Laporan Kasus Tonsilitis

Oleh: Richard A Lantemona

Pembimbing : R.S. Robert Wolter Monginsidi

dr. Giselle Tambayong Manado
Desember 2017
 Laporan Kasus
Identitas
Nama : ST
Umur : 5 tahun
Jenis kelamin : Laki-laki
Bangsa/suku : Manado
Agama : Kristen
Alamat : Paniki Bawah
Tanggal Pemeriksaan : 12 Desember 2017
 Anamnesis
Keluhan utama : Demam
Demam beserta batuk dan nyeri menelan dialami
sejak ± 3 hari yang lalu, hilang dengan obat
demam lalu timbul lagi, mual (-), batuk (+), lendir
(+) warna putih, nyeri menelan (+). Pasien malas
makan dan minum.
BAB & BAK : biasa
Riwayat penyakit sebelumnya : (-)
Riwayat penyakit keluarga : (-)
 Pemeriksaan Fisis
Status Present :
BB : 24 kg
TB : 90 cm
Sakit sedang/composmentis/gizi cukup
Tanda vital :
Tekanan darah : 110/70 mmHg
Nadi : 110 x/menit
Pernapasan : 22 x/menit
Suhu : 380C (axilla)
Pemeriksaan fisis
Kepala : anemis (-), sianosis (-), ikterus (-)
Leher : Tonsil T3-T3, hiperemis, detritus (+)
Thorax : BP: bronko vesikuler, BT : Rh -/-, Wh -/-
Cor : SI/II reguler, murni
Abdomen : Peristaltik (+) kesan normal
Ekstremitas : tidak ada kelainan
Darah Lengkap 12 Desember 2017

Leukosit 10400
Eritrosit 4,71
Hb 7,6
Hct 36,6
MCV 77,7
MCH 16,1
MCHC 20,8

Platelet 320.000
Limfosit17,0 %
Mxd 14,8%
Neut 68,2%
Lym 1.800
Mxd 1.500
Neut 7.100
 Tatalaksana
Farmakologis:

Paracetamol syrup 3x25mg

Amoxicilin 50mg/kgBB dibagi 3 dosis
±25kg x 50mg/kgBB = 1250 dibagi 3 dosis
 3x400mg 5 hari
Non farmakologis:

Istirahat cukup
Makan makanan yang bersih dan hygine
Menghindari makan makanan yang terlalu
panas/dingin
Mencuci tangan sebelum makan
Tinjauan Pustaka
 Tonsil berperan dalam sistem imun manusia dalam
pertahanan terhadap antigen karena mengandung
limfosit-T, makrofag, dan limfosit-B germinal.

Tonsil merupakan tempat sistem mucosa associated

lymphoid tissue (MALT) yang pertama dan paling
mudah dicapai pada manusia.

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Karena peran imunitas, secara fisiologis tonsil
palatina terus mengalami hiperplasi sampai usia
6 tahun lalu mulai mengalami regresi sampai
usia 12 tahun.
Vaskularisasi dari tonsil memiliki aliran darah
yang kuat, terdiri dari arteri lingual, arteri
ascending faringeal, dan arteri palatina
ascending dan descending.

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Tonsilitis akut didefinisikan sebagai tonsilitis viral
atau bakterial dengan odinofagia, yang bisa
disertai dengan pembengkakan dan kemerahan,
eksudat tonsil, limfadenopati servikal dan demam.

Diagnosis dari tonsilitis akut dapat dibuat secara

klinis. Pemeriksaan darah, smears, atau bukti viral
tidak harus dilakukan pada sebagian besar kasus

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Meskipun sering kali terjadi bersamaan, pada
tonsilitis viral biasanya pasien mengeluhkan nyeri
menelan,batuk, demam, dan rinorea.

Penderita dengan tonsilitis bakterial cenderung

mengalami nyeri menelan, pembengkakan nodus
limfatik, deposit/eksudat tonsilar dan demam
>38,3oC.

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Terapi
• Antibiotik
• Suportif
 Antibiotic
In clinically definite or proven bacterial tonsillitis
associated with distress, antibiotic therapy using a
beta-lactam antibiotic is justified.

Betalactam antibiotic therapy provides relatively

reliable protection against the dreaded rheumatic
fever and glomerulonephritis, which often leads
especially in third world countries to arthritis,
myocarditis and death. Some studies have shown that
antibiotic therapy can prevent sequelae such as
peritonsillar abscesses, acute otitis and sinusitis

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 A recent Cochrane analysis from 2013 showed the
effectiveness of different antibiotics in acute
(streptococcal) tonsillitis. The penicilline, in particular
in children and adolescents, show the greatest
benefit at the lowest cost.

Cephalosporines are, however, more effective in

children under 12 years of age and for chronic
recurrent tonsillitis, as they can eradicate more
strains of streptococci.
Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -
Head and Neck Surgery 2014, Vol. 13.
 With regard to the reduction of the course of
the disease and the reduction of the symptoms,
the short-term therapy with azithromycin (20
mg/kg) for three days or clarithromycin and
cephalosporin for five days is equal to the long-
term penicillin therapy with better compliance.

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Steroid
Steroids (I.M.or I.V.) in children and adolescents
also show a significant improvement in symptoms
with minimal side effects and no negative effects on
disease Progression.
The best results were seen in proven streptococcal
pharyngitis for dexamethasone (10 mg), as well as
betamethasone (8 mg) and prednisolone (60 mg)
with a clear reduction in the pain and feeling of
illness, both in acute tonsillitis, and pharyngitis or
sore throat

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Analgesics
NSAID have been used successfully for pain
relief in children for over 40 years. For acute
tonsillitis, ibuprofene shows the highest efficacy
with minimal side effects compared with
paracetamol and acetylsalicylic acid (ASA).

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -

Head and Neck Surgery 2014, Vol. 13.
 Suportif
Antiseptic mouthwashes with chlorhexidine or
benzydamine have been tested in a study from
Turkey (double-blind and placebo-controlled) and
showed symptom improvement there in children
and adults.

Typical herbal gargles contain sage, thyme and

chamomile. They lubricate and maintain the
mucous membranes. However, many contain
ethanol as an extraction solvent and are not
approved for children <12 years old.
Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -
Head and Neck Surgery 2014, Vol. 13.
 Group A Streptococcus (GAS) causes acute
tonsillopharyngitis in children, and approximately
20% of this population are chronic carriers of GAS.
Antibacterial therapy has previously been shown to
be insufficient at clearing GAS carriage.
Our study revealed the presence of GAS within the
tonsillar reticulated crypts of approximately one third
of children who underwent tonsillectomy for either
adenotonsillar hypertrophy or recurrent GAS
tonsillopharyngitis at the Wake Forest School of
Medicine.
Roberts AL, Connolly KL, Kirse DJ, Evans AK, Poehling KA, Peters TR, et al. Detection of group A
Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal
carriage. BMC Pediatrics 2012, 12:3
Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -
Head and Neck Surgery 2014, Vol. 13.
Peritonsillar abscess is a potentially life-
threatening situation and can rapidly spread to
the neck soft tissues, the primary therapy in
children and adults is urgent and surgical.
Whether the abscess is needle aspirated, incised
or treated by tonsillectomy does not matter.
 Neutrophil-to-Lymphocyte Ratio (NLR) can be
used as a predictor for deep neck space
infections (DNSIs) that occur as a complication
of acute bacterial tonsillitis in the pediatric
population.

Baglam T, Binnetoglu A, Yumusakhuylu AC, Gerin F, Demir B, Sari M. Predictive value ofthe
neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute
bacterial tonsillitis.International Journal of Pediatric Otorhinolaryngology 79 (2015) 1421–1424
 Indikasi tonsilektomi:

Obstructive sleep-related breathing disorders

Tonsilitis rekuren
>7 x/thn atau
>5x/thn utk 2 thn
>3x/thn utk 3 thn
Abses peritonsil
Demam periodik
Stomatitis aphthous

Gysin C. Indications of Pediatric Tonsillectomy.S. Karger AG, Basel. 2013;75:193-202.

Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -
Head and Neck Surgery 2014, Vol. 13.
 In general, acute tonsillitis runs its course without
complications and heals within three to four days.
Rare but serious complications after strep tonsillitis
are the glomerulonephritis and rheumatic fever,
which triggers cardiomyopathies and rheumatic-
like joint pain.

Long-lasting (10 days) antibiotic therapy with

penicilline or cephalosporins can reduce the
frequency of both these complications by 70%
Stelter K. Tonsillitis and sore throat in children.GMS Current Topics in Otorhinolaryngology -
Head and Neck Surgery 2014, Vol. 13.
Terima Kasih