Sumber: http://www.nlm.nih.gov/medlineplus/ency/article/000079.

htm diakses tanggal 25 Desember 2008

Alternative Names

Return to top

Walking pneumonia; Chlamydophila pneumoniae Definition Return to top

Atypical pneumonia refers to pneumonia caused by certain bacteria -- namely, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to Legionella, in particular, can be quite severe and lead to high mortality rates. Causes Return to top

Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severe forms of Mycoplasma pneumonia have been described in all age groups. Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low mortality rate. In contrast, atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher mortality rate. Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has also been associated with pneumonia due to Legionella. Symptoms

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Chills Fevers Cough Headache Muscle stiffness and aching Rapid breathing Shortness of breath Loss of appetite Malaise Confusion (especially with Legionella)

Rash (especially with Mycoplasma) Diarrhea (especially with Legionella) Return to top

Exams and Tests

People with suspected pneumonia should undergo a medical evaluation, including a thorough physical exam and a chest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or other respiratory infections. Depending on the severity of illness, additional studies, such as a complete blood count, blood cultures, and sputum cultures, may be obtained. When certain forms of atypical pneumonia are suspected, tests of your urine or a throat swab may be ordered as well. Treatment Return to top

The mainstay of treatment for atypical pneumonia is antibiotic therapy. In mild cases, treatment with oral antibiotics at home may be appropriate. Severe cases (especially common with pneumonia caused by Legionella) may require intravenous antibiotics and oxygen supplementation. Antibiotics with activity against these organisms include -- erythromycin, azithromycin, clarithromycin, fluoroquinolones and their derivatives (such as levofloxacin), and tetracyclines (such as doxycycline). Outlook (Prognosis) Return to top

Most patients with pneumonia due to Mycoplasma or Chlamydophila do well with appropriate antibiotic therapy, although there is a small chance of relapse if antibiotics are used for too short a period of time (less than two weeks). In the case of pneumonia due to Legionella, severe illness occurs particularly among the elderly and those with chronic diseases and weakened immune systems. It is associated with a higher mortality rate. Possible Complications

Return to top

Respiratory failure, mechanical ventilation -- especially in severe forms of pneumonia due to Legionella Rash and hemolytic anemia -- especially associated with pneumonia due to Mycoplasma Return to top

When to Contact a Medical Professional

Seek medical evaluation if you develop fevers, cough, and/or shortness of breath. While there are numerous causes for these symptoms, you will need to be evaluated for pneumonia. Prevention Return to top

There are no proven methods for preventing atypical pneumonia, and no vaccinations are available at this time for atypical pneumonias. References Return to top

Marx JA, Hockberger RS, Walls RM, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier, 2004. Mandell, GL, Bennett JE, Dolin R, eds. Principles of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone, 2000. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

Sumber: http://en.wikipedia.org/wiki/Atypical_pneumonia diakses tanggal 25 Desember 2008

Atypical pneumonia
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Atypical pneumonia Classification and external resources ICD-9 486 DiseasesDB 1132 MedlinePlus 000079

Atypical pneumonia is a term used to describe a form of pneumonia not caused by one of the more traditional pathogens. It can be defined as pneumonia without lobar consolidation.[1][2] The concept of "atypical pneumonia" was introduced in 1934 by Gallagher in his description of bronchopneumonia, which he considered atypical in comparison to lobar pneumonia.[3][4]

Contents
[hide]

1 Terminology 2 Causes
o o

2.1 Bacterial 2.2 Viral

3 Symptoms 4 Treatment

5 Prognosis 6 References

[edit] Terminology
The term "atypical" is used because atypical bacteria commonly affect healthier people,[citation needed] and respond to different antibiotics than other bacteria. The term "primary atypical pneumonia" used to explicitly exclude bacterial pneumonia.[5] However, in recent years, Mycoplasma, Rickettsia, and Chlamydia are now usually considered bacteria, albeit unusual types (Mycoplasma is the only type of bacteria with no cell wall, and Rickettsia and Chlamydia are intracellular parasites, which used to be confused with viruses.) As the conditions caused by these agents have different courses and respond to different treatments, more specific identification of the pneumonia should be used when possible. In MeSH, "Primary Atypical Pneumonia" is mapped to Mycoplasma pneumonia.[6] Compared to typical pneumonias, atypical pneumonia is more likely to have effects outside of the lungs.[7]

[edit] Causes
Pneumonia

Infectious pneumonias

Bacterial pneumonia Viral pneumonia Fungal pneumonia Parasitic pneumonia Atypical pneumonia Community-acquired pneumonia

Healthcare-associated pneumonia

Hospital-acquired pneumonia

Ventilator-associated pneumonia

Severe acute respiratory syndrome

Pneumonias caused by infectious or noninfectious agents

Aspiration pneumonia Lipid pneumonia Eosinophilic pneumonia Bronchiolitis obliterans organizing pneumonia

Noninfectious pneumonia

Chemical pneumonia
This box: view talk edit

It can be caused by one or a combination of the following organisms:

[edit] Bacterial
Legionella pneumophila Causes a severe form of pneumonia with a relatively high mortality rate, known as legionellosis or Legionnaires' disease. Mycoplasma pneumoniae Usually occurs in younger age groups and may be associated with neurological and systemic (e.g. rashes) symptoms. Chlamydophila pneumoniae Mild form of pneumonia with relatively mild symptoms. Sometimes, Chlamydophila psittaci or Chlamydia trachomatis. [8] In one study, a majority of cases where the cause could be identified were due to Mycoplasma, Chlamydia, or Legionella.[9] In the past, these organisms were difficult to culture, which is part of the reason they were grouped together. However, newer techniques aid in the definitive identification of the pathogen,[10] which may lead to more individualized treatment plans.

[edit] Viral
When using the broader, modern definition of bacteria (as described above), term "atypical pneumonia" almost always implies a bacterial etiology, and is contrasted to viral pneumonia. However, before the SARS coronavirus was identified, severe acute respiratory syndrome (SARS) was considered a kind of atypical pneumonia.[11] It is still called so in the Chinese mainland.[citation needed]

[edit] Symptoms
Symptoms include fever, shortness of breath, laboured breathing, cough and potentially cough fractures, arthralgia (joint pain), malaise, loss of appetite, confusion, rash, and diarrhea.

[edit] Treatment
Treatment is with oral antibiotics, mainly with those which interfere with protein synthesis e.g. erythromycin, and diagnosis is confirmed by blood cultures and sputum samples.

[edit] Prognosis
The tone or style of this article may not be appropriate for Wikipedia. Specific concerns may be found on the talk page. See Wikipedia's guide to writing better articles for suggestions. (October 2008) Prognosis is usually good and is influenced by age and immunosuppression.

[edit] References
1. ^ Hindiyeh M, Carroll KC (June 2000). "Laboratory diagnosis of atypical pneumonia". Semin Respir Infect 15 (2): 10113. PMID 10983928. http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372. 2. ^ Gouriet F, Drancourt M, Raoult D (October 2006). "Multiplexed serology in atypical bacterial pneumonia". Ann. N. Y. Acad. Sci. 1078: 53040. doi:10.1196/annals.1374.104. PMID 17114771. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=00778923&date=2006&volume=1078&spage=530. 3. ^ "Pneumonia, Atypical Bacterial: Overview - eMedicine". http://emedicine.medscape.com/article/363083overview. Retrieved on 2008-12-21. 4. ^ Gallagher JR. Bronchopneumonia in adolescence. Yale J Biol Med. 1934;7:23-40. 5. ^ Primary atypical pneumonia at Dorland's Medical Dictionary 6. ^ MeSH Pneumonia,+Primary+Atypical 7. ^ Cunha BA (May 2006). "The atypical pneumonias: clinical diagnosis and importance". Clin. Microbiol. Infect. 12 Suppl 3: 1224. doi:10.1111/j.1469-0691.2006.01393.x. PMID 16669925. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198743X&date=2006&volume=12&issue=&spage=12. 8. ^ Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology: With STUDENT CONSULT Online Access. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition. 9. ^ Ragnar Norrby S (April 1997). "Atypical pneumonia in the Nordic countries: aetiology and clinical results of a trial comparing fleroxacin and doxycycline. Nordic Atypical Pneumonia Study Group". J. Antimicrob. Chemother. 39 (4): 499508. PMID 9145823. http://jac.oxfordjournals.org/cgi/pmidlookup? view=long&pmid=9145823. 10. ^ Tang YW (December 2003). "Molecular diagnostics of atypical pneumonia". Acta Pharmacol. Sin. 24 (12): 130813. PMID 14653964. http://www.chinaphar.com/1671-4083/24/1308.pdf.

11. ^ "Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak". http://www.who.int/csr/don/2003_03_15/en/. Retrieved on 2008-12-21.

Sumber : http://emedicine.medscape.com/article/363083-overview diakses tanggal 25 Desember 2008

Introduction
Background
During the latter half of the 19th century, by which time physicians had embraced autopsy as an essential learning tool, pneumonia diagnoses were usually made post mortem. With the discovery of x-rays (1895), chest radiography became part of the routine evaluation of pneumonia in patients with suggestive signs and symptoms. Patients who presented with fever, shaking chills, and rust-colored sputum (which under examination showed gram-positive diplococci in chains) and whose chest radiographic findings were suggestive of pulmonary infection were considered to have typical pneumonia. History In 1934, Gallagher described a disease outbreak in 16 boys living in a preparatory school. The youngsters had bronchopneumonia, which Gallagher considered to be atypical. Four years later, Reimann reported on 8 patients with chest infection but an atypical presentation, which he referred to as atypical pneumonia. As a result of Gallagher's and Reimann's work, the concept of typical and atypical pneumonia became established in medical literature. The arbitrary classification of typical versus atypical pneumonia is nonetheless of limited clinical value. Moreover, the literature now shows that a primary pathogen may coexist with a secondary one, further blurring the distinction between these terms.
Related eMedicine topics: Pneumonia, Bacterial Pneumonia, Viral Pneumonia, Typical Bacterial Related Medscape Topics: Resource Center Pneumonia CME/CE What's New in Ventilator-Associated Pneumonia CME/CE Healthcare-Associated Pneumonia CME Oral Amoxicillin May Be Effective for Children Admitted to Hospital for Pneumonia CME/CE Macrolides Improve Outcomes Among Elderly With Bacteremic Pneumonia

Pathophysiology
Pathogens

Most pathogens that are responsible for community-acquired pneumonia (CAP) reach the lungs after first colonizing the oropharynx. Community respiratory pathogens that enter the lungs without oropharyngeal colonization include Mycobacterium tuberculosis, Legionella species, and certain viruses. See Clinical Details, below. Radiologic phases A phase of active hyperemia occurs, lasting approximately 24 hours before radiologic consolidation of the alveoli appears. This phase is characterized by engorgement of the arterial blood vessels. Edematous fluid, which may be seen in the alveolus, contains few exudative cells. The next stage is referred to as red hepatization. Neutrophils and fibrin material fill the alveoli, and massive extravasation of red blood cells produces a homogeneous opacity. The red hepatization phase is then followed by gray hepatization. Fibrin and exudative cells accumulate, appearing on radiographs as a clear zone adjoining the alveolar and acinar cells. If the process extends to the pleural space, associated empyema may be present.

Frequency
United States

CAP affects approximately 5.6 million adults in the United States each year, resulting in approximately 1.1 million hospital admissions (Garibaldi, 1985; Neiderman, 1998). Mycoplasma pneumoniae is a frequent cause of community-acquired respiratory infections in adults and children. This organism is one of the most common atypical pathogens responsible for CAP in adults, but infection-rate figures vary, depending on the population and on the diagnostic methods used. Studies have shown that the prevalence of this agent in adults with pneumonia ranges from 2% to over 30% (Mansel, 1989; Pareja, 1992). The prevalence of Chlamydia pneumoniae infection varies by year and geographic setting. It causes 5-15% of all cases of CAP (Marrie, 1998).
International

Data are not currently available. The estimated range is 30-220 million cases per year.

Mortality/Morbidity
The overall mortality rate is approximately 15%, ranging from 5% in studies including both ambulatory and hospitalized patients to 15% in studies of only hospitalized patients.

Mortality rates are as high as 40% in ICU patients. Mortality rates are 20% in the elderly and 30% in nursing-home patients.

Race
In endemic areas, certain zoonotic infections should be considered when patients present with atypical pneumonia.

Age
There is a higher incidence of atypical pneumonia in the elderly as a result of associated comorbidities, reduced immunocompetence, and an increased risk of aspiration in this population.

Presentation
Pneumonia is predominantly a clinical syndrome. The classic etiologic agents of atypical pneumonia are Legionella species, M pneumoniae, and C pneumoniae. Many other diseases, caused by various pathogens, should be considered in the differential diagnosis. Such etiologic agents include fungi, mycobacteria, parasites, and viruses (eg, influenza virus, adenovirus, respiratory syncytial virus, human parainfluenza virus, measles, varicella zoster, Hantavirus). In immunosuppressed patients, outbreaks of isolated cases of respiratory virus infections with atypical presentations are reported. These infections can be severe and may have concomitant bacterial etiologies. In endemic areas, certain zoonotic infections should be considered when patients present with atypical pneumonia. Noninfectious etiologies must be considered in atypical and nonresolving pneumonias.

Legionella pneumonia
Legionella became recognized as a pneumonia agent following an outbreak of L pneumophila infections at a 1976 American Legion convention in Philadelphia. Legionella pneumonia is responsible for 2-15% of all CAPs that require hospitalization. Outbreaks of nosocomial legionellosis (Legionnaires disease) previously occurred in tertiary care centers. More recently, however, sporadic nosocomial cases from community hospitals have predominated. Risk factors The risk factors for Legionella pneumonia include cigarette smoking, chronic lung disease, and immunosuppression (especially that caused by corticosteroid use). Surgery is a major predisposing factor in nosocomial infections; transplant patients are at highest risk. Legionnaires disease can be acquired by aerosol inhalation or by the microaspiration of water contaminated with Legionella pathogens, although aspiration remains an underrecognized mode of transmission. Sources of contaminated water include aerosol-generating systems such as cooling towers, respiratory therapy equipment, and whirlpool baths. Nasogastric tubes are implicated in some cases of nosocomial legionellosis. A high incidence of Legionella pneumonia is reported in patients who undergo head and neck surgery. Although 40 Legionella species have been identified, fewer than 20 have been implicated as human pathogens. L pneumophila is the most pathogenic, accounting for 90% of cases of human legionellosis, followed by L micdadei. Clinical manifestations Early in the course of illness, patients have nonspecific symptoms, including fever, malaise, myalgia, anorexia, and headache. Temperature often exceeds 40C. Cough is usually only minimally productive. Pleuritic chest pain occasionally occurs and can be associated with hemoptysis, which may mistakenly suggest pulmonary embolus. Diarrhea is present in as many as 20-40% of patients and is classically described as watery, rather than bloody. Relative bradycardia is described, but this condition is most often seen in elderly patients with severe pneumonia. Hyponatremia with a serum sodium level of 125-130 mmol/L is more commonly associated with Legionella pneumonia than with other forms of pneumonia.

Extrapulmonary legionellosis is rare, but the clinical manifestations can be severe. The heart is the most common extrapulmonary site. Patients with cardiac involvement may present with myocarditis, pericarditis, postpericardiotomy syndrome, and prosthetic valve endocarditis. Chest radiographs cannot be used to distinguish Legionnaires disease from other pneumonias. Details are described in Radiograph. Laboratory diagnosis Diagnostic laboratory tests for Legionnaires disease are necessary but must be specifically requested. The definitive diagnosis is made by culturing the Legionella organism. However, a specialized medium is needed for testing; a lack of this medium delayed diagnosis in the 1976 American Legion outbreak. Sputum should be cultured regardless of the quality of the specimen. Legionella has been cultured from specimens with more than 25 squamous epithelial cells and fewer than 25 leukocytes per low-power field. This procedure may be important because many patients have a minimally productive cough. The Legionella urine antigen test can be performed rapidly and relatively inexpensively. This test is commercially available as both a radioimmunoassay and an enzyme immunoassay. It detects only the serotype 1, but it should be included in the initial diagnostic work-up because this is the most common serotype that causes clinical infection. The test has a sensitivity of 70% and a specificity of approximately 95%. Direct fluorescent antibody staining is a rapid diagnostic test, but because a large number of organisms are required for visualization, it is less sensitive than are techniques employing bacterial cultures. Serologic tests are useful for epidemiologic purposes. However, they do not help the treating physician, because a convalescent measurement is required. The diagnosis is based on a 4-fold increase of antibody titer to 1:128 or higher. A single titer of 1:256 or higher during convalescence is also suggestive of Legionella infection. If antibody screening is performed, both immunoglobulin G (IgG) and immunoglobulin M (IgM) levels should be evaluated. The polymerase chain reaction (PCR) assay has been used to evaluate serum, urine, and bronchoalveolar fluid. Although PCR is highly specific, it is not more sensitive than culturing. Its primary advantage is its ability to rapidly detect Legionella or species other than L pneumophila. The sensitivity of culturing or direct fluorescent antibody staining of specimens obtained during bronchoscopy is similar to that of sputum analysis. Pleural fluid, if present, should be evaluated by staining and culturing and by performing the radioimmunoassay used to detect urinary antigen. Treatment Delayed treatment of Legionella pneumonia significantly increases the associated mortality rate. The newer macrolides, especially azithromycin, have superior in vitro activity, with greater intracellular and lung tissue penetration than erythromycin. Quinolones, in turn, have greater in vitro activity and intracellular penetration than the macrolides. In severely ill patients, rifampin may be recommended for use in combination with macrolides or quinolones. The duration of therapy is 10-14 days, with a 21-day regimen for immunosuppressed patients or those with extensive disease, as shown on chest radiographs.

Mycoplasma pneumonia
M pneumoniae is a frequent cause of community-acquired respiratory infections in adults and children. This organism is one of the most common atypical pathogens responsible for CAP in adults, but infection-rate figures vary depending on the population and the diagnostic methods used. Recent studies have shown that the prevalence of this agent in adults with pneumonia ranges from 2% to over 30%. The class Mollicutes, generally referred to as the mycoplasmas, comprises 5 genera: Mycoplasma, Ureaplasma, Acholeplasma, Anaeroplasma, and Asteroleplasma. Three well-established causes of human disease are M pneumoniae, M hominis, and U urealyticum. Mycoplasmas grow on cell-free media, multiplying by means of primary fission. Because, unlike other bacteria, they lack a cell wall, these organisms are not susceptible to antibiotics that interfere with cell-wall synthesis. Mycoplasmas may be among the least frequently diagnosed respiratory pathogens in the clinical setting, because of a lack of standardized, specific diagnostic tests for them. M pneumoniae infection tends to be endemic, punctuated by epidemics occurring at 4- to 7-year intervals. When these epidemics develop, M pneumoniae may be responsible for up to 50% of all pneumonia cases. The overall incidence depends on the prevalence and appears to be related to age. The highest prevalence is observed in children aged 5-9 years. Outbreaks may occur in institutional settings, such as military bases, summer camps, and schools. Clinical features M pneumoniae infections may be symptomatic or asymptomatic. The onset is usually gradual, with a prodrome of flu-like symptoms, including headache, malaise, and low-grade fever, occurring. Chills are common, but rigors are not. Objective abnormalities on physical examination are minimal in contrast to the patient's reported symptoms. Symptoms are best divided into pulmonary and extrapulmonary manifestations. M pneumoniae is most frequently responsible for the pulmonary manifestation tracheobronchitis, which is 30 times as common as pneumonia. This pathogen is best known as the primary cause of walking pneumonia. Typical symptoms include sore throat, headaches, chills, and coryza. Myringitis, including hemorrhagic bullous myringitis and otitis, may be present, and transient bronchial hyperreactivity can occur as well. The cough associated with Mycoplasma infection is usually nonproductive or minimally productive. Extrapulmonary manifestations involve the central nervous system (CNS), blood, skin, heart, joints, or gastrointestinal (GI) tract. CNS manifestations include aseptic meningitis, cranial nerve palsies, cerebral ataxia, meningoencephalitis, peripheral neuropathy, and transverse myelitis. These symptoms are infrequent, and when seen, they are usually found in children. They are most often associated with increased morbidity and mortality rates and are thought to represent an immune-mediated reaction of the host to the M pneumoniae infection or to an extrapulmonary manifestation of it. An antecedent respiratory infection is not always present. Hematologic manifestations include the presence of IgM antibodies to the erythrocyte membrane I antigen. Their appearance produces a cold agglutinin response that leads to hemolysis. Dermatologic manifestations include rash, which may be maculopapular or vesicular, and Stevens-Johnson syndrome. Antimicrobials are known to potentiate the dermatosensitive potential of M pneumoniae.

Cardiac involvement may include myocarditis, pericarditis, congestive heart failure, hemopericardium, and various heart blocks. Joint manifestations are occasionally described. Various GI symptoms can include nausea, vomiting, diarrhea, and pancreatitis. Diagnosis Culturing, serologic analysis, PCR testing, and determination of cold agglutinin titers can aid in diagnosing an M pneumoniae infection. However, because each of these tests has certain drawbacks, therapy must be empirical. Because of M pneumoniae 's fastidious growth requirements and long incubation period, culturing has limited utility, and most laboratories do not offer it. IgM and IgG titers are elevated in most cases, but the response is often delayed. Therefore, antibody tests also have limited usefulness. Some authorities consider PCR to be particularly promising. However, amplification techniques have some technical problems because of differences in sample-collection and preparation methods. Cold agglutinin titers higher than 1:64 support the diagnosis, and the cold agglutinin response is correlated with the severity of pulmonary symptoms. However, the test lacks both sensitivity and specificity. The antibody response develops approximately 7-10 days after the onset of symptoms and peaks at approximately 3 weeks. Treatment In most cases, the recommended treatment includes tetracycline or a macrolide. Fluoroquinolones also may be used. Two to three weeks of therapy is generally recommended to reduce the risk of relapse.

Chlamydia pneumonia
The genus Chlamydia includes 3 species that infect humans: C psittaci, C trachomatis, and C pneumoniae (formerly called the TWAR agent). C trachomatis is seen in newborn infants during delivery. It has also been associated with pneumonia in adults. Ornithosis is a systemic infection that is often accompanied by pneumonia and caused by C psittaci, which is common in birds and some domestic animals. The incubation period is approximately 5-15 days. Pet-shop employees and poultry workers are at particular risk, and this organism should be considered when these individuals present with pneumonia. Besides the lungs, other major organs and systems that may be affected by C psittaci infection include the CNS (meningoencephalitis, cranial nerve deficits) and the cardiovascular system (culturenegative endocarditis). The prevalence of C pneumoniae infection varies by year and geographic setting. It causes 5-15% of all cases of CAP. Repeat infection is common. Chlamydia pneumonia may be associated with acute upper-airway infection, sinusitis, bronchitis, and bronchiolitis. Infection by C pneumoniae can cause prolonged, acute bronchitis with reactive airway disease. Bronchiolitis may be seen as a restrictive pattern on pulmonary-function tests. Pneumonia usually tends to be mild. When C pneumoniae is found in association with other pathogens, particularly Streptococcus pneumoniae, the clinical severity is usually determined by the secondary pathogen. The cough associated with C pneumoniae tends to be nonproductive and prolonged despite appropriate antibiotic therapy. Most patients report headache.

Diagnosis Results of C pneumoniae cultures, PCR, and serologic tests can suggest the diagnosis. Cell culture is not routinely available except in research laboratories. PCR technology has not been standardized, and serology is problematic because of its nonspecificity. The preferred diagnostic result is a 4-fold increase in titers from the acute stage to convalescence, with supporting evidence from PCR or culture tests. Therefore, most laboratories cannot confirm the diagnosis in a timely fashion; the treatment of Chlamydia pneumonia should be empirical. Treatment C pneumoniae may be treated with doxycycline, a macrolide, or a fluoroquinolone.

Differential Diagnoses
Acute Respiratory Distress Syndrome Pneumonia, Atypical Bacterial Bronchiolitis Obliterans Organizing Pneumonia Empyema Lung, Drug-Induced Disease Lung, Nontuberculous Mycobacterial Infections Lung, Postprimary Tuberculosis Lung, Primary Tuberculosis Pneumonia, Pneumocystis Carinii Pneumonia, Typical Bacterial Pneumonia, Viral

Sumber: http://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.html diakses tanggal 25 Des 08

Atypical pneumonia refers to pneumonia caused by certain bacteria, including Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. This article provides a general overview of atypical pneumonia. See also:

Legionella pneumonia (Legionnaire's disease) Mycoplasma pneumonia

See All News & Features China Reports Suspected Case of SARS in Beijing Science Panel Recommends Limits on Routine SARS Testing

Tests in China Suggest Some With SARS Don't Become Ill New Worry for China as SARS Hits the Hinterland

Reference from A.D.A.M.

Back to TopAlternative Names

Walking pneumonia; Chlamydophila pneumoniae

Back to TopCauses
Atypical pneumonia due to mycoplasma and chlamydophila bacteria usually cause mild forms of pneumonia, unlike other types of the disease that can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with anemia, certain types of rashes, and neurological conditions such as meningitis, myelitis, and encephalitis. For more information on this type of pneumonia, see: Mycoplasma pneumonia Pneumonia due to chlamydia-related bacteria occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low death rate. Atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher death rate. Older adults, smokers, and those with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Breathing in contaminated air (such as that from infected air conditioning systems) has also been linked to pneumonia due to Legionella. For more information on this type of pneumonia, see: Legionnaire's disease

Back to TopSymptoms

Chills Confusion (especially with Legionella pneumonia) Cough Diarrhea (especially with Legionella pneumonia) Fever General ill feeling Headache Loss of appetite Muscle stiffness and aching Rapid breathing Rash (especially with Mycoplasma pneumonia) Shortness of breath

Back to TopExams and Tests

Persons with suspected pneumonia should have a complete medical evaluation, including a thorough physical exam and a chest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or other respiratory infections. Depending on the severity of illness, additional studies may be done, include:

Complete blood count (CBC) Blood cultures Blood tests for antibodies to specific bacteria Bronchoscopy Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources) Sputum culture

Urine tests or a throat swab may be also be done.

Back to TopTreatment
Antibiotics are used to treat atypical pneumonia. If you have a mild case, you may be able to take antibiotics by mouth. If you have severe atypical pneumonia, you will likely be admitted to a hospital where you will be given antibiotics through a vein (intravenously), as well as oxygen. Antibiotics used to treat atypical pneumonia include:

Azithromycin Clarithromycin Erythromycin Fluoroquinolones and their derivatives (such as levofloxacin) Tetracyclines (such as doxycycline)

Back to TopOutlook (Prognosis)

Most patients with pneumonia due to mycoplasma or chlamydophila do well with appropriate antibiotic therapy, although there is a small chance that the infection will return if antibiotics are used for less than 2 weeks. While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to Legionella, in particular, can be quite severe, especially among the elderly and those with chronic diseases and weakened immune systems. It is associated with a higher death rate.

Back to TopPossible Complications

Hemolytic anemia (especially with mycoplasma pneumonia) Lung failure

Back to TopWhen to Contact a Medical Professional

Contact your health care provider if you develop a fevers, cough, or shortness of breath. There are numerous causes for these symptoms. The doctor will need to rule out pneumonia.

Back to TopPrevention
There is no known prevention for atypical pneumonia. No vaccine is are available at this time for atypical pneumonia.

Back to TopReferences
Limper AH. Overview of Pneumonia. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. Philadelphia, Pa: Saunders; 2007:chap 97. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.

Sumber: http://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumona 101.html diakses tanggal 25 Desember 2008

Penatalaksanaan Pneumonia Bakteri pada Usia Lanjut Dr Ria Faridawati Bagian Pulmonologi Fakultas Kedokteran Universitas Indonesia Unit Paru Rumah Sakit Persahabatan, Jakarta

PENDAHULUAN Walaupun kini telah banyak kemajuan dalam pengobatan infeksi saluran napas ternyata pneumonia masih merupakan masalah kesehatan masyarakat secara umum dan khususnya pada golongan usia lanjut(1,2). Pneumonia usia lanjut mempunyai angka mortalitas mendekati 40%. Tingginya angka mortalitas ini disebabkan oleh penyakit penyerta dan kondisi tertentu seperti diabetes melitus, payah jantung kronik, penyakit vaskuler, penyakit paru obstruksi kronik (PPOK), peminum alkohol dan penyakit-penyakit lainnya. Penyakit-penyakit tersebut di atas umumnya terdapat pada usia lanjut(3). Pengobatan pneumonia pada usia lanjut harus berhati-hati terutama pada penderita yang mempunyai fakta yang bermacam-macam, sehingga sering sulit membuat diagnosis yang tepat. Dalam tinjauan kepustakaan ini dibahas klasifikasi dan epiderniologi, patogenesis, diagnosis, gambaran radiologik dan penatalaksanaan pneumonia pada usia lanjut. KLASLFIKASI PNEUMONIA Menurut gambaran klinik pneumonia dibagi atas typical pneumonia dan atypical pneumonia atau pneumonia yang tidak khas. Typical pneumonia secara klinik ditandai dengan demam tinggi, perasaan dingin, nyeri dada dan batuk produktif, terdapat leukositosis, secara radiologis biasanya melibatkan satu 1obus

(1,4) . Kuman penyebab yang sering antara lain adalah Streptococcus pneumoniae, Hemophilus influenzae, Klebsiella pneumon Staph ylococcus aureus, bakteri aerob gram negatif dan bakteri aerob. Atypical pneumonia sering tanpa gejala demam, rasa dingin, batuk tidak produktif, nyeri kepala, mialgia, leukositosis yang tidak terlalu tinggi (1,4) . Secara radiologis didapatkan gambaran bronkopneumonia (1) . Klasifikasi lain dan pneumonia adalah menurut tempat asal infeksi; dibagi atas: - Community acquired pneumonia yaitu pneumonia yang didapat dalam masyarakat. - Hospital acquired (nosokomial) yaitu pneumonia yang didapat di rumah sakit (1,2,4,5) . Berdasarkan etiologi, pneumonia dapat dibagi atas: - Pneumonia bakteri - Pneumonia virus - Pneumonia mikoplasma - Pneumonia riketsia Pada pneumonia bakteri, kuman penyebab yang sering antara lain Streptococcus pneumonia dan Staphylococcus pyogenes (6) . EPIDEMLOLOGI Pneumonia dapat terjadi di semua negara tetapi data untuk perbandingan sangat sedikit, terutama di negara berkembang. Di Amerika pneumonia merupakan penyebab kematian keempat pada usia lanjut, dengan angka kematian 169,7 per 100.000 penduduk (1) . Tingginya angka kematian pada pneumonia sudah dikenal sejak lama, Osler W menyebutkan pneumonia sebagai "teman pada usia lanjut" (1) . Usia lanjut merupakan risiko tinggi untuk pneumonia, hal ini juga tergantung pada keadaan pejamu dan berdasarkan tempat mereka berada. Pada orang-orang yang tinggal di rumah sendiri insidens pneumonia berkisar antara 25 44 per 1000 orang dan yang tiaggal di tempat perawatan 68 114 per 1000 orang. Di rumah sakit pneumonia usia lanjut insidensnya tiga kali lebih besar daripada penderita usia muda (1) . Venkatesan dkk mendapatkan dan 38 orang pneumonia usia

lanjut yang didapat di masyarakat, 43% diantaranya disebabkan oleh Streptococcus pneumoniae, Hemophilus influenzae dan virus influenza B; tidak ditemukan bakteri gram negatif. Lima puluh tujuh persen lainnya tidak dapat diidentifikasi karena kesulitan pengumpulan spesimen dan sebelumnya telah diberi kan antibiotik (7) . Pada penderita kritis dengan penggunaan ventilator meka nik dapat terjadi pneumonia nosokomial sebanyak 10% sampai 70% (1) . PATOGENESIS Terjadinya pneumonia berhubungan dengan jumlah bakteri yang teraspirasi, penurunan daya tahan tubuh pejamu dan vim lensi koloni bakteri di orofaring (8) . Pada penderita pneumonia usia lanjut yang berada di rumah, umumnya terdapat peningkatan koloni gram negatif. Mekanisme tersebut dihubungkan dengan pemakaian antibiotik serta tubuh yang lemah dengan adanya penyakit kronik. Secara kuantitatifaspirasi bakteri dan orofaring mungkin akan meningkat pada penderita dengan penurunan kesadaran seperti penyakit degeneratif, kelainan esofagus, CVD, trakeostomi, pemasangan pipa lambung, dan pemakaian obat-obatan seperti sedatif. Turunnya daya tahan tubuh dihubungkan juga dengan imunitas humoral dan imunitas seluler, malnutrisi, perokok berat dan penyakit sistemik. Faktor predisposisi pneumonia adalah penggunaan pipa endotrakeal, pemakaian nebuhaler, adanya super infeksi dan malnutrisi. Hampir sebagian besar (50%60%) pneumonia yang di dapat di rumah sakit disebabkan oleh hasil aerob gram negatif, dapat juga disebabkan oleh Streptococcus aureus, Hemophillus influenzae (3,10) . DIAGNOSIS Tidak didapatkan demam pada 20% pneumonia usia lanjut dan dapat tanpa disertai batuk produktif dan perasaan dingin (3,4) . Pada pemeriksaan fisik, tanda klasik seperti perkusi yang redup, suara napas bronkial, ronki basah tidak selalu dijumpai. Frekuensi pernapasan 24 kali per menit cukup bermakna pada penderita pneumonia usia lanjut (3) . Pneumonia usia lanjut dapat bersama sama syok septik yang memberi gejala letargi, anoreksi, dan perubahan mental. Pada sebagian besar penderita didapatkan leukosit yang normal atau sedikit meninggi, kadang-kadang didapatkan leu-

kositosis (3) . Dapat terjadi peningkatan ureum, kreatinin dan glukosa, terdapat juga hiponatremi atau hipernatremi, hipofosfatemi; dapat terjadi hipoksemi yang disebabkan infeksi akut dan dapat disertai payah jantung, PPOK atau keduanya. Pada pneumonia usia lanjut diagnosis radiologik ditegakkan bila didapatkan gambaran infiltrat baru. Tetapi kadang-kadang sulit menilai gambaran radiologik terutama jika didapatkan keadaan dehidrasi. Sering kali infiltrat belum terlihat pada 24-48 jam setelah perawatan (3) . Gambaran radiologi kadang-kadang masih tampak normal pada pneumonia dini, pneumonia oleh bakteri gram negatif dan tuberkulosis endobronkial. Pada pneumonia usia anjut sering didapatkan penyakit penyerta seperti PPOK, gagal jantung dan sindrom gawat napas pada dewasa; pada keadaan ini gambaran radiologi sangat sukar dinilai (3) . Pneumonia oleh pneumococcus Penyakit ini biasanya akut dengan demam tinggi; pada usia lanjut tidak selalu demam, mungkin disertai keadaan umum yang lemah, malaise dan dehidrasi berat. Gambaran radiologik menunjukkan konsolidasi, biasanya unilateral. Buruk prognosisnya bila terdapat leukopeni, hipotermi, infiltrat bilateral, dan adanya penyakit di luar paru. Pneumonia oleh Hemophillus influensa Umumnya terdapat pada pneumonia di masyarakat dengan penyakit penyerta dan keadaan tertentu seperti PPOK, keganas an pada paru, diabetes melitus, serta pada peminum alkohol (3,10) . Secara radiologik tampak bercak-bercak infiltrat, hampir semua pada lobus kanan bawah dengan efusi pleura (3) . Pneumonia oleh Klebsiella Pneumonia dapat terjadi karena infeksi nosokomial dan mengakibatkan bakteremi. Umumnya berkembang dengan ada nya diabetes melitus, PPOK dan pada peminum alkohol (3,11) . Pneumonia oleh Legionella Pada usia lanjut merupakan keadaan berbahaya terutama dengan riwayat perokok dan penyakit hati. Gejala klinik yang penting adalah perasaan dingin berulang; gejala di luar paru seperti diare, nausea dan vomitus terjadi sebanyak 25%,sakit kepala dan perubahan mental terjadi lebih dan 30% penderita (3) . Diagnosis banding pneumonia legionella pada usia lanjut

adalah gagal jantung, emboli paru, sindrom gawat napas pada dewasa, aspirasi lambung, keganasan di paru, pneumonitis radiasi, reaksi hipersensitif obat (3) . PENATALAKSANAAN Identifikasi etiologi penting untuk pengobatan antibiotika. Pemeriksaan bakteri dapat dengan cara pewarnaan gram dan sputum, pewarnaan gram cairan pleura, kultur sputum, kultur darah dan cairan pleura. Kadang-kadang sukar untuk memper oleh sputum yang baik pada pneumoniausia lanjut, karena itu dapat digunakan antibiotik secana empirik. Dapat juga dilakukan upaya diagnostik secara invasif seperti aspirasi transtrakeal, aspirasi endotrakeal dan bronkoskopi. Hasil yang didapat pada tindakan diagnostik invasif ini tergantung dan keahlian me lakukan prosedur, dibutuhkan nilai yang akurat secara mikro biologi (1,3) . Pada pneumonia oleh pneumococcus, penisilin adalah obat pilihan utama (1,3,5,6) . Pada pneumonia ringan dapat diberikan peroral, tetapi pada pneumonia berat dengan malabsorbsi perlu diberikan dengan cara parenteral, dosis dapat lebih dari 1.2 juta unit per hari. Pada bakteremi tidak dibenarkan pemberian penisilin dosis tinggi guna untuk menghindari efek samping penisilin seperti anemi hemolitik. Pada penderita yang alergi terhadap penisilin dapat diberikan eritromisin. Pemberian eritromisin intravena dapat mengakibatkan nausea, vomitus, tromboflebitis dan kehilangan pendengaran yang reversibel terutama pada usia lanjut dengan fungsi ginjal menurun. Pemberian sefalosporin harus hati-hati pada penderita alergi terhadap penisilin sebab dapat terjadi reaksi hipersensitif si1ang (2,10) . Terjadinya demam berulang umumnya karena reaksi obat atau terjadi superinfeksi yang terjadi hari keempat sampai ketujuh pengobatan. Pneumonia oleh Hemophilus influenzae Obat antibiotik yang terpilih adalah ampisilin. Pada pende rita yang resisten terhadap ampisilin dapat diberikan cefonicid atau cefuroxime sodium. Pilihan lain adalah penisilin atau sefalosporin. Bila alergi terhadap penisilin dapat diberikan kloramfenikol atau trimetoprim-sulfametoksasol (2,3) . Pada pneumonia oleh gram negatif dianjurkan terapi dengan dua obat yaitu aminoglikosid dan sefalosporin generasi ketiga. Efek samping nefrotoksik dan ototoksik dapat dikurangi dengan memeriksa kadar dalam serum. Kadar tertinggi dalam serum pada tobramisin sulfat dan gentamisin sulfat 89 ug/ml dan 30 ug/ml untuk amikasin sulfat.

Pneumonia oleh strain staphylococcus Diterapi dengan oksasilin, nafsilin dan sefalotin. Pada pneumonia oleh karena Staphylococcus maka vankomisin adalah obat pilihan utama. Pneumonia oleh Legionella Sebagai obat pilihan utama yaitu entromisin. Bila klinis tidak ada kemajuan dapat ditambahkan rifampisin yang bekerja sinergis dengan eritromisin (3,6,12) . Pleuropneumoni oleh bakteri anaerob Paling baik diterapi dengan penisilin dan pilihan lain yaitu klindamisin. Klindamisin sering memberi hasil yang cepat dan baik pada penderita yang sebelumnya diterapi dengan penisilin. Berdasarkan penelitian maka standar lama pengobatan pada pneumonia oleh pneumococcus tanpa komplikasi adalah 7-10 hari; untuk bakteri anaerob 2 minggu, pada Hemophilus influenza lebih dan 2 minggu karena lesi yang biasanya luas, 2-3 minggu untuk batang gram negatif atau Streptococcus aureus dan 3 minggu untuk Legionella. Dalam penatalaksanaan harus diperhatikan nutrisi, jumlah kalori yang dibutuhkan baik parenteral atau melalui pipa lambung (9) . Cairan dan elektrolit perlu dinilai karena pada pneumonia dapat terjadi hiponatremi atau hipernatremi. Infeksi meningkatkan katabolisme protein dan melemahkan sistim imunitas humoral dan seluler. Sistim respirasi harus diperhatikan, bila terjadi hipoksemi dapat diberi oksigen. Pemberian oksigen dapat dinilai dengan analisis gas darah, karena keracunan oksigen dapat melemahkan gerakan mukosiliar dan menyebabkan fibrosis Penting diperhatikan interaksi obat-obat yang dipakai, agar dicapai efek obat yang maksimum dengan efek samping yang minimal. Dalam pemberian obat lebih dan dua macam dapat terjadi percepatan metabolisme obat, penganuh terhadap pembuluh darah perifer atau mempengaruhi sistim saraf sentral (13) . Fisioterapi diperlukan untuk pengeluaran sputum dan juga untuk mencegah terjadinya dekubitus serta mencegah terjadinya kontraktur (9) . KESIMPULAN 1) Pneumonia pada usia lanjut sering memberikan gambaran klinik yang ringan, sehingga kadang-kadang tidak segera di terapi. 2) Pemberian antibiotik pada pneumonia usia lanjut dapat secara empirik dan data statistik dan epidemiologi sambil me nunggu identifikasi bakteri atau bila mendapatkan kesulitan pada identifikasi bakteri. 3) Dalam penanganan pneumonia usia lanjut harus diperhati

kan penyakit penyerta yang umumnya terdapat pada usia lanjut seperti diabetes melitus, payah jantung kronik, penyakit vaskuler, PPOK dan lain-lain. KEPUSTAKAAN 1. Niederman MS, Sarosi GA. Respiratory infection. In: George RB, Light RW, Matthay MA, 2nd eds. Chest medicine essentials of pulmonary and critical care medicine. Baltimore: Williams & Wilkins, 1990; 30709. 2. Gleckman RA, Bergman MH. Bacterial pneumonia: specific diagnosis and treatment of the elderly. Geriatrics 1987; 42: 2941. 3. Cunha BA, Gingrich D, Rosenbaum GS. Pneumonia syndromes: a clinical approach in the olderly. Geriatrics 1990; 45: 4955. 4. Kiss TG. Infections of the lung parenchyma. In: Diagnosis and management of pulmonary disease in primary practice. Sydney: AddisonWesley Pubi Co 1982; 12231. 5. Finegold SM, Johnson CC. Pyogenic bacterial pneumonia, lung abscess and empyema. In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. Philadelphia: WB Saunders Co 1988; 80320. 6. Crofton J, Douglas A. Pneumonia. In: Respiratory disease. Singapore: PG Publ Pte Ltd, 1983; 16587. 7. Ven Katesen Pet al. A hospital study of community acquired pneumonia in the elderly. Thorax 1990; 5: 25458. 8. Stein D. Managing pneumonia acquired in nursing homes: special con cerns. Geriatrics 1987; 42: 8190. 9. Pemington JE. In: Respiratory infections: diagnosis and management. 2nd ed. New York: Raven Press, 1989; 17781. 10. Harris GD, Johanson WG. Pathogenesis of bacterial pneumonia. In: Guenter CA, Welch MG. ed. Pulmonary medicine. Second ed. Philadelphia: lB Lippincott Co. 1982; 34768. 11. Cherniack RM, Cherniack L. Lung parenchymal disease. In: Respiration in health and disease. Third ed. Tokyo: WB Saunders Co. 1983; 299301. 12. Hodson ME. Pneumonia. In: Warwick MT. Hodson ME, Corri, Kerr IH. (eds). Clinical atlas respiratory disease. New York: JB LippincottCo. 1989; 12229 Cermin Dunia Kedokteran No. 101, 1995 11
Sumber: http://www.infeksi.com/articles.php?lng=in&pg=48 diakses tanggal 25 Desember 2008

PNEUMONIA Pengertian Pnemonia Pnemonia adalah proses infeksi akut yang mengenai jaringan paru-paru (alveoli). Terjadinya pnemonia pada anak seringkali bersamaan dengan proses infeksi akut pada bronkus (biasa disebut bronchopneumonia). Gejala penyakit ini berupa napas cepat dan napas sesak, karena paru meradang secara mendadak. Batas napas cepat adalah frekuensi pernapasan sebanyak 50 kali per menit atau lebih pada anak usia 2 bulan sampai kurang dari 1 tahun, dan 40 kali permenit atau lebih pada anak usia 1 tahun sampai kurang dari 5 tahun. Pada anak dibawah usia 2 bulan, tidak dikenal diagnosis pnemonia. Pneumonia Berat ditandai dengan adanya batuk atau (juga disertai) kesukaran bernapas, napas sesak atau penarikan dinding dada sebelah bawah ke dalam (severe chest indrawing) pada anak usia 2 bulan sampai kurang dari 5 tahun. Pada kelompok usia ini dikenal juga Pnemonia sangat berat, dengan gejala batuk, kesukaran bernapas disertai gejala sianosis sentral dan tidak dapat

minum. Sementara untuk anak dibawah 2 bulan, pnemonia berat ditandai dengan frekuensi pernapasan sebanyak 60 kali permenit atau lebih atau (juga disertai) penarikan kuat pada dinding dada sebelah bawah ke dalam. Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P2ISPA (Pemberantasan Penyakit Infeksi Saluran Pernafasan Akut). Program ini mengupayakan agar istilah Pnemonia lebih dikenal masyarakat, sehingga memudahkan kegiatan penyuluhan dan penyebaran informasi tentang penanggulangan Pnemonia. Program P2ISPA mengklasifikasikan penderita kedalam 2 kelompok usia: Usia dibawah 2 bulan (Pnemonia Berat dan Bukan Pnemonia) Usia 2 bulan sampai kurang dari 5 tahun (2 bulan - Pnemonia, Pnemonia Berat dan Bukan Pnemonia ) Klasifikasi Bukan-pnemonia mencakup kelompok balita penderita batuk yang tidak menunjukkan gejala peningkatan frekuensi nafas dan tidak menunjukkan adanya penarikan dinding dada bagian bawah ke dalam. Penyakit ISPA diluar pnemonia ini antara lain: batuk-pilek biasa (common cold), pharyngitis, tonsilitis dan otitis. Pharyngitis, tonsilitis dan otitis, tidak termasuk penyakit yang tercakup dalam program ini. Pneumonia merupakan masalah kesehatan di dunia karena angka kematiannya tinggi, tidak saja dinegara berkembang, tapi juga di negara maju seperti AS, Kanada dan negara-negara Eropah. Di AS misalnya, terdapat dua juta sampai tiga juta kasus pneumonia per tahun dengan jumlah kematian rata-rata 45.000 orang. Di Indonesia, pneumonia merupakan penyebab kematian nomor tiga setelah kardiovaskuler dan tuberkulosis. Faktor sosial ekonomi yang rendah mempertinggi angka kematian. Gejala Pneumonia adalah demam, sesak napas, napas dan nadi cepat, dahak berwarna kehijauan atau seperti karet, serta gambaran hasil ronsen memperlihatkan kepadatan pada bagian paru Kepadatan terjadi karena paru dipenuhi sel radang dan cairan yang sebenarnya merupakan reaksi tubuh untuk mematikan luman. Tapi akibatnya fungsi paru terganggu, penderita mengalami kesulitan bernapas, karena tak tersisa ruang untuk oksigen. Pneumonia yang ada di masyarakat umumnya, disebabkan oleh bakteri, virus atau mikoplasma ( bentuk peralihan antara bakteri dan virus ). Bakteri yang umum adalah streptococcus Pneumoniae, Staphylococcus Aureus, Klebsiella Sp, Pseudomonas sp,vIrus misalnya virus influensa. Mengobati Pneumonia Anda mengalami tanda-tanda penumonia ?, Jangan khawatir, kesempatan sembuh masih amat besar dengan syarat-syarat berikut ini; usia masih muda, dideteksi sejak dini, sistem kekebalan tubuh bekerja dengan baik, infeksi belum menyebar, dan tidak ada infeksi lain. Pengobatan awal biasanya adalah antibiotik, yang cukup manjur mengatasi penumonia oleh bakteri, mikoplasma dan beberapa kasus rickettsia. Untuk pneumonia oleh virus sampai saat ini belum ada panduan khusus, meski beberapa obat antivirus telah digunakan. Kebanyakan pasien juga bisa diobati dirumah. Biasanya dokter yang menangani peneumonia akan memilihkan obat sesuai pertimbangan masing-masing, setelah suhu pasien kembali normal, dokter akan menginstruksikan pengobatan lanjutan untuk mencegah kekambuhan. Soalnya, seranganberikutnya bisa lebih berat dibanding yang pertama. Selain antibiotika, pasien juga akan mendapat pengobatan tambahan berupa pengaturan pola makan dan oksigen untuk meningkatkan jumlah oksigen dalam darah. Pada pasien yang berusia pertengahan, diperlukan istirahat lebih panjang untuk mengembvalikan kondisi tubuh. Namun, mereka yang sudah sembuh dari dari pneumonia mikoplasma akan letih lesu dalam waktu yang panjang. Secara rutin, pasien yang sudah sembuh dari pneumonia jangan dilarang kembali melakukan aktifitasnya. Namun mereka perlu diingatkan untuk tidak langsung melakukan yang berat-berat. Soalnya, istirahat cukup merupakan kunci untuk kembali sehat. Untuk menangani pernapasan akut parah ( Severe Acute Respiratory Syndrom/SARS) yang masih misterius, organisasi Kesehatan Dunia (WHO) menganjurkan para petugas kesehatan untuk menerapkan Universal Precautions. Artinya, mereka harus mengenakan sarung tangan, masker, sepatu boot dan jas yang melindungi seluruh tubuh dari kontak langsung dengan penderita. Buat penderitanya juga dianjurkan untuk mengenakan masker dan pelindung lain sampai SARS-nya ditanggulangi. Pasien yang dicurigai atau kemungkinan besar terkena SARS harus diisolasi. Ruang perawatannya harus bertekanan rendah dengan pintu tertutup rapat, tidak sharing dengan pasien lain ( termasuk dengan pasien sindrom serupa ) dan punya fasilitas kamar mandi dan kloset sendiri.

Semua peralatan yang digunakan sebaiknya sekali pakai dan ruangan dibersihkan dengan menggunakan desinfektans yang mengandung antibakteri, antivirus dan antijamur. Pasien sebaiknya dijaga tidak banyak bergerak. Pasien maupun para petugas kesehatan yang menangani dianjurkan untuk selalu mencuci tangan dengan sabun untuk menghindari penyebaran. Karena antibiotika berspekturm luas tidak menunjukkan efektifitas menangani SARS, WHO lebih menganjurkan untuk memanfaatkan suntikan intravena ribavirin dan steroid untuk menstabilkan kondisi pasien yang sudah kritis. Kenali Pneumonia biar tak Terlambat PNEUMONIA sebenarnya bukan peyakit baru. American Lung Association misalnya, menyebutkan hingga tahun 1936 pneumonia menjadi penyebab kematian nomor satu di Amerika. Penggunaan antibiotik, membuat penyakit ini bisa dikontrol beberapa tahun kemudian. Namun tahun 2000, kombinasi pneumonia dan influenza kembali merajalela dan menjadi penyebab kematian ketujuh di negara itu. Pneumonia adalah infeksi yang menyebabkan paru ? paru meradang. Kantung-kantung udara dalam paru yang disebut alveoli dipenuhi nanah dan cairan sehingga kemampuan menyerap oksigen menjadi kurang. Kekurangan oksigen membuat sel-sel tubuh tidak bisa bekerja. Gara ? gara inilah, selain penyebaran infeksi ke seluruh tubuh, penderita pneumonia bisa meninggal. Sebenarnya pneumonia bukanlah penyakit tunggal. Penyebabnya bisa bermacam-macam dan diketahui ada 30 sumber infeksi, dengan sumber utama bakteri, virus, mikroplasma, jamur, berbagai senyawa kimia maupun partikel. Pneumonia Oleh Bakteri Pneumonia yang dipicu bakteri bisa menyerang siapa saja, dari bayi sampai usia lanjut. Pencandu alkohol, pasien pasca-operasi, orang-orang dengan penyakit gangguan pernapasan, sedang terinfeksi virus atau menurun kekebalan tubuhnya, adalah yang paling berisiko. Sebenarnya bakteri penyebab pneumonia yang paling umum adalah Streptococcus pneumoniae sudah ada di kerongkongan manusia sehat. Begitu pertahanan tubuh menurun oleh sakit, usia tua, atau malnutrisi, bakteri segera memperbanyak diri dan menyebabkan kerusakan. Seluruh jaringan paru dipenuhi cairan dan infeksi dengan cepat menyebar ke seluruh tubuh melalui aliran darah. Pasien yang terinfeksi pneumonia akan panas tinggi, berkeringat, napas terengahengah, dan denyut jantungnya meningkat cepat. Bibir dan kuku mungkin membiru karena tubuh kekurangan oksigen. Pada kasus yang eksterm, pasien akan mengigil, gigi bergemelutuk, sakit dada, dan kalau batuk mengeluarkan lendir berwarna hijau. Sebelum terlambat, penyakit ini masih bisa diobati. Bahkan untuk pencegahan vaksinnya pun sudah tersedia. Pneumonia Oleh Virus Setengah dari kejadian pneumonia diperkirakan disebabkan oleh virus. Saat ini makin banyak saja virus yang berhasil diidentifikasi. Meski virus-virus ini kebanyakan menyerang saluran pernapasan bagian atas-terutama pada anak-anak- gangguan ini bisa memicu pneumonia. Untunglah, sebagian besar pneumonia jenis ini tidak berat dan sembuh dalam waktu singkat. Namun bila infeksi terjadi bersamaan dengan virus influensa, gangguan bisa berat dan kadang menyebabkan kematian, Virus yang menginfeksi paru akan berkembang biak walau tidak terlihat jaringan paru yang dipenuhi cairan. Gejala Pneumonia oleh virus sama saja dengan influensa, yaitu demam, batuk kering sakit kepala, ngilu diseluruh tubuh. Dan letih lesu, selama 12 ? 136 jam, napas menjadi sesak, batuk makin hebat dan menghasilkan sejumlah lendir. Demam tinggi kadang membuat bibir menjadi biru. Pneumonia Mikoplasma Pneumonia jenis ini berbeda gejala dan tanda-tanda fisiknya bila dibandingkan dengan pneumonia pada umumnya. Karena itu, pneumonia yang diduga disebabkan oleh virus yang belum ditemukan ini sering juga disebut pneumonia yang tidak tipikal ( Atypical Penumonia ). Pneumonia mikoplasma mulai diidentifikasi dalam perang dnia II. Mikoplasma adalah agen terkecil dialam bebas yang menyebabkan penyakit pada manusia. Mikoplasma tidak bisa diklasifikasikan sebagai virus maupun bakteri, meski memiliki karakteristik keduanya. Pneumonia yang dihasilkan biasanya berderajat ringan dan tersebar luas. Mikoplasma menyerang segala jenis usia. Tetapi paling sering pada anak pria remaja dan usia muda. Angka kematian sangat

rendah, bahkan juga pada yang tidak diobati. Gejala yang paling sering adalah batuk berat, namun dengan sedikit lendir. Demam dan menggigil hanya muncul di awal, dan pada beberapa pasien bisa mual dan muntah. Rasa lemah baru hilang dalam waktu lama. Pneumonia Jenis Lain Termasuk golongan ini adalah Pneumocystitis Carinii pnumonia ( PCP ) yang diduga disebabkan oleh jamur, PCP biasanya menjadi tanda awal serangan penyakit pada pengidap HIV/AIDS. PCP bisa diobati pada banyak kasus. Bisa saja penyakit ini muncul lagi beberapa bulan kemudian, namun pengobatan yang baik akan mencegah atau menundah kekambuhan. Pneumonia lain yang lebih jarang disebabkan oleh masuknya makanan, cairan , gas, debu maupun jamur. Rickettsia- juga masuk golongan antara virus dan bakteri-menyebabkan demam Rocky Mountain, demam Q, tipus, dan psittacosis. Penyakit-penyakit ini juga mengganggu fungsi Paru, namun pneumonia tuberkulosis alis TBC adalah infeksi paru paling berbahaya kecuali dioabati sejak dini.

Sumber:

Atypical pneumonia
Definition: Atypical pneumonia refers to pneumonia caused by certain bacteria -- namely, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to Legionella, in particular, can be quite severe and lead to high mortality rates. Alternative Names: Walking pneumonia; Chlamydophila pneumoniae Causes, incidence, and risk factors: Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severe forms of Mycoplasma pneumonia have been described in all age groups. Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low mortality rate. In contrast, atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher mortality rate. Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has also been associated with pneumonia due to Legionella. Sumber: http://www.healthline.com/adamcontent/atypical-pneumonia/2 diakses tanggal 25 Desember 2008

Definition
Atypical pneumonia refers to pneumonia caused by certain bacteria -- namely, , , and Chlamydophila pneumoniae. While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to Legionella, in particular, can be quite severe and lead to high mortality rates.

Alternative Names
Walking pneumonia; Chlamydophila pneumoniae

Causes, incidence, and risk factors

Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severe forms of Mycoplasma pneumonia have been described in all age groups. Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low mortality rate. In contrast, atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher mortality rate. Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has also been associated with pneumonia due to Legionella.

Symptoms

Chills Fevers Cough Headache Muscle stiffness and aching Rapid breathing Shortness of breath Loss of appetite Malaise Confusion (especially with Legionella) Rash (especially with Mycoplasma)

Diarrhea (especially with Legionella)

Signs and tests

People with suspected pneumonia should undergo a medical evaluation, including a thorough physical exam and a chest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or other respiratory infections. Depending on the severity of illness, additional studies, such as a complete blood count, blood cultures, and sputum cultures, may be obtained. When certain forms of atypical pneumonia are suspected, tests of your urine or a throat swab may be ordered as well.

Treatment
The mainstay of treatment for atypical pneumonia is antibiotic therapy. In mild cases, treatment with oral antibiotics at home may be appropriate. Severe cases (especially common with pneumonia caused by Legionella) may require intravenous antibiotics and oxygen supplementation. Antibiotics with activity against these organisms include -- erythromycin, azithromycin, clarithromycin, fluoroquinolones and their derivatives (such as levofloxacin), and tetracyclines (such as doxycycline).

Expectations (prognosis)
Most patients with pneumonia due to Mycoplasma or Chlamydophila do well with appropriate antibiotic therapy, although there is a small chance of relapse if antibiotics are used for too short a period of time (less than two weeks). In the case of pneumonia due to Legionella, severe illness occurs particularly among the elderly and those with chronic diseases and weakened immune systems. It is associated with a higher mortality rate.

Complications

Respiratory failure, mechanical ventilation -- especially in severe forms of pneumonia due to Legionella Rash and hemolytic anemia -- especially associated with pneumonia due to Mycoplasma

Calling your health care provider

Seek medical evaluation if you develop fevers, cough, and/or shortness of breath. While there are numerous causes for these symptoms, you will need to be evaluated for pneumonia.

Prevention
There are no proven methods for preventing atypical pneumonia, and no vaccinations are available at this time for atypical pneumonias.

References
Marx JA, Hockberger RS, Walls RM, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002. Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier, 2004. Mandell, GL, Bennett JE, Dolin R, eds. Principles of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone, 2000. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

Sumber: http://www.who.int/mediacentre/news/releases/2003/pr22/en/ diakses tanggal 25 Desember 2008

WHO issues a global alert about cases of atypical pneumonia

Cases Of Severe Respiratory Illness May Spread To Hospital Staff
12 March 2003 | GENEVA -- Since mid February, WHO has been actively working to confirm reports of outbreaks of a severe form of pneumonia in Viet Nam, Hong Kong Special Administrative Region (SAR), China, and Guangdong province in China. In Viet Nam the outbreak began with a single initial case who was hospitalized for treatment of severe, acute respiratory syndrome of unknown origin. He felt unwell during his journey and fell ill shortly after arrival in Hanoi from Shanghai and Hong Kong SAR, China. Following his admission to the hospital, approximately 20 hospital staff became sick with similar symptoms. The signs and symptoms of the disease in Hanoi include initial flu-like illness (rapid onset of high fever followed by muscle aches, headache and sore throat). These are the most common symptoms. Early laboratory findings may include thrombocytopenia (low platelet count) and leucopenia (low white blood cell count). In some, but not all cases, this is followed by bilateral pneumonia, in some cases progressing to acute respiratory distress requiring assisted breathing on a respirator. Some patients are recovering but some patients remain critically ill. Today, the Department of Health Hong Kong SAR has reported on an outbreak of respiratory illness in one of its public hospitals. As of midnight 11 March, 50 health care workers had been screened and 23 of them were found to have febrile illness. They were admitted to the hospital for observation as a precautionary measure. In this group, eight have developed early chest x-ray signs of pneumonia. Their conditions are stable. Three other health care workers self-presented to hospitals with febrile illness and two of them have chest x-ray signs of pneumonia. Investigation by Hong Kong SAR public health authorities is on-going. The Hospital Authority has increased infection control measures to prevent the spread of the disease in the hospital. So far, no link has been found between these cases and the outbreak in Hanoi.

In mid February, the Government of China reported that 305 cases of atypical pneumonia, with five deaths, had occurred in Guangdong province. In two cases that died, chlamydia infection was found. Further investigations of the cause of the outbreak is ongoing. Overall the outbreaks in Hanoi and Hong Kong SAR appear to be confined to the hospital environment. Those at highest risk appear to be staff caring for the patients. No link has so far been made between these outbreaks of acute respiratory illness in Hanoi and Hong Kong and the outbreak of `bird flu,` A(H5N1) in Hong Kong SAR reported on 19 February. Further investigations continue and laboratory tests on specimens from Viet Nam and Hong Kong SAR are being studied by WHO collaborating centres in Japan and the United States. Until more is known about the cause of these outbreaks, WHO recommends patients with atypical pneumonia who may be related to these outbreaks be isolated with barrier nursing techniques. At the same time, WHO recommends that any suspect cases be reported to national health authorities. WHO is in close contact with relevant national authorities and has also offered epidemiological, laboratory and clinical support. WHO is working with national authorities to ensure appropriate investigation, reporting and containment of these outbreaks.

Sumber: http://72.14.235.132/search?q=cache:Ez_rJtGvTy0J:fkuii.org/tiki-download_wiki_attachment.php%3FattId %3D1062%26page%3DLalu%2520Ramadlan+diagnosa+pneumonia&hl=id&ct=clnk&cd=4&gl=id

PNEUMONIA I. PENDAHULUAN

Walaupun kini telah banyak kemajuan dalam berbagai bidang seperti teknologi, informasi, tetapi pengobatan infeksi saluran napas pneumonia masih merupakan masalah kesehatan masyarakat secara umum, baik pada anakanak, orang dewasa, maupun orang yang sudah lanjut usia. Pneumonia pada anak-anak paling sering disebabkan oleh virus pernafasan, Pneumonia pada orang dewasa paling sering disebabkan oleh bakteri, yang tersering yaitu bakteri Streptococcus pneumoniae (pneumococcus). Sedangkan pada orang lanjut usia sering disebabkan oleh Streptococcus pneumoniae, Hemophilus influenzae dan virus influenza B, tidak ditemukan bakteri gram negatif. Di Indonesia, pneumonia merupakan penyebab kematian nomor tiga setelah kardiovaskuler dan TBC. Pada artikel ini mencoba membahas tentang jenis-jenis pneumonia, selain itu tahap-tahap penyembuhan pneumonia. Baik mulai dari patofisologisnya, gejala, diagnosa serta pengobatannya. Dan dengan lebih terfokus pada penyakit pneumonia ini, memudahkan setiap orang mengetahui bagaimana gejala-gejala awal pneumonia serta penatalaksanaannya. II. PEMBAHASAN 1. Definisi Pneumonia adalah peradangan yang mengenai parenkim paru, distal dari bronkiolus terminalis yang mencakup bronkiolus respiratorius dan alveoli, serta menimbulkan konsolidasi jaringan paru dan gangguan pertukaran gas setempat. Pada pemeriksaan histologis terdapat pneumonitis atau reaksi inflamasi berupa alveolitis dan pengumpulan eksudat yang dapat ditimbulkan oleh berbagai penyebab dan berlangsung dalam jangka waktu yang bervariasi. Pneumonia di sebabkan oleh beberapa mikooganisme seperti virus, bakteri, parasit dan fungi.

Adapun cara mikroorganisme itu sampai ke paru-paru bisa melalui : 1. Inhalasi (penghirupan) mikroorgnisme dari udara yang tercemar 2. Aliran darah dari infeksi di organ tubuh yang lain 3. Migrasi (perpindahan) organisme langsung dari infeksi di dekat paru-paru. Yang lebih jarang, bakteri dapat mencapai parenkim paru melalui aliran darah dari bagian ekstrapulmonal (khususnya stafilokokus) ataupun dari penggunaan obat intravena. (Zuh Dahlan, Buku Ajar Ilmu Penyakit Dalam, 2006) Pneumonia di bagi menjadi dua jenis berdasarkan asal penyakit itu didapat. Apabila penyakit itu didapat di masyarakat, maka dikenal dengan istilah pneumonia komunitas atau community acquired pneumonia dan pneumonia nosokomial atau hospitality acquired pneumonia yang berarti penyakit itu didapat saat pasien berada di rumah sakit atau tempat pelayanan kesehatan. Pneumonia yang didapat di rumah sakit cenderung bersifat lebih serius karena pada saat menjalani perawatan di rumah sakit, sistem pertahanan tubuh penderita untuk melawan infeksi seringkali terganggu. Selain itu, kemungkinan terjadinya infeksi oleh bakteri yang resisten terhadap antibiotik lebih besar. Diagnosis pneumonia harus didasarkan pada pengertian patogenesis penyakit hingga diagnosis yang dibuat mencakup bentuk manifestasi, beratnya proses penyakit dan etiologi pneumonia. Cara ini akan mengarahkan dengan baik kepada terapi empiris dan pemilihan antibiotik yang paling sesuai terhadap mikrooganisme penyebabnya. Faktor-faktor resiko pneumonia antara lain : Usia yang ekstrem (sangat muda atau sangat tua), infeksi virus saluran nafas atas, merokok, penyalahgunaan etanol, kanker (khususnya kanker paru), penyakit kronis (misalnya diabetes militus, uremia), bedah abdomen atau toraks, dirawat di tempat tidur terlalu lama, Pipa endotrakeal atau trakostomi, fraktur tulang iga, terapi imunoupresif dan AIDS, malnutrisi, COPD dan aspirasi secret orofaringeal dll. (Sylvia Price Anderson. Patofisiologi edisi 6, 2005) 2. Etiologi Pada masa sekarang terjadi perubahan pola mikroorganisme penyebab ISNBA (Infeksi Saluran Napas Bawah Akut) akibat adanya perubahan keadaan pasien seperti gangguan kekebalan dan penyakit kronik, polusi lingkungan, dan penggunaan antibiotik yang tidak tepat hingga menimbulkan perubahan karakteristik pada kuman. Etiologi pneumonia berbeda-beda pada berbagai tipe dari pneumonia, dan hal ini berdampak kepada obat yang akan di berikan. Mikroorganisme penyebab yang tersering adalah bakteri, yang jenisnya berbeda antar Negara, antara suatu daerah dengan daerah yang lain pada suatu Negara, diluar RS dan didalam RS. Karena itu perlu diketahui dengan baik pola kuman di suatu tempat. Pneumonia yang disebabkan oleh infeksi antara lain : Bakteri Agen penyebab pneumonia di bagi menjadi organisme gram-positif atau gram-negatif seperti : Steptococcus pneumoniae (pneumokokus), Streptococcus piogenes, Staphylococcus aureus, Klebsiela pneumoniae, Legionella, hemophilus influenzae. Virus Influenzae virus, Parainfluenzae virus, Respiratory, Syncytial adenovirus, chicken-pox (cacar air), Rhinovirus, Sitomegalovirus, Virus herves simpleks, Virus sinial pernapasan, hantavirus.

Fungi Aspergilus, Fikomisetes, Blastomises dermatitidis, histoplasma kapsulatum. (hhtp:/medicastore.com/med/subkategori_pyk.Php,2007) Selain disebabkan oleh infeksi, pneumonia juga bisa di sebabkan oleh bahan-bahan lain/noninfeksi : 1. Pneumonia Lipid : Disebabkan karena aspirasi minyak mineral 2. Pneumonia Kimiawi : Inhalasi bahan-bahan organik dan anorganik atau uap kimia seperti berillium 3. Extrinsik allergic alveolitis : Inhalasi bahan debu yang mengandung alergen seperti spora aktinomisetes termofilik yang terdapat pada ampas debu di pabrik gula 4. Pneumonia karena obat : Nitofurantoin, busulfan, metotreksat 5. Pneumonia karena radiasi 6. Pneumonia dengan penyebab tak jelas. (Dasar-dasar Ilmu Penyakit Paru, 2006 Etiologi Pneumonia Komunitas Pneumonia komunitas banyak disebabkan oleh bakteri gram positif (pneumonia tipik) dan dapat disebabkan juga oleh bakteri atipik (pneumonia atipik).seperti : Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus viridans, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus haemoliticus, Enterobacter, dan Pseudomonas spp. Etiologi pneumonia nosokomial Bakteri adalah penyebab yang tersering dari PNO. Jenis kuman penyebab ditentukan oleh berbagai faktor antara lain berdasarkan imunitas pasien, tempat dan cara pasien terinfeksi. Kuman penyebab PNO sering berbeda jenisnya antara di ruangan biasa dengan ruangan perawatan intensif (ICU): infeksi melalui slang infus sering berupa Staphylococcus aureus sedangkan melalui ventilator Ps. aeruginosa dan Enterobacter. PNO bakteril dapat dibagi atas PNI onset awal dalam waktu kurang dari 3 hari yang sering pula didapat di luar RS, biasanya disebabkan oleh Streptococcus pneumonia (510%). M. catarr-halis (< 5%) dan H. influenza. PNO onset lanjut bila lebih dari 3 hari, Sering disebabkan oleh kuman Gr() aerob (60%) berupa K. Pneumonia. Entcrobacter spp, Serratia spp. P. aeruginosa: atau S. aureus ( 2025%). Kelompok kedua ini biasanya merupakan kuman yang resisten terhadap antibiotika. Kuman anaerob dapat ditemukan pada kedua kelompok (35%)(2) Akhir-akhir ini sejumlah kuman baru/oportunis telah menimbulkaninfeksi pada pasien dengan kekebalan tubuh yang rendah, misalnya Legionella, Chlamydia, Trachomatis, TB, M atypical, berbagai jenis jamur ( C. Albicans,Aspergillus fumigitus) dan virus. 3. Manifestasi klinis Dapat berupa gambaran pneumonia bakteril akut yang di tandai oleh : 1. Demam (390-40C) dan menggigil 2. Batuk yang mengeluarkan dahak yang berwarna kuning, hijau, keperangan atau mungkin mengandung darah (mukus di keluarkan dari paru-paru) 3. Sakit dada terutama saat batuk atau saat menarik nafas yang dalam 4. Bernafas dengan cepat dan pendek, hilang selera makan/ perut meragam

5. Berpeluh dan muka kelihatan merah dan batuk. 4. Diagnosis Penegakan diagnosis dibuat dengan maksud pengarahan kepada pemberian terapi yaitu dengan cara mencakup bentuk dan luas penyakit, tingkat berat penyakit, dan perkiraan jenis kuman penyebab infeksi. Diagnosis didasarkan pada riwayat penyakit yang lengkap, pemeriksaan fisis yang teliti dan pemeriksaan penunjang. Diagnosis pneumonia komunitas didapatkan dari anamnesis, gejala klinis, pemeriksaan fisik, foto toraks dan laboratorium. Anamnesis Ditujukan untuk mengetahui kemungkinan kuman penyebab yang berhubungan dengan faktor infeksi : a. Evaluasi faktor pasien/ predisposisi : PPOK (H. Influenza) penyakit kronik, kejang atau tidak sadar, penurunan imunitas, pneumocystic carini, CMV, legionella, jamur, mycobacterium, kecanduan obat bius b. Bedakan lokasi infeksi : PK, rumah jompo, PN, gram negatif c. Usia pasien : bayi, muda, dewasa d. Awitan : cepat, akut dengan rusty coloured sputum;perlahan dengan batuk, dahak sedikit. Pemeriksaan Fisik a. Awitan akut biasanya oleh kuman pathogen seperti Steptococcus pneumoniae, Streptoccus spp, Staphylococcus. Pneumonia virus di tandai dengan mialgia, malaise, batuk kering dan non productive b. Awitan lebih insidious dan ringan pada orang tua/imunitas menurun akibat kuman yang kurang pathogen/oportunistik c. Tanda-tanda fisis pada tipe pneumonia klasik bisa didapatkan berupa demam, sesak nafas, tanda-tanda konsolidasi paru d. Warna, konsistensi dan jumlah sputum penting untuk di perhatikan. Pemeriksaan Penunjang a. Pemeriksaan Radiologis : foto toraks PA/lateral, gambaran infiltrat sampai gambaran konsolidasi (berawan), dapat di sertai air bronchogram. b. Pemeriksaan Laboraturium : terdapat peningkatan jumlah leukosit lebih dari 10.000/ul, kadangkadang dapat mencapai 30.000/ul. c. Untuk menentukan diagnosis etiologi dilakukan pemeriksaan biakan dahak, biakan darah dan serologi. d. Analisis gas darah menunjukkan hipoksemia pada stadium lanjut asidosis respiratorik. Diagnosis pasti pneumonia komunitas ditegakkan jika pada foto toraks terdapat infiltrat baru, atau infiltrat progresif ditambah dengan dua atau lebih gejala seperti batuk-batuk bertambah, perubahan karakteristik dahak atau purulen, suhu tubuh lebih dari 38oC (aksila) atau riwayat demam, pada pemeriksaan fisik ditemukan tanda-tanda konsolidasi, suara napas bronkhial, ronkhi, dan leukosit >10.000 atau <4500 /uL. Pada pasien usia lanjut atau dengan respon imun rendah, gejala pneumonia tidak khas dan dapat berupa gejala non-pernafasan seperti pusing, gagal tumbuh (failure to thrive), perburukan dari penyakit yang sudah ada sebelumnya, dan pingsan. Biasanya ditemukan frekuensi nafas bertambah cepat (takipnea) tetapi demam sering tidak ada. Penilaian derajat keparahan

penyakit pneumonia komunitas dapat dilakukan dengan menggunakan sistem skor menurut hasil penelitian pneumonia Patient Outcome Research Team (PORT). Diagnosis pneumonia nosokomial dari CDC : 1. Ronkhi atau Dullness pada perkusi torak. Ditambah salah satu a. Onset baru spurum purulen atau perubahan krakteristiknya b. Isolasi kuman dari darah c. Isolasi dari bahan aspirasi transtrakheal,au sapuan bronkhus. 2. Gambaran radiologik berupa infiltrat baru atau yang pogresif, kosolidasi, kavitasi, atau efusi pleura : a. Isolasi virus atau deteksi antigen virus dari sekret respirasi b. Titer antibodi tunggal yang diagnostik (IgM) atau peningkatan 4 kali titer IgG dari kuman c. Bukti histopatologik dari pnumonia. 3. pasien 12 tahun dengan 2 dari gejala-gejala berikut : apnea, tachypnea, bradycardia, wheezing, ronkhi atau batuk. Dan di sertai salah satu dari peningkatan produksi sekresi respirasi atau salah satu kriteria no 2 di atas. 4. Pasien 12 tahun yang menunjukkan infiltrat baru atau progresif, kavitasi, konsolidasi, efusi pleura pada foto torak. 5. Pencegahan

Pneumonia Komunitas (community acquired pneumonia) Diluar negeri dianjurkan pemberian vaksinasi influenza dan pneumokokus terhadap orang dengan resiko tinggi, misalnya pasien dengan gangguan imunologis, penyakit berat termasuk penyakit paru kronik, hati, ginjal dan jantung. Disamping itu vaksinasi juga diberikan untuk penghuni rumah jompo atau rumah penampungan penyakit kronik, dan usia diatas 65 tahun. Pneumonia Nosokomial (hospitality acquired pneumonia) Pencegahan PN berkaitan erat dengan prinsip umum pencegahan infeksi dengan cara penggunaan peralatan invasif yang tepat. Perlu dilakukan terapi agresif tethadap penyakit pasien yang akut atau dasar. Pada pasien yang gagal organ miultipel, skor Aphace-II yang tinggi dan penyakit dasar yang dapat berakibat fatal perlu diberikan terapi pencegahan. Terdapat berbagai factor terjadinya PN. Dari berbagai resiko tersebut beberapa factor penting tidak bisa dikoreksi. Beberapa dapat dikoreksi untuk mengurangi terjadinya PN, yaitu antara lain dengan pembatasan pemakaian selang nasogastrik atau endotrakeal atau pemakaian obat sitoprotektif sebagai pengganti antagonis H2 dan antasid. 6. Penatalaksanaan Terapi pneumonia dilandaskan pada diagnosis berupa AB untuk mengeradikasi MO yang diduga sebagai kausalnya. Dalam pemakaian AB harus dipakai pola berfikir Panca Tepat yaitu diagnosis tepat, pilihan AB yang tepat dan dosis yang tepat, dalam jangka waktu yang tepat dan pengertian patogenesis secara tepat. AB yang bermanfaat untuk mengobati kuman intraseluler seperti pada PA oleh kelompok M. Pneumonia adalah obat yang bisa berakumulasi intraseluler disamping ekstraseluler, seperti halnya obat golongan makrolid. Dapat dijumpai beberapa Pendekatan terapi :

a. Anjuran American Thoracic Society ATS membagi PK untuk terapi empiris atas 4 kelompok berdasarkan usia, adanya penyakit dasar dan tempat rawat pasien. Untuk PK <60 tahun, tanpa penyakit dasar dianjurkan sefalosporin generasi 2, betalaktam, antibetalaktamase atau makroid. b. Berdasarkan diagnosis empirik kuman penyebab Tabel 1 : Antibiotika pada pneumonia komunitas. Patogen Potensial Pneumoccus Haenophillus Stapyloccus Legionella Mycroplasma Anaerob Kuman Gr (-) Virus Kuman opportunis Antibiotik Penisilin, sefalosporin, makrolide Sefalosporin agen 3, amoxyc/clvulanic Flucloxacilin, sefalosporin, makrolide makrolide Tetrasiklin, makrolide Metronidazole Sefalosporin, aminoglikosida Ribavirin Sesuia diagnosis

Dalam memilih AB untuk PK perlu diingat : a. Sebanyak 69-100% kuman penyebab PK berupa Hemophilus spp, Staphylococcus sp menghasilkan B laktamase b. Konsentrasi makrolide di jaringan dan paru lebih tinggi dari plasma hingga kadarnya dapat mencapi level yang cukup untuk mikroplasma, Hemophilus dan Staphylococcus. AB yang dipilih harus mencakup kedua tipe kuman, karena itu pada PK yang berobat jalan dapat digunakan makrolid. (Zuh Dahlan, Buku Ajar Ilmu Penyakit Dalam, 2006)

DAFTAR PUSTAKA 1. Dahlan, zul. 2006. Buku Ajar Ilmu Penyakit Dalam. Jakarta : Balai pemerbit FKUI 2. Price, Sylvia Anderson. 2005. Patofisiologi edisi 6. Jakarta : EGC 3. hhtp:/medicastore.com/med/subkategori_pyk.Php?idktg 4. Alsagaff, hood,abdul Mukty. 2006. Dasar-dasar Ilmu Penyakit Paru. Surabaya: Airlangga University Press. 5. http://www.ashanet.org/seattle/events/tsunamirelief/resources/reliefworkers-bahasa-indonesian.pdf 6. http://www.infosihat.gov.my/PDF%20Penyakit/PNEUMONIA.pdf