " %e$mo%ia %oo*omial di)a,i me%#adi &i,a #e%i 5ai&$ hospital acquired   pneumonia  ;?A<( ventilator associated pneumonia ;VA< da% health care associated   pneumonia ;?A<"

>erdaar*a% )a*&eri 4e%5e)a) 4%e$mo%ia di)a,i me%#adi 4%e$mo%ia )a*&eri=&i4i*al(  4%e$mo%ia a*i)a& 7ir$( 4%e$mo%ia a*i)a& #am$r da% 4%e$mo%ia a&i4i*al" %e$mo%ia  )a*&eri=&i4i*al da4a& &er#adi 4ada em$a $ia" %e$mo%ia )a*&erial eri%, dii&ila*a% de%,a%  4%e$mo%ia a*i)a& *$ma%" %e$mo%ia #e%i i&$ )ia me%5era%, ia4a a#a( dari )a5i i%,,a mere*a 5a%, &ela la%#$& $ia" ara 4emi%$m al*ool( 4aie% 5a%, &er*e)ela*a%, me%&al( 4aie%  4a/ao4erai( ora%, 5a%, me%deri&a 4e%5a*i& 4er%a4aa% lai% a&a$ i%e*i 7ir$ adala 5a%, mem4$%5ai i&em *e*e)ala% &$)$ re%da da% me%#adi a%,a& re%&a% &erada4 4e%5a*i& i&$" ada aa& 4er&aa%a% &$)$ me%$r$%( mial%5a *are%a 4e%5a*i&( $ia la%#$&( da% mal%$&rii(  )a*&eri 4%e$mo%ia a*a% de%,a% /e4a& )er*em)a%, )ia* da% mer$a* 4ar$64ar$" !i*a &er#adi i%e*i( e)a,ia% #ari%,a% dari lo)$ 4ar$64ar$( a&a$ 4$% el$r$ lo)$( )a*a% e)a,ia% )ear  dari lima lo)$ 4ar$64ar$ ;&i,a di 4ar$64ar$ *a%a%( da% d$a di 4ar$64ar$ *iri< me%#adi &erii /aira%" Dari #ari%,a% 4ar$64ar$( i%e*i de%,a% /e4a& me%5e)ar *e el$r$ &$)$ melal$i  4eredara% dara" >a*&eri %e$mo*o*$ adala *$ma% 5a%, 4ali%, $m$m e)a,ai 4e%5e)a)  4%e$mo%ia )a*&eri &ere)$&" %e$mo%ia a*i)a& 7ir$ )iaa%5a die)a)*a% ole 7ir$ i%l$e%a ;)eda*a% de%,a% )a*&eri emofilus influen-a 5a%, )$*a% 4e%5e)a) 4e%5a*i& i%l$e%a( &e&a4i  )ia me%5e)a)*a% 4%e$mo%ia #$,a<" Ti4e 4%e$mo%ia i&$ )ia di&$m4a%,i de%,a% i%e*i  4%e$mo%ia *are%a )a*&eri" ?al i&$ 5a%, die)$& de%,a% $4eri%e*i )a*&erial" Sala a&$ &a%da &er#adi $4eri%e*i )a*&erial adala *el$ar%5a le%dir 5a%, *e%&al da% )er-ar%a i#a$ a&a$ mera &$a" %e$mo%ia a*i)a& #am$r eri%, mer$4a*a% i%e*i e*$%der" redile*i &er$&ama 4ada  4e%deri&a de%,a% da5a &aa% lema &immunocompromised'( )ia #$,a dida4a& 4ada i%di7id$ 5a%,

&erlal$ lama )erada di r$a%,a% 5a%, &erda4a& aerool dari air 5a%, lama &er,e%a%, mial%5a dari $%i& 4e%di%,i% r$a%,a% a&a$ ala& 4elem)a) 5a%, *o&or( )ia me%,ida4 4%e$mo%ia Le,io%ella" %e$mo%ia a&i4i*al die)a)*a% ole +ycoplasma, (egionella, dan 0haamydia"

>erdaar*a% 4redile*i i%e*i 4%e$mo%ia di)a,i me%#adi 4%e$mo%ia lo)ari da%  4%e$mo%ia )ro%*o4%e$mo%ia" %e$mo%ia lo)ari adala 4%e$mo%ia 5a%, &er#adi 4ada a&$ lo)$ ;4er/a)a%,a% )ear dari 4oo% )ro%*$< *a%a% ma$4$% *iri" %e$mo%ia )ro%*o4%e$mo%ia

di&a%dai )er/a*6)er/a*%i%e*i 4ada )er)a,ai &em4a& di 4ar$( )ai* di *a%a% Ma$4i% *iri 5a%, die)a)*a% ole 7ir$ a&a$ )a*&eri da% eri%, &er#adi 4ada )a5i a&a$ ora%, &$a"163

Gejala Klinis

Demam da% )a&$* ;a-al%5a %o%4rod$*&i< mer$4a*a% ,e#ala $m$m" Da4a& #$,a &er#adi %5eri dada da% ea* %a4a" Gam)ara% i&emi* ;le)i eri%, &er#adi %am$% &ida* 4eii* $%&$*   4%e$mo%ia a&i4i*< dia%&ara%5a adala %5eri *e4ala( confusion( mial,ia( da% malaie" Ada%5a

maa 4rodormal 5a%, lama le)i 4eii* )a,i or,a%im a&i4i*" ada 4emeri*aa% ii* )ia di&em$*a% &a%da6&a%da *o%olidai lo*al da% ro%*i *aar &crackles'  4ada lo)$ 5a%, &er*e%a" Ta*i4%ea( i4o&e%i( da% ia%oi mer$4a*a% &a%da )era&%5a 4e%5a*i&"B

tiologi

>ai* 4%e$mo%ia *om$%i&i ma$4$% 4%e$mo%ia %oo*omial *ed$a%5a memili*i e&ioo,i 5a%, ama 5ai&$ *$ma% 4a&o,e% e4er&i %treptokokus pneumonia(  aemophilus influen-ae(  +oraxella catarrhalis da% )e)era4a )a*&eri a&i4i*al" e%5e)a) $&ama 4%e$mo%ia %oo*omial adala )a*&eri ,ram %e,a&i aemophilus influen-a" Me*i demi*ia%( e*i&ar 1C: 4%e$mo%ia %oo*omial die)a)*a% ole  Pseudomonas aeruginosa 5a%, &er%5a&a me%#adi 4e%5e)a) *ema&ia% da% *ea*i&a% 4ada 4%e$mo%ia %oo*omial" %e$mo%ia *are%a #am$r &ida* )a%5a*  di&em$*a% &e&a4i )iaa%5a &erda4a& 4ada 4aie% de%,a% ,a%,,$a% im$%olo,i* e4er&i AIDS da%  4ema*aia% o)a&6o)a&a% im$%o$4rea% 4ada 4aie% &ra%4la%&ai( *emo&era4i da% 4ada 4e%5a*i&

imunocompromised  lai%%5a"

!am$r 5a%, eri%, me%im)$l*a% 4%e$mo%ia adala a%dida( A4er,ill$( ?i&o4lama /a4$la&e$m( r54&o/o//$ %eoorma% da% o//idiode immi&i" %e$mo%ia 4ada 4aie% imunocompromised diam4i%, 4e%5e)a)%5a adala )a*&eri da% #am$r o4o&$r%i&i* da4a& #$,a die)a)*a% 7ir$ e4er&i 5&ome,alo7ir$ ;MV<( E4&ei%6>arr 7ir$( Ri%o7ir$( Ade%o7ir$( aram5o7ir$( arai%l$e%a 7ir$( ?er4e im4le*( ?er4e 7ir$ ' da% ?er4e 7ir$ " U%&$*  da4a& me%,e&a$i 4e%5e)a) lai%%5a da4a& dilia& 4ada &a)el 1"

Ta)el 1" A,e% I%e*i$ e%5e)a) %e$mo%ia"

>a*&eri S&re4&o/o//$ 4%e$mo%ia %e$mo%ia )a/&erial S&re4&o/o//$ 45o,e%e S&a45lo/o//$ a$re$ Kle)iella 4%e$mo%ia e$domo%a aer$,i%oa E/eri/ia /oli eri%ia 4e&i

Le,io%%aire )a/ill$ e%5a*i& Le,io%%aire

e4&o&re4&o/o//$( e4&o/o//$ %e$mo%ia a4irai ;a%aero)< >a/&eroide

F$o)a/&eri$m Veillo%ella

A/&i%om5/e&e A/&i%om5/e iraelii A*&i%omi*oi 4$lmo%ar  

 No/ardia &eroid No*ardioi 4$lmo%ar 

F$%,i o//idioide immi&i Ko*idiomi*oi

?i&o4lama /a4$la&$m ?i&o4lamoi >la&om5/e derma&idi&i >la&omi*oi

A4er,ill$ A4er,iloi

5/om5/e&e M$*omi*oi

Ri/*e&&ia iiella )$r%e&&i Demam 

lam5dia lam5dia 4i&&a/i i&a*oi

Omi&oi

M5/o4lama M5/o4lama 4%e$mo%ia %e$mo%ia mi*o4lama

Vir$ I%l$e%a 7ir$( ade%o7ir$ %e$mo%ia 7iral

ro&ooa %e$mo/5&i /ari%ii %e$mo%ia 4%e$moi&i

%e$mo%ia 5a%, dida4a& di ma5ara*a& a%,a& eri%, &er#adi" I%ide% di ma5ara*a& adala 163=1000 ora%, de-aa" Se4erem4a& #$mla *a$ mem)$&$*a% 4era-a&a% di r$ma a*i&" I%ide% *e#adia% 4ada la*i6la*i ama de%,a% 4erem4$a%( -ala$4$% 4e%5a*i& Le,io%aire le)i eri%, dida4a&*a% 4ada la*i6la*i" %e$mo%ia %oo*omial le)i eri%, &er#adi 4ada ma%$la( mer$4a*a 2(: *om4li*ai dari el$r$ 4era-a&a% di r$ma a*i& da% 1061: dari em$a *a$ i%e*i 5a%, dida4a& di r$ma a*i&" ada 4%e$mo%ia 4aie% de%,a% 5&em im$% re%da me%i%,*a& a*i)a& i%ide% 4e%,,$%aa% o)a&6o)a&a% im$%o$4rei ;&ra%4la%&ai( 7a*$li&i<( *emo&era4i( da% i%e*i ?IV"

Patogenesis

Pneumonia Komunitas

%e$mo%ia 5a%, dida4a& di ma5ara*a& /e%der$%, &er#adi 4ada $ia e*&rem( %am$% &e&a4 mer$4a*a% 4e%5e)a) mor)idi&a 5a%, 4e%&i%, da% )a*a% 4e%5e)a) morali&a 4ada de-aa m$da" e%5e)ara% i%e*i &er#adi melal$i dro4le&" Or,a%ime )erm$l&i4li*ai dalam 4ar$ da% #i*a &ela )erail me%,ala*a% me*a%ime 4er&aa%a% 4ar$ ma*a a*a% &er#adi 4%e$mo%ia" Ke)iaaa% mero*o* melema*a% 4er&aa%a% lo/al *are%a me%e*a% $%,i ilier"

Pneumonia "osokomial

Terda4a& )e)era4a a*&or 4redi4oii 5a%, me%5e)a)*a% eora%, 4aie% me%,alami  4%e$mo%ia di r$ma a*i&( 5ai&$ me%i%,*a&%5a rei*o a4irai( me%$r$%%5a 4er&aa%a% &$)$( da% 4ema*aia% ala& melal$i 4ar$=*$li& 5a%, me%,,a%,,$ 4er&aa%a% &$)$ %ormal" Wala$4$% or,a%ime 4e%5e)a) 4%e$mo%ia 5a%, dida4a& di dalam ma5ara*a& #$,a me%5e)a)*a% i%e*i di r$ma a*i&( )a*&eri ,ram %e,a&i( %taphilococcus aureus( da% or,a%ime a%aero) #a$ le)i eri%, di&em$*a%" e%deri&a 4e%5a*i& 4ar$ 5a%, me%,alami 4%e$mo%ia 4a/a o4erai mai a%,a& m$%,*i% me%,alami i%e*i 4%e$mo*o*$ a&a$ emoil$"

Pneumonia pada Pasien  Immunocompromised 

I%e*i 4ar$ %iaa%5a di/e,a de%,a% *om)i%ai )er)a,ai eleme% me*a%i ;e4i,lo&&i( rele* )a&$* da% rele* m$%&a( da% el$)$%, m$*oilier< er&a me*a%ime im$%olo,i 4eii*  ;ma*roa,=%e$&roil( a%&i)od5 5a%, diail*a% ole limoi& >( da% im$%i&a el$ler ole limoi& T<" Dee* 4ada )a,ia% ma%a4$% dari me*a%ime i%i me%i%,*a&*a% rei*o i%e*i" Seri%,

di&em$*a% i%e*i ole mi*roor,a%ime m$l&i4el" I%e*i 5a%, di$)$%,*a% de%,a% 5&em im$% 5a%, &er&e*a% adala %e$&ro4e%ia ;)a*&eri ,ram %e,a&i( %taphylococcus aureus( #am$r ;/a%dida( a4er,ill$<( me%$r$%%5a imm$%o,lo)$li% ;)a*&eri 4%e$mo*o*$( aemophilus influen-a<( d%a dee* el T ;)a*&eri 4%e$mo*o*$( . $nfluen-ae( %taph. Aureus( #am$r ;/a%dida( 4%e$mo/5&i<( 7ir$ ;MV *elom4o* er4e( ade%o7ir$<( mi*ro)a*&eria<"'

Penatalaksanaan

Pneumonia Komunitas

Tera4i $4or&i $m$m da4a& dila*$*a% de%,a% 4em)eria% /aira% i%&ra7e%a( o*i,e% da% iio&era4i" Tera4i a%&i)io&i* 4ada 4%e$mo%ia )era& da4a& di)eri*a% ealo4ori% i%&ra7e%a da% ma*rolid ;eri&romii%( *lari&omii%< da% ,olo%,a% l$oroH$i%olo%" ada *a$ 5a%, le)i ri%,a% da4a& di,$%a*a% am4iili% me%,,a%&i*a% ealo4ori% da% 4ada *a$ 5a%, ri%,a% /$*$4 de%,a% amo*iili% a#a"

Pneumonia "osokomial

Tera4i $4or&i da4a& dila*$*a% de%,a% 4em)eria% o*i,e%( /aira%( da% iio&era4i" Tera4i a%&i)io&i* 4eii* di4erl$*a% $%&$* mem)ami or,a%im ,ram %e,a&i 5a%, rei&e% &erada4 a%&i)io&i* 5a%, di)eri*a% 4ada 4%e$mo%ia *om$%i&a" A%&i)io&i* $%&$* 4%e$mo%ia %oo*omial adala ,olo%,a% ealo4ori% ,e%erai *e&i,a ;mial eo&a*im< da% ami%o,li*oida( l$oroH$io%olo%( &ie%amii% ;imi4e%em( mero4e%em<( 4e%iili% a%&i4e$domo%a ;4i4eraili%=&ao)a*&am< da% 4em)eria% a%&i&ailo*o*$ $%&$* %taphilococcus aureus  5a%, rei&e%6me&iili% &methicillinresistant %taph. Aureus' ;MRSA< mial l$*lo*aili%=7a%*omii%" Pneumonia pada Pasien  Immunocompromised 

Dia,%oi mi*ro)ial eri%, *ali )el$m di&e,a**a% aa& dim$lai%5a &era4i" Um$m%5a( am)il me%$%,,$ ail *$l&$r 4erl$ di)eri*a% o)a& a%&i)a*&eri 4e/&r$m l$a" Kom)i%ai o)a& 5a%, di)eri*a% ar$ )ia mem)ami )a*&eri ,ram %e,a&i( dia%&ara%5a e$domo%a 44" da% d&ailo*o*$" a%, eri%, di,$%a*a% e)a,ai &era4i em4iri adala *om)i%ai a%&ara 4e%iili% a%&i4e$domo%a a&a$ ealo4ori% ,e%erai *e&i,a da% ami%o,li*oida" Kem$dia% &era4i )ia di,a%&i e$ai de%,a% ail 4emeri*aa% mi*ro)iolo,i" Tera4i 4eii* $%&$* 7ir$ da% #am$r  mai%,6mai%, adala ,a%i*lo7ir a&a$ amo&erii%"C

Komplikasi

Kom4li*ai 4%e$mo%ia da4a& )er$4a ,a%,,$a% 4er&$*ara% ,a( o)&r$*i #ala% %aa( ,a,al 4er%aaa%(  Pleural 1ffusion ;bacterial pneumoniae<" A)e *$li&( a)e #ari%,a% l$%a*( o&i&i media( i%$i&i( me%i%,i&i 4$r$le%&a( 4eri*ardi&i da% e4i,lo&i *ada%, di&em$*a% 4ada i%e*i  emophylus influen-ae" De%,a% me%,,$%a*a% a%&i)io&i*a( *om4li*ai 4%e$mo%ia am4ir &ida* 4er%a di#$m4ai" Kom4li*ai 5a%, da4a& di#$m4ai a%&ara lai% em4iema da%o&i&i media a*$&" Seme%&ara *om4li*ai lai%%5a e4er&i me%i%,i&i( 4eri*ardi&i( o&eomieli&i( da%  4eri&o%i&i le)i #ara%, &er#adi"

Prognosis

Se)a,ia% )ear a%a*6a%a* de%,a% 4%e$mo%ia 7ir$ da4a& em)$ em4$r%a da% &ida*  mem4$%5ai ,e#ala ia( -ala$4$% m$%,*i% le)i lama" A%a*6a%a* 5a%, &ida* mem4$%5ai  4e%5a*i& 4o*o* mem4$%5ai 4ro,%oi 5a%, )ai* e*ali $%&$* em)$ em4$r%a( &erma$*   4er&$m)$a% da% 4er*em)a%,a% 5a%, %ormal( $%,i 4ar$ 5a%, %ormal( da% &ida* me%i%,*a&%5a

*ere%&a%a% 4ada i%e*i 4ar$"

Pen#egahan

e%/e,aa% 4%e$mo%ia da4a& dila*$*a% de%,a% /ara me%#a$*a% aa4 ro*o* dari a%a*  er&a 4em)eria% 7a*i% ID ; $nvansive Pneumococcal *isease< *are%a a%5a de%,a%  4e%/e,aa% i%ila 4e%5a*i& me%i%,i&i ;rada%, ela4$& o&a*< da% 4%e$mo%ia ;rada%, 4ar$< )ia

&eri%dar"

Kesimpulan

%e$mo%ia adala $a&$ 4roe 4erada%,a% di ma%a &erda4a& *o%olidai 5a%, die)a)*a% 4e%,iia% ro%,,a al7eoli ole e*$da&" %e$mo%ia da4a& die)a)*a% ole )a*&eri( 7ir$( #am$r( a&a$4$% )e%da ai%, lai% 5a%, ma$* *e al$ra% %aa" Ge#ala *li%i 4%e$mo%ia me%$%#$**a% ada%5a )a&$* )er4$&$m da% 4eri&e%( ea* %aa( %5eri dada( demam $)e)ril( re&ra*i ela i,a( %aa /e4a&( da% &a*i4%e$" %e$mo%ia da4a& di*elom4o*a% me%#adi )e)era4a *elom4o*( )erdaar*a% $m$r( ,e#ala da% e4idemiolo,i( )a*&eri 4e%5e)a)( da% 4redile*i i%e*i"

e%,o)a&a% 4%e$mo%ia da4a& de%,a% 4em)eria% a%&i)io&i*a i%&ra7e%a ma$4$% oral mial  4e%iili%( a%&i)io&i* ,olo%,a% l$oro*$i%olo%( da% ,olo%,a% ealo4ori%" e%/e,aa%  4%e$mo%ia 4ada a%a* da4a& dila*$*a% de%,a% me%,i%dari aa4 ro*o* er&a 4em)eria% 7a*i%

ID ; $nvansive Pneumococcal *isease<"

Daftar Pustaka

1" Ar7i% >K" Ilm$ Keea&a% A%a*" Vol 2" Edii 1" !a*ar&a8 EG2012""103B6C"

2" S$do5o AW( >am)a%, S( d**" >$*$ A#ar Ilm$ e%5a*i& Dalam" Edii B #ilid 3" !a*ar&a8 I%&er%a $)lii%,2009""220C610

3" Mi%adiarl5" e%5a*i& I%e*i Sal$ra% Na4a %e$mo%ia" !a*ar&a8 a5aa% O)or  I%do%eia2010""216B

B" Ma&o%da%, S( Waida5a& I( Sa&roamoro S" Dia,%oi Fii 4ada A%a*" 2%d Ed" !a*ar&a 8 Sa,$%, Se&o200C""1''6C1

" !a-e&/ E( Mel%i/* !L( Adel)er, EA" Mi*ro)iolo,i *edo*&era%" Edii 20" !a*ar&a8 EG2009"(1CC69

'" Lea/ R  . Acute and 0ritical 0are +edicine at a 2lance" Edii 2" Ne- or*8 !o% Wile5 a%d So%2010""C26

C" K$mar V( o&ra% RS( Ro))i% SL" >$*$ A#ar a&olo,i Ro))i%" Edii" !a*ar&a8EG200C ""9226

" Ro))i%( o&ra%( K$mar" >$*$ Sa*$ Daar a&olo,i e%5a*i&" Edii *e6" !a*ar&a8EG"2012"116B"