Anda di halaman 1dari 9

Riset Kesehatan Dasar.

, 2013, Period Prev =-alence Pneumonia Balita, dan Prevalensi


Pneumonia Menurut Provinsi, Indonesia 2013, Badan Penelitian dan Pengembangan
Kesehatan Kementrian Kesehatan RI, Jakarta
Menurut Riset Kesehatan Dasar tahun 2013 periode prevalensi dan prevalensi
pneumonia tahun 2013 sebesar 1,8 persen dan 4,5 persen. Lima provinsi yang mempunyai
insiden dan prevalensi pneumonia tertinggi untuk semua umur adalah Nusa Tenggara Timur
(4,6% dan 10,3%), Papua (2,6% dan 8,2%), Sulawesi Tengah (2,3% dan 5,7%), Sulawesi
Barat (3,1% dan 6,1%), dan Sulawesi Selatan (2,4% dan 4,8%). Period prevalensi pneumonia
balita di Indonesia adalah 18,5 per mil. Balita dengan pneumonia yang berobat hanya 1,6 per
mil. Lima provinsi yang mempunyai insiden pneumonia balita tertinggi adalah Nusa
Tenggara Timur (38,5), Aceh (35,6), Bangka Belitung (34,8), Sulawesi Barat
(34,8), dan Kalimantan Tengah (32,7). Insidens tertinggi pneumonia balita terdapat pada
kelompok umur 12-23 bulan (21,7).
Bradley, John et al., 2011, The Management of Community-Acquired Pneumonia in Infants
and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric
Infectious Diseases Society and the Infectious Diseases Society of America, Infectious
Diseases Society of America: San Diego
1. Pemberian ASI eksklusif sampai usia 6 bulan dan dilanjutkan dengan pemberian
PASI hingga usia 2 tahun dapat menurunkan kejadian dan keparahan dari pneumonia
dan diare
2. Pemberian vaksin terhadap Streptococcus pneumoniae dan Haemophilus influenzae
tipe b, yang merupakan dua bakteri yang paling sering menyebabkan pneumonia pada
anak-anak.
3. Pemberian vaksin campak dan pertusis secara nyata mengurangi angka kejadian
pneumonia dan kematian pada anak-anak.
4. Bayi dengan resiko tinggi diberikan profilaksis berupa antibodi monoklonal untuk
mencegah atau mengurangi resiko pneumonia berat yang disebabkan oleh respiratory
syncytial virus (RSV).
5. Menjaga kebersihan lingkungan, penyediaan air bersih, kebiasaan memasak air
sebelum diminum, kebiasaan mencuci tangan dengan sabun.
6. Mengurangi jumlah polusi udara disekitar tempat tinggal
Faktor Resiko
Pranatal Perinatal Postnatal
Gizi ibu saat hamil yang
buruk
Ibu perokok
Ibu alkoholik
Infeksi pada ibu


BBLR
Asfiksia
Penggunaan ventilator
Tidak mendapatkan ASI
dini
Malnutrisi
Polusi udara didalam
maupun diluar rumah
Tidak mendapatkan ASI
ekslusif
Tidak mendapatkan
Imunisasi
Sanitasi dan heigiene
lingkungan yang buruk
Jumlah penduduk yang
padat




Don, Massimilliano., 2009, Community-Acquired Pneumonia,University of Tampere: Italy
Definite Risk Factor Likely Risk Factor Possible Risk Factor
Gizi ibu hamil yang buruk
Malnutrisi
BBLR
Tidak mendapatkan imunisasi
Polusi udara indor
Jumlah penduduk yang padat
Orang tua yang merokok
dan alkoholik
Defisiensi zink
Menderita penyakit lain
(diare, Penyakit jantung,
asma)
Defisiensi vitamin A
Polusi udara outdor
Curah hujan yang tinggi
Udara yang dingin
Sanitasi lingkungan yang
buruk

M, Korppi., 1993, White blood cell and differential counts in acute respiratory viral and
bacterial infections in children, Scand Journal Infection Disease, no. 25, vol. 4, hh.435-40.

WBC and granulocyte counts were higher in patients with bacterial infection than in those with viral
infection. Lymphocyte counts, by contrast, had no such aetiological association. The 95% confidence
limits for WBCs and granulocytes distinguished bacterial and pneumococcal cases completely from
viral cases with no bacterial involvement. The sensitivity of WBC counts, as well as granulocyte or
lymphocytes counts, for distinguishing bacterial from viral cases was low at all cut-off levels.
Specificity, in contrast, was 86% and 95% for WBCs at the cut-off levels 15.0 and 20.0 x 10(9)/l, and
84% and 97% for granulocytes at the cut-off levels 10.0 and 15.0 x 10(9)/l, respectively. It is
concluded that high WBC and granulocyte counts are clear evidence of the bacterial aetiology of
respiratory infection, but low or normal values do not rule it out. Lymphocyte counts are of no value for
distinguishing between viral and bacterial infections.
WBC count >15,000/mm3 revealed that neither a polymorphonuclear count of >10,000/mm3
(>66% segmented forms) nor a band count of >500/mm3 was associated with an increased
likelihood of occult bacterial infection. To improve the diagnostic utility of the CBC, other
studies have examined individual components of the white blood cell differential count
(TaBlE 1). In particular, the use of the absolute neutrophil count (ANC) has been proposed as
a superior marker of serious bacterial infection.
A review of 6579 outpatients aged 3 to 36 months presenting to the emergency department
with temperatures of 39C or higher showed an ANC of >10,000/mm3 as more predictive of
occult pneumococcal bacteremia than an elevated WBC count (>15,000/mm3) alone.
Another retrospective review of more than 10,000 patients aged 3 to 36 months presenting to
the emergency department used logistic regression to identify predictors of bacteremia. In
this study, ANC (>9500/mm3) and WBC (>14,300/mm3) were of equal sensitivity (75%) and
specificity (75%) in identifying serious bacterial infection.
Finally, the band count alone does not accurately predict serious bacterial infection. In
summary, the CBC cannot be used in isolation to differentiate bacterial from viral illness. The
CBC can, however, augment clinical data from the history and physical examination to
predict the likelihood of serious bacterial illness. As a result, numerous diagnostic criteria,
each incorporating elements of the CBC, have been developed in an attempt to accurately
differentiate bacterial from viral illness in acutely febrile patients, most typically children
(TaBlE 2). These criteria differ by age of the patient, clinical testing recommendations,
indications for antibiotic therapy, as well as WBC cutoffs.
The American College of Emergency Physicians recommends considering antibiotic therapy
for previously healthy, well appearing children ages 3 to 36 months who present with a fever
with out a clinical source and a WBC count >15,000/mm3
The University of Cincinnati Evidence-Based Clinical Practice Guidelines for fever of
uncertain source in children ages 2 to 36 months recommends obtaining a CBC for any child
who is ill appear ing or at high risk for bacteremia (determined by the clinicians judgment).
A WBC of 15,000/mm3 or ANC >10,000/mm3 provide support for antibiotic therapy.
The 1993 American Academy of Pediatrics guidelines for fever 39C with out a source in
children ages 3 months to 3 years recommends a CBC; if the WBC count 15,000/mm3, they
recommend a blood culture and treatment with antibiotics pending culture results.
It is important to note that in the age of Haemophilus influenza and Streptococcus pneumonia
vaccination, the rate of occult bacteremia in febrile children presenting without a source has
fallen from 3% to 10% to 1% or less.
A lower prevalence reduces the utility of routine CBC or blood culture in the evaluation of
immunized, febrile children. Parameters such as procalcitonin, interleukin-6, interleukin-8,
interleukin-1 receptor antagonist and C-reactive protein show future promise as biochemical
markers for identifying serious bacterial infections.





























WBC dan jumlah granulosit lebih tinggi pada pasien dengan infeksi bakteri dibandingkan
pada mereka dengan infeksi virus . Untuk leukosit dengan nilai cut-off 15,0 dan 20,0 x 10
3

memiliki spesifisitas 86% dan 95% , untuk granulosit di tingkat cut-off 10,0 dan 15,0 x 10
3

memiliki spesifisitas 84 % dan 97 % sehingga dapat disimpulkan bahwa WBC tinggi dan
jumlah granulosit tinggi merupakan tanda infeksi bakteri saluran pernapasan. Jumlah limfosit
tidak dapat membedakan antara infeksi virus dan bakteri .
WBC lebih dari 15.000/mm3 dengan jumlah polimorfonuklear lebih dari 10.000/mm3 ( > 66
% tersegmentasi ) atau jumlah band > 500/mm3 dikaitkan dengan kemungkinan peningkatan
infeksi bakteri. Penggunaan jumlah neutrofil mutlak (ANC) telah diusulkan sebagai penanda
untuk infeksi bakteri yang serius . ANC lebih dari 10.000/mm3 merupakan penanda infeksi
bkteri dengan nilai sensitivitas (75%) dan spesifisitas (75%).