Infeksi Saluran

Pernafasan Atas

Simptom &Tanda-tanda utama

Batuk
Sputum
Haemoptysis
Dyspnoe (Sulit nafas)
Tachypnoea (Bernafas cepat)
Wheezing (Pengeluaran udara dr bronchi dan bronchiole yg
sdh sebagian rusak)

Sakit di pleura

1. Batuk

Hampir semua symptom penyakit

pernafasan
Mungkin muncul krn stimulus dr
mukosa di tiap bag dr resp tract
Reflek batuk terjadi di larynx
berupa:

c) Produktif dan bekaitan dg

sputum kental dan agak
susah keluar
Bronchitis kronis
Astma
Bisa tiba2 muncul dan sulit di stop

a) Batuk kerin dan tdk produktif

Tahap awal dari Cold
Spt menyalak di larynx (Laryngitis,
pertussis), croup, batuk merusak
Asthma (Penyempitan bronchus)
ACEI

b) Kering di awal lalu produktif

Berkaitan dg sputum yg agak encer,
umumnya infeksi bakteri
Pneumonia
Bronchitis akut
Bronchirtasis

d) Lainnya
Batuk syncope atau batuk Cheyne Stokes
Death Rattle

2.Sputum / Riak

3. Haemoptysis

Kuantitas dan character penting:4

Seous: jernih atau pink dan
frothy
Spt Abu2
Purulent umumnya bakteri
Mucopurulent

Mengeluarkan darah atau

secercah darah dalam sputum
Jangan terkecoh dg darah dari
lambung Haematemesis atau
epistaxis
Berfariasi dari frank
haemoptysis (carcinoma) ke ru
sty sputum (pneumococcal
pneumonia-haemoglobin)
Haemoptysis umumnya dari
infeksi akut (Pneumonia)

Sputum infeksi berwarna tgt

bakteri yg menginfeksi, trkadang
ada darah
Viskositas dan bau

4. Dyspnoe (Sulit
bernafa) Infeksi akut,
meningkatnya resistensi nafas,
menurunnya fleksibilitas paru2

5. Tachipnoea (Bernafas

pendek dan cepat)

Asthma, Asidosis, CHF,
anemia

yg mungkin akibat:

Kerusakan jalan nafas

(Asthma)
Kerusakan dead space spt pd
(Pneumonia dan emphysema)
Gagal jantung
Lainnya: Anemia, emboli pd
pulmo, asidosis

7. Nyeri pleura
Inflamasi atau distorsi dr membrane
pleura

6. Wheezing (Keluarnya

udara lewat bronchi atau

bronchiole yg sebagian
rusak)
Bisa kering (rhonchi) atau
lembab (spt ada suara
cairan)
Asthma, bronchitis
Crepitasi (berkaitan dg
adanya air di paru2, spt CHF)

Site of respiratory tract Infection

Umumnya hanya URTI
LRTI umumnya jarang
dan yg mengancam
kehidupan
Patologi:
Inflamasi
Meningkatnya jml pathogen
dlm sel epitel atau sekresi
resp
Sekresi IgA jika
sebelumnya ter ekspos
Jika bakteri, pyogenesis

Acute Coryza ( Common Cold)

Acute Coryza ( Common Cold)

Simptom:
Mirip Rhinitis dan symptom mata (Conjunctivis & Photofobia)
Penyebab selalu virus, banyak strain, tp yg utama adl rhinoviruses,
coronaviruses, parainfluenza)
Rx : Atasi komplikasi sekunder
Cough suppressants
Antipyretic & analgesic; Acetaminophen, AINS(NSAID)

Swine influenza (H1N1)

Salah satu infeksi dari berbagai tipe Swine influenza viruses

MANAGEMENT
Annual vaccination
Stay at home
Get plenty of rest
Drink a lot of liquids
Do not smoke or drink alcohol

Diagnosis
Blood Test
Chest X-Ray
Nose or throat swab

Treatment
Antivirals e.g. Zanamivir and oseltamivir
Amantadine and Rimantadine.

Faringitis

Faringitis?
Inflamasi pada faring
akibat infeksi
Paling banyak penyebab
sore throat
Simptom: Fever,
headache, joint pain and
muscle ashes, skin
rashes, swollen lymph
nodes in the neck
Penyebab infeksi adalah:
Sterptokokus dan virus
Sering muncul bersamaan
dengan tonsilitis

Case 1: Pharingitis
Kasus Pharyngitis
13 tahun anak laki laki mengalami gatal tenggorokan dengan sulit
menelan, demam, nafsu makan turun, lemas. Orang tua bercerita
kalau anaknya sering mengalami tonsillitis (5-6 kali) saat 5-6
tahun. Akan tetapi selanjutnya tidak lagi dan hanya cold biasa.
Pada pemeriksaan tonsil, bengkak dan merah dg pus putih.
Pharynx dan lidah inflamasi. Lymph node membesar dan lagak
lembek. Suara serak, suhu 39C. Kultur bakteri dan menentukan
WBC di lakukan. Selagi menunggu hasil, pasien dianjurkan
bedrest, suplay cairan dan resep amoxicillin 250mg 5 hari. 2 hari
kemudian hasil menyatakan : beta haemolytic streptoccus dan
WBC tinggi. Pasien mengeluh sakit perut dan mual.

1.

Jelaskan Anatomi dan fungsi

tonsil?
Ada cincin lymphoid di mulut
(Tonsil, adenoid, limph node
di bawah llidah) yg bisa sbg
tempat lokalisasi infeksi
virus, mencegah viraemia
(tdk seefektif infeksi bakteri
spt: B-haemolytic Strep)
Pengeringan limph node dpt
melibatkan infeksi

2. Simptom apa yg terlihat pd

pasien ini? Apa bedanya dg
pharyngitis sederhana?
Diagnosisi apa yg berbeda pada
kasus ini dan mengapa?
Pharynx + tonsil umumnya
terlibat dg virus (60%)
Exudat putih artinya bukan virus
Mungkin conjunctivis juga (Viral)
Pharingitis bakteri: Strep
pyogenes -> toxin
Muncul lymphadenopathy:
beberapa memproduksi
erythrogenic toxin (Scarlet fever)

Perbedaan pharyngitis bakteri dan virus

Differential between bacterial and viral Pharingitis
Bacterial

Viral

High

Low(37,7C)

Usually (Headache)

No

Severe

Mild

Exudate

Usually(Purulen)

Not usually

Location

Tonsilar

Diffuse in pharynx

Enlarge n tender

Less effected not tender

Other resp involvement

no

Often(Cough,nasal)

Secondary involvement

Otitis media

Slower

Sudden

Slower

General illness (Toxic)

Dysphagia

Lymph nodes

Onset

Other course of sore throat

Diphteria -> myocarditis
(Msh jg bayak yg tdk
imunisasi)
Malnutrition, poor dental
hygine
Infection mononucleus
(viral) caution
amoxicillin administration
(resembles bacterial
infection)

3. What are recommended

for this disorders? What
alternatives are available
for penicillin allergic
patients? How long shold
therapy be continued?
Rx Penicillin V recommended
Erythromycin
All treatment 10 days
minimum

Tonsilitis

Acute Upper Respiratory Tract

Infections in Children:
Tonsillitis:
What is tonsillitis?
Tonsillitis is a viral or bacterial infection in the throat
that causes inflammation of the tonsils. Tonsils are
small glands (lymphoid tissue) in the pharyngeal
cavity.
In the first six months of life tonsils provide a useful
defense against infections. Tonsillitis is one of the
most common ailments in pre-school children, but it
can also occur at any age.

Tonsilitis ~ pharyngitis
Uncommon in children < 1 yr
Occuring between 4-7 yr of age
Causative: Viruses or bacterial (grup A beta hemolytic
streptococcus)

4. Under what circustances circumstances should

tonsillectomy be considered?
Tonsilectomy only required if chronic recurring infection
occur, complication with obstruction. because of the
problem of excessive blood loss & the possibility of regrowth or hypertrophy of lymphoid tissue, in young
children.

5. What complication can arise from this condition?

- Adenoidal obstruction of breathing
- Can act as immune complex trigger causing glomerulus
nephritis and rheumatic fever
- Complication involves Staph infection producing a
peritonsilar absess treatment require surgical drainage

Advice and treatment:

Encourage bed rest.
Introduce soft liquid diet according to the
child's preferences.
Provide cool mist atmosphere to keep the
mucous membranes moist during periods of
mouth breathing.
Warm saline gargles & paracetamol are
useful to promote comfort.
If antibiotics are prescribed, counsel the
child's parents regarding the necessity of
completing the treatment period

Anatomic position of
Eustachian tube in adult

Otitis Media

Otitis media:
Background:
Otitis media (OM) is the second most
common disease of childhood, after
upper respiratory infection (URI).

Definition:
It is defined as an inflammation of the
middle ear.

Etiology of (O .M) : Obstruction of Eust. Tube by edematous

mucosa during URI or enlarged adenoid.

Eustachian tube obstruction lead to

high ve pressure in the middle ear
cavity lead to occurance of
trasudative middle ear (ME) effusion.
Organisms contaminate the ME
effusion..otitis media occur.

 Pathophysiology:
Otitis media is the result of dysfunctioning
Eustachian tube.
The Eustachian tube, which connects the middle ear
to the naso-pharynx, is normally closed, narrow &,
directed downward, preventing organisms from the
pharyngeal cavity from entering the middle ear.
It opens to allow drainage of secretions produced by
middle ear mucosa & to equalize air pressure
between the middle ear & outside environment.
Impaired drainage causes the pathological condition
due to retention of secretion in the middle ear.

 Acute Otitis media:

Predisposing factors of developing otitis media in
children:
In children, developmental alterations of the Eustachian
tube (short, wide, & straight), an immature immune
system, and frequent infections of the upper
respiratory mucosa all play major roles in AOM
development.
Furthermore, the usual lying-down position of infants
favors the pooling of fluids, such as formula.

Therapeutic management of
otitis media:
Administration of antibiotic (Ambicillin
or Amoxicillin).
Anti-inflammatory (analgesic &
antipyretic).

Antibiotics
First choice
Amoxicilline
Trimet./Sulfamethoxazole
Second choice
Amoxicilline/clavulanate
Erythromycin
Reurrent AOM prophylaxis
Sulfisoxazole
Amoxicilline
/ 42

40 mg/kg/day, 3 doses
8mg TM/40mg SMX/kg 2 dose
45 mg/kg/day, 2 doses
40-50 mg/kg/day, 3 doses
75 mg/kg/day, single dose 3-6 mo
20 mg/kg/day, sinle dose 3-6 mo
30

Antibiotics NOT to be used

/ 42

Tetracycline
Sulphonamides
Co-trimoxasole
Cloramphenicole
Aminoglycosides

31

Complications of O.M
Extr-acranial complication:

Hearing loss
Chronic suppurative O.M
Adhesive otitis
Facial palsy
Perforation
Mastoiditis
Tympanosclerosis

Intra-cranial complication:

Meningitis.
Focal encephalitis.
Brain abscess.
Sinus thrombophlebitis

Epiglotitis and Croup

Croup syndrome

Croup

Aetiology

Pathophysiology

Clinical features

History

Physical

Basic management of acute upper

airways obstruction

Management

Acute epiglottitis

Aetiological agents

Pathophysiology

Clinical presentation
History

Physical

Treatment and management

Croup vs Epiglottitis