Pneumonia PDF

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 !"ommunity Ac#uired Pneumonia$ Pneumonia nosokomial !%ospital Ac#uired Pneumonia$ Pneumonia Aspirasi Pneumonia &munocompromised Klasifikasi pneumonia berdasarkan penyebabnya, yaitu Pneumonia bakterial ' tipikal staphylococcus, streptococcus, %emofilus influen(a, klebsiella, pseudomonas, dll Pneumonia atipical mycoplasma, legionella, dan chlamydia Pneumonia virus Pneumonia jamur Klasifikasi pneumonia berdasarkan predileksi, yaitu Pneumonia lobaris, lobularis )ronkopneumonia 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 &nokulasi langsung Penyebaran melalui pembuluh darah &nhalasi bahan aerosol Kolonisasi di permukaan mukosa )akteri masuk ke alveoli menyebabkan reaksi radang, sehingga timbullah edema di seluruh alveoli, infiltrasi sel*sel PM+ !polimorfonuclear$, dan diapedesis eritrosit. ,el*sel PM+ mendesak bakteri ke permukaan alveoli. Dengan bantuan lekosit yang lain melalui psedopodosis sitoplasmik mengelilingi bakteri tersebut kemudian di fagosit. Terdapat - (ona pada daerah reaksi inflamasi, antara lain .ona luar alveoli yang terisi bakteri dan cairan edema. .ona permulaan konsolidasi terdiri dari PM+ dan beberapa eksudasi sel darah merah. .ona konsolidasi luar daerah tempat terjadi fagositosis yang aktif dengan jumlah PM+ yang banyak. .ona resolusi daerah tempat terjadi resolusi dengan banyak bakteri yang mati, lekosit dan alveolar makrofag. ,ehingga, terlihat adanya / gambaran, yaitu 0ed hepati(ation daerah perifer yang terdapat edema dan perdarahan 1ray hepati(ation daerah konsolidasi yang luas Diagnosis Pneumonia Anamnesis Demam menggigil ,uhu tubuh meningkat )atuk berdahak mukoid atau purulen ,esak napas Kadang nyeri dada Pemeriksaan 2isik Tergantung luas lesi paru &nspeksi bagian yang sakit tertinggal Palpasi fremitus dapat mengeras Perkusi redup Auskultasi suara dasar bronkovesikuler sampai bronkial, suara tambahan ronki basah halus sampai ronki basah kasar pada stadium resolusi. Pemeriksaan Penunjang 1ambaran radiologis foto toraks PA' lateral, gambaran infiltrat sampai gambaran konsolidasi !bera3an$, dapat disertai air bronchogram. Pemeriksaan laboratorium terdapat peningkatan jumlah lekosit lebih dari 45.555'ul kadang dapat mencapai 65.555'ul. 7ntuk menentukan diagnosis etiologi dilakukan pemeriksaan biakan dahak, biakan darah, dan serologi. Analisis gas darah menunjukkan hipoksemia8 pada stadium lanjut asidosis respiratorik. Penilaian Derajat Keparahan Pneumonia ,istem skor pada pneumonia komuniti berdasarkan Patient 9utcome 0esearch Team !P90T$. Penilaian skor P90T ini meliputi 2aktor demografi 7sia :aki*laki, nilainya ; umur !tahun$ < 45 Perempuan, nilainya ; umur !tahun$ Pera3atan di rumah, nilainya 45 Adanya penyakit penyerta berupa Keganasan, nilainya 65 Penyakit hati, nilainya /5 1agal jantung kongestif, nilainya 45 Penyakit "=, nilainya 45 Penyakit ginjal, nilainya 45 Pemeriksaan fisis Perubahan status mental, nilainya /5 Pernapasan lebih dari atau sama dengan 65 kali per menit, nilainya /5 Tekanan darah sistolik kurang dari atau sama dengan >5 mm%g, nilainya /5 ,uhu tubuh kurang dari 6?@" atau lebih dari atau sama dengan -5@", nilainya 4? +adi lebih dari atau sama dengan 4/? kali per menit, nilainya 45 %asil laboratorium ' radiologi Analisis gas darah arteri didapatkan p% sebesar A,6?, nilainya 65 )7+ lebih dari 65 mg'dl, nilainya /5 +atrium kurang dari 465 mB#'liter, nilainya /5 1lukosa lebih dari /?5 mg'dl, nilainya 45 %ematokrit kurang dari 65 C, nilainya 45 P9/ kurang dari atau sama dengan D5 mm%g, nilainya 45 Bfusi pleura, nilainya 45 Penatalaksanaan Pneumonia &ndikasi ra3at inap penderita pneumonia, antara lain ,kor P90T lebih dari A5 )ila skor P90T kurang dari A5, dengan kriteria seperti pada kriteria minor. Pneumonia pada pengguna +AP.A Penilaian derajat keparahan penyakit pneumonia berdasarkan AT,. Kriteria pneumonia berat bila dijumpai salah satu atau lebih dari kriteria di ba3ah ini. Kriteria Minor Pneumonia 2rekuensi pernapasan lebih dari 65 kali per menit Pa9/'2i9/ kurang dari /?5 mm%g 2oto toraks paru menunjukkan adanya kelainan bilateral 2oto toraks paru melibatkan lebih dari / lobus Tekanan sistolik kurang dari >5 mm%g Tekanan diastolik kurang dari D5 mm%g Kriteria Mayor Pneumonia Membutuhkan ventilasi mekanik &nfiltrat bertambah lebih dari ?5 C Membutuhkan vasopressor lebih dari - jam Kreatinin serum lebih dari sama dengan / mg'dl8 atau, peningkatan lebih dari sama dengan / mg'dl pada penderita ri3ayat penyakit ginjal atau gagal ginjal yang membutuhkan dialisis. Kriteria pera3atan intensif penderita pneumonia, antara lain

Paling sedikit 4 dari / gejala minor tertentu, yaitu membutuh ventilasi mekanik8 atau, membutuhkan vasopresor lebih dari - jam. Atau / dari 6 gejala minor tertentu, yaitu nilai Pa9/'2i9/ kurang dari /?5 mm%g8 foto toraks menunjukkan adanya kelainan bilateral8 dan, tekanan sistolik kurang dari >5 mm%g. 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 ji3a )akteri patogen yang berhasil di isolasi belum tentu sebagai penyebab pneumonia %asil pembiakan bakteri memerlukan 3aktu maka, pemberian antibiotika dilakukan secara empiris. 7ntuk Penisilin ,ensitif ,treptococcus Pneumoniae !P,,P$, dapat diberikan 1olongan penisilin TMP*,M. Makrolid 7ntuk Penisilin 0esisten ,treptococcus Pneumoniae !P0,P$, dapat diberikan )etalaktam oral dosis tinggi !untuk ra3at jalan$ ,efotaksim, ,efriakson dosis tinggi Makrolid baru dosis tinggi 2luorokuinolon respirasi 7ntuk Pseudomonas aeruginosa, dapat diberikan Aminoglikosid ,efta(idim, ,efoperason, ,efepim Tikarsilin, Piperasilin Karbapenem Meropenem, &mipenem ,iprofloksasin, levofloksasin 7ntuk Methicillin 0esistent ,taphylococcus Aureus !M0,A$, dapat diberikan =ankomisin Teikoplanin :ine(olid 7ntuk %emophilus influen(a, dapat diberikan TMP*,M. A(ithromisin ,efalosporin gen./ atau 6 2luorokuinolone respirasi 7ntuk :egionella, dapat diberikan Makrolid 2luorokuinolone 0afampicin 7ntuk Mycoplasma pneumoniae, dapat diberikan Doksisiklin Makrolid 2luorokuinolone 7ntuk "hlamydia pneumoniae, dapat diberikan Doksisiklin Makrolid 2luorokuinolone Komplikasi Penumonia Komplikasi yang dapat terjadi pada pneumonia, antara lain Bfusi pleura Bmpiema Abses paru Pneumothoraks 1agal napas ,epsis o99o Pneumonia sebenarnya bukan peyakit baru. Tahun 4>6D pneumonia menjadi penyebab kematian nomor satu di Amerika. Penggunaan antibiotik, membuat penyakit ini bisa dikontrol beberapa tahun kemudian. +amun tahun /555, kombinasi pneumonia dan influen(a kembali merajalela. Di &ndonesia, pneumonia merupakan penyebab kematian nomor tiga setelah kardiovaskuler dan T)". 2aktor sosial ekonomi yang rendah mempertinggi angka kematian. Kasus pneumonia ditemukan paling banyak menyerang anak balita. Menurut laporan E%9, sekitar F55.555 hingga 4 juta anak meninggal dunia tiap tahun akibat pneumonia. )ahkan 7+&"B2 dan E%9 menyebutkan pneumonia sebagai penyebab kematian anak balita tertinggi, melebihi penyakit* penyakit lain seperti campak, malaria, serta A&D,. Pneumonia adalah infeksi yang menyebabkan paru* paru meradang. Kantong*kantong udara dalam paru yang disebut alveoli dipenuhi nanah dan cairan sehingga kemampuan menyerap oksigen menjadi kurang. Kekurangan oksigen membuat sel*sel tubuh tidak bisa bekerja. Karena inilah, selain penyebaran infeksi ke seluruh tubuh, penderita pneumonia bisa meninggal. ,ebenarnya pneumonia bukanlah penyakit tunggal. Penyebabnya bisa bermacam*macam dan diketahui ada 65 sumber infeksi dengan sumber utama bakteri, virus, mikroplasma, jamur, berbagai senya3a kimia maupun partikel. Pneumonia adalah proses infeksi akut yang mengenai jaringan paru*paru !alveoli$. Terjadinya pneumonia pada anak seringkali bersamaan dengan proses infeksi akut pada bronkus !biasa disebut bronchopneumonia$. 1ejala penyakit ini berupa napas cepat dan napas sesak, karena paru meradang secara mendadak. )atas napas cepat adalah frekuensi pernapasan sebanyak ?5 kali per menit atau lebih pada anak usia / bulan sampai kurang dari 4 tahun, dan -5 kali per menit atau lebih pada anak usia 4 tahun sampai kurang dari ? tahun. Pada anak diba3ah usia / bulan, tidak dikenal diagnosis pneumonia. Pneumonia berat ditandai dengan adanya batuk atau !juga disertai$ kesukaran bernapas, napas sesak atau penarikan dinding dada sebelah ba3ah ke dalam pada anak usia / bulan sampai kurang dari ? tahun. Pada kelompok usia ini dikenal juga pneumonia sangat berat dengan gejala batuk, kesukaran bernapas disertai gejala sianosis sentral dan tidak dapat minum. ,ementara untuk anak diba3ah / bulan, pneumonia berat ditandai dengan frekuensi pernapasan sebanyak D5 kali per menit atau lebih atau !juga disertai$ penarikan kuat pada dinding dada sebelah ba3ah ke dalam. Menurut dokter spesialis paru dari 0,&A %ermina Gatinegara, Dr. )ambang ,upriyatno ,pA!K$, perbedaan mendasar antara pneumonia dengan T)" terletak pada jenis mikroorganisme yang menginfeksi. HIPneumonia yang ada di masyarakat umumnya, disebabkan oleh bakteri, virus atau mikoplasma !bentuk peralihan antara bakteri dan virus $,II katanya. )ambang menyebutkan, bakteri yang umum adalah streptococcus Pneumoniae, ,taphylococcus Aureus, Klebsiella ,p, Pseudomonas sp. ,edangkan, v&rus misalnya virus influensa. JPada T)", jenis mikroorganisme yang menginfeksinya adalah mikrobakterium tuberculosis,II sambungnya. 0entannya anak terkena penyakit pneumonia umumnya dikarenakan lemahnya atau belum sempurnanya sistem kekebalan tubuh balita. 9leh sebab itu, mikrorganisme atau kuman lebih mudah menembus pertahanan tubuh. Genis bakteri pneumococcus atau pneumokok belakangan semakin populer seiring kian dikenalnya jenis penyakit &nvasive Pneumococcal Disease !&PD$. ,elain pneumonia, yang termasuk &PD adalah radang selaput otak !meningitis$ atau infeksi darah !bakteremia$. KPada pneumonia yang disebabkan oleh bakteri pneumokok, kerap menimbulkan komplikasi dan mengakibatkan penderita juga terkena meningitis atau bakteremia,K kata )ambang. Dokter spesialis anak dari 0,A) %arapan Kita, Dr. Attila De3anti ,pA menjelaskan bah3a 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. JAkibatnya, timbul peradangan pada paru dan daerah selaput otak,L tambahnya. 1ejala khususnya adalah demam, sesak napas, napas dan nadi cepat, dahak ber3arna 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.

+amun, gejala a3alnya yang tergolong sederhana seringkali membuat orangtua kurang 3aspada terhadap penyakit ini. J9rang tua sering datang terlambat memba3a anaknya ke dokter. Karena gejala a3al panas dan batuk, orang tua sering mengobati sendiri dirumah dengan obat biasa, bila sudah sesak baru diba3a ke dokter, L 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. ,etelah itu ada pula pemeriksaan penunjuang seperti rontgen paru dan pemeriksaan darah. Penanganan pneumonia pun dapat dilakukan dengan beberapa cara. 7mumnya pengobatan dengan pemberian antibiotik. JPenderita pneumonia dapat sembuh bila diberikan antibiotik yg sesuai dengan jenis kumannya, hanya saja perlu dosis tinggi dan 3aktu yg lama,L papar Atilla. +amun, bakteri ,treptococcus pneumoniae mulai resisten atau kebal terhadap beberapa jenis antibiotik. )ahkan ka3asan Asia dinyatakan sebagai hot (one, yakni daerah dengan tingkat resistensi tinggi untuk bakteri pneumokok. 9leh sebab itu apabila pneumonia yang dialami cukup parah, penanganannya juga dilakukan dengan cara opname. Dengan pera3atan khusus di rumah sakit, pasien bisa mendapatkan istirahat dan pengobatan yang lebih intensif, atau bahkan terapi oksigen sebagai penunjang. ,elain itu penderita pneumonia juga membutuhkan banyak cairan untuk mencegahnya dari dehidrasi. "airan ini bisa diperoleh dengan cara banyak minum air putih maupun melalui infus. 7ntuk pneumonia oleh virus sampai saat ini belum ada panduan khusus, meski beberapa obat antivirus telah digunakan. Kebanyakan pasien juga bisa diobati dirumah. )iasanya dokter yang menangani pneumonia akan memilihkan obat sesuai pertimbangan masing* masing, setelah suhu pasien kembali normal, dokter akan menginstruksikan pengobatan lanjutan untuk mencegah kekambuhan. ,oalnya, serangan berikutnya bisa lebih berat dibanding yang pertama. ,elain antibiotika, pasien juga akan mendapat pengobatan tambahan berupa pengaturan pola makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. Pada beberapa kasus, Atilla menerangkan bah3a pneumonia yang sudah mengalami komplikasi tersebut bisa meninggalkan berbagai efek samping. JAnak dapat mengalami berbagai efek samping seperti gangguan kecerdasan, gangguan perkembangan motorik, gangguan pendengaran dan keterlambatan bicara,L paparnya. Ealaupun demikian, )ambang tetap meyakinkan bah3a anak dengan pneumonia juga bisa sembuh total dan hidup dengan normal. Pencegahan Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P/&,PA !Pemberantasan Penyakit &nfeksi ,aluran Pernafasan Akut$. Program ini mengupayakan agar istilah pneumonia lebih dikenal masyarakat, sehingga memudahkan kegiatan penyuluhan dan penyebaran informasi tentang penanggulangannya. Program P/&,PA mengklasifikasikan penderita kedalam / kelompok usia. Maitu, usia diba3ah / bulan !Pnemonia )erat dan )ukan Pnemonia$ dan usia / bulan sampai kurang dari ? tahun. Klasifikasi )ukan*pnemonia mencakup kelompok balita penderita batuk yang tidak menunjukkan gejala peningkatan frekuensi nafas dan tidak menunjukkan adanya penarikan dinding dada bagian ba3ah ke dalam. Penyakit &,PA diluar pneumonia ini antara lain batuk*pilek biasa, pharyngitis, tonsilitis dan otitis. 7ngkapan klasik bah3a Jmencegah lebih baik daripada mengobatiL 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 &PD, termasuk pneumonia, dapat dilakukan dengan cara vaksinasi pneumokokus atau sering juga disebut sebagai vaksin &PD. Menurut Atilla yang juga bertugas di klinik khusus tumbuh kembang anak 0,A) %arapan kita, peluang mencegah Pneumonia dengan vaksin &PD adalah sekitar F5*>5C. Adapun mengenai 3aktu ideal pemberian vaksin &PD, menurut penjelasan Atilla adalah sebanyak - kali, yakni pada saat bayi berusia / bulan, - bulan, D bulan dan diulang lagi pada usia 4/ bulan. Atilla menguatkan bah3a vaksin itu aman dan dapat diberikan bersamaan dengan vaksin lain seperti %ib, MM0 maupun %epatitis ). ,elain imunisasi, pencegahan pneumonia menurut )ambang adalah dengan menjaga keseimbangan nutrisi anak. J,elain itu, upayakan agar anak memiliki daya tahan tubuh yang baik, antara lain dengan cara cukup istirahat juga olahraga,L jelasnya. Pneumonia oleh )akteri Pneumonia yang dipicu bakteri bisa menyerang siapa saja, dari bayi sampai usia lanjut. ,ebenarnya bakteri penyebab pneumonia yang paling umum adalah ,treptococcus pneumoniae sudah ada di kerongkongan manusia sehat. )egitu pertahanan tubuh menurun oleh sakit, usia tua, atau malnutrisi, bakteri segera memperbanyak diri dan menyebabkan kerusakan. ,eluruh 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. )ibir dan kuku mungkin membiru karena tubuh kekurangan oksigen. Pada kasus yang eksterm, pasien akan mengigil, gigi bergemelutuk, sakit dada, dan kalau batuk mengeluarkan lendir ber3arna hijau. ,ebelum terlambat, penyakit ini masih bisa diobati. )ahkan untuk pencegahan vaksinnya pun sudah tersedia. Pneumonia oleh virus ,etengah dari kejadian pneumonia diperkirakan disebabkan oleh virus. ,aat 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. 1ejala yang paling sering adalah batuk berat, namun dengan sedikit lendir. Demam dan menggigil hanya muncul di a3al, dan pada beberapa pasien bisa mual dan muntah. 0asa lemah baru hilang dalam 3aktu lama. Pneumonia Genis :ain Termasuk golongan ini adalah Pneumocystitis "arinii pnumonia ! P"P $ yang diduga disebabkan oleh jamur, P"P biasanya menjadi tanda a3al serangan penyakit pada pengidap %&='A&D,. P"P bisa diobati pada banyak kasus. )isa saja penyakit ini muncul lagi beberapa bulan kemudian, namun pengobatan yang atas*terutama pada anak*anak* gangguan ini bisa memicu pneumonia. 7ntunglah, sebagian besar pneumonia jenis ini tidak berat dan sembuh dalam 3aktu singkat. +amun, bila infeksi terjadi bersamaan dengan virus influensa, gangguan bisa berat dan kadang menyebabkan kematian, =irus yang menginfeksi paru akan berkembang biak 3alau tidak terlihat jaringan paru yang dipenuhi cairan. 1ejala Pneumonia oleh virus sama saja dengan influensa, yaitu demam, batuk kering sakit kepala, ngilu diseluruh tubuh. Dan letih lesu, selama 4/ * 46D 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. 0ickettsia* juga masuk golongan antara virus dan bakteri*menyebabkan demam 0ocky Mountain, demam N, tipus, dan psittacosis. Penyakit*penyakit ini juga mengganggu fungsi paru, namun pneumonia tuberkulosis alis T)" adalah infeksi paru paling berbahaya kecuali dioabati sejak dini. o99o 901A+&,A,& Kesehatan Dunia atau Eorld %ealth 9rgani(ation !E%9$ mengungkap, angka kematian anak akibat pneumonia lebih banyak dibandingkan jumlah total kematian karena A&D,, 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. ,ekitar tiga per empat jumlah kasus pneumonia balita terdapat di 4? negara, termasuk &ndonesia yang menempati urutan ke*D. Dengan angka kematian total D juta anak. KPneumonia menjadi masalah signifikan di banyak negara, terutama di negara dengan angka kematian balita yang tinggi,K kata Kepala Divisi Kesehatan 7+&"B2, Peter ,alama. Pneumonia adalah bagian dari penyakit infeksi pneumokokus invasif !&PD$ 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. &PD bisa berdampak pada kecacatan permanen berupa ketulian, gangguan mental, kemunduran intelegensi, kelumpuhan, dan gangguan saraf, hingga kematian. K)akteri pneumokokus dulu bisa dimatikan dengan antibiotik. )elakangan, bakteri ini kebal terhadap antibiotik sehingga menyulitkan pengobatan,K sebut Ketua Divisi Tumbuh Kembang*Pediatri ,osial Departemen &lmu Kesehatan Anak 2K7&'0,"M Dr ,oedjatmiko ,pA!K$ M,i. Tingginya angka kematian akibat pneumonia sekaligus membuktikan masih rendahnya kesadaran masyarakat akan pentingnya imunisasi sebagai langkah pencegahan. ,oedjatmiko mengemukakan, setiap tahun sekitar 6 juta orang meninggal akibat berbagai penyakit yang sebenarnya bisa dicegah dengan imunisasi. &munisasi dianjurkan sedini mungkin supaya lebih efektif sehingga unsur perlindungannya mencapai level optimal. 9leh karena itu, bayi disarankan diimunisasi P"= mulai usia bayi / bulan, - bulan, D bulan, lalu diberikan satu dosis lagi pada usia 4/*4? bulan sebagai penguat. K&tu adalah jad3al idealnya, tapi kalaupun sudah le3at tidak masalah. :ebih baik telat daripada tidak diberikan sama sekali. =aksin ini masih dapat diberikan hingga usia > tahun,K papar dokter yang juga menjabat ,ekretaris ,atgas &munisasi &katan Dokter Anak &ndonesia !PP &DA&$ ini. Menurut Peter ,alama, negara dengan angka kematian balita yang tinggi, terutama akibat pneumonia pada anak, menjadi prioritas utama. %al itu merujuk pada negara dengan lebih dari ?5 kematian per 4.555 kelahiran hidup anak balita, maupun negara dengan lebih dari ?5.555 kematian balita per tahun. K&ndonesia dengan ?F kematian per 4.555 kelahiran hidup, masuk kategori direkomendasikan,K sahut ,oedjatmiko seraya mengungkapkan bah3a &DA& juga telah menerbitkan rekomendasi dan petunjuk pemakaian vaksin pneumokokus sejak bulan Guni /55D. &PD dapat menyerang siapa saja dan di mana saja. %anya, kelompok usia paling rentan menderita &PD 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 de3asa. +amun kembali meninggi lagi di usia lanjut. K&tulah sebabnya, imunisasi P"= tak hanya melindungi si bayi yang diimunisasi, juga proteksi bagi anggota keluarga lain,K tandas Dr ,oedjatmiko ,pA!K$ M,i. Adapun cara penularan bakteri pneumokokus, antara lain melalui percikan ludah melalui udara saat bersin, batuk atau berbicara. !sindo''tty$ o99o )anyak 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 ,egera setelah anda mencurigai anak menderita pneumonia. Anak anda mungkin butuh Oray untuk diagnosa. )atuk rejan ! pertusis$ 1ejala )atuk 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 ,esegera mungkin. Anak diba3ah D bulan mungkin perlu dira3at dirumah sakit. )ila dia berusia lebih tua, dia butuh antibiotika sesegera mungkin o99o Pneumonia is a general term that refers to an infection of the lungs, 3hich can be caused by a variety of microorganisms, including viruses, bacteria, fungi, and parasites. 9ften pneumonia begins after an upper respiratory tract infection !an infection of the nose and throat$. Ehen this happens, symptoms of pneumonia begin after / or 6 days of a cold or sore throat. ,igns and ,ymptoms ,ymptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. ,ome common symptoms include fever chills cough unusually rapid breathing breathing 3ith grunting or 3hee(ing sounds labored breathing that makes a childPs rib muscles retract !3hen muscles under the rib cage or bet3een ribs dra3 in3ard 3ith each breath$ vomiting chest pain abdominal pain decreased activity loss of appetite !in older children$ or poor feeding !in infants$
"roup 1ejala )atuk 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 sho3er selama 4?*/5 menit akan membantunya bernapas. Kapan harus menghubungi dokter )ila anak benar*benar sulit bernapas atau dengik berlanjut lebih dari ? menit atau malah lebih buruk. )ronchiolitis ! 0,=$ 1ejalanya hidung meler, lekas marah, hilang selera makan, demam, batuk, suara dengik ketika anak bernapas. Penanganan )anyak cairan dan istirahat. Pada kasus yang serius, anak*anak ! khususnya bayi$ mungkin dira3at di rumah sakit untuk menerima oksigen, cairan, atau obat. Kapan harus menghubungi dokter )ila bayi anda sulit bernapas, lendir yang kental, ada tanda*tanda dehidrasi, tidak aktif seperti biasanya atau menolak menyusu. Pnaeumonia 1ejala 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 eQtreme cases, bluish or gray color of the lips and fingernails ,ometimes a childPs only symptom is rapid breathing. ,ometimes 3hen the pneumonia is in the lo3er 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. Ehen pneumonia is caused by bacteria, an infected child usually becomes sick relatively #uickly and eQperiences the sudden onset of high fever and unusually rapid breathing. Ehen pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Ehee(ing may be more common in viral pneumonia. ,ome types of pneumonia cause symptoms that give important clues about 3hich germ is causing the illness. 2or eQample, in older children and adolescents, pneumonia due to Mycoplasma !also called 3alking pneumonia$ is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia. &n infants, pneumonia due to chlamydia may cause conjunctivitis !pinkeye$ 3ith only mild illness and no fever. Ehen pneumonia is due to 3hooping cough !pertussis$, the child may have long coughing spells, turn blue from lack of air, or make a classic K3hoopK sound 3hen trying to take a breath. Description Pneumonia is a lung infection that can be caused by different types of germs, including bacteria, viruses, fungi, and parasites. Although different types of pneumonia tend to affect children in different age groups, pneumonia is most commonly caused by viruses. ,ome viruses that cause pneumonia are adenoviruses, rhinovirus, influen(a virus !flu$, respiratory syncytial virus !0,=$, and parainfluen(a virus !the virus that causes croup$. &ncubation The incubation period for pneumonia varies, depending on the type of virus or bacteria causing the infection. ,ome common incubation periods are respiratory syncytial virus, - to D days8 influen(a, 4F to A/ hours. Duration Eith treatment, most types of bacterial pneumonia can be cured 3ithin 4 to / 3eeks. =iral pneumonia may last longer. Mycoplasmal pneumonia may take - to D 3eeks to resolve completely. "ontagiousness The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. &llness can spread 3hen an infected person coughs or snee(es on a person, by sharing drinking glasses and eating utensils, and 3hen 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. "hildren usually receive routine immuni(ations against %aemophilus influen(ae and pertussis !3hooping cough$ beginning at / months of age. !The pertussis immuni(ation is the KPK part of the routine DTaP injection.$ =accines are no3 also given against the pneumococcus organism !P"=$, a common cause of bacterial pneumonia. "hildren 3ith chronic illnesses, 3ho are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. The flu vaccine is strongly recommended for children 3ith chronic illnesses such as chronic heart or lung disorders or asthma, as 3ell as other3ise healthy children. )ecause they are at higher risk for serious complications, infants 3ho 3ere born prematurely may be given treatments that temporarily protect against 0,=, 3hich can lead to pneumonia in younger children. Doctors may give prophylactic !disease*preventing$ antibiotics to prevent pneumonia in children 3ho have been eQposed to someone 3ith certain types of pneumonia, such as pertussis. "hildren 3ith %&= infection may also receive prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii. Antiviral medication is no3 available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe. &n addition, regular tuberculosis screening is performed yearly in some high*risk areas because early detection 3ill prevent active tuberculosis infection including pneumonia. &n general, pneumonia is not contagious, but the upper respiratory viruses that lead to it are, so it is best to keep your child a3ay from anyone 3ho has an upper respiratory tract infection. &f 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 3ash your hands fre#uently, especially if you are handling used tissues or dirty handkerchiefs. Ehen to "all Mour "hildPs Doctor "all your childPs 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 45/ degrees 2ahrenheit !6F.> degrees "elsius$, or above 455.- degrees 2ahrenheit !6F degrees "elsius$ in infants under D months of age Professional Treatment Doctors usually make the diagnosis of pneumonia after a physical eQamination. The doctor may possibly use a chest O*ray, blood tests, and !sometimes$ bacterial cultures of mucus produced by coughing 3hen making a diagnosis. &n most cases, pneumonia can be treated 3ith oral antibiotics given to your child at home. The type of antibiotic used depends on the type of pneumonia. "hildren may be hospitali(ed for treatment if they have pneumonia caused by pertussis or other bacterial pneumonia that causes high fevers and respiratory distress. They may also be hospitali(ed if supplemental oQygen 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. %ome Treatment &f your childPs doctor has prescribed antibiotics for bacterial pneumonia, give the medicine on schedule for as long as the doctor directs. This 3ill help your child recover faster and 3ill decrease the chance that infection 3ill spread to other household members. DonPt force a child 3hoPs not feeling 3ell to eat, but encourage your child to drink fluids, especially if fever is present. Ask your childPs doctor before you use a medicine to treat your childPs cough because cough suppressants stop the lungs from clearing mucus, 3hich may not be helpful in some types of pneumonia. &f your child has chest pain, try a heating pad or 3arm compress on the chest area. Take your childPs temperature at least once each morning and each evening, and call the doctor if it goes above 45/ degrees 2ahrenheit !6F.> degrees "elsius$ in an older infant or child, or above 455.- degrees 2ahrenheit !6F degrees "elsius$ in an infant under D months of age. "heck your childPs lips and fingernails to make sure that they are rosy and pink, not bluish or gray, 3hich is a sign that your childPs lungs are not getting enough oQygen. Pneumonia merupakan penyebab kematian terbesar balita dan menjadi masalah kesehatan di negara berkembang , termasuk &ndonesia. =aksinasi 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 ,aid ,pA!K$. :ebih dari 65 tahun, ia menekuni bidang

kesehatan anak khususnya respirologi. ,elama itu pula penyakit infeksi pernapasan terutama pneumonia menjadi masalah kesehatan anak dan penyebab kematian balita terbesar di &ndonesia. Pneumonia merupakan Ppredator P balita nomor satu di negara berkembang. )adan Kesehatan Dunia !E%9$ tahun /55? memperkirakan kematian balita akibat pneumonia diseluruh dunia sekitar 4> persen atau berkisar 4,D < /,/ juta. Dimana sekitar A5 persennya terjadi di negara*negara berkembang, terutama Afrika dan Asia Tenggara. Persentase ini terbesar bahkan bila dibandingkan dengan diare !4A persen$ dan malaria !F persen$. Di &ndonesia, prevalensi pneumonia pada balita cenderung meningkat. )erdasarkan ,urvei Kesehatan 0umah Tangga !,K0T$ tahun /554 kematian balita akibat pneumonia meningkat, berkisar 4F,? *6F,F persen. K%al ini tidak hanya terjadi di &ndonesia, tapi juga menjadi persoalan negera berkembang yang kondisi lingkungannya buruk dan malnutrisiK kata Prof. dr. Mardjanis ,aid ,pA,, pada pidato pengukuhannya sebagai 1uru )esar Tetap dalam &lmu Kesehatan Anak pada 2akultas Kedokteran 7niversitas &ndonesia, di Aula 2K7&, /> April lalu. Dalam orasinya yang bertema KPneumonia Penyebab 7tama Mortalitas Anak )alita Tantangan dan %arapanK, Prof. Mardjanis memaparkan perkembangan pneumonia di &ndonesia. Pneumonia tergolong penyakit &nfeksi ,aluran Pernapasan Akut !&,PA$. Penyakit ini dipicu oleh berbagai mikroorganisme terutama bakteri dan virus pada saluran pernafasan, jaringan paru dan adneksanya. Tapi etiologi pasti mikrobiologisnya sukar didapat. Di negara maju, menurut )ritish Thoracic ,ociety, /5*D5 persen etiologi pneumonia tidak terindentifikasi. Pada beberapa studi melaporkan bah3a pada anak usia / bulan sampai ? tahun bakteri utama penyebab pneumonia adalah ,treptococcus pneumoniae !,. pneumoniae$, %emophilus influen(ae tipe b !%ib$, dan ,taphilococcus aureus !,. aureus$. Penelitian di beberapa negara berkembang menunjukan bah3a ,. pneumoniae dan %ib merupakan bakteri yang selalu ditemukan pada dua pertiga hasil isolasi, yaitu A6,> persen dari aspirat baru dan D>,4 persen dari spesimen darah. Pada bayi usia kurang dari dua bulan, terutama pada masa neonatus, pneumonia sukar dibedakan dengan sepsis dan meningitis. ,ebab etiologi bakterilogiknya berbeda dengan pneumonia anak usia di atas dua bulan. Di negara maju penyebab terbanyak adalah ,terptococcus grup ) sedangkan di negara berkembang dilaporkan sering disebabkan oleh bakteri gram negatif seperti Bnterobacter sp, Klebsilla sp, dan "oli sp. 1ambaran 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. 1ambaran 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 ra3at jalan, diberi antibiotik seperti kortrimoksa(ol atau amoksisilin yang diberikan secara oral. ,ebagai perbandingan, sebuah penelitian multisenter di Pakistan yang membuktikan bah3a pada pneumonia ra3at jalan, amoksisilin !/? mg'kg'))$ dan kotrimoksa(ol !- mg'kg )) TMP* /5 mg'kg )) sulfametaksa(ol$ / kali sehari adalah sama* sama efektif. ,ementara pada pneumonia ra3at inap diberikan antibiotik beta*laktam intravena atau kombinasi antibiotik beta*laktam dan kloramfenikol intravena . Di Departemen &KA 2K7&'0,"M pneumonia berat yang diberikan kombinasi amoksisilin dan kloramfenikol intravena, sejauh ini efektifitasnya cukup memuaskan. ,ebagai referensi, suatu penelitian terapi antibiotik pada anak usia /* /- bulan dengan pneumonia berat antara penisilin 1 intravena !/? 555 7'kg )) setiap empat jam plus kloramfenikol !4? mg'kg )) setiap D jam$ dibandingkan dengan seftriakson intravena !?5 mg'kg )) setiap D jam$ yang diberikan selama 45 hari, efektifitasnya ternyata sama. Ealaupun prevalensi pneumokokus resistensi penisilin makin berkembang namun studi bakteriologi klugman masih memberi harapan. Dilaporkan bah3a antibiotik beta*laktam dosis tinggi masih mampu mengatasi aktivitas bakteri gram positif resisten*penisilin. 9leh karena itu antibiotik beta*laktam masih merupakan antibiotik pilihan untuk pengobatan pneumonia "egah dengan &munisasi &munisasi menjadi pengalaman sukses dunia kedokteran. Program Pengembangan &munisasi !PP&$ yang dicanangkan di seluruh dunia, terbukti menurunkan angka kematian balita. )egitu pula dengan program imunisasi terhadap penyakit infeksi pernapasan akut memberikan kontribusi cukup besar dalam menurunkan angka kematian balita. K7paya pencegahan dengan pemberian vaksin merupakan komponen penting dalam menurunkan mortalitas,K tegas Prof. Mardjanis. ,ekarang ini telah dikembangkan vaksin untuk mengatasi %ib dan pneumokokus. =aksin %ib konjugat dikembangkan dengan mengkonjugasikan protein*karier pada kapsul polisakarida %ib. Protein*karier yang digunakan dapat berasal dari toksoid tetanus, toksin difteri, atau protein membran luar + meningitides. =aksin ini telah terbukti cukup poten, aman dan efektif sejak usia enam minggu ke atas. Tetapi di &ndonesia vaksin ini dimulai pada usia / bulan. ,. pneumonia berbeda dengan %ib yang hanya memiliki satu serotipe. ,. pneumonia mempunyai lebih dari >5 serotipe yang sebagian besar menjadi penyebab penyakit pada anak. Di Amerika ,erikat telah dikenal A serotipe ! -, D), >=, 4-, 4F", 4>2, /62 $ yang bertanggung ja3ab terhadap F6 persen penyakit pneumokokus invasif pada anak usia di ba3ah ? tahun. Atas dasar itu, dikembangkan vaksin heptavalen yang berasal dari A serotipe tersebut dan masing*masing serotipe dikonjugasikan dengan protein*karier yang berasal dari mutan non toksis difteri "0M 4>A. )eberapa studi menunjukan vaksin pneumokokus konjugat heptavalen memberikan efektivitas sangat tinggi dalam mencegah penyakit pneumokokus invasif !bakteriemia, meningitis, dan pneumonia$, serta menurunkan angka kejadian otitis media akut dan prevalensi kolonisasi di nasofaring. Di samping itu, timbul juga efek herd immunity, yaitu anak yang tidak divaksinasi akan terproteksi akibat anak*anak lain diimuniasi. ,tudi klinis pada 6A.555 bayi di "alifornia 7tara menunjukan vaksin pneumokokus memiliki tingkat keampuhan >A persen efektif dalam mencegah serotype spesifik dari bakteri pneumokokus pada bayi yang telah divaksinasi penuh, F> persen efektif dalam mencegah semua kasus infeksi invasif akibat pneumokokus dari berbagai serotype pada anak yang telah mendapat satu kali atau lebih dosis vaksinasi. ,tudi lain pada /556 memperlihatkan penurunan jumlah bayi penderita infeksi invasif akibat pneumokokus sebanyak AF persen setelah divaksinasi saat berusia / tahun. )erdasarkan keefektifan vaksin tersebut dalam mencegah pneumonia, meningitis dan bakteremia maka vaksin ini menjadi vaksin yang di3ajibkan di Amerika ,erikat, Bropa dan Australia serta telah digunakan lebih dari 455 juta dosis di seluruh dunia. ,aat ini, di &ndonesia, vaksin pneumokokus ini telah tersedia. Pneumonia Dari Eikipedia &ndonesia, ensiklopedia bebas berbahasa &ndonesia. :angsung ke navigasi, cari Artikel ini tentang pneumonia pada manusia. 7ntuk membaca tentang pneumonia dalam he3an lainnya, lihat pneumonia !non*manusia$.Pneumonia Kode &"D*45 G4/*G4F, P/6 Kode &"D*> -F5*-FD, AA5.5 Pneumonia adalah sebuah penyakit pada paru*paru di mana pulmonary alveolus !alveoli$ yang bertanggung ja3ab menyerap oksigen dari atmosfer menjadi KinflameK 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. 1ejala yang berhubungan dengan pneumonia termasuk batuk, sakit dada, demam, dan kesulitan bernafas. Alat diagnosa termasuk sinar*Q dan pemeriksaan sputum. Pera3atan tergantung dari penyebab pneumonia8 pneumonia disebabkan bakteri dira3at dengan antibiotik. o99o 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. =aksin untuk mencegah beberapa jenis pneumonia tersedia. Prognosis untuk individu tergantung dari jenis pneumonia, pera3atan yang cocok, komplikasin lainnya, dan kesehatan orang tersebut. ,alah satu kasus Pneumonia yang mempunya tingkat kematian tinggi pada saat ini adalah kasus Pneumonia yang disebabkan oleh 2lu burung. o99o Pneumonia 2rom Eikipedia, the free encyclopedia Pneumonia is an inflammatory illness of the lung.R4S 2re#uently, it is described as lung parenchyma'alveolar inflammation and abnormal alveolar filling 3ith fluid. !The alveoli are microscopic air*filled sacs in the lungs responsible for absorbing oQygen from the atmosphere.$ Pneumonia can result from a variety of causes, including infection 3ith bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. &ts cause may also be officially described as idiopathicTthat is, unkno3nT3hen infectious causes have been eQcluded. Typical symptoms associated 3ith pneumonia include cough, chest pain, fever, and difficulty in breathing. Diagnostic tools include Q*rays and eQamination of the sputum. Treatment depends on the cause of pneumonia8 bacterial pneumonia is treated 3ith antibiotics. Pneumonia is a common illness 3hich occurs in all age groups, and is a leading cause of death among the elderly and people 3ho are chronically and terminally ill. =accines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the appropriate treatment, any complications, and the personPs underlying health. ,igns and symptoms Pneumonia fills the lungPs alveoli 3ith fluid, keeping oQygen from reaching the bloodstream. The alveolus on the left is normal, 3hile the alveolus on the right is full of fluid from pneumonia. People 3ith infectious pneumonia often have a cough producing greenish or yello3 sputum, or phlegm and a high fever that may be accompanied by shaking chills. ,hortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either eQperienced during deep breaths or coughs or 3orsened by it. People 3ith pneumonia may cough up blood, eQperience headaches, or develop s3eaty and clammy skin. 9ther possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood s3ings, and joint pains or muscle aches. :ess common forms of pneumonia can cause other symptoms8 for instance, pneumonia caused by :egionella may cause abdominal pain and diarrhea, 3hile pneumonia caused by tuberculosis or Pneumocystis may cause only 3eight loss and night s3eats. &n elderly people manifestations of pneumonia may not be typical. They may develop a ne3 or 3orsening confusion or may eQperience unsteadiness, leading to falls. &nfants 3ith pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite.R/S ,ymptoms of pneumonia need immediate medical evaluation. Physical eQamination by a health care provider may reveal fever or sometimes lo3 body temperature, an increased respiratory rate, lo3 blood pressure, a fast heart rate, or a lo3 oQygen saturation, 3hich is the amount of oQygen in the blood as indicated by either pulse oQimetry or blood gas analysis. People 3ho are struggling to breathe, 3ho are confused, or 3ho have cyanosis !blue*tinged skin$ re#uire immediate attention. Physical eQamination of the lungs may be normal, but often sho3s decreased eQpansion of the chest on the affected side, bronchial breathing on auscultation 3ith a stethoscope !harsher sounds from the larger air3ays transmitted through the inflamed and consolidated lung$, and rales heard over the affected area. Percussion may be dulled over the affected lung, but increased rather than decreased vocal resonance !3hich distinguishes it from a pleural effusion$.R/S Ehile these signs are relevant, they are insufficient to diagnose or rule out a pneumonia8 moreover, in studies it has been sho3n that t3o doctors can arrive at different findings on the same patient.R6S R-S ReditS Diagnosis &f pneumonia is suspected on the basis of a patientPs symptoms and findings from physical eQamination, further investigations are needed to confirm the diagnosis. &nformation from a chest O*ray and blood tests are helpful, and sputum cultures in some cases. The chest O*ray is typically used for diagnosis in hospitals and some clinics 3ith O*ray facilities. %o3ever, in a community setting !general practice$, pneumonia is usually diagnosed based on symptoms and physical eQamination alone. Diagnosing pneumonia can be difficult in some people, especially those 3ho have other illnesses. 9ccasionally a chest "T scan or other tests may be needed to distinguish pneumonia from other illnesses. ReditS &nvestigations Pneumonia as seen on chest Q*ray. A +ormal chest Q* ray. ) Abnormal chest Q*ray 3ith shado3ing from pneumonia in the right lung !3hite area, left side of image$. An important test for pneumonia in unclear situations is a chest Q*ray. "hest Q*rays can reveal areas of opacity !seen as 3hite$ 3hich represent consolidation. Pneumonia is not al3ays seen on Q*rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by Q*ray. &n some cases, chest "T !computed tomography$ can reveal pneumonia that is not seen on chest Q*ray. O* rays can be misleading, because other problems, like lung scarring and congestive heart failure, can mimic pneumonia on Q*ray.R?S "hest Q*rays are also used to evaluate for complications of pneumonia. !,ee belo3.$ &f antibiotics fail to improve the patientPs health, or if the health care provider has concerns about the diagnosis, a culture of the personPs sputum may be re#uested. ,putum cultures generally take at least t3o 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$. Any bacteria identified are then tested to see 3hich antibiotics 3ill be most effective. A complete blood count may sho3 a high 3hite blood cell count, indicating the presence of an infection or inflammation. &n some people 3ith immune system problems, the 3hite blood cell count may appear deceptively normal. )lood tests may be used to evaluate kidney function !important 3hen prescribing certain antibiotics$ or to look for lo3 blood sodium. :o3 blood sodium in pneumonia is thought to be due to eQtra anti*diuretic hormone produced 3hen the lungs are diseased !,&AD%$. ,pecific blood serology tests for other bacteria !Mycoplasma, :egionella and "hlamydophila$ and a urine test for :egionella antigen are available. 0espiratory secretions can also be tested for the presence of viruses such as influen(a, respiratory syncytial virus, and adenovirus. :iver function tests should be carried out to test for damage caused by sepsis.R/S
ReditS "ombining findings 9ne study created a prediction rule that found the five follo3ing signs best predicted infiltrates on the chest

radiograph of 446- patients presenting to an emergency room RDS Temperature U 455 degrees 2 !6A.F degrees "$ Pulse U 455 beats'min "rackles Decreased breath sounds Absence of asthma The probability of an infiltrate in t3o separate validations 3as based on the number of findings ? findings * F-C to >4C probability - findings * ?FC to F?C 6 findings * 6?C to ?4C / findings * 4-C to /-C 4 findings * ?C to >C 5 findings * /C to 6C A subse#uent studyRAS comparing four prediction rules to physician judgment found that t3o rules, the one aboveRDS and alsoRFS 3ere more accurate than physician judgment because of the increased specificity of the prediction rules. ReditS Differential diagnosis ,everal diseases and'or conditions can present 3ith similar clinical features to pneumonia and as such care must be taken in the proper diagnosis of the disease. "hronic obstructive pulmonary disease !"9PD$ or asthma can present 3ith a polyphonic 3hee(e, similar to that of pneumonia. Pulmonary edema can be mistaken for pneumonia due to itPs ability to sho3 a third heart sound and present 3ith an abnormal B"1. 9ther diseases to be taken into consideration include bronchiectasis, lung cancer and pulmonary emboli.R/S ReditS Pathophysiology 7pper panel sho3s a normal lung under a microscope. The 3hite spaces are alveoli that contain air. :o3er panel sho3s a lung 3ith pneumonia under a microscope. The alveoli are filled 3ith inflammation and debris. Pneumonia can be caused by microorganisms, irritants and unkno3n causes. Ehen pneumonias are grouped this 3ay, 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 systemPs response to the infection. Although more than one hundred strains of microorganism can cause pneumonia, only a fe3 are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. :ess common causes of infectious pneumonia are fungi and parasites. ReditS =iruses Main article =iral pneumonia =iruses invade cells in order to reproduce. Typically, a virus reaches the lungs 3hen airborne droplets are inhaled through the mouth and nose. 9nce in the lungs, the virus invades the cells lining the air3ays and alveoli. This invasion often leads to cell death, either 3hen the virus directly kills the cells, or through a type of cell controlled self*destruction called apoptosis. Ehen the immune system responds to the viral infection, even more lung damage occurs. Ehite blood cells, mainly lymphocytes, activate certain chemical cytokines 3hich allo3 fluid to leak into the alveoli. This combination of cell destruction and fluid*filled alveoli interrupts the normal transportation of oQygen into the bloodstream. As 3ell as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. =iruses can also make the body more susceptible to bacterial infections8 for 3hich reason bacterial pneumonia often complicates viral pneumonia. =iral pneumonia is commonly caused by viruses such as influen(a virus, respiratory syncytial virus !0,=$, adenovirus, and metapneumovirus. %erpes simpleQ virus is a rare cause of pneumonia eQcept in ne3borns. People 3ith immune system problems are also at risk of pneumonia caused by cytomegalovirus !"M=$. ReditS )acteria Main article )acterial pneumonia )acteria typically enter the lung 3hen airborne droplets are inhaled, but can also reach the lung through the bloodstream 3hen 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. 9nce inside, bacteria may invade the spaces bet3een cells and bet3een alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive 3hite 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 oQygen transportation. The bacterium ,treptococcus pneumoniae, a common cause of pneumonia, photographed through an electron microscope. )acteria often travel from an infected lung into the bloodstream, causing serious or even fatal illness such as septic shock, 3ith lo3 blood pressure and damage to multiple parts of the body including the brain, kidneys, and heart. )acteria can also travel to the area bet3een the lungs and the chest 3all !the pleural cavity$ causing a complication called an empyema. The most common causes of bacterial pneumonia are ,treptococcus pneumoniae, 1ram*positive bacteria and KatypicalK bacteria. The terms K1ram*positiveK and K1ram*negativeK refer to the bacteriaPs color !purple or red, respectively$ 3hen stained using a process called the 1ram stain. The term KatypicalK 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 1ram*positive bacteria that cause pneumonia can be found in the nose or mouth of many healthy people. ,treptococcus pneumoniae, often called KpneumococcusK, is the most common bacterial cause of pneumonia in all age groups eQcept ne3born infants. Another important 1ram*positive cause of pneumonia is ,taphylococcus aureus, 3ith ,treptococcus agalactiae being an important cause of pneumonia in ne3born babies. 1ram*negative bacteria cause pneumonia less fre#uently than gram*positive bacteria. ,ome of the gram*negative bacteria that cause pneumonia include %aemophilus influen(ae, Klebsiella pneumoniae, Bscherichia coli, Pseudomonas aeruginosa and MoraQella catarrhalis. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. KAtypicalK bacteria 3hich cause pneumonia include "hlamydophila pneumoniae, Mycoplasma pneumoniae, and :egionella pneumophila. ReditS 2ungi Main article 2ungal pneumonia 2ungal pneumonia is uncommon, but it may occur in individuals 3ith immune system problems due to A&D,, immunosuppresive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. 2ungal pneumonia is most often caused by %istoplasma capsulatum, blastomyces, "ryptococcus neoformans, Pneumocystis jiroveci, and "occidioides immitis. %istoplasmosis is most common in the Mississippi 0iver basin, and coccidioidomycosis in the south3estern 7nited ,tates. ReditS 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 s3allo3ed. 9nce 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 oQygen transportation. 9ne type of 3hite blood cell, the eosinophil, responds vigorously to parasite infection. Bosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are ToQoplasma gondii, ,trongyloides stercoralis, and Ascariasis. ReditS &diopathic Main article &diopathic interstitial pneumonia

&diopathic interstitial pneumonias !&&P$ are a class as diffuse lung diseases. &n some types of &&P, e.g. some types of usual interstitial pneumonia, the cause, indeed, is unkno3n or idiopathic. &n some types of &&P the cause of the pneumonia is kno3n, e.g. des#uamative interstitial pneumonia is caused by smoking, and the name is a misnomer. ReditS "lassification Pneumonias can be classified in several 3ays. Pathologists originally classified them according to the anatomic changes that 3ere found in the lungs during autopsies. As more became kno3n about the microorganisms causing pneumonia, a microbiologic classification arose, and 3ith the advent of Q*rays, a radiological classification. Another important system of classification is the combined clinical classification, 3hich combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease and underlying systemic disease, and 3hether the person has recently been hospitali(ed. ReditS Barly classification schemes &nitial 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. :obar pneumonia is often due to ,treptococcus pneumoniae. Multilobar pneumonia involves more than one lobe, and it often causes a more severe illness. &nterstitial pneumonia involves the areas in bet3een the alveoli, and it may be called Kinterstitial pneumonitis.K &t is more likely to be caused by viruses or by atypical bacteria. The discovery of Q*rays made it possible to determine the anatomic type of pneumonia 3ithout direct eQamination of the lungs at autopsy and led to the development of a radiological classification. Barly investigators distinguished bet3een typical lobar pneumonia and atypical !e.g. "hlamydophila$ or viral pneumonia using the location, distribution, and appearance of the opacities they sa3 on chest Q*rays. "ertain Q*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 3ith Q*rays alone. Eith the advent of modern microbiology, classification based upon the causative microorganism became possible. Determining 3hich microorganism is causing an individualPs pneumonia is an important step in deciding treatment type and length. ,putum cultures, blood cultures, tests on respiratory secretions, and specific blood tests are used to determine the microbiologic classification. )ecause such laboratory testing typically takes several days, microbiologic classification is usually not possible at the time of initial diagnosis. ReditS "ombined clinical classification Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into KacuteK !less than three 3eeks duration$ and KchronicK pneumonias. This is useful because chronic pneumonias tend to be either non*infectious, or mycobacterial, fungal, or miQed bacterial infections caused by air3ay obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias !such as ,treptococcus pneumoniae$, the atypical pneumonias !such as the interstitial pneumonitis of Mycoplasma pneumoniae or "hlamydia pneumoniae$, and the aspiration pneumonia syndromes. The combined clinical classification, no3 the most commonly used classification scheme, attempts to identify a personPs risk factors 3hen 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 kno3n. There are t3o broad categories of pneumonia in this scheme community*ac#uired pneumonia and hospital*ac#uired pneumonia. A recently introduced type of healthcare*associated pneumonia !in patients living outside the hospital 3ho have recently been in close contact 3ith the health care system$ lies bet3een these t3o categories. ReditS "ommunity*ac#uired pneumonia Main article "ommunity*ac#uired pneumonia "ommunity*ac#uired pneumonia !"AP$ is infectious pneumonia in a person 3ho has not recently been hospitali(ed. "AP is the most common type of pneumonia. The most common causes of "AP vary depending on a personPs age, but they include ,treptococcus pneumoniae, viruses, the atypical bacteria, and %aemophilus influen(ae. 9verall, ,treptococcus pneumoniae is the most common cause of community*ac#uired pneumonia 3orld3ide. 1ram* negative bacteria cause "AP in certain at*risk populations. "AP is the fourth most common cause of death in the 7nited Kingdom and the siQth in the 7nited ,tates. An outdated term, 3alking pneumonia, has been used to describe a type of community* ac#uired pneumonia of less severity !hence the fact that the patient can continue to K3alkK rather than re#uire hospitali(ation$. Ealking pneumonia is usually caused by a virus or by atypical bacteria. ReditS %ospital*ac#uired pneumonia Main article %ospital*ac#uired pneumonia %ospital*ac#uired pneumonia, also called nosocomial pneumonia, is pneumonia ac#uired during or after hospitali(ation for another illness or procedure 3ith onset at least A/ hrs after admission. The causes, microbiology, treatment and prognosis are different from those of community*ac#uired pneumonia. 7p to ?C of patients admitted to a hospital for other causes subse#uently develop pneumonia. %ospitali(ed patients may have many risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances. Additionally, the microorganisms a person is eQposed to in a hospital are often different from those at home . %ospital*ac#uired microorganisms may include resistant bacteria such as M0,A, Pseudomonas, Bnterobacter, and ,erratia. )ecause individuals 3ith hospital*ac#uired pneumonia usually have underlying illnesses and are eQposed to more dangerous bacteria, it tends to be more deadly than community*ac#uired pneumonia. =entilator*associated pneumonia !=AP$ is a subset of hospital*ac#uired pneumonia. =AP is pneumonia 3hich occurs after at least -F hours of intubation and mechanical ventilation. ReditS 9ther types of pneumonia ,evere acute respiratory syndrome !,A0,$ ,A0, is a highly contagious and deadly type of pneumonia 3hich first occurred in /55/ after initial outbreaks in "hina. ,A0, is caused by the ,A0, coronavirus, a previously unkno3n pathogen. +e3 cases of ,A0, have not been seen since Gune /556. )ronchiolitis obliterans organi(ing pneumonia !)99P$ )99P is caused by inflammation of the small air3ays of the lungs. &t is also kno3n as cryptogenic organi(ing pneumonitis !"9P$. Bosinophilic pneumonia Bosinophilic pneumonia is invasion of the lung by eosinophils, a particular kind of 3hite blood cell. Bosinophilic pneumonia often occurs in response to infection 3ith a parasite or after eQposure to certain types of environmental factors. "hemical pneumonia "hemical pneumonia !usually called chemical pneumonitis$ is caused by chemical toQins such as pesticides, 3hich may enter the body by inhalation or by skin contact. Ehen the toQic substance is an oil, the pneumonia may be called lipoid pneumonia. Aspiration pneumonia Aspiration pneumonia !or aspiration pneumonitis$ is caused by aspirating foreign objects 3hich are usually oral or gastric contents, either 3hile eating, or after refluQ or vomiting 3hich 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 ade#uately protect their air3ays and may have other3ise impaired defenses. ReditS Treatment

Most cases of pneumonia can be treated 3ithout hospitali(ation. Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution. %o3ever, people 3ith pneumonia 3ho are having trouble breathing, people 3ith other medical problems, and the elderly may need more advanced treatment. &f the symptoms get 3orse, the pneumonia does not improve 3ith home treatment, or complications occur, the person 3ill often have to be hospitali(ed. Antibiotics are used to treat bacterial pneumonia. &n 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 kno3n antibiotic sensitivity. %o3ever, a specific cause for pneumonia is identified in only ?5C of people, even after eQtensive evaluation. )ecause treatment should generally not be delayed in any person 3ith a serious pneumonia, empiric treatment is usually started 3ell before laboratory reports are available. &n the 7nited Kingdom, amoQicillin is the antibiotic selected for most patients 3ith community*ac#uired pneumonia, sometimes 3ith added clarithromycin8 patients allergic to penicillins are given erythromycin instead of amoQicillin. &n +orth America, 3here the KatypicalK forms of community* ac#uired pneumonia are becoming more common, a(ithromycin, clarithromycin, and the fluoro#uinolones have displaced amoQicillin 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.R>SR45S R44S Antibiotics for hospital*ac#uired pneumonia include vancomycin, third* and fourth*generation cephalosporins, carbapenems, fluoro#uinolones, 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 microorganismsP abilities to resist various antibiotic treatments. People 3ho have difficulty breathing due to pneumonia may re#uire eQtra oQygen. BQtremely sick individuals may re#uire intensive care treatment, often including intubation and artificial ventilation. =iral pneumonia caused by influen(a A may be treated 3ith rimantadine or amantadine, 3hile viral pneumonia caused by influen(a A or ) may be treated 3ith oseltamivir or (anamivir. These treatments are beneficial only if they are started 3ithin -F hours of the onset of symptoms. Many strains of %?+4 influen(a A, also kno3n as avian influen(a or Kbird flu,K have sho3n resistance to rimantadine and amantadine. There are no kno3n effective treatments for viral pneumonias caused by the ,A0, coronavirus, adenovirus, hantavirus, or parainfluen(a virus. ReditS "omplications ,ometimes pneumonia can lead to additional complications. "omplications are more fre#uently associated 3ith bacterial pneumonia than 3ith viral pneumonia. The most important complications include ReditS 0espiratory and circulatory failure )ecause pneumonia affects the lungs, often people 3ith pneumonia have difficulty breathing, and it may not be possible for them to breathe 3ell enough to stay alive 3ithout support. +on*invasive breathing assistance may be helpful, such as 3ith a bi*level positive air3ay pressure machine. &n 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 !A0D,$, 3hich results from a combination of infection and inflammatory response. The lungs #uickly fill 3ith fluid and become very stiff. This stiffness, combined 3ith severe difficulties eQtracting oQygen due to the alveolar fluid, create a need for mechanical ventilation. Pleural effusion. "hest Q*ray sho3ing a pleural effusion. The A arro3 indicates Kfluid layeringK in the right chest. The ) arro3 indicates the 3idth of the right lung. The volume of useful lung is reduced because of the collection of fluid around the lung. ,epsis and septic shock are potential complications of pneumonia. ,epsis occurs 3hen microorganisms enter the bloodstream and the immune system responds by secreting cytokines. ,epsis most often occurs 3ith bacterial pneumonia8 ,treptococcus pneumoniae is the most common cause. &ndividuals 3ith sepsis or septic shock need hospitali(ation in an intensive care unit. They often re#uire intravenous fluids and medications to help keep their blood pressure from dropping too lo3. ,epsis can cause liver, kidney, and heart damage, among other problems, and it often causes death. ReditS Pleural effusion, empyema, and abscess ReditS "linical prediction rules 9ccasionally, microorganisms infecting the lung 3ill cause fluid !a pleural effusion$ to build up in the space that surrounds the lung !the pleural cavity$. &f the microorganisms themselves are present in the pleural cavity, the fluid collection is called an empyema. Ehen pleural fluid is present in a person 3ith pneumonia, the fluid can often be collected 3ith a needle !thoracentesis$ and eQamined. Depending on the results of this eQamination, complete drainage of the fluid may be necessary, often re#uiring a chest tube. &n severe cases of empyema, surgery may be needed. &f the fluid is not drained, the infection may persist, because antibiotics do not penetrate 3ell into the pleural cavity. 0arely, bacteria in the lung 3ill form a pocket of infected fluid called an abscess. :ung abscesses can usually be seen 3ith a chest Q*ray or chest "T scan. Abscesses typically occur in aspiration pneumonia and often contain several types of bacteria. Antibiotics are usually ade#uate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist. ReditS Prognosis and mortality "linical prediction rules have been developed to more objectively prognosticate outcomes in pneumonia. These rules can be helpful in deciding 3hether or not to hospitali(e the person. Pneumonia severity indeQ !or P90T ,core$R4?S * online calculator "70)*D? score, 3hich takes into account the severity of symptoms, any underlying diseases, and ageR4DS * online calculator ReditS Prevention There are several 3ays to prevent infectious pneumonia. Appropriately treating underlying illnesses !such as A&D,$ can decrease a personPs risk of pneumonia. ,moking cessation is important not only because it helps to limit lung damage, but also because cigarette smoke interferes 3ith many of the bodyPs natural defenses against pneumonia. 0esearch sho3s that there are several 3ays to prevent pneumonia in ne3born infants. Testing pregnant Eith treatment, most types of bacterial pneumonia can be cleared 3ithin t3o to four 3eeks.R4/S =iral pneumonia may last longer, and mycoplasmal pneumonia may take four to siQ 3eeks to resolve completely.R4/S &n cases 3here the pneumonia progresses to blood poisoning !bacteremia$, just over /5C of sufferers 3ill die.R46S The death rate !or mortality$ also depends on the underlying cause of the pneumonia. Pneumonia caused by Mycoplasma, for instance, is associated 3ith little mortality. %o3ever, about half of the people 3ho develop methicillin*resistant ,taphylococcus aureus !M0,A$ pneumonia 3hile on a ventilator 3ill die.R4-S &n regions of the 3orld 3ithout advanced health care systems, pneumonia is even deadlier. :imited access to clinics and hospitals, limited access to Q*rays, limited antibiotic choices, and inability to treat underlying conditions inevitably leads to higher rates of death from pneumonia.

3omen for 1roup ) ,treptococcus and "hlamydia trachomatis, and then giving antibiotic treatment if needed, reduces pneumonia in infants. ,uctioning the mouth and throat of infants 3ith meconium*stained amniotic fluid decreases the rate of aspiration pneumonia. =accination is important for preventing pneumonia in both children and adults. =accinations against %aemophilus influen(ae and ,treptococcus pneumoniae in the first year of life have greatly reduced their role in pneumonia in children. =accinating children against ,treptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults ac#uire infections from children. A vaccine against ,treptococcus pneumoniae is also available for adults. &n the 7.,., it is currently recommended for all healthy individuals older than D? and any adults 3ith emphysema, congestive heart failure, diabetes mellitus, cirrhosis of the liver, alcoholism, cerebrospinal fluid leaks, or those 3ho do not have a spleen. A repeat vaccination may also be re#uired after five or ten years. R4AS &nfluen(a vaccines should be given yearly to the same individuals 3ho receive vaccination against ,treptococcus pneumoniae. &n addition, health care 3orkers, nursing home residents, and pregnant 3omen should receive the vaccine.R4FS Ehen an influen(a outbreak is occurring, medications such as amantadine, rimantadine, (anamivir, and oseltamivir can help prevent influen(a.R4>SR/5S ReditS Bpidemiology Pneumonia is a common illness in all parts of the 3orld. &t is a major cause of death among all age groups. &n children, the majority of deaths occur in the ne3born period, 3ith over t3o million deaths a year 3orld3ide. The Eorld %ealth 9rgani(ation estimates that one in three ne3born infant deaths are due to pneumoniaR/4S and E%9 also estimates that up to 4 million of these !vaccine preventable$ deaths are caused by the bacteria ,treptococcus pneumoniae, and >5C of these deaths take place in developing countries. Peripneumonia, and pleuritic affections, are to be thus observed &f the fever be acute, and if there be pains on either side, or in both, and if eQpiration be if cough be present, and the sputa eQpectorated be of a blond or livid color, or like3ise thin, frothy, and florid, or having any other character different from the common... Ehen 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 s3eats come out about the neck and head, for such s3eats are bad, as proceeding from the suffocation, R//S Mortality from pneumonia generally decreases 3ith age until late adulthood. Blderly individuals, ho3ever, are at particular risk for pneumonia and associated mortality. &n the 7nited Kingdom, the annual incidence of pneumonia is approQimately D cases for every 4555 people for the 4F*6> age group. 2or those over A? years of age, this rises to A? cases for every 4555 people. 0oughly /5*-5C of individuals 3ho contract pneumonia re#uire hospital admission of 3hich bet3een ?*45C are admitted to a critical care unit. ,imilarly, the mortality rate in the 7K is around ?* 45C.R/S More cases of pneumonia occur during the 3inter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in )lacks than "aucasians. &ndividuals 3ith underlying illnesses such as Al(heimerPs disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia.R/6S These individuals are also more likely to have repeated episodes of pneumonia. People 3ho are hospitali(ed for any reason are also at high risk for pneumonia. ReditS %istory %ippocrates, the ancient 1reek physician kno3n as the Kfather of medicine.K The symptoms of pneumonia 3ere described by %ippocrates !c. -D5 )"<6A5 )"$ ,ir Eilliam 9sler, kno3n as Kthe father of modern medicine,K appreciated the morbidity and mortality of pneumonia, describing it as the Kcaptain of the men of deathK in 4>4F. %o3ever, several key developments in the 4>55s improved the outcome for those 3ith pneumonia. Eith the advent of penicillin and other antibiotics, modern surgical techni#ues, and intensive care in the t3entieth century, mortality from pneumonia dropped precipitously in the developed 3orld. =accination of infants against %aemophilus influen(ae type b began in 4>FF and led to a dramatic decline in cases shortly thereafter.R65S =accination against ,treptococcus pneumoniae in adults began in 4>AA and in children began in /555, 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 3hich is obtaining the upper hand.R/-S %o3ever, %ippocrates referred to pneumonia as a disease Knamed by the ancients.K %e also reported the results of surgical drainage of empyemas. Maimonides !446F<4/5- AD$ observed KThe basic symptoms 3hich occur in pneumonia and 3hich are never lacking are as follo3s acute fever, sticking RpleuriticS pain in the side, short rapid breaths, serrated pulse and cough.KR/?S This clinical description is #uite similar to those found in modern teQtbooks, and it reflected the eQtent of medical kno3ledge through the Middle Ages into the 4>th century. )acteria 3ere first seen in the air3ays of individuals 3ho died from pneumonia by Bd3in Klebs in 4FA?. R/DS &nitial 3ork identifying the t3o common bacterial causes ,treptococcus pneumoniae and Klebsiella pneumoniae 3as performed by "arl 2riedlVnderR/AS and Albert 2rVnkelR/FS in 4FF/ and 4FF-, respectively. 2riedlVnderPs initial 3ork introduced the 1ram stain, a fundamental laboratory test still used to identify and categori(e bacteria. "hristian 1ramPs paper describing the procedure in 4FF- helped differentiate the t3o different bacteria and sho3ed that pneumonia could be caused by more than one microorganism.R/>S dengan gi(i seimbang dan menjaga lingkungan adalah langkah terbaik nmnghindarinya. Ketika seorang anak atau orang de3asa berbaring di lantai tanpa alas, kerap muncul seruan, KBh, jangan tiduran begitu, nanti kena paru*paru basah, lhoWKMang ditegur pun menurut, lalu pindah ke sofa atau tempat tidur. )anyak orang menganggap, lembabnya udara dari lantai atau yang kita hirup bisa menyebabkan paru*paru basah. )enarkahX Apa sebenarnya paru*paru basah ituX 65 ,umber &nfeksi Dalam dunia kedokteran, tidak dikenal istilah paru* paru basah. Mang 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, 2""P, menyebutkan bah3a penyakit ini disebabkan oleh sekitar 65 macam sumber infeksi. +amun, penyebab utamanya adalah bakteri, virus, mikroplasma, jamur, berbagai senya3a kimia, dan partikel. Meski kasus pneumonia akibat bakteri tidak terlalu banyak, jenis ini cenderung menimbulkan infeksi lebih berat daripada yang disebabkan oleh nonbakteri. =irus sinsitial pernapasan !respiratory syncitial virus atau 0,=$, painfluen(ae, influen(ae, dan adenovirus merupakan yang paling kerap menyebabkan pneumonia. 7mumnya infeksi virus saluran pernapasan ba3ah berlangsung selama musim dingin atau hujan. Dan 0,= yang paling umum menjadi penyebab pneumonia, terutama pada bayi. ,ulit )ernapas Pneumonia muncul karena kuman penyakit terhirup hidung dan mulut. )ila lingkungan di sekitar ada orang atau anak yang terinfeksi, risiko tertular sangat besar, apalagi bila daya tahan tubuh sedang tidak baik.

KPneumonia termasuk penyakit yang serius dan berbahaya,K ujar spesialis paru dari 0,PAD 1atot ,ubroto yang akrab disapa Dr. Mita ini. 1ara*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 ba3ah ke dalam !severe chest indra3ing$. 1ejala sulit bernapas bisa juga disertai gejala sianosis !kebiruan di bagian kulit dan mukosa karena hemoglobin berkurang dalam darah kapiler$ sentral dan tidak dapat minum. Pada anak usia di ba3ah / bulan, pneumonia berat ditandai kerapnya frekuensi bernapas. )isa D5 kali permenit atau lebih tarikan napas, dengan penarikan kuat pada dinding dada sebelah ba3ah ke dalam. 1ejala lain adalah radang tenggorokan !laringitis$. Akibatnya suara berubah serak karena di sekitar pita suara banyak terdapat lendir. :e3at pemeriksaan rontgen dada, bisa diketahui ada masalah di paru. Tanda klinis yang bisa ditemui biasanya flek pada paru. +amun, 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 T)" atau pneumonia. Perlu Mengatur Makan Pengobatan a3al untuk pneumonia biasanya berupa antibiotika. )ila penyebabnya bakteri, mikroplasma, dan rickettsia, biasanya antibiotika ini cukup manjur. 7ntuk pneumonia akibat virus, sampai saat ini belum ada panduan khusus, meski beberapa obat antivirus telah digunakan. ,elain antibiotika, pasien juga akan mendapat terapi tambahan berupa pengaturan makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. &stirahat panjang diperlukan untuk mengembalikan kondisi tubuh. :angkah untuk Mencegah Genis 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 / dan 6 tahun dan sesudahnya akan menurun sedikit demi sedikit. )eberapa kasus pneumonia tidak disebabkan infeksi mikroorganisme. )isa 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 Y Menjaga kebersihan lingkungan tempat tinggal. Y Mengusahakan sirkulasi udara yang baik. Y %indari rokok dan penderita batuk. Y Makanlah dengan gi(i seimbang, Y :akukan imunisasi, terutama untuk anak. =aksin %b sudah banyak dipakai untuk menangkal pneumonia, selain meningitis. =aksin ini untuk menangkal serangan bakteri %aemophyllus influen(ae tipe ) yang bisa menyebabkan kedua jenis penyakit itu. ,udah Ada =aksinnya Pneumonia )akteri Genis 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. )akteri penyebab pneumonia yang paling umum adalah ,treptococcus pneumoniae, dan sudah ada di kerongkongan manusia sehat. ,aat kekebalan tubuh menurun, usia tua, atau kurang gi(i, bakteri segera memperbanyak diri dan merusak tubuh. ,eluruh jaringan paru dipenuhi cairan dan infeksi terjadi cepat menyebar ke seluruh tubuh le3at darah. Pasien yang terinfeksi pneumonia akan panas tinggi, berkeringat, napas terengah*engah, dan denyut jantung meningkat cepat. )ibir dan kuku bisa membiru karena tubuh kekurangan oksigen. Pada kasus berat, pasien akan menggigil, gigi bergemelutuk, sakit dada, dan kalau batuk mengeluarkan lendir ber3arna hljau. ,ebelum terlambat, penyakit ini bisa diobati. =aksin pencegahannya pun sudah tersedia. Pneumonia =irus sebagian besar kasus pneumonia disebabkan oleh virus. Kebanyakan virus menyerang saluran pernapasan atas. 7ntungnya, sebagian besar pneumonia ini tidak berat dan sembuh dalam 3aktu singkat. Gika infeksi terjadi berbarengan dengan virus influen(a, gangguan bisa berat, bahkan menyebabkan kematian. =irus penginfeksi paru akan berkembang biak, meski tak tampak di jaringan paru yang penuh cairan. 1ejala pneumonia ini mirip influen(a. Tandanya, demam, batuk kering, sakit kepala, ngilu di seluruh tubuh. :etih lesu selama 4/*46D jam, napas sesak batuk makin hebat dan menghasilkan sejumlah lendir juga bisa dialami. Demam tinggi kadang membuat bibir membiru. ,umber ,enior Pneumonia Penyebab 7tama Mortalitas Anak )alita di &ndonesia8 Prof. Dr. %. Mardjanis ,aid, ,p.A!K$ Pnumonia adalah penyakit infeksi akut paru yang disebabkan terutama oleh bakteri8 merupakan penyakit &nfeksi ,aluran Pernapasan Akut !&,PA$ yang paling sering menyebabkan kematian pada bayi dan anak balita. )akteri penyebab pneumonia paling sering adalah ,treptococcus pneumoniae !pneumokokus$, %emophilus influen(ae tipe b !%ib$ dan ,taphylococcus aureus !, aureus$. Diperkirakan A?C pneumonia pada anak balita di negara berkembang termasuk di &ndonesia disebabkan oleh pneumokokus dan %ib. Di seluruh dunia setiap tahun diperkirakan terjadi lebih / juta kematian balita karena pneumonia. Di &ndonesia menurut ,urvei Kesehatan 0umah Tangga tahun /554 kematian balita akibat pneumonia ? per 4555 balita per tahun. &ni berarti bah3a pneumonia menyebabkan kematian lebih dari 455.555 balita setiap tahun, atau hampir 655 balita setiap hari, atau 4 balita setiap ? menit. Demikian pidato Prof. Dr. Mardjanis ,aid ,pA!K$ dan Departemen &lmu Kesehatan Anak 2K7& sebagai 1uru )esar Tetap dalam &lmu Kesehatan Anak di 2akultas Kedokteran 7niversitas &ndonesia Gakarta, pada tanggal /> April /55D. Menujuk angka*angka di atas bisa dimengerti para ahli menyebut pneumonia sebagai The 2orgotten Pandemic atau K3abah raya yang terlupakanK 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 Kpembunuh balita nomor satuK. 7paya pencegahan merupakan komponen strategis dalam pemberantasan pneumonia pada anak8 tendiri dari pencegahan melalui imunisasi dan upaya pencegahan non*imunisasi. Program Pengembangan &munisasi !PP&$ yang meliputi imunisasi DPT dan campak yang telah dilaksanakan pemerintah selama ini dapat menurunkan proporsi kematian balita akibat pneumonia. %al 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 %ib dan vaksin pneumokokus konjugat untuk pencegahan terhadap infeksi bakteri penyebab pneumonia dan penyakit berat lain seperti meningitis. +amun vaksin ini belum masuk dalam Program Pengembangan &munisasi !PP&$ Pemerintah. Mang tidak kalah penting sebenarnya adalah upaya pencegahan non*imunisasi yang meliputi pemberian A,& eksklusif, pemberian nutrisi yang baik, penghindaran pajanan asap nokok, asap dapur d&l8 perbaikan lingkungan hidup dan sikap hidup sehat8 yang kesemuanya itu dapat menghindarkan terhadap

risiko terinfeksi penyakit menular termasuk penghindaran terhadap pneumonia. )eliau 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 )aku rekomendasi E%9 dimasukkan ke dalam kurikulum pendidikan di 2K. Penelitian klinis, mikrobiologis maupun lapangan yang berhubungan dengan pemberantasan pneumonia kiranya dapat dilakukan. &dealnya dilakukan penelitian berbasis masyarakat berskala luas. 7ntuk Program',ubdit P/*&,PA Depkes, beliau mengusulkan agar istilah &,PA yang sering disalahtafsirkan sebagai &nfeksi ,aluran Pernapasan Atas dipakai sebagai pengganti istilah batuk*pilek biasa !common cold, flu, selesma$. 7ntuk &,PA yang lama digunakan istilah &0A atay lnfeksi 0espirasi Akut. &stilah Kbukan pneumoniaK dalam Pedoman Tatalaksana )aku diganti dengan &,PA sehingga di masyarakat terdapat / istilah populer yaitu &,PA !penyakit saluran napas atas, biasanya ringan sebagian besar disebabkan oleh virus dan tidak perlu antibiotik$ 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 pera3atan di rumah sakit$. ,etelah upacara pidato pengukuhan, acara syukuran diadakan di Departemen &KA 2K7& 0,"M. %adir dalam kesempatan tersebut, para undangan, staf &KA dan para kolega Divisi 0espirologi daerah berbagai senter di tanah air. ,ekali lagi selamat Prof. Mardjanis. !%1$ )atuk o99o ,ecara umum, peradangan pada jaringan paru disebut pneumonia. Ada beberapa jenis peradangan pada paru, yang paling utama dan sering terjadi adalah pneumonia lobaris dan bronkopneumonia dupleQ. Pneumonia lobaris merupakan peradangan pada sebagian paru atau salah satu lobus paru. ,edangkan bronkopneumonia dupleQ, peradangannya mengenai saluran napas kecil dan jaringan paru yang terjadi pada sebagian besar atau keseluruhan lapangan paru kiri dan kanan. Y Menjaga Kesehatan ,e3aktu %amil )erdasarkan penyebabnya, secara garis besar pneumonia dapat dikelompokkan menjadi 6, yaitu 4. 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 A,& yang bukan masuk ke saluran cerna melainkan ke saluran pernapasan. )ila ia tersedak, tentu harus segera ditangani. Kalau tidak, bayi akan sesak napas atau bahkan tak bisa bernapas sehingga ji3anya pun tak tertolong. /. Pneumonia karena infeksi virus, bakteri, atau jamur. 7mumnya di &ndonesia, penyebab infeksi paru adalah virus dan bakteri seperti ,treptococcus pneumoniae dan %aemophylus influen(ae. ,edangkan jamur sangat jarang terjadi. &nfeksi ini bisa menyebabkan pneumonia lobaris maupun bronkopneumonia dupleQ. 6. Pneumonia akibat faktor lingkungan. Di kota*kota besar seperti Gakarta, 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. )ila saat itu daya tahan tubuhnya lemah, bisa berkembang menjadi infeksi di saluran pernapasan. )ila kemudian tak diobati dengan baik, mungkin saja akan menjadi pneumonia. MB+"B1A% :ebih B2BKT&2 Mengingat pengobatan yang butuh 3aktu lama dan dananya pun cukup besar, belum lagi dengan tingkat keberhasilan yang terkadang sulit dicapai, sebaiknya kita memang mencegah terjadinya infeksi pada paru. )erikut adalah langkah*langkah yang perlu dilakukan Ada bayi yang baru lahir terkena pneumonia. %al ini bisa disebabkan penularan dari ibu yang memiliki kuman penyebab pneumonia sehingga masuk ke janin le3at plasenta. )isa juga karena infeksi virus atau bakteri yang masuk dari vagina ke dalam rahim, sehingga kemudian janin seakan berkubang dalam air ketuban yang mengandung kuman. 7ntuk itu, saat mengandung si kecil, kita harus memerhatikan betul kesehatan diri dan janin. "aranya 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. Y Perkecil 0isiko 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 le3at udara. Guga terus berikan A,& supaya daya tahan tubuhnya tetap terjaga. )ila anak menderita batuk dan pilek, jangan dibiarkan berlarut*larut. ,egera ba3a ke dokter bila flu dan batuk tak juga sembuh dalam 3aktu 6*? hari. &nfeksi saluran pernapasan atas seperti batuk dan flu bisa menjadi a3al terjadinya infeksi paru. ,ebab, saluran pernapasan atas merupakan pintu masuk udara, virus dan kuman ke dalam tubuh. Y )erikan =aksin ,upaya anak lebih kebal terhadap serangan infeksi paru, disarankan untuk diberikan vaksinasi, antara lain vaksin influen(a, vaksin %i), dan vaksin P"=. Pemberiannya dapat dilakukan sejak bayi. %al ini perlu dilakukan mengingat pneumonia paling sering menyerang anak di ba3ah usia / tahun. Y Menjaga Kebersihan :ingkungan Menjaga kebersihan lingkungan penting dilakukan supaya udara yang kita hirup bersih dan menyehatkan. )uang 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. )ila udara yang dihirup kotor atau berdebu, pada anak yang memilik bakat alergi, akan sering bersin*bersin, flu, batuk. )ila hal ini sering terjadi, maka mudah terjadi peradangan pada saluran pernapasan dan tak mustahil terjadi pula infeksi di paru*parunya. Dua K9MP:&KA,& &nfeksi paru dapat menimbulkan komplikasi pneumothoraQ 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. 1ejala yang muncul umumnya sama dengan gangguan paru lainnya, yaitu demam, sesak napas, frekuensi napas cepat, dan lainnya. ,eperti halnya gangguan yang lain, komplikasi ini harus segera diatasi supaya bisa tertangani dengan baik. 4. PneumothoraQ )erasal dari kata pneumo ; udara, dan thoraQ ; dada. Artinya, ada udara di dalam rongga dada. 7dara 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. :ambat laun alveolus menjadi penuh sehingga tak kuat menampung udara dan pecah. 7dara kemudian masuk ke dalam rongga antara paru dan tulang dada. )ila terus*menerus terjadi, maka di

rongga tersebut akan penuh dengan udara. :ambat*laun paru*paru menjadi kempis karena terdesak oleh udara. /. Bmpiyema !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. o99o 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 &ndonesia, pneumonia adalah penyebab kematian nomor tiga setelah kardiovaskuler dan tuberkulosis. 1ejala Pada anak usia / bulan sampai kurang dari ? tahun Pneumonia )erat ditandai batuk atau !juga disertai$ kesulitan bernapas, napas sesak atau penarikan dinding dada sebelah ba3ah ke dalam !severe chest indra3ing$. Dahak ber3arna kehijauan atau seperti karet. Pada kelompok usia ini dikenal juga Pnemonia sangat berat, dengan gejala batuk dan kesukaran bernapas karena tidak ada ruang tersisa untuk oksigen di paru*paru. Pada anak di ba3ah / bulan Pnemonia berat ditandai frekuensi pernapasan sebanyak D5 kali per menit atau lebih atau !juga disertai$ penarikan kuat pada dinding dada sebelah ba3ah ke dalam. Gika bayi bernapas dengan bantuan ventilator, akan tampak bah3a jumlah lendir meningkat. Kadang bayi tiba*tiba menjadi sakit yang disertai dengan turun naiknya suhu tubuh o99o Definisi Pneumonia adalah peradangan paru yang disebabkan oleh infeksi bakteri, virus maupun jamur. Penyebab pneumonia adalah 4. )akteri !paling sering menyebabkan pneumonia pada de3asa$ ,treptococcus pneumoniae /. =irus virus influen(a, chicken*poQ !cacar air$ 6. 9rganisme mirip bakteri Mycoplasma pneumoniae !terutama pada anak*anak dan de3asa muda$ -. Gamur tertentu. Adapun cara mikroorganisme itu sampai ke paru*paru bisa melalui &nhalasi !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. )eberapa orang yang rentan !mudah terkena$ pneumonia adalah Peminum alkohol Perokok Penderita diabetes Penderita gagal jantung Penderita penyakit paru obstruktif menahun 1angguan sistem kekebalan karena obat tertentu !penderita kanker,penerima organ cangkokan$ 1angguan sistem kekebalan karena penyakit !penderita A&D,$. Pneumonia juga bisa terjadi setelah pembedahan !terutama pembedahan perut$ atau cedera !terutama cedera dada$, sebagai akibat dari dangkalnya pernafasan, gangguan terhadap kemampuan batuk dan lendir yang tertahan. Mang sering menjadi penyebabnya adalah ,taphylococcus aureus, pneumokokus, %emophilus influen(ae atau kombinasi ketiganya. Pneumonia pada orang de3asa paling sering disebabkan oleh bakteri, yang tersering yaitu bakteri ,treptococcus pneumoniae pneumococcus$. Pneumonia pada anak*anak paling sering disebabkan oleh virus pernafasan, dan puncaknya terjadi pada umur /*6 tahun. Pada usia sekolah, pneumonia paling sering disebabkan oleh bakteri Mycoplasma pneumoniae. ,taphylococcus aureus :egionella %emophilus influen(ae Pneumonia dikelompokkan berdasarkan sejumlah sistem yang berlainan. ,alah satu diantaranya adalah berdasarkan cara diperolehnya, dibagi menjadi / kelompok, yaitu Kcommunity*ac#uiredK !diperoleh diluar institusi kesehatan$ dan Khospital*ac#uiredK !diperoleh di rumah sakit atau sarana kesehatan lainnya$. Pneumonia yang didapat diluar institusi kesehatan paling sering disebabkan oleh ,treptococcus pneumoniae. Pneumonia yang didapat di rumah sakit cenderung bersifat lebih serius karena pada saat menjalani pera3atan di rumah sakit, sistem pertahanan tubuh penderita untuk mela3an infeksi seringkali terganggu. ,elain itu, kemungkinannya terjadinya infeksi oleh bakteri yang resisten terhadap antibiotik adalah lebih besar. 1ejala 1ejala*gejala yang biasa ditemukan adalah batuk berdahak !dahaknya seperti lendir, kehijauan atau seperti nanah$ 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. 1ejala 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 0ontgen dada Pembiakan dahak %itung jenis darah 1as darah arteri. Pengobatan Kepada penderita yang penyakitnya tidak terlalu berat, bisa diberikan antibiotik per*oral !le3at mulut$ dan tetap tinggal di rumah. Penderita yang lebih tua dan penderita dengan sesak nafas atau dengan penyakit jantung atau paru*paru lainnya, harus dira3at 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 3aktu / minggu. Pencegahan 7ntuk orang*orang yang rentan terhadap pneumonia, latihan bernafas dalam dan terapi untuk membuang dahak, bisa membantu mencegah terjadinya pneumonia. =aksinasi bisa membantu mencegah beberapa jenis pneumonia pada anak*anak dan orang de3asa yang beresiko tinggi =aksin pneumokokus !untuk mencegah pneumonia karena ,treptococcus pneumoniae$ =aksin flu =aksin %ib !untuk mencegah pneumonia karena %aemophilus influen(ae type b$. o99o Pneumonia is characteri(ed 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, 3hich is caused by noninfectious agents such as radiation or chemicals. An inhaled infectious organism must bypass the hostPs normal nonimmune and immune defense mechanisms in order to cause pneumonia. The nonimmune mechanisms include aerodynamic filtering of inhaled

particles based on si(e, shape, and electrostatic charges8 the cough refleQ8 mucociliary clearance8 and several secreted substances !eg, lyso(ymes, complement, defensins$. Macrophages, neutrophils, lymphocytes, and eosinophils carry out the immune* mediated host defense. "onditions that allo3 pneumonia*causing infectious organisms to circumvent the upper air3ay defense mechanisms include the follo3ing &ntubation, tracheostomy, impaired cough refleQ, and aspiration These conditions provide infectious organisms 3ith easier access to the alveoli and terminal airspaces. "iliary dyskinesia, bronchial obstruction, viral infection, cigarette smoke, and certain chemical agents These conditions create disruption in the mucociliary blanket. Anatomic abnormalities !eg, se#uestrations$, gastric fluid aspiration or other causes of noninfectious inflammation, altered pulmonary blood flo3, and pulmonary edema These conditions increase the predisposition for pneumonia. &mmunodeficiency and immunosuppression These conditions increase predisposition for pneumonia. Pathophysiology &noculation of the respiratory tract by infectious organisms leads to an acute inflammatory response in the host that typically lasts 4*/ 3eeks. This inflammatory response differs according to the type of infectious agent. =iral infections structural integrity and surfactant production is diminished, a hyaline membrane forms, and pulmonary edema develops. )acterial infections The alveoli fill 3ith proteinaceous fluid, 3hich triggers a brisk influQ of 0)"s and polymorphonuclear cells !red hepati(ation$ follo3ed by the deposition of fibrin and the degradation of inflammatory cells !gray hepati(ation$. o During resolution, intra*alveolar debris is ingested and removed by the alveolar macrophages. This consolidation leads to decreased air entry and dullness to percussion. &nflammation in the small air3ays leads to crackles. Ehee(ing is less common than in viral infections. o The inflammation and pulmonary edema that result from these infections cause the lungs to become stiff and less distensible, thereby decreasing tidal volume. The patient must increase his or her respiratory rate to maintain ade#uate ventilation. o Poorly ventilated areas of the lung may remain 3ell perfused, resulting in ventilation'perfusion !='N$ mismatch and hypoQemia. Tachypnea and hypoQia are common. 2ungal infections
o o
The pathology may be a diffuse infiltrate of organisms or focal areas of fungal gro3th. Patients often appear ill and may have more subtle physical findings than their overall clinical appearance may suggest.
These infections are characteri(ed by the accumulation of mononuclear cells in the submucosa and perivascular space, resulting in partial obstruction of the air3ay. Patients 3ith these infections present 3ith 3hee(ing and crackles. Disease progresses 3hen the alveolar type && cells lose their
2ungal infections are unusual and are typically found in patients 3ith inade#uate immune function !eg, patients 3ith A&D,, patients 3ho have undergone chemotherapy, ne3born infants$.
Frequency United States Pneumonia accounts for 46C of all infectious illnesses in infants younger than / years. &n a large community* based study conducted by Denny and "lyde, the annual incidence rate of pneumonia 3as - cases per 455 children in the preschool*aged group, / cases per 455 children aged ?*> years, and 4 case per 455 children aged >*4? years.4 Mortality/Morbidity The 7nited +ations "hildrenPs 2und !7+&"B2$ estimates that 6 million children die 3orld3ide from pneumonia each year. Although most fatalities occur in developing countries, pneumonia remains a significant cause of morbidity in industriali(ed 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, hich affects diagnostic and therapeutic decisions. See !auses for specific details. Physical )ecause pneumonia is common and is associated 3ith significant morbidity and mortality, properly diagnosing pneumonia, correctly recogni(ing any complications or underlying conditions, and appropriately treating patients is important. The signs and symptoms of pneumonia are often nonspecific and 3idely vary based on the patientIs age and the infectious organisms involved. +e3borns o +e3borns 3ith pneumonia rarely cough8 they more commonly present 3ith tachypnea, retractions, grunting, and hypoQemia.
1runting in a ne3born is due to vocal cord approQimation as they try to provide increased positive end*eQpiratory pressure !PBBP$ and keep their lo3er air3ays open. 1runting suggests a lo3er respiratory tract disease. 0etractions result from the effort to increase intrathoracic pressure to compensate for decreased compliance. 9lder infants 1runting may be less common8 ho3ever, tachypnea, retractions, and hypoQemia are common and may be accompanied by a persistent cough, congestion, fever, irritability, and decreased feeding. Toddlers and preschoolers These children most often present 3ith fever, cough !productive or nonproductive$, tachypnea, and congestion. They may have some posttussive emesis. 9lder children and adolescents o This group may also present 3ith fever, cough !productive or nonproductive$, congestion, chest pain, dehydration, and lethargy. o BQtrapulmonary signs and symptoms include !4$ abdominal pain or an ileus accompanied by emesis in patients 3ith lo3er lobe pneumonia, !/$ nuchal rigidity in patients 3ith right upper lobe pneumonia, or !6$ a rub caused by pericardial effusion in patients 3ith lo3er lobe pneumonia due to Haemophilus influenzae infection. All children o Many children present 3ith nasal flaring, 3hich increases airflo3 to respiratory surfaces. o Auscultation of the lung fields may yield rales, 3hee(ing, 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 3ell as egophony, may be appreciated over the area of pneumonia. !auses =arious organisms cause pneumonia. )acterial, 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 3idely vary. %o3ever, certain age trends in the etiology of pneumonia can aid in decision*making, even before testing is complete. +e3borns !aged 5*65 d$ o &nfections 3ith group ) Streptococcus, Listeria monocytogenes, or gram*negative rods !eg, Escherichia coli, Klebsiella pneumoniae$ are a common cause of bacterial pneumonia. These pathogens can be ac#uired in utero, via aspiration of organisms present in the birth canal, or by postnatal contact 3ith other people or contaminated e#uipment. o ,ome organisms ac#uired perinatally may not cause illness until later in infancy, including Chlamydia pneumoniae, Ureaplasma urealyticum, Mycoplasma hominis, cytomegalovirus, and Pneumocystis carinii &nfants infected 3ith these organisms present bet3een age -*44 3eeks 3ith an afebrile pneumonia characteri(ed by a staccato cough, tachypnea, and, occasionally, hypoQia. "ommunity*ac#uired viral infections occur in ne3borns, although less commonly than in older infants. The most commonly isolated virus is respiratory syncytial virus !0,=$. The transfer of maternal antibodies is important in protecting ne3borns and young infants from such infections, making premature infants !3ho may not have benefited from sufficient transfer of transplacental immunoglobulin 1 R&g1S$ especially vulnerable to lo3er*tract disease. &n addition, premature infants may have chronic lung disease of prematurity, 3ith associated hyperreactive air3ays, fe3er functional alveoli, and baseline increased oQygen re#uirements. &nfants and toddlers o =iruses are the most common cause of pneumonia, accounting for approQimately >5C of all lo3er respiratory infections. o 0,= is the most common viral pathogen, follo3ed by parainfluen(a types 4, /, and 6 and influen(a A or ). 0,= infection occurs in the 3inter and early spring. Parainfluen(a type 6 infection occurs in the spring, and types 4 and / occur in the fall. &nfluen(a occurs in the 3inter. o 9ther viruses that cause pneumonia less fre#uently in infants include adenovirus, enterovirus, rhinovirus, coronavirus, herpesvirus, and cytomegalovirus. A recent addition to this list is human metapneumovirus, 3hich causes an illness similar to 0,= and may be
responsible for one third to one half of non*0,= bronchiolitis. o )acterial infections in this age group are uncommon and are attributable to Streptococcus pneumoniae, H influenzae type ) !less common in immuni(ed children$, or Staphylococcus aureus. &nfants or toddlers 3ith bacterial pneumonia may present 3ith lethargy, irritability, acidosis, hypotonia, or hypoQia that is out of proportion to ausculatory findings. o "hildren younger than ? years, children enrolled in daycare, or those 3ith fre#uent ear infections are at increased risk for invasive pneumococcal disease and infection 3ith resistant pneumococcal strains. They are often treated 3ith an antibiotic 3ithin a month of contracting pneumonia. o Bvidence suggests that breastfeeding has a protective effect against invasive pneumococcus. "hildren aged ? years !ready to start school$
Mycoplasma pneumoniae is the most common cause of community*ac#uired pneumonia and accounts for /5C of pneumonia cases in the general population, >*4DC of cases in early*school<aged children, 4D* /4C of cases in older children, and 65*?5C of cases in college students and military recruits. Mycoplasma infections are indolent, 3ith gradual onset of malaise, lo3*grade fever, headache, and cough. Chlamydia pneumoniae is also fairly common
in this age group and presents in a similar fashion. ,chool*aged children and adolescents )acterial pneumonia !45C$ is common, and these children are often febrile and appear ill. o Tuberculosis !T)$ pneumonia in children 3arrants special mention. o "hildren 3ith T) usually do not present 3ith symptoms until 4*D months after primary infection. o &nfants and postpubertal adolescents are at increased risk of disease progression. These children may present 3ith fever, night s3eats, chills, cough !3hich may include hemoptysis$, and 3eight loss. o "hest radiography findings may include hilar or mediastinal lymphadenopathy, atelectasis, or consolidation of a segment or lobe !usually right upper lobe$, pleural effusion, cavitary lesions !in adolescents and adults only$, or miliary disease. o A history of eQposure to possible sources should be obtained !eg, immigrants from Africa, certain parts of Asia, and Bastern Burope8 contacts 3ith persons in the penal system8 close contact 3ith kno3n individuals 3ith T)$. o &f T) is not treated during the early stages of infection, approQimately /?C of children younger than 4? years develop eQtrapulmonary disease. !ordetella pertussis also causes pneumonia, although predominantly in infants 3ho have not completed their vaccinations or in children 3ho did not receive vaccinations. )ronchopneumonia occurs in 5.F*/C of all pertussis cases and 4D*/5C of hospitali(ed cases. The survival rate 3ith this complication is much lo3er than in pneumonia attributed to other causes. A study conducted in the 7nited Kingdom sho3ed that ?>C of

deaths from pertussis are associated 3ith pneumonia. "linical presentation includes cory(a, malaise, fever, paroQysms of cough occasionally accompanied by emesis, apnea, poor feeding, and cyanosis. =iral pneumonias are common in this age group and are usually mild and self*limited. %o3ever, 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 conse#uence of subse#uent bacterial infection. 1roup A streptococcal, pneumococcal, and staphylococcal secondary infections are all relatively common. Aspiration pneumonia is more common in children 3ith neurological impairment and s3allo3ing abnormalities. 9ral anaerobic flora, 3ith or 3ithout aerobes, is the most common etiologic agent. &n immunosuppressed individuals, opportunistic infections 3ith organisms such as "spergillus species, Candida species, Pneumocystis species, and cytomegalovirus can occur. "ab Studies &dentifying the causative infectious agent is the most valuable step in managing a complicated case of pneumonia. 7nfortunately, an etiologic agent can be difficult to identify. Therefore, in most patients 3ith community*ac#uired pneumonia 3ho are treated on an outpatient basis, treatment is empiric and based primarily on patient age and clinical presentation. &n patients 3ith complicated pneumonia 3ho have not responded to treatment or 3ho re#uire admission to the hospital, several diagnostic studies aimed at identifying the infectious culprit are 3arranted, including cultures, serology, and a ")" count 3ith the differential and acute*phase reactants !erythrocyte sedimentation rate RB,0S, "*reactive protein R"0PS$. Direct antigen detection correct diagnosis allo3s for appropriate placement of patients in the hospital. 2or eQample, if necessary, / infants 3ith 0,= infection may share a room, 3hereas such patients 3ould normally need isolation and may unnecessarily tie up a bed. o =iral cultures can be obtained in 4* / days using ne3er cell culture techni#ues and may permit discontinuation of unnecessary antibiotics. ,putum culture ,putum is rarely produced in children younger than 45 years, and samples are al3ays contaminated by oral flora. An ade#uate sputum culture should contain more than /? polymorphonuclear !PM+$ cells per field and fe3er than 45 s#uamous cells per field. o The common agents that cause pneumonia may be normal oral flora. 2or these reasons, sputum cultures are not useful in most children 3ith pneumonia, although a 1ram stain may help. )ronchoscopy necessary to send the samples for the appropriate tests. o "ontamination of the bronchoscopic aspirate 3ith upper air3ay secretions is common8 #uantitative cultures can help distinguish contamination from infection. )lood 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 &n a study of 4DF patients 3ith kno3n pneumonia, Mc"racken and associates found only sterile blood cultures. &n general, blood culture results are positive in 45* 4?C of patients 3ith streptococcal pneumonia !Media file 4$. The numbers are even less in patients 3ith Staphylococcus infection. A blood culture is still recommended in complicated cases of pneumonia. :ung aspirate aspirate. The organisms obtained in the blood and lung aspirate differed in - of the F children in 3hom both culture results 3ere positive, suggesting that a blood culture may not al3ays accurately reveal the lung pathogen. o 9ther studies have demonstrated lung aspirate results to be positive in ?5*D5C of patients 3ith kno3n pneumonia. &n these studies, 4.?* >C of patients had a pneumothoraQ and 5.A*6C had transient small hemoptysis complicating their lung aspirations. )ecause of the possible risks associated 3ith lung aspiration, it should be reserved for patients 3ho are ill enough to re#uire hospitali(ation, have not improved 3ith previous empiric treatment, or are immunocompromised and an eQact etiology is needed. o A lung aspirate should not be performed in patients 3ho are on ventilators, patients 3ith a bleeding diathesis, or in patients suspected of having an infection 3ith Pneumocystis. Thoracentesis
Although antiviral therapies are not often used, performing a nasal 3ash for 0,= and influen(a en(yme*linked immunoassay !B:&,A$ and viral culture can help to establish a rapid diagnosis, 3hich may be helpful in eQcluding other diagnoses. &n addition,
2leQible fiberoptic bronchoscopy is occasionally useful to obtain lo3er air3ay secretions for culture or cytology. This procedure is most useful in immunocompromised patients 3ho are believed to be infected 3ith unusual organisms !Pneumocystis, other fungi$ or in patients 3ho are severely ill. "areful 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 !4$ positive culture results obtained 3ith blood culture 3ith !/$ positive culture results obtained 3ith lung aspiration in 455 children aged 6*?F months 3ith pneumonia merits mention./ )lood culture implicated an organism in 4FC of the patients compared 3ith ?/C 3ith lung
This test is performed for diagnostic and therapeutic purposes in children 3ith pleural effusions. &f the 1ram stain or the culture result from the pleural fluid is positive or the E)" is higher than 4555 cells'm:, by definition, the patient has an empyema, 3hich may re#uire drainage for complete resolution. 9ther therapeutic decisions can be made based on the properties of the effusion !see "omplications$.
,erology
)ecause of the relatively lo3 yield of cultures, more efforts are under3ay to develop #uick and accurate serologic tests for common lung pathogens, such as M pneumoniae. &n a 2innish study, /AF patients diagnosed 3ith community* ac#uired pneumonia under3ent eQtensive testing for Mycoplasma infection.6 Acute and convalescent serum samples 3ere collected and tested using en(yme immunoassay for M pneumoniae immunoglobulin M !&gM$ and &g1 antibodies. +asopharyngeal aspirates 3ere tested using P"0 and cultured 3ith a Pneumofast kit. Positive results 3ere confirmed 3ith ,outhern hybridi(ation of P"0 products and an &gM test 3ith solid*phase antigen. A total of /!>C$ confirmed diagnoses of Mycoplasma infection 3ere made. All /- cases had positive results 3ith &gM*capture test 3ith convalescent*phase serum. 7sing an &gM*capture test in acute*phase serum, A>C of results 3ere positive, A>C 3ere positive using &g1 serology, ?5C positive using P"0, and -AC positive using culture. The authors of this study concluded that &gM serologic studies for Mycoplasma infection 3ere not only #uick but also sensitive and 3ere the most valuable tools for diagnosis of M pneumoniae infection in any age group. &gM serology is much more sensitive than cold agglutinin
assessments, 3hich are more commonly used to aid in the diagnosis of Mycoplasma infection and demonstrate positive results in only ?5C of cases. Polymerase chain reaction
o o
This test sho3s promise of being useful in diagnosing streptococcal pneumonia. P"0 is noninvasive, an advantage over lung aspirate or bronchoalveolar lavage !)A:$ cultures. ,imilarly, C pneumoniae infection is diagnosed more readily 3ith P"0 than 3ith culture8 ho3ever, positive test results must correlate 3ith acute symptoms to have any validity because /*?C of the population may be asymptomatically infected 3ith C pneumoniae. Although ne3 serologic and P"0 tests for common lung pathogens hold definite promise for making rapid, accurate, and noninvasive diagnosis, they are not 3idely 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 0,= and influen(a, as 3ell as a P"0 test for T), are 3idely available and have proven to be of considerable benefit in the treatment of hospitali(ed patients.
,kin tests
These tests are used in diagnosing T). MantouQ skin test !intradermal inoculation of ? T7 of purified protein derivative$ results should
be read -F*A/ hours after placement. &n children older than - years 3ithout any risk factors, test results are positive if the induration !not the area of erythema, 3hich may be larger$ is 4? mm or larger. Among children younger than - years, those 3ho have an increased environmental eQposure to T) or other medical risk factors !eg, lymphoma, diabetes mellitus, malnutrition, renal failure$, results are positive if the induration is 45 mm or larger. &n immunosuppressed children or those in close contact 3ith others 3ho have kno3n or suspected cases of T), test results are positive if the induration is ? mm or larger. Bven if the child has received the )acillus "almette*1uZrin !)"1$ vaccine, MantouQ test results should be interpreted using the criteria outlined above. "hest radiography helps to confirm the diagnosis of a child 3ith positive MantouQ test results. &f the chest radiography findings are positive or if the child has other symptoms consistent 3ith the diagnosis of T), an attempt should be made to isolate the tubercle bacilli from early*morning gastric aspirates, cerebrospinal fluid, sputum, urine, pleural fluid, or biopsy specimen. &n a child 3ith suspected pulmonary T), the cough may be scarce or nonproductive. Therefore, the best test for diagnosis is an early*morning gastric aspirate sent for acid*fast bacilli !A2)$ stain, culture, and, if
available, P"0. 1astric aspirates should be obtained by first placing a nasogastric !+1$ tube the night before sample collection8 a sample is aspirated first thing the follo3ing morning, before ambulation and feeding. This should be repeated on 6 consecutive mornings. ")" count Testing should include a ")" count 3ith differential and evaluation of acute*phase reactants !B,0, "0P, or both$ and sedimentation rate. The total E)" and differential may aid in determining if an infection is bacterial or viral, and, together 3ith clinical symptoms, chest radiography and B,0 can be useful in monitoring the course of pneumonia. Arterial blood gas This test is indicated in any patient 3ith significant respiratory distress to determine the degree of respiratory insufficiency.
#maging Studies 0adiography o This is the primary imaging study used to confirm the diagnosis of pneumonia. Physicians often obtain radiographs 3hen diagnosing pneumonia8 ho3ever, they are not al3ays necessary or useful in determining the etiology of the infection. o "hest radiography is indicated in an infant or toddler 3ho presents 3ith fever and any of the follo3ing tachypnea, nasal flaring, retractions, grunting, rales, decreased breath sounds, or respiratory distress. &n older children and adolescents, the diagnosis of pneumonia is often based on clinical presentation. o "hest radiography is indicated primarily in complicated cases in

3hich treatment fails to elicit a response, in patients respiratory distress, or in those 3ho re#uire hospitali(ation. 9btain both frontal and lateral radiographs, particularly in cases in 3hich the clinical eQamination findings are e#uivocal. &n complicated cases of pneumonia, obtain a chest radiograph D 3eeks after treatment to verify resolution of the pneumonia and to screen for any underlying predisposing conditions, such as se#uestration. Although trends in radiographic findings may prove useful, chest radiography findings fre#uently do not correlate 3ith the infectious agent involved. "hest radiography findings may be negative in the presence of pneumonia, particularly early in the course. A lobar infiltrate can be seen 3ith viral infections, foreign body aspirations, and mucous plugging that results in atelectasis. 2urthermore, pleural effusions, although usually parapneumonic !F5C$, may be observed in numerous disease processes. ,everal studies have demonstrated that chest radiography is -/*A6C accurate in predicting the etiology of a case of pneumonia. &n one study of 4DF children 3ith pneumonia, / radiologists 3ho independently evaluated all chest radiographs 3ere unable to distinguish 3hether the agent involved 3as bacterial, viral, or unidentified. 1iven the fre#uency of nonspecific findings obtained 3ith imaging, clinical presentation and other laboratory findings must be considered in the diagnosis of pneumonia and the determination of the etiologic agent. o &n general, viral pneumonias are associated 3ith a patchy perihilar infiltrate, hyperinflation, and atelectasis on chest radiography. o &n patients 3ith bacterial pneumonia, typical findings include a lobar consolidation 3ith air bronchograms occasionally accompanied by a pleural effusion !&mages /*6$. 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. Barly in the infection, the pattern tends to be reticular and interstitial8 as the infection progresses, patchy and segmental areas of consolidation are noted, along 3ith hilar adenopathy and pleural effusions. o BQcept for patients 3ith sickle cell disease !,"D$, a significant pleural effusion usually indicates a bacterial etiology. Although these patterns are typical, the etiology cannot be reliably identified based solely on chest radiography findings. 7ltrasonography o These studies are indicated primarily in children 3ith complications such as pleural effusions and in those in 3hom antibiotic treatment fails to elicit a response. o 7ltrasonography is used to effectively differentiate bet3een a lo3*grade !nonfibrinopurulent$ effusion and one that is high*grade !fibrinopurulent and organi(ing$. &n a study of children 3hose effusions 3ere characteri(ed as high grade based on ultrasonography findings, hospital stay 3as reduced by nearly ?5C after surgery. o 7ltrasonography may also prove useful for guidance in thoracentesis of a loculated effusion. &n addition to a pleural effusion or empyema, other suppurative complications of pneumonia include cavitary necrosis or abscess and purulent pericarditis. A significant number of these complications are not evident using radiography. "ontrast "T scanning o This test is also indicated in children 3ith complications such as pleural effusions and in those in 3hom antibiotic treatment fails to elicit a response. o "ontrast "T scanning is often more sensitive and demonstrates changes typical for these complications. This information is beneficial 3hen making treatment decisions !eg, 3hether to perform surgical debridement of organi(ed empyemas or loculated effusions$ and in outlining the projected course of the patientPs illness. Procedures )ronchoscopy 3ith )A: :ung biopsy !guided 3ith "T scanning or ultrasonography, as part of a video*assisted thorascopic surgery R=AT,S procedure, or during bronchoscopy$ to assist in the diagnosis of infection 3ith rare or unusual organisms $istologic Findings +o specific histologic findings are reported in most patients 3ith pneumonias beyond evidence of inflammation and cellular infiltration and eQudation into alveolar spaces and the interstitium. ,putum, lavage, or biopsy material may yield diagnostic findings. o &n patients 3ith T), acid*fast bacilli are present and can be detected using the .iehl* +eelsen stain or can be gro3n on the :o3enstein*Gensen medium. "aseating granulomas are highly suspicious, even in the absence of detectable organisms. o 2indings of foamy alveolar casts are practically diagnostic for Pneumocystis #iro$eci pneumonia, and the cup*shaped organisms are often found using 1omori methenamine silver staining or direct immunofluorescence. o 2ungal elements may be seen using 1omori methenamine silver staining or periodic acid* ,chiff staining. "spergillus and %ygomycetes species may be seen using simple hematoQylin and eosin staining. The specific morphology of the organisms may be diagnostic, but, occasionally, culture or immunostaining is re#uired. Medical !are Treatment decisions in children 3ith 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 eQposure, the possibility of resistance !3hich may vary, depending on local resistance patterns$, and other pertinent history. "hest percussion is usually unnecessary in children 3ith pneumonia. ,tudies in adults have not sho3n benefit8 ho3ever, no definitive studies have been performed in children. Although most children do not eQpectorate sputum, they are able to clear it from their lungs and to s3allo3 it. &n young infants 3ith bronchiolitis, chest percussion can be helpful in moving mucus and improving air entry !postpercussion auscultation often results in increased

3hee(es and crackles because of the better air entry$ and oQygenation. %o3ever, the fe3 studies that have involved children have not sho3n shortened hospital stays. )ronchodilators should not be routinely used. )acterial lo3er respiratory tract infections rarely trigger asthma attacks, and the 3hee(ing that is sometimes heard in patients 3ith pneumonia is usually caused by air3ay inflammation, mucus plugging, or both and is not bronchodilator responsive. %o3ever, infants or children 3ith reactive air3ay disease or asthma may react to a viral infection 3ith bronchospasm, 3hich 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. BQtra humidification of inspired air !eg, room humidifiers$ is also not useful, although supplemental oQygen is fre#uently humidified for patient comfort. ,chool*aged children o Many of these children do not re#uire hospitali(ation and respond 3ell to oral antibiotics. Macrolide antibiotics are useful in this age group because they cover the most common bacteriologic and atypical agents. %o3ever, increasing levels of resistance to macrolides among streptococcal isolates should be considered !depending on local resistance rates$. re#uires drainage usually dictates a hospital admission. "hildren younger than ? years These children are hospitali(ed more often, but their clinical status, degree of hydration, degree of hypoQia, and need for intravenous therapy dictate this decision. Surgical !are Drainage of parapneumonic effusions 3ith or 3ithout intrapleural instillation of a fibrinolytic agent !eg, tissue plasminogen activator RTPAS$ may be indicated. "hest tube placement for drainage of an effusion or empyema may be performed. =AT, procedure may be performed for decortication of organi(ed empyema or loculated effusions. Diet +o specific dietary considerations are recommended. %o3ever, anoreQia is commonly associated 3ith inflammatory conditions. Acti%ity Activity stimulates mucus mobili(ation, cough, and a resolution of the disease process. 1entle activity should be encouraged. Bven very young infants can benefit from repositioning to help shift mucus. "hildren usually do not participate in vigorous activity if they are ill and, in general, can be trusted to limit their o3n activity 3hen necessary. Further &utpatient !are &f therapy fails to elicit a response, the 3hole treatment approach must be reconsidered. After initiating therapy, the most important tasks are resolving the symptoms and clearing the infiltrate. Eith successful therapy, symptoms resolve much sooner that the infiltrate. &n a study of adults 3ith pneumococcal pneumonia, the infiltrate did not completely resolve in all patients until F 3eeks after therapy !although it 3as sooner in most patients$. &n a patient 3ho is clinically doing 3ell, follo3*up radiography should be performed after F 3eeks. Although some pneumonias are destructive !eg, adenovirus$ and can cause permanent changes, most childhood pneumonias have complete radiologic clearing. &f a significant abnormality persists, consideration of an anatomic abnormality is appropriate. ,evere respiratory compromise may re#uire intubation and transfer to a suitable &"7 for more intensive monitoring and therapy. younger than / months, 3ho have not received their first shot. "onjugated and unconjugated polysaccharide vaccines for S pneumoniae have been developed for infants and children, respectively. The pneumococcal A*valent conjugate vaccine !diphtheria "0M4>A protein8 Prevnar$ contains epitopes to A different strains. Pneumococcal vaccine polyvalent !PneumovaQ$ covers /6 different strains. &nfluen(a vaccine is recommended for children aged D months and older. o The vaccine eQists in / forms inactivated vaccine !various products$, administered as an intramuscular injection, and a cold*adapted attenuated vaccine !2luMist Rmade by Med&mmuneS$, administered as a nasal spray, 3hich is currently licensed only for persons aged /*-> years. o Although the vaccine is especially recommended for children at high risk, such as those 3ith bronchopulmonary dysplasia !)PD$, cystic fibrosis, or asthma, the use of 2luMist is cautioned in persons 3ith kno3n asthma because of reports of transient increases in 3hee(ing episodes in the 3eeks after administration. %o3ever, in years 3hen vaccine strains have been mismatched 3ith the circulating influen(a strains, 2luMist has provided good protection !approQimately A5C$, even 3hen the inactivated vaccine 3as entirely useless. o "linical trials are ongoing to lo3er the age of administration of 2lu(one !made by Aventis Pasteur$, one of the inactivated intramuscular vaccines, to / months !currently approved for
'ransfer
7sually, these patients are not toQic or hypoQic enough to re#uire supplemental oQygen. 7nless they are vomiting, they do not re#uire intravenous fluids or antibiotics. A parapneumonic effusion that
&ndications for transfer include refractory hypoQia, decompensated respiratory distress !eg, lessening tachypnea due to fatigue, hypercapnia$, and systemic complications such as sepsis. o Transfer may need to be initiated at a lo3er threshold for infants or young children, as decompensation may be rapid. o Transfer of very sick infants or young children to a pediatric &"7 is best done 3ith a specialist pediatric transfer team, even if that entails a slightly longer 3ait, compared 3ith conventional medical transport or even air transport. Deterrence/Pre%ention Aside from avoiding infectious contacts !difficult for many families 3ho use daycare facilities$, vaccination is the primary mode of prevention. ,ince the introduction of the conjugated H &nfluenzae type ) !%&)$ vaccine, the rates of %&) pneumonia have significantly declined. %o3ever, it should still be considered in unvaccinated persons, including those

children D months or older$ to help protect this high*risk, but unvaccinated, population. The safety and efficacy of this approach remains unkno3n. 0,= prophylaQis consists of monthly intramuscular injections of a monoclonal humani(ed antibody, palivi(umab !,ynagis Rmade by Med&mmuneS$ at a dose of 4? mg'kg !maQimum volume 4 m: per injection8 multiple injections may be re#uired per dose$. Monthly injections during the 0,= season approQimately halve the rate of serious 0,= disease that leads to hospitali(ation. o This eQpensive therapy is generally restricted to infants at high*risk, such as children younger than / years 3ith chronic lung disease of prematurity, premature infants younger than D months !or 3ith other risk factors$, and children 3ith significant congenital heart disease. o A ne3 monoclonal antibody !motavi(umab R+umaQ8 also made by Med&mmuneS$ is in phase &&& clinical trials for similar indications and, if approved, 3ill likely replace ,ynagis. &n an 3orld3ide comparison bet3een +umaQ and ,ynagis during the /55-*/55D 0,= seasons, +umaQ sho3ed a /DC improvement in preventing hospitali(ations due to 0,= and a ?/C reduction in outpatient medically attended lo3er*tract 0,= infections compared 3ith ,ynagis. +umaQ remains an investigational drug at this time 3ith no plans for licensure for the /55A*/55F 0,= season. o ,ynagis has no role in the treatment of 0,= infection. 9ne study of intubated patients sho3ed a reduction in viral titers but no change in clinical status, perhaps reflective of a large inflammatory component to the disease process. &n addition, ,ynagis has not been sho3n to reduce upper*respiratory infections 3ith 0,=. &t reduces only the serious complications of infection. Preliminary results from animal and small*scale human studies suggest that +umaQ may be effective in reducing 0,= viral load in the upper and lo3er air3ays. "linical studies to evaluate the safety and efficacy of +umaQ in the setting of treating 0,= infection in hospitali(ed children are ongoing. !omplications Pleural effusions and empyemas Ehen a child 3ith pneumonia develops a pleural effusion, thoracentesis should be performed for diagnostic and therapeutic purposes. The pleural fluid should be obtained to assess p% and glucose levels and a 1ram stain and culture, ")" count 3ith differential, and protein assessment should be performed. Amylase and lactase dehydrogenase !:D%$ 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 eQudate and help to determine the best course of management for the effusion. PneumothoraQ ,evere coughing, especially in the conteQt of necroti(ing pneumonias or bullae formation, may lead to spontaneous pneumothoraces. These may or may not re#uire treatment depending on the si(e of the pneumothoraQ and 3hether it is under tension and compromising ventilation and cardiac output. Prognosis 9verall, the prognosis is good. :ong*term alteration of pulmonary function is rare, even in children 3ith pneumonia that has been complicated by empyema or lung abscess. ,ignificant se#uelae occur 3ith adenoviral disease, including bronchiolitis obliterans. Death occurs almost eQclusively in children 3ith underlying conditions, such as chronic lung disease of prematurity, congenital heart disease, and immunosuppression. Patient (ducation 2or eQcellent patient education resources, visit eMedicinePs Pneumonia "enter. Also, see eMedicinePs patient education articles =iral Pneumonia and )acterial Pneumonia. o99o
)atuk bukanlah suatu penyakit. )atuk 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. )atuk terjadi karena rangsangan tertentu, misalnya debu di reseptor batuk !hidung, saluran pernafasan, bahkan telinga$. Kemudian reseptor akan mengalirkan le3at syaraf ke pusat batuk yang berada di otak. Di sini akan memberi sinyal kepada otot*otot tubuh untuk mengeluarkan benda asing tadi, hingga terjadilah batuk. RsuntingS Akut dan Kronis )atuk dapat dibedakan menjadi dua jenis yaitu batuk akut dan batuk kronis, keduanya dikelompokkan berdasarkan 3aktu. )atuk akut adalah batuk yang berlangsung kurang dari 4- hari, serta dalam 4 episode. )ila batuk sudah lebih dari 4- hari atau terjadi dalam 6 episode selama 6 bulan berturut*turut, disebut batuk kronis atau batuk kronis berulang. )atuk kronis berulang yang sering menyerang anak* anak adalah karena asma, tuberkolosis !T)$, dan pertusis !batuk rejan'batuk 455 hari$. Pertusis adalah batuk kronis yang disebabkan oleh kuman )ordetella pertussis. Pertussis dapat dicegah dengan imunisasi DPT. RsuntingS Penyebab batuk Ada beberapa macam penyebab batuk 7mumnya disebabkan oleh infeksi di saluran pernafasan bagian atas yang merupakan gejala flu. &nfeksi saluran pernafasan bagian atas !&,PA$. Alergi Asma atau tuberculosis )enda asing yang masuk kedalam saluran napas Tersedak akibat minum susu Menghirup asap rokok dari orang sekitar )atuk Psikogenik. )atuk ini banyak diakibatkan karena masalah emosi dan psikologis.
A thin layer of fluid !approQimately 45 m:$ is usually found bet3een the visceral and parietal pleura and helps prevent friction. This pleural fluid is produced at 455 m:'h. +inety percent of the fluid is reabsorbed on the visceral surface, and 45C is reabsorbed by the lymphatics. Pleural fluid accumulates 3hen the balance bet3een production and reabsorption is disrupted. A transudate accumulates in the pleural cavity 3hen changes in the hydrostatic or oncotic pressures are not accompanied by changes in the membranes. &ncreased membrane permeability and hydrostatic pressure often result from inflammation and result in a subse#uent loss of protein from the capillaries and an accumulation of eQudates in the pleural cavity.

o99o %ampir setiap orang pernah mengalami batuk. )atuk memiliki ciri khas, sehingga dapat dikenali. ,atu hal yang perlu diingat adalah bah3a batuk hanyalah merupakan gejala, bukan suatu penyakit. )atuk baru dapat ditentukan sebagai tanda suatu penyakit jika ada gejala lain yang muncul. )erdasarkan produktivitasnya, dikenal ada / jenis batuk, yakni batuk produktif !biasa disebut batuk berdahak$ dan batuk tidak produktif !lebih dikenal sebagai batuk kering$. ,edangkan berdasarkan 3aktu berlangsungnya, batuk ada / jenis, batuk akut dan batuk kronis. Dengan mengenali jenis batuk anda, dapat membantu anda mengambil langkah yang tepat untuk mengatasi keluhan anda. )atuk Produktif )atuk produktif menghasilkan dahak atau lendir !sputum$ sehingga lebih dikenal dengan sebutan batuk berdahak. )atuk produktif memiliki ciri khas yaitu dada terasa penuh atau berbunyi. Mereka yang mengalami batuk produktif umumnya kesulitan bernapas dan disertai pengeluaran dahak. 1ejala biasanya bertambah berat ketika terjaga dan berbicara. )atuk produktif sebaiknya tidak ditekan karena batuk ini membantu membersihkan lendir di paru*paru. Ada beberapa penyebab batuk produktif, yaitu =irus. )atuk produktif yang menyertai flu merupakan hal yang normal. Terjadinya batuk sering dipicu oleh lendir yang mengalir sepanjang tenggorokan. &nfeksi. &nfeksi paru*paru atau saluran pernapasan bagian atas dapat menyebabkan batuk. )atuk produktif dapat merupakan gejala dari pneumonia, bronkitis, sinusitis, atau tuberkulosis. Penyakit paru*paru kronis. )atuk produktif dapat merupakan tanda penyakit seperti Penyakit Paru 9bstruktif Kronik !PP9K$ yang bertambah buruk atau sebagai tanda bah3a anda telah terinfeksi. Asam lambung yang kembali ke kerongkongan. Genis batuk ini mungkin merupakan gejala gastroesophageal refluQ dan mungkin dapat membangunkan anda saat tertidur. :endir yang mengalir ke bagian belakang tenggorokan !postnasal drip syndrome$. %al ini dapat menyebabkan batuk produktif atau perasaan bah3a anda harus batuk terus*menerus untuk membersihkan tenggorokan anda. Perokok atau pengguna tembakau. )atuk produktif pada orang yang merokok atau menggunakan tembakau sering merupakan tanda kerusakan paru*paru atau iritasi tenggorokan atau kerongkongan. )atuk Tidak Produktif )atuk tidak produktif merupakan batuk yang tidak menghasilkan sputum sehingga disebut juga batuk kering. )atuk tidak produktif sering membuat tenggorokan terasa gatal sehingga menyebabkan suara menjadi serak atau hilang. )atuk ini sering dipicu oleh inhalasi partikel makanan, bahan iritan, asap rokok, baik oleh perokok aktif maupun pasif, dan perubahan temperatur. )atuk semacam ini dapat merupakan gejala sisa dari infeksi virus atau flu. Ada beberapa penyebab batuk tidak produktif, yaitu =irus. ,etelah terserang flu, batuk kering mungkin bertahan selama beberapa minggu lebih panjang daripada gejala lain dan sering menjadi lebih buruk pada malam hari. )ronkospasme. )atuk tidak produktif, terutama malam hari, mungkin menunjukkan kejang !spasme$ di bronkial yang disebabkan oleh iritasi. Alergi. ,ering bersin juga gejala umum dari alergi radang selaput lendir hidung !allergic rhinitis$. 9bat pengontrol tekanan darah tinggi golongan penghambat A"B !Angiotensin "onverting Bn(yme$. Penghambat A"B termasuk captopril, enalapril maleate, dan lisinopril. Kontak dengan debu, asap, dan bahan kimia di lingkungan kerja. Asma. Gika batuk berlangsung lebih dari 6 minggu atau terjadi dalam 6 episode selama 6 bulan berturut*turut, disebut batuk kronis atau batuk kronis berulang. )atuk jenis ini biasanya disebabkan oleh bronkitis, postnasal drip syndrome, asma, gastroesophageal refluQ, tuberkulosis, dan pertusis !batuk rejan'batuk 455 hari$. o99o Demam Dari Eikipedia &ndonesia, ensiklopedia bebas berbahasa &ndonesia. Demam adalah suatu keadaan di mana suhu badan melebihi 6A5" yang disebabkan oleh penyakit atau radang. Anak yang memiliki suhu tinggi karena suhu tinggi berkepanjangan dapat menyebabkan sa3an. Demam yang melebihi 6 hari mungkin merupakan malaria atau penyakit yang disebabkan oleh nyamuk lainnya. Most parents have eQperienced this scenario Mou 3ake up in the middle of the night to find your child standing by your bed, flushed, hot, and s3eaty. Mour little onePs forehead feels 3arm. Mou immediately suspect a fever, but are unsure of 3hat to do neQt. ,hould you get out the thermometerX "all the doctorX &n healthy kids, fevers usually donPt indicate anything serious. Although it can be frightening 3hen your childPs temperature rises, fever itself causes no harm and can actually be a good thing T itPs often the bodyPs 3ay of fighting off infections. And not all fevers need to be treated. %igh fever, ho3ever, can make a child )atuk kering yang kronis mungkin menjadi tanda asma ringan. 1ejala lain mungkin termasuk mengi !napas berbunyi$, sesak napas, atau rasa sakit di dada. %ambatan saluran udara karena benda yang dihirup, seperti makanan atau pil. )atuk Akut atau KronisX )atuk akut merupakan batuk yang berlangsung kurang dari 6 minggu serta terjadi dalam 4 episode. )atuk jenis ini biasanya disebabkan oleh flu dan alergi. "ommon cold, bentuk batuk yang sering ditemui merupakan jenis batuk akut ringan yang disertai demam ringan dan pilek. uncomfortable and aggravate problems such as dehydration. )ut itPs easy to learn ho3 to correctly take a childPs temperature 3hen itPs a little higher than usual. 0ead on for more about fevers, ho3 to measure and treat them, and 3hen to call your childPs doctor. Ehat &s 2everX 2ever occurs 3hen the bodyPs internal KthermostatK raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. The hypothalamus kno3s 3hat temperature your body should be !usually around >F.D@ 2ahrenheit, or about 6A@ "elsius$ and 3ill send messages to your body to keep it that 3ay. Most peoplePs body temperatures even change a little bit during the course of the day &tPs usually a little lo3er in the morning and a little higher in the evening and can fluctuate as kids run around, play, and eQercise. ,ometimes, though, the hypothalamus 3ill KresetK the body to a higher temperature in response to an infection, illness, or some other cause. ,o, 3hy does the hypothalamus tell the body to change to a ne3 temperatureX 0esearchers believe turning up the heat is the bodyPs 3ay of fighting the germs that cause infections and making the body a less comfortable place for them. Ehat "auses 2everX &tPs important to remember that fever by itself is not an illness T itPs usually a symptom of an underlying problem. 2ever has several potential causes &nfection Most fevers are caused by infection or other illness. 2ever helps the body fight infections by stimulating natural defense mechanisms. 9verdressing &nfants, especially ne3borns, may get fevers if theyPre overbundled or in a hot environment because they donPt regulate their body temperature as 3ell as older children. %o3ever, because fevers in ne3borns can indicate a serious infection, even infants

3ho are overdressed must be evaluated by a doctor if they have a fever. &mmuni(ations )abies and children sometimes get a lo3*grade fever after getting vaccinated. Although teething may cause a slight rise in body temperature, itPs probably not the cause if a childPs temperature is higher than 455@ 2ahrenheit !6A.F@ "elsius$. Ehen "an a 2ever )e a ,ign of ,omething ,eriousX &n the past, doctors advised treating a fever on the basis of temperature alone. )ut no3 they recommend considering both the temperature and the childPs overall condition. Kids 3hose temperatures are lo3er than 45/@ 2ahrenheit !6F.>@ "elsius$ often donPt re#uire medication unless theyPre uncomfortable. TherePs one important eQception to this rule &f you have an infant 6 months or younger 3ith a rectal temperature of 455.-@ 2ahrenheit !6F@ "elsius$ or higher, call your doctor or go to the emergency department immediately. Bven a slight fever can be a sign of a potentially serious infection in very young infants. &f your child is bet3een 6 months and 6 years old and has a fever of 45/./@ 2ahrenheit !6>@ "elsius$ or higher, call the doctor to see if he or she needs to see your child. 2or older kids, take behavior and activity level into account. Eatching ho3 your child behaves 3ill give you a pretty good idea 3hether 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 3ell is alert and smiling at you has a normal skin color looks 3ell 3hen his or her temperature comes do3n And donPt 3orry too much about a child 3ith a fever 3ho doesnPt 3ant to eat. This is very common 3ith infections that cause fever. 2or kids 3ho still drink and urinate normally, not eating as much as usual is 9K. %o3 Do & Kno3 if My "hild %as a 2everX A gentle kiss on the forehead or a hand placed lightly on your childPs skin is often enough to give you a hint that your child has a fever. %o3ever, this method of taking a temperature !called tactile temperature$ is dependent on the person doing the feeling and doesnPt give an accurate measure of temperature. 7se a reliable thermometer to tell if your child has a fever 3hen his or her temperature is at or above one of these levels 455.-@ 2ahrenheit !6F@ "elsius$ measured rectally !in the bottom$ >>.?@ 2ahrenheit !6A.?@ "elsius$ measured orally !in the mouth$ >>@ 2ahrenheit !6A./@ "elsius$ measured in an aQillary position !under the arm$ )ut ho3 high a fever is doesnPt tell you much about ho3 sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever !in the 45/@<45-@ 2ahrenheit ' 6F.>@<-5@ "elsius range$, but this doesnPt usually indicate a serious problem. And serious infections may cause no fever or even an abnormally lo3 body temperature, especially in infants. )ecause fevers may rise and fall, a child 3ith fever might eQperience chills as the body tries to generate additional heat as its temperature begins to rise. The child may s3eat as the body releases eQtra heat 3hen the temperature starts to drop. ,ometimes kids 3ith a fever breathe faster than usual and may have a higher heart rate. Mou should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes do3n. Different Types of Thermometers Ehichever type of thermometer you choose, be sure you kno3 ho3 to use it correctly to get an accurate reading. Keep and follo3 the manufacturerPs recommendations for any thermometer. Digital thermometers usually provide the #uickest, most accurate readings. They come in many si(es and shapes, are available at most supermarkets and pharmacies, and are available in a range of prices. Although you should read the manufacturerPs instructions to determine 3hat method or methods the thermometer is designed for, many digital thermometers can be used for the follo3ing temperature*taking methods oral !in the mouth$ rectal !in the bottom$ aQillary !under the arm$ Digital thermometers usually have a plastic, fleQible probe 3ith a temperature sensor at the tip and an easy* to*read digital display on the opposite end. Blectronic ear thermometers measure the tympanic temperature T the temperature inside the ear canal. Although theyPre #uick and easy to use in older babies and children, electronic ear thermometers arenPt as accurate for infants 6 months or younger as digital thermometers and are more eQpensive. Plastic strip thermometers !small plastic strips that you press against your childPs forehead$ may be able to tell you 3hether your child has a fever, but they arenPt reliable for taking an eQact measurement, especially in infants and very young children. &f you need to kno3 your childPs eQact temperature, plastic strip thermometers are not the 3ay to go. 2orehead 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 shouldnPt be used in infants younger than 6 months. They also re#uire the child to keep the pacifier in the mouth for several minutes 3ithout moving, 3hich is a nearly impossible task for most babies and toddlers. 1lass mercury thermometers 3ere once common, but the American Academy of Pediatrics !AAP$ no3 says they should not be used because of concerns about possible eQposure to mercury, 3hich is an environmental toQin. !&f you still have a mercury thermometer, do not simply thro3 it in the trash 3here the mercury can leak out. Talk to your doctor or your local health department about ho3 and 3here to dispose of a mercury thermometer.$ As any parent kno3s, taking a s#uirming childPs temperature can be challenging. )ut itPs 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 childPs temperature 3ill depend on his or her age and ho3 cooperative your child is. &f your child is younger than 6 months, youPll get the most reliable reading by using a digital thermometer to take a rectal temperature. Blectronic ear thermometers arenPt recommended for infants younger than 6 months because their ear canals are usually too small. &f your child is bet3een 6 months to - 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. Mou could also use a digital thermometer to take an aQillary temperature, although this is a less accurate method. &f your child is - years or older, you can usually use a digital thermometer to take an oral temperature if your child 3ill cooperate. %o3ever, kids 3ho have fre#uent 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. &n these cases, you can use the tympanic method !3ith an electronic ear thermometer$ or aQillary method !3ith a digital thermometer$. %o3 to 7se a Digital Thermometer A digital thermometer offers the #uickest, most accurate 3ay to take a childPs temperature and can be used in the mouth, armpit, or rectum. )efore you use one, read the directions thoroughly. Mou need to kno3 ho3 the thermometer signals that the reading is complete !usually, itPs a beep or a series of beeps or the

temperature flashes in the digital 3indo3 on the front of the thermometer$. 2irst, turn on the thermometer and make sure the screen is clear of any old readings. &f your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturerPs instructions. 0emember to discard the sleeve after each use and to clean the thermometer according to the manufacturerPs instructions before putting it back in its case. To take a rectal temperature )efore becoming parents, most people cringe at the thought of taking a rectal temperature. )ut donPt 3orry T itPs a simple process :ubricate the tip of the thermometer 3ith a lubricant, such as petroleum jelly. Place your child * belly*do3n across your lap or on a firm, flat surface and keep your palm along the lo3er back * or face*up 3ith legs bent to3ard the chest 3ith your hand against the back of the thighs Eith your other hand, insert the lubricated thermometer into the anal opening about [ inch to 4 inch !about 4./? to /.? centimeters$. ,top if you feel any resistance. ,teady the thermometer bet3een your second and third fingers as you cup your hand against your babyPs bottom. ,oothe your child and speak #uietly as you hold the thermometer in place. Eait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Erite do3n 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. Eait /5 to 65 minutes after your child finishes eating or drinking to take an oral temperature, and make sure therePs no gum or candy in your childPs mouth. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. 0emind your child not to bite do3n or talk, and to relaQ and breathe normally through the nose. Eait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Erite do3n the number on the screen, noting the time of day that you took the reading. To take an aQillary temperature This is a convenient 3ay to take a childPs temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents may prefer to take an aQillary temperature, especially for kids 3ho canPt hold a thermometer in their mouths. 0emove your childPs shirt and undershirt, and place the thermometer under an armpit !it must be touching skin only, not clothing$. 2old your childPs arm across the chest to hold the thermometer in place. Eait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Erite do3n the number on the screen, noting the time of day that you took the reading. Ehatever method you choose, keep these additional tips in mind +ever take a childPs temperature right after a bath or if he or she has been bundled tightly for a 3hile T this can affect the temperature reading. +ever leave a child unattended 3hile taking a temperature. %elping Kids 2eel )etter Again, not all fevers need to be treated. And in most cases, a fever should be treated only if itPs causing a child discomfort. %ere are 3ays to alleviate symptoms that often accompany a fever &f your child is fussy or appears uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or 3eight. &f you donPt kno3 the recommended dose or your child is younger than / years, call the doctor to find out ho3 much to give. 0emember that fever medication 3ill usually temporarily bring a temperature do3n, but it 3ill not return it to normal T and it 3onPt treat the underlying reason for the fever. !7nless instructed by a doctor, never give aspirin to a child due to its association 3ith 0eye syndrome, a rare but potentially fatal disease.$ &nfants under / months old should not be given any medication for fever 3ithout being evaluated by a doctor. &f your child has any medical problems, check 3ith the doctor to see 3hich medication is best to use. 1iving a sponge bath can make your child more comfortable and help bring the fever do3n. 7se only luke3arm 3ater8 cool 3ater may cause shivering, 3hich actually raises body temperature. +ever use alcohol !it can cause poisoning 3hen absorbed through the skin$ or ice packs'cold baths !they can cause chills that may raise body temperature$. Dress your child in light3eight clothing and cover him or her 3ith a light sheet or blanket. 9verdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise. Make sure your childPs room is a comfortable temperature T not too hot or too cold. 9ffer plenty of fluids to avoid dehydration T a fever 3ill cause a child to lose fluids more rapidly. Eater, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks containing caffeine, including colas and tea, because they can cause increased urination. &f your child also is vomiting and'or has diarrhea, ask the doctor if you should give an electrolyte !rehydration$ solution made especially for kids. Mou can find these solutions at pharmacies and supermarkets. DonPt offer sports drinks T theyPre not designed for younger children, and the added sugars may make diarrhea 3orse. Also, limit your childPs intake of fruits and apple juice. &n general, let your child eat 3hat he or she 3ants !in reasonable amounts$ but donPt force eating if your child doesnPt feel like it. Make sure your child gets plenty of rest. ,taying in bed all day isnPt necessary, but a sick child should take it easy. &tPs best to keep a child 3ith a fever home from school or child care. Most doctors feel that itPs safe to return 3hen the temperature has been normal for /- hours. Ehen to "all the Doctor The eQact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and 3hether the child has other symptoms 3ith the fever. "all your doctor if you have an infant younger than 6 months 3ith a temperature of 455.-@ 2ahrenheit !6F@ "elsius$ or higher older child 3ith a temperature of higher than 45/./@ 2ahrenheit !6>@ "elsius$ "all the doctor if an older child has a fever of less than 45/./@ 2ahrenheit !6>@ "elsius$ but also refuses fluids or seems too ill to drink ade#uately has persistent diarrhea or repeated vomiting has any signs of dehydration !urinating less than usual, not having tears 3hen crying, less alert and less active than usual$ has a specific complaint !i.e., sore throat or earache$ still has a fever after /- hours !in kids younger than / years$ or A/ hours !in kids / years or older$ has recurrent fevers, even if they only last a fe3 hours each night has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia has a rash has pain 3ith urination ,eek emergency care if your child sho3s any of the follo3ing signs along 3ith a fever inconsolable crying eQtreme irritability lethargy and difficulty 3aking rash or purple spots that look like bruises on the skin !that 3ere not there before the child got sick$ blue lips, tongue, or nails infantPs soft spot on the head seems to be bulging out3ard or sunken in3ards stiff neck severe headache limpness or refusal to move difficulty breathing that doesnPt get better 3hen the nose is cleared leaning for3ard and drooling sei(ure abdominal pain Also, ask your childPs doctor for his or her specific guidelines on 3hen to call about a fever. 2ever A "ommon Part of "hildhood

All kids get fevers, and in the majority of cases, most are completely back to normal 3ithin a fe3 days. 2or older infants and children !but not necessarily for infants younger than 6 months$, the 3ay they act is far more important than the reading on your thermometer. Bveryone gets cranky 3hen they have a fever. This is normal and should be eQpected. )ut if youPre ever in doubt about 3hat to do or 3hat a fever might mean, or if your child is acting ill in a 3ay that concerns you even if therePs no fever, al3ays call your doctor for advice.

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