Pneumonia

PNEUMONIA Tia_Sabrina (06-038)
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 35C atau lebih dari atau sama dengan 40C, 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:

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.

Namun, gejala awalnya yang tergolong sederhana seringkali membuat orangtua kurang waspada terhadap penyakit ini. Orang tua sering datang terlambat membawa anaknya ke dokter. Karena gejala awal panas dan batuk, orang tua sering mengobati sendiri dirumah dengan obat biasa, bila sudah sesak baru dibawa ke dokter, jelas Atilla. Karenanya dokter spesialins bagian neurologi anak ini menyatakan sebaiknya bila anak sakit panas tinggi dan batuk, segeralah ke dokter untuk dicari tahu penyebabnya. Diagnosa dan Pengobatan Diagnosis pneumonia dilakukan dengan berbagai cara. Pertama dengan pemeriksaan fisik secara umum. Setelah itu ada pula pemeriksaan penunjuang seperti rontgen paru dan pemeriksaan darah. Penanganan pneumonia pun dapat dilakukan dengan beberapa cara. Umumnya pengobatan dengan pemberian antibiotik. Penderita pneumonia dapat sembuh bila diberikan antibiotik yg sesuai dengan jenis kumannya, hanya saja perlu dosis tinggi dan waktu yg lama, papar Atilla. Namun, bakteri Streptococcus pneumoniae mulai resisten atau kebal terhadap beberapa jenis antibiotik. Bahkan kawasan Asia dinyatakan sebagai hot zone, yakni daerah dengan tingkat resistensi tinggi untuk bakteri pneumokok. Oleh sebab itu apabila pneumonia yang dialami cukup parah, penanganannya juga dilakukan dengan cara opname. Dengan perawatan khusus di rumah sakit, pasien bisa mendapatkan istirahat dan pengobatan yang lebih intensif, atau bahkan terapi oksigen sebagai penunjang. Selain itu penderita pneumonia juga membutuhkan banyak cairan untuk mencegahnya dari dehidrasi. Cairan ini bisa diperoleh dengan cara banyak minum air putih maupun melalui infus. 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 pneumonia akan memilihkan obat sesuai pertimbangan masingmasing, setelah suhu pasien kembali normal, dokter akan menginstruksikan pengobatan lanjutan untuk mencegah kekambuhan. Soalnya, serangan berikutnya 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 beberapa kasus, Atilla menerangkan bahwa pneumonia yang sudah mengalami komplikasi tersebut bisa meninggalkan berbagai efek samping. Anak dapat mengalami berbagai efek samping seperti gangguan kecerdasan, gangguan perkembangan motorik, gangguan pendengaran dan keterlambatan bicara, paparnya. Walaupun demikian, Bambang tetap meyakinkan bahwa anak dengan pneumonia juga bisa sembuh total dan hidup dengan normal. Pencegahan Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P2ISPA (Pemberantasan Penyakit Infeksi Saluran Pernafasan Akut). Program ini mengupayakan agar istilah pneumonia lebih dikenal masyarakat, sehingga memudahkan kegiatan penyuluhan dan penyebaran informasi tentang penanggulangannya. Program P2ISPA mengklasifikasikan penderita kedalam 2 kelompok usia. Yaitu, usia dibawah 2 bulan (Pnemonia Berat dan Bukan Pnemonia) dan usia 2 bulan sampai kurang dari 5 tahun. 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 pneumonia ini antara lain batuk-pilek biasa, pharyngitis, tonsilitis dan otitis. Ungkapan klasik bahwa mencegah lebih baik daripada mengobati benar-benar relevan dengan penyakit pneumonia ini. Mengingat pengobatannya yang semakin sulit, terutama terkait dengan meningkatkan resistensi bakteri pneumokokus, maka tindakan pencegahan sangatlah dianjurkan. Pencegahan penyakit IPD, termasuk pneumonia, dapat dilakukan dengan cara vaksinasi pneumokokus atau sering juga disebut sebagai vaksin IPD. Menurut Atilla yang juga bertugas di klinik khusus tumbuh kembang anak RSAB Harapan kita, peluang mencegah Pneumonia dengan vaksin IPD adalah sekitar 80-90%. Adapun mengenai waktu ideal pemberian vaksin IPD, menurut penjelasan Atilla adalah sebanyak 4 kali, yakni pada saat bayi berusia 2 bulan, 4 bulan, 6 bulan dan diulang lagi pada usia 12 bulan. Atilla menguatkan bahwa vaksin itu aman dan dapat diberikan bersamaan dengan vaksin lain seperti Hib, MMR maupun Hepatitis B. Selain imunisasi, pencegahan pneumonia menurut Bambang adalah dengan menjaga keseimbangan nutrisi anak. Selain itu, upayakan agar anak memiliki daya tahan tubuh yang baik, antara lain dengan cara cukup istirahat juga olahraga, jelasnya. Pneumonia oleh Bakteri Pneumonia yang dipicu bakteri bisa menyerang siapa saja, dari bayi sampai usia lanjut. 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 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 ). 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 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

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. oOOo ORGANISASI Kesehatan Dunia atau World Health Organization (WHO) mengungkap, angka kematian anak akibat pneumonia lebih banyak dibandingkan jumlah total kematian karena AIDS, malaria, dan cacar air. Padahal vaksinasi bisa mencegah penyakit itu. Tercatat lebih dari satu juta bayi dan balita meninggal setiap tahun akibat pneumonia. Dengan kata lain, satu dari lima kematian anak dan balita disebabkan pneumonia. Sekitar tiga per empat jumlah kasus pneumonia balita terdapat di 15 negara, termasuk Indonesia yang menempati urutan ke-6. Dengan angka kematian total 6 juta anak. "Pneumonia menjadi masalah signifikan di banyak negara, terutama di negara dengan angka kematian balita yang tinggi," kata Kepala Divisi Kesehatan UNICEF, Peter Salama. Pneumonia adalah bagian dari penyakit infeksi pneumokokus invasif (IPD) yang merupakan sekelompok penyakit karena bakteri streptococcus pneumoniae. Kuman pneumokokus dapat menyerang paru-paru, selaput otak, atau masuk ke pembuluh darah hingga mampu menginfiltrasi organ lainnya. IPD bisa berdampak pada kecacatan permanen berupa ketulian, gangguan mental, kemunduran intelegensi, kelumpuhan, dan gangguan saraf, hingga kematian. "Bakteri pneumokokus dulu bisa dimatikan dengan antibiotik. Belakangan, bakteri ini kebal terhadap antibiotik sehingga menyulitkan pengobatan," sebut Ketua Divisi Tumbuh Kembang-Pediatri Sosial Departemen Ilmu Kesehatan Anak FKUI/RSCM Dr Soedjatmiko SpA(K) MSi. Tingginya angka kematian akibat pneumonia sekaligus membuktikan masih rendahnya kesadaran masyarakat akan pentingnya imunisasi sebagai langkah pencegahan. Soedjatmiko mengemukakan, setiap tahun sekitar 3 juta orang meninggal akibat berbagai penyakit yang sebenarnya bisa dicegah dengan imunisasi. Imunisasi dianjurkan sedini mungkin supaya lebih efektif sehingga unsur perlindungannya mencapai level optimal. Oleh karena itu, bayi disarankan diimunisasi PCV mulai usia bayi 2 bulan, 4 bulan, 6 bulan, lalu diberikan satu dosis lagi pada usia 12-15 bulan sebagai penguat. "Itu adalah jadwal idealnya, tapi kalaupun sudah lewat tidak masalah. Lebih baik telat daripada tidak diberikan sama sekali. Vaksin ini masih dapat diberikan hingga usia 9 tahun," papar dokter yang juga menjabat Sekretaris Satgas Imunisasi Ikatan Dokter Anak Indonesia (PP IDAI) ini. Menurut Peter Salama, negara dengan angka kematian balita yang tinggi, terutama akibat pneumonia pada anak, menjadi prioritas utama. Hal itu merujuk pada negara dengan lebih dari 50 kematian per 1.000 kelahiran hidup anak balita, maupun negara dengan lebih dari 50.000 kematian balita per tahun. "Indonesia dengan 58 kematian per 1.000 kelahiran hidup, masuk kategori direkomendasikan," sahut Soedjatmiko seraya mengungkapkan bahwa IDAI juga telah menerbitkan rekomendasi dan petunjuk pemakaian vaksin pneumokokus sejak bulan Juni 2006. IPD dapat menyerang siapa saja dan di mana saja. Hanya, kelompok usia paling rentan menderita IPD adalah bayi dan anak-anak usia kurang dari dua tahun. Ditandai dengan gejala demam tinggi, menggigil, batuk, dan sesak napas. Kasus kejadiannya amat tinggi pada usia kurang dari dua tahun, lalu kian berkurang pada remaja dan dewasa. Namun kembali meninggi lagi di usia lanjut. "Itulah sebabnya, imunisasi PCV tak hanya melindungi si bayi yang diimunisasi, juga proteksi bagi anggota keluarga lain," tandas Dr Soedjatmiko SpA(K) MSi. Adapun cara penularan bakteri pneumokokus, antara lain melalui percikan ludah melalui udara saat bersin, batuk atau berbicara. (sindo//tty) oOOo Banyak gejala batuk dan pilek yang mirip dengan gejala penyakit lain. Periksa dulu dengan gejala lain yang menyerupai berikut ini . disebabkan virus dibiarkan saja. Asetaminofen atau ibu protein bisa membantu meredakan rasa nyeri dan demam. Kapan harus menghubungi dokter: Segera setelah anda mencurigai anak menderita pneumonia. Anak anda mungkin butuh Xray untuk diagnosa. Batuk rejan ( pertusis) Gejala: Batuk yang bertahan lebih dari satu menit dalam pernapasan di antara batuk, dan ada suara dengik saat dia mengambil napas. Penanganan : Antibiotika, istirahat, serta pelembab udara untuk mengencerkan lendir serta melegakan jalur pernapasan. Kapan harus menghubungi dokter: Sesegera mungkin. Anak dibawah 6 bulan mungkin perlu dirawat dirumah sakit. Bila dia berusia lebih tua, dia butuh antibiotika sesegera mungkin oOOo Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, including viruses, bacteria, fungi, and parasites. Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). When this happens, symptoms of pneumonia begin after 2 or 3 days of a cold or sore throat. Signs and Symptoms Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. 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, dan dengik berdana tinggi ketika anak menarik napas, hidung meler, demam penanganan: Duduk di kamar mandi dan berikan air hangat melalui shower selama 15-20 menit akan membantunya bernapas. Kapan harus menghubungi dokter: Bila anak benar-benar sulit bernapas atau dengik berlanjut lebih dari 5 menit atau malah lebih buruk. Bronchiolitis ( RSV) Gejalanya: hidung meler, lekas marah, hilang selera makan, demam, batuk, suara dengik ketika anak bernapas. Penanganan: Banyak cairan dan istirahat. Pada kasus yang serius, anak-anak ( khususnya bayi) mungkin dirawat di rumah sakit untuk menerima oksigen, cairan, atau obat. Kapan harus menghubungi dokter : Bila bayi anda sulit bernapas, lendir yang kental, ada tanda-tanda dehidrasi, tidak aktif seperti biasanya atau menolak menyusu. Pnaeumonia Gejala: Demam, gejala pilek yang bertahan lebih dari seminggu dan terus memburuk, batuk basah dan berlendir, sakit di dada atau perut, menggigil, napas tersengal-sengal, kelelahan. Penanganan : Antibiotika ( jika disebabkan bakteri), sementara pneumonia yang

in extreme cases, bluish or gray color of the lips and fingernails Sometimes a child's only symptom is rapid breathing. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing problems at all, but there may be fever and abdominal pain or vomiting. When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia. Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older children and adolescents, 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. In infants, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. When pneumonia is due to whooping cough (pertussis), the child may have long coughing spells, turn blue from lack of air, or make a classic "whoop" sound when trying to take a breath. Description Pneumonia is a lung infection that can be caused by different types of germs, including bacteria, viruses, fungi, and parasites. Although different types of pneumonia tend to affect children in different age groups, pneumonia is most commonly caused by viruses. Some viruses that cause pneumonia are adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (the virus that causes croup). Incubation The incubation period for pneumonia varies, depending on the type of virus or bacteria causing the infection. Some common incubation periods are: respiratory syncytial virus, 4 to 6 days; influenza, 18 to 72 hours. Duration With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely. 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. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person. Prevention There are vaccines to prevent infections by viruses or bacteria that cause some types of pneumonia. Children usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. (The pertussis immunization is the "P" part of the routine DTaP injection.) Vaccines are now also given against the pneumococcus organism (PCV), a common cause of bacterial pneumonia. Children with chronic illnesses, who are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. The flu vaccine is strongly recommended for children with chronic illnesses such as chronic heart or lung disorders or asthma, as well as otherwise healthy children. Because they are at higher risk for serious complications, infants who were born prematurely may be given treatments that temporarily protect against RSV, which can lead to pneumonia in younger children. Doctors may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in children who have been exposed to someone with certain types of pneumonia, such as pertussis. Children with HIV infection may also receive prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii. Antiviral medication is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe. In addition, regular tuberculosis screening is performed yearly in some high-risk areas because early detection will prevent active tuberculosis infection including pneumonia. In general, pneumonia is not contagious, but the upper respiratory viruses that lead to it are, so it is best to keep your child away from anyone who has an upper respiratory tract infection. If someone in your home has a respiratory infection or throat infection, keep his or her drinking glass and eating utensils separate from those of other family members, and wash your hands frequently, especially if you are handling used tissues or dirty handkerchiefs. 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, 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 (38.9 degrees Celsius), or above 100.4 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. The doctor may possibly use a chest X-ray, blood tests, and (sometimes) bacterial cultures of mucus produced by coughing when making a diagnosis. In most cases, pneumonia can be treated with oral antibiotics given to your child at home. The type of antibiotic used depends on the type of pneumonia. Children may be hospitalized for treatment if they have pneumonia caused by pertussis or other bacterial pneumonia that causes high fevers and respiratory distress. They may also be hospitalized if supplemental oxygen is needed, if they have lung infections that may have spread into the bloodstream, if they have chronic illnesses that affect the immune system, if they are vomiting so much that they cannot take medicine by mouth, or if they have recurrent episodes of pneumonia. Home Treatment If your child's doctor has prescribed antibiotics for bacterial pneumonia, give the medicine on schedule for as long as the doctor directs. This will help your child recover faster and will decrease the chance that infection will spread to other household members. Don't force a child who's not feeling well to eat, but encourage your child to drink fluids, especially if fever is present. 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, which may not be helpful in some types of pneumonia. If your child has chest pain, try a heating pad or warm compress on the chest area. Take your child's temperature at least once each morning and each evening, and call the doctor if it goes above 102 degrees Fahrenheit (38.9 degrees Celsius) in an older infant or child, or above 100.4 degrees Fahrenheit (38 degrees Celsius) in an infant under 6 months of age. Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that your child's lungs are not getting enough oxygen. Pneumonia merupakan penyebab kematian terbesar balita dan menjadi masalah kesehatan di negara berkembang , termasuk Indonesia. Vaksinasi merupakan upaya terpenting untuk menurunkan mortalitas dan morbiditas akibat penyakit ini . Perkembangan kesehatan respirasi anak di negeri ini tak luput dari perhatian Prof.Dr. Mardjanis Said SpA(K). Lebih dari 30 tahun, ia menekuni bidang

kesehatan anak khususnya respirologi. Selama itu pula penyakit infeksi pernapasan terutama pneumonia menjadi masalah kesehatan anak dan penyebab kematian balita terbesar di Indonesia. Pneumonia merupakan 'predator ' balita nomor satu di negara berkembang. Badan Kesehatan Dunia (WHO) tahun 2005 memperkirakan kematian balita akibat pneumonia diseluruh dunia sekitar 19 persen atau berkisar 1,6 2,2 juta. Dimana sekitar 70 persennya terjadi di negara-negara berkembang, terutama Afrika dan Asia Tenggara. Persentase ini terbesar bahkan bila dibandingkan dengan diare (17 persen) dan malaria (8 persen). Di Indonesia, prevalensi pneumonia pada balita cenderung meningkat. Berdasarkan Survei Kesehatan Rumah Tangga (SKRT) tahun 2001 kematian balita akibat pneumonia meningkat, berkisar 18,5 -38,8 persen. "Hal ini tidak hanya terjadi di Indonesia, tapi juga menjadi persoalan negera berkembang yang kondisi lingkungannya buruk dan malnutrisi" kata Prof. dr. Mardjanis Said SpA,, pada pidato pengukuhannya sebagai Guru Besar Tetap dalam Ilmu Kesehatan Anak pada Fakultas Kedokteran Universitas Indonesia, di Aula FKUI, 29 April lalu. Dalam orasinya yang bertema "Pneumonia Penyebab Utama Mortalitas Anak Balita: Tantangan dan Harapan", Prof. Mardjanis memaparkan perkembangan pneumonia di Indonesia. Pneumonia tergolong penyakit Infeksi Saluran Pernapasan Akut (ISPA). Penyakit ini dipicu oleh berbagai mikroorganisme terutama bakteri dan virus pada saluran pernafasan, jaringan paru dan adneksanya. Tapi etiologi pasti mikrobiologisnya sukar didapat. Di negara maju, menurut British Thoracic Society, 20-60 persen etiologi pneumonia tidak terindentifikasi. Pada beberapa studi melaporkan bahwa pada anak usia 2 bulan sampai 5 tahun bakteri utama penyebab pneumonia adalah Streptococcus pneumoniae (S. pneumoniae), Hemophilus influenzae tipe b (Hib), dan Staphilococcus aureus (S. aureus). Penelitian di beberapa negara berkembang menunjukan bahwa S. pneumoniae dan Hib merupakan bakteri yang selalu ditemukan pada dua pertiga hasil isolasi, yaitu 73,9 persen dari aspirat baru dan 69,1 persen dari spesimen darah. Pada bayi usia kurang dari dua bulan, terutama pada masa neonatus, pneumonia sukar dibedakan dengan sepsis dan meningitis. Sebab etiologi bakterilogiknya berbeda dengan pneumonia anak usia di atas dua bulan. 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, dan Coli sp. Gambaran klinis, diagnosis dan prognosis pneumonia pada bayi dan balita dipengaruhi oleh berbagai faktor. Antara lain faktor imaturitas anatomis dan imunologis, gejala klinis yang kadang-kadang tidak khas terutama pada bayi, keterbatasan penggunaan prosedur diagnosis invasif, etiologi non infeksi yang relatif lebih sering dan faktor patogenesis. Gambaran klinis pneumonia diklasifikasikan menjadi dua kelompok. Pertama, gejala infeksi umum seperti demam , sakit kepala, gelisah, malaise, nafsu makan berkurang, gejala gastrointestinal seperti mual, muntah atau diare. Kedua, gejala gangguan respiratorik seperti batuk, sesak napas, retraksi dada, takipnu, napas cuping hidung, air hunger dan sianosis. Pemberian antibiotik merupakan salah satu kunci terapi pneumonia. Pasien pneumonia rawat jalan, diberi antibiotik seperti kortrimoksazol atau amoksisilin yang diberikan secara oral. Sebagai perbandingan, sebuah penelitian multisenter di Pakistan yang membuktikan bahwa pada pneumonia rawat jalan, amoksisilin (25 mg/kg/BB) dan kotrimoksazol (4 mg/kg BB TMP- 20 mg/kg BB sulfametaksazol) 2 kali sehari adalah samasama efektif. Sementara pada pneumonia rawat inap diberikan antibiotik beta-laktam intravena atau kombinasi antibiotik beta-laktam dan kloramfenikol intravena . Di Departemen IKA FKUI/RSCM pneumonia berat yang diberikan kombinasi amoksisilin dan kloramfenikol intravena, sejauh ini efektifitasnya cukup memuaskan. Sebagai referensi, suatu penelitian terapi antibiotik pada anak usia 2- 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, efektifitasnya ternyata sama. Walaupun prevalensi pneumokokus resistensi penisilin makin berkembang namun studi bakteriologi klugman masih memberi harapan. Dilaporkan bahwa antibiotik beta-laktam dosis tinggi masih mampu mengatasi aktivitas bakteri gram positif resisten-penisilin. Oleh karena itu antibiotik beta-laktam masih merupakan antibiotik pilihan untuk pengobatan pneumonia Cegah dengan Imunisasi Imunisasi menjadi pengalaman sukses dunia kedokteran. Program Pengembangan Imunisasi (PPI) yang dicanangkan di seluruh dunia, terbukti menurunkan angka kematian balita. Begitu pula dengan program imunisasi terhadap penyakit infeksi pernapasan akut memberikan kontribusi cukup besar dalam menurunkan angka kematian balita. "Upaya pencegahan dengan pemberian vaksin merupakan komponen penting dalam menurunkan mortalitas," tegas Prof. Mardjanis. Sekarang ini telah dikembangkan vaksin untuk mengatasi Hib dan pneumokokus. Vaksin Hib konjugat dikembangkan dengan mengkonjugasikan protein-karier pada kapsul polisakarida Hib. Protein-karier yang digunakan dapat berasal dari toksoid tetanus, toksin difteri, atau protein membran luar N meningitides. Vaksin ini telah terbukti cukup poten, aman dan efektif sejak usia enam minggu ke atas. Tetapi di Indonesia vaksin ini dimulai pada usia 2 bulan. S. pneumonia berbeda dengan Hib yang hanya memiliki satu serotipe. S. pneumonia mempunyai lebih dari 90 serotipe yang sebagian besar menjadi penyebab penyakit pada anak. Di Amerika Serikat telah dikenal 7 serotipe ( 4, 6B, 9V, 14, 18C, 19F, 23F ) yang bertanggung jawab terhadap 83 persen penyakit pneumokokus invasif pada anak usia di bawah 5 tahun. Atas dasar itu, 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. Beberapa studi menunjukan vaksin pneumokokus konjugat heptavalen memberikan efektivitas sangat tinggi dalam mencegah penyakit pneumokokus invasif (bakteriemia, meningitis, dan pneumonia), serta menurunkan angka kejadian otitis media akut dan prevalensi kolonisasi di nasofaring. Di samping itu, timbul juga efek herd immunity, yaitu anak yang tidak divaksinasi akan terproteksi akibat anak-anak lain diimuniasi. Studi klinis pada 37.000 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, 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. Studi lain pada 2003 memperlihatkan penurunan jumlah bayi penderita infeksi invasif akibat pneumokokus sebanyak 78 persen setelah divaksinasi saat berusia 2 tahun. Berdasarkan keefektifan vaksin tersebut dalam mencegah pneumonia, meningitis dan bakteremia maka vaksin ini menjadi vaksin yang diwajibkan di Amerika Serikat, Eropa dan Australia serta telah digunakan lebih dari 100 juta dosis di seluruh dunia. Saat ini, di Indonesia, vaksin pneumokokus ini telah tersedia. Pneumonia Dari Wikipedia Indonesia, ensiklopedia bebas berbahasa Indonesia. Langsung ke: navigasi, cari Artikel ini tentang pneumonia pada manusia. Untuk membaca tentang pneumonia dalam hewan lainnya, lihat pneumonia (non-manusia).Pneumonia Kode ICD-10: J12-J18, P23 Kode ICD-9: 480-486, 770.0 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 dapat disebabkan oleh beberapa penyebab, termasuk infeksi

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

radiograph of 1134 patients presenting to an emergency room:[6] Temperature > 100 degrees F (37.8 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 - 84% to 91% probability 4 findings - 58% to 85% 3 findings - 35% to 51% 2 findings - 14% to 24% 1 findings - 5% to 9% 0 findings - 2% to 3% A subsequent study[7] comparing four prediction rules to physician judgment found that two rules, the one above[6] and also[8] were more accurate than physician judgment because of the increased specificity of the prediction rules. [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. Chronic obstructive pulmonary disease (COPD) or asthma can present with a polyphonic wheeze, similar to that of pneumonia. Pulmonary edema can be mistaken for pneumonia due to it's ability to show a third heart sound and present with an abnormal ECG. Other diseases to be taken into consideration include bronchiectasis, lung cancer and pulmonary emboli.[2] [edit] Pathophysiology Upper panel shows a normal lung under a microscope. The white spaces are alveoli that contain air. Lower panel shows a lung with pneumonia under a microscope. The alveoli are filled with inflammation and debris. Pneumonia can be caused by microorganisms, irritants and unknown causes. When pneumonias are grouped this way, infectious causes are the most common type. 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. Although more than one hundred strains of microorganism can cause pneumonia, only a few are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. Less common causes of infectious pneumonia are fungi and parasites. [edit] Viruses Main article: Viral pneumonia Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either when the virus directly kills the cells, or through a type of cell controlled self-destruction called apoptosis. When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain chemical cytokines which allow fluid to leak into the alveoli. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to bacterial infections; for which reason bacterial pneumonia often complicates viral pneumonia. Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare cause of pneumonia except in newborns. People with immune system problems are also at risk of pneumonia caused by cytomegalovirus (CMV). [edit] Bacteria Main article: Bacterial pneumonia Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the spaces between cells and between alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation. The bacterium Streptococcus pneumoniae, a common cause of pneumonia, photographed through an electron microscope. Bacteria often travel from an infected lung into the bloodstream, causing serious or even fatal illness such as septic shock, with low blood pressure and damage to multiple parts of the body including the brain, kidneys, and heart. Bacteria can also travel to the area between the lungs and the chest wall (the pleural cavity) causing a complication called an empyema. The most common causes of bacterial pneumonia are Streptococcus pneumoniae, Gram-positive bacteria and "atypical" bacteria. The terms "Gram-positive" and "Gram-negative" refer to the bacteria's color (purple or red, respectively) when stained using a process called the Gram stain. The term "atypical" is used because atypical bacteria commonly affect healthier people, cause generally less severe pneumonia, and respond to different antibiotics than other bacteria. The types of Gram-positive bacteria that cause pneumonia can be found in the nose or mouth of many healthy people. Streptococcus pneumoniae, often called "pneumococcus", is the most common bacterial cause of pneumonia in all age groups except newborn infants. Another important Gram-positive cause of pneumonia is Staphylococcus aureus, with Streptococcus agalactiae being an important cause of pneumonia in newborn babies. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. "Atypical" bacteria which cause pneumonia include Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. [edit] Fungi Main article: Fungal pneumonia Fungal pneumonia is uncommon, but it may occur in individuals with immune system problems due to AIDS, immunosuppresive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal pneumonia is most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis in the southwestern United States. [edit] Parasites Main article: Parasitic pneumonia A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or by being swallowed. Once inside, they travel to the lungs, usually through the blood. There, as in other cases of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation. One type of white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are Toxoplasma gondii, Strongyloides stercoralis, and Ascariasis. [edit] Idiopathic Main article: Idiopathic interstitial pneumonia

Idiopathic interstitial pneumonias (IIP) are a class as diffuse lung diseases. In some types of IIP, e.g. some types of usual interstitial pneumonia, the cause, indeed, is unknown or idiopathic. In some types of IIP the cause of the pneumonia is known, e.g. desquamative interstitial pneumonia is caused by smoking, and the name is a misnomer. [edit] Classification Pneumonias can be classified in several ways. Pathologists originally classified them according to the anatomic changes that were found in the lungs during autopsies. As more became known about the microorganisms causing pneumonia, a microbiologic classification arose, and with the advent of x-rays, a radiological classification. Another important system of classification is the combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease and underlying systemic disease, and whether the person has recently been hospitalized. [edit] Early classification schemes Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of the lung, either by direct inspection at autopsy or by its appearance under a microscope. A lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Lobar pneumonia is often due to Streptococcus pneumoniae. Multilobar pneumonia involves more than one lobe, and it often causes a more severe illness. Interstitial pneumonia involves the areas in between the alveoli, and it may be called "interstitial pneumonitis." It is more likely to be caused by viruses or by atypical bacteria. 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. Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray findings can be used to help predict the course of illness, although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone. With the advent of modern microbiology, classification based upon the causative microorganism became possible. Determining which microorganism is causing an individual's pneumonia is an important step in deciding treatment type and length. Sputum cultures, blood cultures, tests on respiratory secretions, and specific blood tests are used to determine the microbiologic classification. Because such laboratory testing typically takes several days, microbiologic classification is usually not possible at the time of initial diagnosis. [edit] Combined clinical classification Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. This is useful because chronic pneumonias tend to be either non-infectious, or mycobacterial, fungal, or mixed bacterial infections caused by airway obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as Streptococcus pneumoniae), the atypical pneumonias (such as the interstitial pneumonitis of Mycoplasma pneumoniae or Chlamydia pneumoniae), and the aspiration pneumonia syndromes. The combined clinical classification, now the most commonly used classification scheme, attempts to identify a person's risk factors when he or she first comes to medical attention. 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. There are two broad categories of pneumonia in this scheme: community-acquired pneumonia and hospital-acquired pneumonia. 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. [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. CAP is the most common type of pneumonia. The most common causes of CAP vary depending on a person's age, but they include Streptococcus pneumoniae, viruses, the atypical bacteria, and Haemophilus influenzae. Overall, Streptococcus pneumoniae is the most common cause of community-acquired pneumonia worldwide. Gramnegative bacteria cause CAP in certain at-risk populations. CAP is the fourth most common cause of death in the United Kingdom and the sixth in the United States. An outdated term, 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). Walking pneumonia is usually caused by a virus or by atypical bacteria. [edit] Hospital-acquired pneumonia Main article: Hospital-acquired pneumonia Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission. The causes, microbiology, treatment and prognosis are different from those of community-acquired pneumonia. Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. Hospitalized patients may have many risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances. Additionally, the microorganisms a person is exposed to in a hospital are often different from those at home . Hospital-acquired microorganisms may include resistant bacteria such as MRSA, Pseudomonas, Enterobacter, and Serratia. Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired pneumonia. Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonia. VAP is pneumonia which occurs after at least 48 hours of intubation and mechanical ventilation. [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. SARS is caused by the SARS coronavirus, a previously unknown pathogen. New cases of SARS have not been seen since June 2003. Bronchiolitis obliterans organizing pneumonia (BOOP) BOOP is caused by inflammation of the small airways of the lungs. It is also known as cryptogenic organizing pneumonitis (COP). Eosinophilic pneumonia Eosinophilic pneumonia is invasion of the lung by eosinophils, a particular kind of white blood cell. Eosinophilic pneumonia often occurs in response to infection with a parasite or after exposure to certain types of environmental factors. Chemical pneumonia Chemical pneumonia (usually called chemical pneumonitis) is caused by chemical toxins such as pesticides, which may enter the body by inhalation or by skin contact. When the toxic substance is an oil, the pneumonia may be called lipoid pneumonia. Aspiration pneumonia Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating foreign objects which are usually oral or gastric contents, either while eating, or after reflux or vomiting which results in bronchopneumonia. The resulting lung inflammation is not an infection but can contribute to one, since the material aspirated may contain anaerobic bacteria or other unusual causes of pneumonia. Aspiration is a leading cause of death among hospital and nursing home patients, since they often cannot adequately protect their airways and may have otherwise impaired defenses. [edit] Treatment

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

women for Group B Streptococcus and Chlamydia trachomatis, and then giving antibiotic treatment if needed, reduces pneumonia in infants. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia. Vaccination is important for preventing pneumonia in both children and adults. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced their role in pneumonia in children. Vaccinating children against Streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. A vaccine against Streptococcus pneumoniae is also available for adults. In the U.S., it is currently recommended for all healthy individuals older than 65 and any adults with emphysema, congestive heart failure, diabetes mellitus, cirrhosis of the liver, alcoholism, cerebrospinal fluid leaks, or those who do not have a spleen. A repeat vaccination may also be required after five or ten years. [17] Influenza vaccines should be given yearly to the same individuals who receive vaccination against Streptococcus pneumoniae. In addition, health care workers, nursing home residents, and pregnant women should receive the vaccine.[18] When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivir can help prevent influenza.[19][20] [edit] Epidemiology Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. In children, the majority of deaths occur in the newborn period, with over two million deaths a year worldwide. 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, and 90% of these deaths take place in developing countries. Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, [22] Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. In the United Kingdom, the annual incidence of pneumonia is approximately 6 cases for every 1000 people for the 18-39 age group. For those over 75 years of age, this rises to 75 cases for every 1000 people. Roughly 20-40% of individuals who contract pneumonia require hospital admission of which between 5-10% are admitted to a critical care unit. Similarly, the mortality rate in the UK is around 510%.[2] More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in Blacks than Caucasians. Individuals with underlying illnesses such as Alzheimer's disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia.[23] These individuals are also more likely to have repeated episodes of pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia. [edit] History Hippocrates, the ancient Greek physician known as the "father of medicine." The symptoms of pneumonia were described by Hippocrates (c. 460 BC370 BC): Sir William Osler, known as "the father of modern medicine," appreciated the morbidity and mortality of pneumonia, describing it as the "captain of the men of death" in 1918. However, several key developments in the 1900s improved the outcome for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the twentieth century, mortality from pneumonia dropped precipitously in the developed world. Vaccination of infants against Haemophilus influenzae type b began in 1988 and led to a dramatic decline in cases shortly thereafter.[30] Vaccination against Streptococcus pneumoniae in adults began in 1977 and in children began in 2000, resulting in a similar decline. Pneumonia yang kerap disebut paru-paru basah termasuk jenis penyakit berbahaya. Perkuat tubuh rales, and the violence of the disease which is obtaining the upper hand.[24] However, Hippocrates referred to pneumonia as a disease "named by the ancients." He also reported the results of surgical drainage of empyemas. Maimonides (11381204 AD) observed "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever, sticking [pleuritic] pain in the side, short rapid breaths, serrated pulse and cough."[25] This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century. Bacteria were first seen in the airways of individuals who died from pneumonia by Edwin Klebs in 1875. [26] Initial work identifying the two common bacterial causes Streptococcus pneumoniae and Klebsiella pneumoniae was performed by Carl Friedlnder[27] and Albert Frnkel[28] in 1882 and 1884, respectively. Friedlnder's initial work introduced the Gram stain, a fundamental laboratory test still used to identify and categorize bacteria. 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.[29] dengan gizi seimbang dan menjaga lingkungan adalah langkah terbaik nmnghindarinya. Ketika seorang anak atau orang dewasa berbaring di lantai tanpa alas, kerap muncul seruan, "Eh, jangan tiduran begitu, nanti kena paru-paru basah, lho!"Yang ditegur pun menurut, lalu pindah ke sofa atau tempat tidur. Banyak orang menganggap, lembabnya udara dari lantai atau yang kita hirup bisa menyebabkan paru-paru basah. Benarkah? Apa sebenarnya paru-paru basah itu? 30 Sumber Infeksi Dalam dunia kedokteran, tidak dikenal istilah paruparu basah. Yang ada pneumonia, yaitu infeksi yang menyebabkan paru-paru meradang. Kantong-kantong udara dalam paru (alveoli) dipenuhi nanah dan cairan, sehingga kemampuan menyerap oksigen berkurang. Dr. Prajna Paramita, MD, FCCP, menyebutkan bahwa penyakit ini disebabkan oleh sekitar 30 macam sumber infeksi. Namun, penyebab utamanya adalah bakteri, virus, mikroplasma, jamur, berbagai senyawa kimia, dan partikel. Meski kasus pneumonia akibat bakteri tidak terlalu banyak, jenis ini cenderung menimbulkan infeksi lebih berat daripada yang disebabkan oleh nonbakteri. Virus sinsitial pernapasan (respiratory syncitial virus atau RSV), painfluenzae, influenzae, dan adenovirus merupakan yang paling kerap menyebabkan pneumonia. Umumnya infeksi virus saluran pernapasan bawah berlangsung selama musim dingin atau hujan. Dan RSV yang paling umum menjadi penyebab pneumonia, terutama pada bayi. Sulit Bernapas Pneumonia muncul karena kuman penyakit terhirup hidung dan mulut. Bila lingkungan di sekitar ada orang atau anak yang terinfeksi, risiko tertular sangat besar, apalagi bila daya tahan tubuh sedang tidak baik.

"Pneumonia termasuk penyakit yang serius dan berbahaya," ujar spesialis paru dari RSPAD Gatot Subroto yang akrab disapa Dr. Mita ini. Gara-gara nanah dan cairan memenuhi paru-paru, oksigen di selsel tubuh pun berkurang dan tidak bisa bekerja. Akibatnya, selain penyebaran infeksi ke seluruh tubuh, penderita bisa meninggal. Pneumonia ditandai oleh batuk disertai sulit bernapas, napas sesak, atau terjadi penarikan dinding dada sebelah bawah ke dalam (severe chest indrawing). 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. Pada anak usia di bawah 2 bulan, pneumonia berat ditandai kerapnya frekuensi bernapas. Bisa 60 kali permenit atau lebih tarikan napas, dengan penarikan kuat pada dinding dada sebelah bawah ke dalam. Gejala lain adalah radang tenggorokan (laringitis). Akibatnya suara berubah serak karena di sekitar pita suara banyak terdapat lendir. Lewat pemeriksaan rontgen dada, bisa diketahui ada masalah di paru. Tanda klinis yang bisa ditemui biasanya flek pada paru. Namun, tanda klinis ini tidak mencukupi sebab tuberkulosis pun ditandai oleh flek ini. Karena itu, pemeriksaan penunjang seperti pemeriksaan darah, dahak, serta gejala sangat penting untuk menentukan flek ini pertanda TBC atau pneumonia. Perlu Mengatur Makan Pengobatan awal untuk pneumonia biasanya berupa antibiotika. Bila penyebabnya bakteri, mikroplasma, dan rickettsia, biasanya antibiotika ini cukup manjur. Untuk pneumonia akibat virus, sampai saat ini belum ada panduan khusus, meski beberapa obat antivirus telah digunakan. Selain antibiotika, pasien juga akan mendapat terapi tambahan berupa pengaturan makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. Istirahat panjang diperlukan untuk mengembalikan kondisi tubuh. Langkah untuk Mencegah Jenis dan parahnya penyakit ini disebabkan oleh beberapa faktor, termasuk usia, jenis kelemin, musim, dan kepadatan penduduk. Pada anak, infeksi lebih sering mengenai laki-laki dibanding anak perempuan. Puncak serangan infeksi antara usia 2 dan 3 tahun dan sesudahnya akan menurun sedikit demi sedikit. Beberapa kasus pneumonia tidak disebabkan infeksi mikroorganisme. Bisa juga akibat aspirasi makanan atau asam lambung, benda asing, hidrokarbon, bahan lipoid, reaksi hipersensitivitas dari saluran napas, akibat obat, radiasi, serta kondisi lingkungan. Agar terhindar dari pneumonia perlu beberapa langkah strategis seperti: * Menjaga kebersihan lingkungan tempat tinggal. * Mengusahakan sirkulasi udara yang baik. * Hindari rokok dan penderita batuk. * Makanlah dengan gizi seimbang, * Lakukan imunisasi, terutama untuk anak. Vaksin Hb sudah banyak dipakai untuk menangkal pneumonia, selain meningitis. Vaksin ini untuk menangkal serangan bakteri Haemophyllus influenzae tipe B yang bisa menyebabkan kedua jenis penyakit itu. Sudah Ada Vaksinnya Pneumonia Bakteri Jenis ini bisa menyerang bayi sampai usia lanjut. Pecandu alkohol, pasien pasca operasi, penderita penyakit pernapasan, sedang terinfeksi virus atau kekebalan tubuh menurun, rentan terkena penyakit ini. Bakteri penyebab pneumonia yang paling umum adalah Streptococcus pneumoniae, dan sudah ada di kerongkongan manusia sehat. Saat kekebalan tubuh menurun, usia tua, atau kurang gizi, bakteri segera memperbanyak diri dan merusak tubuh. Seluruh jaringan paru dipenuhi cairan dan infeksi terjadi cepat menyebar ke seluruh tubuh lewat darah. Pasien yang terinfeksi pneumonia akan panas tinggi, berkeringat, napas terengah-engah, dan denyut jantung meningkat cepat. Bibir dan kuku bisa membiru karena tubuh kekurangan oksigen. Pada kasus berat, pasien akan menggigil, gigi bergemelutuk, sakit dada, dan kalau batuk mengeluarkan lendir berwarna hljau. Sebelum terlambat, penyakit ini bisa diobati. Vaksin pencegahannya pun sudah tersedia. Pneumonia Virus sebagian besar kasus pneumonia disebabkan oleh virus. Kebanyakan virus menyerang saluran pernapasan atas. Untungnya, sebagian besar pneumonia ini tidak berat dan sembuh dalam waktu singkat. Jika infeksi terjadi berbarengan dengan virus influenza, gangguan bisa berat, bahkan menyebabkan kematian. Virus penginfeksi paru akan berkembang biak, meski tak tampak di jaringan paru yang penuh cairan. Gejala pneumonia ini mirip influenza. Tandanya, demam, batuk kering, sakit kepala, ngilu di seluruh tubuh. Letih lesu selama 12-136 jam, napas sesak batuk makin hebat dan menghasilkan sejumlah lendir juga bisa dialami. Demam tinggi kadang membuat bibir membiru. Sumber: Senior Pneumonia Penyebab Utama Mortalitas Anak Balita di Indonesia; Prof. Dr. H. Mardjanis Said, Sp.A(K) Pnumonia adalah penyakit infeksi akut paru yang disebabkan terutama oleh bakteri; merupakan penyakit Infeksi Saluran Pernapasan Akut (ISPA) yang paling sering menyebabkan kematian pada bayi dan anak balita. Bakteri penyebab pneumonia paling sering adalah Streptococcus pneumoniae (pneumokokus), Hemophilus influenzae tipe b (Hib) dan Staphylococcus aureus (S aureus). Diperkirakan 75% pneumonia pada anak balita di negara berkembang termasuk di Indonesia disebabkan oleh pneumokokus dan Hib. Di seluruh dunia setiap tahun diperkirakan terjadi lebih 2 juta kematian balita karena pneumonia. Di Indonesia menurut Survei Kesehatan Rumah Tangga tahun 2001 kematian balita akibat pneumonia 5 per 1000 balita per tahun. Ini berarti bahwa pneumonia menyebabkan kematian lebih dari 100.000 balita setiap tahun, atau hampir 300 balita setiap hari, atau 1 balita setiap 5 menit. Demikian pidato Prof. Dr. Mardjanis Said SpA(K) dan Departemen Ilmu Kesehatan Anak FKUI sebagai Guru Besar Tetap dalam Ilmu Kesehatan Anak di Fakultas Kedokteran Universitas Indonesia Jakarta, pada tanggal 29 April 2006. 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. Tidak heran bila melihat kontribusinya yang besar terhadap kematian balita pneumonia dikenal juga sebagai "pembunuh balita nomor satu". Upaya pencegahan merupakan komponen strategis dalam pemberantasan pneumonia pada anak; tendiri dari pencegahan melalui imunisasi dan upaya pencegahan non-imunisasi. Program Pengembangan Imunisasi (PPI) yang meliputi imunisasi DPT dan campak yang telah dilaksanakan pemerintah selama ini dapat menurunkan proporsi kematian balita akibat pneumonia. Hal ini dapat dimengerti karena campak, pertusis dan juga difteri bisa juga menyebabkan pneumonia atau merupakan penyakit penyerta pada pneumonia balita. Di samping itu, sekarang telah tersedia vaksin Hib dan vaksin pneumokokus konjugat untuk pencegahan terhadap infeksi bakteri penyebab pneumonia dan penyakit berat lain seperti meningitis. Namun vaksin ini belum masuk dalam Program Pengembangan Imunisasi (PPI) Pemerintah. Yang tidak kalah penting sebenarnya adalah upaya pencegahan non-imunisasi yang meliputi pemberian ASI eksklusif, pemberian nutrisi yang baik, penghindaran pajanan asap nokok, asap dapur dIl; perbaikan lingkungan hidup dan sikap hidup sehat; yang kesemuanya itu dapat menghindarkan terhadap

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

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

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

sounds, or pleural friction rub. The affected lung field may be dull to percussion. Decreased tactile and vocal fremitus, as well as egophony, may be appreciated over the area of pneumonia. Causes Various organisms cause pneumonia. Bacterial, viral, mycoplasmal, chlamydial, fungal, and mycobacterial infections are relatively common and have similar presentations, complicating clinical diagnosis. To complicate matters, basic laboratory and radiologic testing is often not helpful in determining the etiology of pneumonia, and the treatments widely vary. However, certain age trends in the etiology of pneumonia can aid in decision-making, even before testing is complete. Newborns (aged 0-30 d) o Infections with group B Streptococcus, Listeria monocytogenes, or gram-negative rods (eg, Escherichia coli, Klebsiella pneumoniae) are a common cause of bacterial pneumonia. These pathogens can be acquired in utero, via aspiration of organisms present in the birth canal, or by postnatal contact with other people or contaminated equipment. o Some organisms acquired perinatally may not cause illness until later in infancy, including Chlamydia pneumoniae, Ureaplasma urealyticum, Mycoplasma hominis, cytomegalovirus, and Pneumocystis carinii. Infants infected with these organisms present between age 4-11 weeks with an afebrile pneumonia characterized by a staccato cough, tachypnea, and, occasionally, hypoxia. Community-acquired viral infections occur in newborns, although less commonly than in older infants. The most commonly isolated virus is respiratory syncytial virus (RSV). The transfer of maternal antibodies is important in protecting newborns and young infants from such infections, making premature infants (who may not have benefited from sufficient transfer of transplacental immunoglobulin G [IgG]) especially vulnerable to lower-tract disease. In addition, premature infants may have chronic lung disease of prematurity, with associated hyperreactive airways, fewer functional alveoli, and baseline increased oxygen requirements. Infants and toddlers o Viruses are the most common cause of pneumonia, accounting for approximately 90% of all lower respiratory infections. o RSV is the most common viral pathogen, followed by parainfluenza types 1, 2, and 3 and influenza A or B. RSV infection occurs in the winter and early spring. Parainfluenza type 3 infection occurs in the spring, and types 1 and 2 occur in the fall. Influenza occurs in the winter. o Other viruses that cause pneumonia less frequently in infants include adenovirus, enterovirus, rhinovirus, coronavirus, herpesvirus, and cytomegalovirus. A recent addition to this list is human metapneumovirus, which causes an illness similar to RSV and may be
responsible for one third to one half of non-RSV bronchiolitis. o Bacterial infections in this age group are uncommon and are attributable to Streptococcus pneumoniae, H influenzae type B (less common in immunized children), or Staphylococcus aureus. Infants or toddlers with bacterial pneumonia may present with lethargy, irritability, acidosis, hypotonia, or hypoxia that is out of proportion to ausculatory findings. o Children younger than 5 years, children enrolled in daycare, or those with frequent ear infections are at increased risk for invasive pneumococcal disease and infection with resistant pneumococcal strains. They are often treated with an antibiotic within a month of contracting pneumonia. o Evidence suggests that breastfeeding has a protective effect against invasive pneumococcus. Children aged 5 years (ready to start school)
Mycoplasma pneumoniae is the most common cause of community-acquired pneumonia and accounts for 20% of pneumonia cases in the general population, 9-16% of cases in early-schoolaged children, 1621% of cases in older children, and 30-50% of cases in college students and military recruits. Mycoplasma infections are indolent, with gradual onset of malaise, low-grade fever, headache, and cough. Chlamydia pneumoniae is also fairly common
in this age group and presents in a similar fashion. School-aged children and adolescents: Bacterial pneumonia (10%) is common, and these children are often febrile and appear ill. o Tuberculosis (TB) pneumonia in children warrants special mention. o Children with TB usually do not present with symptoms until 1-6 months after primary infection. o Infants and postpubertal adolescents are at increased risk of disease progression. These children may present with fever, night sweats, chills, cough (which may include hemoptysis), and weight loss. o Chest radiography findings may include hilar or mediastinal lymphadenopathy, atelectasis, or consolidation of a segment or lobe (usually right upper lobe), pleural effusion, cavitary lesions (in adolescents and adults only), or miliary disease. o A history of exposure to possible sources should be obtained (eg, immigrants from Africa, certain parts of Asia, and Eastern Europe; contacts with persons in the penal system; close contact with known individuals with TB). o If TB is not treated during the early stages of infection, approximately 25% of children younger than 15 years develop extrapulmonary disease. Bordetella pertussis also causes pneumonia, although predominantly in infants who have not completed their vaccinations or in children who did not receive vaccinations. Bronchopneumonia occurs in 0.8-2% of all pertussis cases and 16-20% of hospitalized cases. The survival rate with this complication is much lower than in pneumonia attributed to other causes. A study conducted in the United Kingdom showed that 59% of

deaths from pertussis are associated with pneumonia. Clinical presentation includes coryza, malaise, fever, paroxysms of cough occasionally accompanied by emesis, apnea, poor feeding, and cyanosis. Viral pneumonias are common in this age group and are usually mild and self-limited. However, as in adults, viral pneumonias are occasionally severe and can rapidly progress to respiratory failure, either as a primary manifestation of viral infection or as a consequence of subsequent bacterial infection. Group A streptococcal, pneumococcal, and staphylococcal secondary infections are all relatively common. Aspiration pneumonia is more common in children with neurological impairment and swallowing abnormalities. Oral anaerobic flora, with or without aerobes, is the most common etiologic agent. In immunosuppressed individuals, opportunistic infections with organisms such as Aspergillus species, Candida species, Pneumocystis species, and cytomegalovirus can occur. Lab Studies Identifying the causative infectious agent is the most valuable step in managing a complicated case of pneumonia. Unfortunately, an etiologic agent can be difficult to identify. Therefore, in most patients with community-acquired pneumonia who are treated on an outpatient basis, treatment is empiric and based primarily on patient age and clinical presentation. In patients with complicated pneumonia who have not responded to treatment or who require admission to the hospital, several diagnostic studies aimed at identifying the infectious culprit are warranted, including cultures, serology, and a CBC count with the differential and acute-phase reactants (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]). Direct antigen detection correct diagnosis allows for appropriate placement of patients in the hospital. For example, if necessary, 2 infants with RSV infection may share a room, whereas such patients would normally need isolation and may unnecessarily tie up a bed. o Viral cultures can be obtained in 12 days using newer cell culture techniques and may permit discontinuation of unnecessary antibiotics. Sputum culture Sputum is rarely produced in children younger than 10 years, and samples are always contaminated by oral flora. An adequate sputum culture should contain more than 25 polymorphonuclear (PMN) cells per field and fewer than 10 squamous cells per field. o The common agents that cause pneumonia may be normal oral flora. For these reasons, sputum cultures are not useful in most children with pneumonia, although a Gram stain may help. Bronchoscopy necessary to send the samples for the appropriate tests. o Contamination of the bronchoscopic aspirate with upper airway secretions is common; quantitative cultures can help distinguish contamination from infection. Blood culture Although blood cultures are technically easy to obtain and relatively noninvasive and nontraumatic, the results are rarely positive in the presence of pneumonia and even less so in cases of pretreated pneumonia. o In a study of 168 patients with known pneumonia, McCracken and associates found only sterile blood cultures. In general, blood culture results are positive in 1015% of patients with streptococcal pneumonia (Media file 1). The numbers are even less in patients with Staphylococcus infection. A blood culture is still recommended in complicated cases of pneumonia. Lung aspirate aspirate. The organisms obtained in the blood and lung aspirate differed in 4 of the 8 children in whom both culture results were positive, suggesting that a blood culture may not always accurately reveal the lung pathogen. o Other studies have demonstrated lung aspirate results to be positive in 50-60% of patients with known pneumonia. In these studies, 1.59% of patients had a pneumothorax and 0.7-3% had transient small hemoptysis complicating their lung aspirations. Because of the possible risks associated with lung aspiration, it should be reserved for patients who are ill enough to require hospitalization, have not improved with previous empiric treatment, or are immunocompromised and an exact etiology is needed. o A lung aspirate should not be performed in patients who are on ventilators, patients with a bleeding diathesis, or in patients suspected of having an infection with Pneumocystis. Thoracentesis
Although antiviral therapies are not often used, performing a nasal wash for RSV and influenza enzyme-linked immunoassay (ELISA) and viral culture can help to establish a rapid diagnosis, which may be helpful in excluding other diagnoses. In addition,
Flexible fiberoptic bronchoscopy is occasionally useful to obtain lower airway secretions for culture or cytology. This procedure is most useful in immunocompromised patients who are believed to be infected with unusual organisms (Pneumocystis, other fungi) or in patients who are severely ill. Careful consideration of the diagnostic possibilities is
o o
This test is underused and is a significantly more efficient method of obtaining a culture. 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.2 Blood culture implicated an organism in 18% of the patients compared with 52% with lung
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, by definition, the patient has an empyema, which may require drainage for complete resolution. Other therapeutic decisions can be made based on the properties of the effusion (see Complications).
Serology
Because of the relatively low yield of cultures, more efforts are underway to develop quick and accurate serologic tests for common lung pathogens, such as M pneumoniae. In a Finnish study, 278 patients diagnosed with communityacquired pneumonia underwent extensive testing for Mycoplasma infection.3 Acute and convalescent serum samples were collected and tested using enzyme immunoassay for M pneumoniae immunoglobulin M (IgM) and IgG antibodies. Nasopharyngeal aspirates were tested using PCR and cultured with a Pneumofast kit. Positive results were confirmed with Southern hybridization of PCR products and an IgM test with solid-phase antigen. A total of 24 (9%) confirmed diagnoses of Mycoplasma infection were made. All 24 cases had positive results with IgM-capture test with convalescent-phase serum. Using an IgM-capture test in acute-phase serum, 79% of results were positive, 79% were positive using IgG serology, 50% positive using PCR, and 47% positive using culture. 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. IgM serology is much more sensitive than cold agglutinin
assessments, which are more commonly used to aid in the diagnosis of Mycoplasma infection and demonstrate positive results in only 50% of cases. Polymerase chain reaction
o o
This test shows promise of being useful in diagnosing streptococcal pneumonia. PCR is noninvasive, an advantage over lung aspirate or bronchoalveolar lavage (BAL) cultures. Similarly, C pneumoniae infection is diagnosed more readily with PCR than with culture; however, 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. Although new serologic and PCR tests for common lung pathogens hold definite promise for making rapid, accurate, and noninvasive diagnosis, they are not widely available, and the results may not return until after the patient has already completed a course of antibiotics. Direct fluorescent antibody and serologic tests for RSV and influenza, as well as a PCR test for TB, are widely available and have proven to be of considerable benefit in the treatment of hospitalized patients.
Skin tests
These tests are used in diagnosing TB. Mantoux skin test (intradermal inoculation of 5 TU of purified protein derivative) results should
be read 48-72 hours after placement. In children older than 4 years without any risk factors, test results are positive if the induration (not the area of erythema, which may be larger) is 15 mm or larger. Among children younger than 4 years, those who have an increased environmental exposure to TB or other medical risk factors (eg, lymphoma, diabetes mellitus, malnutrition, renal failure), results are positive if the induration is 10 mm or larger. In immunosuppressed children or those in close contact with others who have known or suspected cases of TB, test results are positive if the induration is 5 mm or larger. Even if the child has received the Bacillus Calmette-Gurin (BCG) vaccine, Mantoux test results should be interpreted using the criteria outlined above. Chest radiography helps to confirm the diagnosis of a child with positive Mantoux test results. If the chest radiography findings are positive or if the child has other symptoms consistent with the diagnosis of TB, an attempt should be made to isolate the tubercle bacilli from early-morning gastric aspirates, cerebrospinal fluid, sputum, urine, pleural fluid, or biopsy specimen. In a child with suspected pulmonary TB, the cough may be scarce or nonproductive. Therefore, the best test for diagnosis is an early-morning gastric aspirate sent for acid-fast bacilli (AFB) stain, culture, and, if
available, PCR. Gastric aspirates should be obtained by first placing a nasogastric (NG) tube the night before sample collection; a sample is aspirated first thing the following morning, before ambulation and feeding. This should be repeated on 3 consecutive mornings. CBC count: Testing should include a CBC count with differential and evaluation of acute-phase reactants (ESR, CRP, or both) and sedimentation rate. The total WBC and differential may aid in determining if an infection is bacterial or viral, and, together with clinical symptoms, chest radiography and ESR can be useful in monitoring the course of pneumonia. Arterial blood gas: This test is indicated in any patient with significant respiratory distress to determine the degree of respiratory insufficiency.
Imaging Studies Radiography o This is the primary imaging study used to confirm the diagnosis of pneumonia. Physicians often obtain radiographs when diagnosing pneumonia; however, they are not always necessary or useful in determining the etiology of the infection. o Chest radiography is indicated in an infant or toddler who presents with fever and any of the following: tachypnea, nasal flaring, retractions, grunting, rales, decreased breath sounds, or respiratory distress. In older children and adolescents, the diagnosis of pneumonia is often based on clinical presentation. o Chest radiography is indicated primarily in complicated cases in

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

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

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

oOOo Hampir setiap orang pernah mengalami batuk. Batuk memiliki ciri khas, sehingga dapat dikenali. Satu hal yang perlu diingat adalah bahwa batuk hanyalah merupakan gejala, bukan suatu penyakit. Batuk baru dapat ditentukan sebagai tanda suatu penyakit jika ada gejala lain yang muncul. Berdasarkan produktivitasnya, dikenal ada 2 jenis batuk, yakni batuk produktif (biasa disebut batuk berdahak) dan batuk tidak produktif (lebih dikenal sebagai batuk kering). Sedangkan berdasarkan waktu berlangsungnya, batuk ada 2 jenis, batuk akut dan batuk kronis. Dengan mengenali jenis batuk anda, 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 produktif memiliki ciri khas yaitu dada terasa penuh atau berbunyi. Mereka yang mengalami batuk produktif umumnya kesulitan bernapas dan disertai pengeluaran dahak. Gejala biasanya bertambah berat ketika terjaga dan berbicara. Batuk produktif sebaiknya tidak ditekan karena batuk ini membantu membersihkan lendir di paru-paru. Ada beberapa penyebab batuk produktif, yaitu: Virus. Batuk produktif yang menyertai flu merupakan hal yang normal. Terjadinya batuk sering dipicu oleh lendir yang mengalir sepanjang tenggorokan. Infeksi. Infeksi paru-paru atau saluran pernapasan bagian atas dapat menyebabkan batuk. Batuk produktif dapat merupakan gejala dari pneumonia, bronkitis, sinusitis, atau tuberkulosis. Penyakit paru-paru kronis. Batuk produktif dapat merupakan tanda penyakit seperti Penyakit Paru Obstruktif Kronik (PPOK) yang bertambah buruk atau sebagai tanda bahwa anda telah terinfeksi. Asam lambung yang kembali ke kerongkongan. Jenis batuk ini mungkin merupakan gejala gastroesophageal reflux dan mungkin dapat membangunkan anda saat tertidur. Lendir yang mengalir ke bagian belakang tenggorokan (postnasal drip syndrome). Hal ini dapat menyebabkan batuk produktif atau perasaan bahwa anda harus batuk terus-menerus untuk membersihkan tenggorokan anda. Perokok atau pengguna tembakau. Batuk produktif pada orang yang merokok atau menggunakan tembakau sering merupakan tanda kerusakan paru-paru atau iritasi tenggorokan atau kerongkongan. Batuk Tidak Produktif Batuk tidak produktif merupakan batuk yang tidak menghasilkan sputum sehingga disebut juga batuk kering. Batuk tidak produktif sering membuat tenggorokan terasa gatal sehingga menyebabkan suara menjadi serak atau hilang. Batuk ini sering dipicu oleh inhalasi partikel makanan, bahan iritan, asap rokok, baik oleh perokok aktif maupun pasif, dan perubahan temperatur. Batuk semacam ini dapat merupakan gejala sisa dari infeksi virus atau flu. Ada beberapa penyebab batuk tidak produktif, yaitu: Virus. Setelah terserang flu, batuk kering mungkin bertahan selama beberapa minggu lebih panjang daripada gejala lain dan sering menjadi lebih buruk pada malam hari. Bronkospasme. Batuk tidak produktif, terutama malam hari, mungkin menunjukkan kejang (spasme) di bronkial yang disebabkan oleh iritasi. Alergi. Sering bersin juga gejala umum dari alergi radang selaput lendir hidung (allergic rhinitis). Obat pengontrol tekanan darah tinggi golongan penghambat ACE (Angiotensin Converting Enzyme). Penghambat ACE termasuk captopril, enalapril maleate, dan lisinopril. Kontak dengan debu, asap, dan bahan kimia di lingkungan kerja. Asma. Jika batuk berlangsung lebih dari 3 minggu atau terjadi dalam 3 episode selama 3 bulan berturut-turut, disebut batuk kronis atau batuk kronis berulang. Batuk jenis ini biasanya disebabkan oleh bronkitis, postnasal drip syndrome, asma, gastroesophageal reflux, tuberkulosis, dan pertusis (batuk rejan/batuk 100 hari). oOOo Demam Dari Wikipedia Indonesia, ensiklopedia bebas berbahasa Indonesia. Demam adalah suatu keadaan di mana suhu badan melebihi 370C yang disebabkan oleh penyakit atau radang. Anak yang memiliki suhu tinggi karena suhu tinggi berkepanjangan dapat menyebabkan sawan. 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, flushed, hot, and sweaty. Your little one's forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor? In healthy kids, fevers usually don't indicate anything serious. Although it can be frightening when your child's temperature rises, fever itself causes no harm and can actually be a good thing it's often the body's way of fighting off infections. And not all fevers need to be treated. High fever, however, can make a child Batuk kering yang kronis mungkin menjadi tanda asma ringan. Gejala lain mungkin termasuk mengi (napas berbunyi), sesak napas, atau rasa sakit di dada. Hambatan saluran udara karena benda yang dihirup, seperti makanan atau pil. Batuk Akut atau Kronis? Batuk akut merupakan batuk yang berlangsung kurang dari 3 minggu serta terjadi dalam 1 episode. Batuk jenis ini biasanya disebabkan oleh flu dan alergi. Common cold, bentuk batuk yang sering ditemui merupakan jenis batuk akut ringan yang disertai demam ringan dan pilek. uncomfortable and aggravate problems such as dehydration. But it's easy to learn how to correctly take a child's temperature when it's a little higher than usual. Read on for more about fevers, how to measure and treat them, and when to call your child's doctor. What Is Fever? Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6 Fahrenheit, or about 37 Celsius) and will send messages to your body to keep it that way. 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, play, and exercise. Sometimes, though, the hypothalamus will "reset" the body to a higher temperature in response to an infection, illness, or some other cause. So, 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. 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. Fever has several potential causes: Infection: Most fevers are caused by infection or other illness. Fever helps the body fight infections by stimulating natural defense mechanisms. Overdressing: Infants, especially newborns, 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. However, because fevers in newborns can indicate a serious infection, even infants

who are overdressed must be evaluated by a doctor if they have a fever. Immunizations: Babies and children sometimes get a low-grade fever after getting vaccinated. Although teething may cause a slight rise in body temperature, it's probably not the cause if a child's temperature is higher than 100 Fahrenheit (37.8 Celsius). When Can a Fever Be a Sign of Something Serious? In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and the child's overall condition. Kids whose temperatures are lower than 102 Fahrenheit (38.9 Celsius) often don't require medication unless they're uncomfortable. There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4 Fahrenheit (38 Celsius) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young infants. If your child is between 3 months and 3 years old and has a fever of 102.2 Fahrenheit (39 Celsius) or higher, call the doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. 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. 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. This is very common with infections that cause fever. For kids who still drink and urinate normally, not eating as much as usual is OK. 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. However, 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. 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: 100.4 Fahrenheit (38 Celsius) measured rectally (in the bottom) 99.5 Fahrenheit (37.5 Celsius) measured orally (in the mouth) 99 Fahrenheit (37.2 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. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102104 Fahrenheit / 38.940 Celsius range), but this doesn't usually indicate a serious problem. And serious infections may cause no fever or even an abnormally low body temperature, especially in infants. Because fevers may rise and fall, a child with fever might experience chills as the body tries to generate additional heat as its temperature begins to rise. The child may sweat as the body releases extra heat when the temperature starts to drop. Sometimes kids with a fever breathe faster than usual and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down. Different Types of Thermometers Whichever type of thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer's recommendations for any thermometer. Digital thermometers usually provide the quickest, most accurate readings. They come in many sizes and shapes, are available at most supermarkets and pharmacies, and are available in a range of prices. Although you should read the manufacturer's instructions to determine what method or methods the thermometer is designed for, 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, flexible probe with a temperature sensor at the tip and an easyto-read digital display on the opposite end. Electronic ear thermometers measure the tympanic temperature the temperature inside the ear canal. Although they're quick and easy to use in older babies and children, electronic ear thermometers aren't as accurate for infants 3 months or younger as digital thermometers and are more expensive. 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, but they aren't reliable for taking an exact measurement, especially in infants and very young children. If you need to know your child's exact temperature, plastic strip thermometers are not the way to go. Forehead thermometers also may be able to tell you if your child has a fever, but are not as accurate as oral or rectal digital thermometers. Pacifier thermometers may seem convenient, but again, their readings are less reliable than rectal temperatures and shouldn't be used in infants younger than 3 months. They also require the child to keep the pacifier in the mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers. Glass mercury thermometers were once common, but the American Academy of Pediatrics (AAP) now says they should not be used because of concerns about possible exposure to mercury, which is an environmental toxin. (If you still have a mercury thermometer, do not simply throw it in the trash where the mercury can leak out. Talk to your doctor or your local health department about how and where to dispose of a mercury thermometer.) As any parent knows, taking a squirming child's temperature can be challenging. But it's one of the most important tools doctors have to determine if a child has an illness or infection. The method you choose to take your child's temperature will depend on his or her age and how cooperative your child is. If your child is younger than 3 months, you'll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small. If your child is between 3 months to 4 years old, you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method. If your child is 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, 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. In these cases, you can use the tympanic method (with an electronic ear thermometer) or axillary method (with a digital thermometer). How to Use a Digital Thermometer A digital thermometer offers the quickest, most accurate way to take a child's temperature and can be used in the mouth, armpit, or rectum. Before you use one, read the directions thoroughly. You need to know how the thermometer signals that the reading is complete (usually, it's a beep or a series of beeps or the

temperature flashes in the digital window on the front of the thermometer). First, turn on the thermometer and make sure the screen is clear of any old readings. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer's instructions. 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. To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don't worry it's a simple process: Lubricate the tip of the thermometer with a lubricant, such as petroleum jelly. Place your child: - belly-down across your lap or on a firm, flat surface and keep your palm along the lower back - or face-up with legs bent toward the chest with your hand against the back of the thighs With your other hand, insert the lubricated thermometer into the anal opening about inch to 1 inch (about 1.25 to 2.5 centimeters). Stop if you feel any resistance. Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. Soothe your child and speak quietly as you hold the thermometer in place. 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, noting the time of day that you took the reading. To take an oral temperature: This process is easy in an older, cooperative child. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there's no gum or candy in your child's mouth. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk, and to relax and breathe normally through the nose. 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, noting the time of day that you took the reading. To take an axillary temperature: This is a convenient way to take a child's temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents may prefer to take an axillary temperature, especially for kids who can't hold a thermometer in their mouths. Remove your child's shirt and undershirt, and place the thermometer under an armpit (it must be touching skin only, not clothing). Fold your child's arm across the chest to hold the thermometer in place. 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, noting the time of day that you took the reading. Whatever method you choose, 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. Never leave a child unattended while taking a temperature. Helping Kids Feel Better Again, not all fevers need to be treated. And in most cases, a fever should be treated only if it's causing a child discomfort. Here are ways to alleviate symptoms that often accompany a fever: If your child is fussy or appears uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or weight. If you don't know the recommended dose or your child is younger than 2 years, call the doctor to find out how much to give. Remember that fever medication will usually temporarily bring a temperature down, but it will not return it to normal and it won't treat the underlying reason for the fever. (Unless instructed by a doctor, never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.) Infants under 2 months old should not be given any medication for fever without being evaluated by a doctor. If your child has any medical problems, check with the doctor to see which medication is best to use. Giving a sponge bath can make your child more comfortable and help bring the fever down. Use only lukewarm water; cool water may cause shivering, which actually raises body temperature. 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). Dress your child in lightweight clothing and cover him or her with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise. Make sure your child's room is a comfortable temperature not too hot or too cold. Offer plenty of fluids to avoid dehydration a fever will cause a child to lose fluids more rapidly. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks containing caffeine, including colas and tea, because they can cause increased urination. If your child also is vomiting and/or has diarrhea, ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. You can find these solutions at pharmacies and supermarkets. Don't offer sports drinks they're not designed for younger children, and the added sugars may make diarrhea worse. Also, limit your child's intake of fruits and apple juice. In general, 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. Make sure your child gets plenty of rest. Staying in bed all day isn't necessary, but a sick child should take it easy. It's best to keep a child with a fever home from school or child care. Most doctors feel that it's safe to return when the temperature has been normal for 24 hours. When to Call the Doctor The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether the child has other symptoms with the fever. Call your doctor if you have an: infant younger than 3 months with a temperature of 100.4 Fahrenheit (38 Celsius) or higher older child with a temperature of higher than 102.2 Fahrenheit (39 Celsius) Call the doctor if an older child has a fever of less than 102.2 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, not having tears when crying, less alert and less active than usual) has a specific complaint (i.e., 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, even if they only last a few hours each night has a chronic medical problem such as heart disease, cancer, lupus, 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, tongue, 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, ask your child's doctor for his or her specific guidelines on when to call about a fever. Fever: A Common Part of Childhood

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

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