Impetigo + BBLC

+ BCB + SMK

dr. Yusriandi Ramadhan

Pembimbing:
dr. I Putu Ardhika Y, Sp.A
 LAPORAN KASUS
• Nama : By Nurdiansyah
• Umur : 15 hari
• Jenis Kelamin : laki-laki
• Alamat : Bajuin, Pelaihari.
• TL/JL/CL : 08-02-2019/ Spt Bk/ Bidan
• BBL/PBL : 3100 gram / 51 cm
• BBS : 3800 gram
• No RM : 27 99 28
• Tgl MRS : 23 February 2019
• Tgl KRS : 28 February 2019
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 Kasus

Anamnesis

• Muncul bintik-bintik kemerahan dukulit dengan berbagai ukuran, awalnya 2 hari Smrs,
pertama muncul di area wajah, kemudian ke sekitar paha dan seluruh tubuh menyebar. Bintik-
bitnik semakin membesar berisi cairan dan pecah, menyisakan keropeng kekuningan di
permukaan kulit dan kulit tampak kering dan pecah-pecah.
• Demam di sangkal, berobat kebidan diberi Amoxycilin syrup , namun tidak membaik.
• Minum ASI (+) banyak.
• Riw Hygine buruk, bayi dimandikan 1x sehari.
• Riw Kehamilan dan persalinan : Bayi Cukup bulan, persalinan normal ditolong bidan, bayi
langsung menangis, lahir dengan berat badan lahir cukup dan sesuai masa kehamilan,.

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 Kasus
Pemeriksaan Fisik
Keadaan umum/ Kesadaran : Baik / Gerak aktif
Tanda Vital :
Denyut jantung : 134 x/menit, kuat angkat reguler
Temperatur : 36,7 0C
Respirasi : 30 x/menit, reguler
CRT : < 2 detik

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 • ikterik (-) , sianosis (-), Multiple Makula eritema, dengan Kasus
Kulit squama dan crusta kuning tua seperti madu kering
Kepala • mesosefali, kaput suksadeneum (-), lessi kulit (+)

Mata • konjungtiva anemis (-), sklera ikterik (-), konjungtivitis (-)

• simetris, deviasi septum (-), pernapasan cuping hidung (-), epitaksis
Hidung (-), lessi kulit (+)
Telinga • simetris, recoil cepat kembali, lipatan pinna jelas

Mulut • mukosa bibir basah, sianosis (-), sariawan (-) gusi berdarah(-)

Thoraks • simetris, retraksi (-)

Paru • suara napas bronkovesikuler, ronkhi (-/-), wheezing (-/-)

Jantung •S1 > S2 tunggal, murmur (-)

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 Kasus
Abdomen • cembung, H/L/M tidak teraba, perkusi timpani

•Laki-laki, phymosis (-) dengan scrotum dextra

Genitalia tampak membesar, testis (+/+)

Ekstrimitas •akral hangat, parese (-/-), edema (-/-)

Arteri femoralis •berdenyut kiri dan kanan

Tulang belakang •skoliosis (-), spina bifida (-)

Tanda-tanda fraktur •Deformitas (-), nyeri (-)

Neurologi •Refleks primitive (+)

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Clinical Picture
 Pemeriksaan Hasil Nilai Rujukan Satuan Kasus
HEMATOLOGI
Hemoglobin 12.8 14.00-24.00 g/dl
Leukosit 7.6 4.65-10-3 ribu/ul
Eritrosit 4.03 4.80-7.10 juta/ul
Hematokrit 38.2 44.00-64.00 vol%
Trombosit 368 150-356 ribu/ul
RDW-CV 14.7 12.1-14.0 %
Pemeriksaan Penunjang
MCV, MCH, MCHC
MCV 94.8 75.0-96.0 fl
Hasil Lab
MCH 31.7
33.5
28.0-32.0 pg (08/02/2019)
MCHC 33.0-37.0 %
HITUNG JENIS
Gran% 17.9 50.0-70.0 %
Limfosit% 74.5 25.0-40.0 %
MID% 7.6 4.0-11.0 %
Gran# 1.4 2.50-7.00 ribu/ul
Limfosit# 5.7 1.25-4.0 ribu/ul
MID# 0.5 ribu/ul

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 Kasus
Diagnosis Kerja

• I. Impetigo Bulosa
• II. Bayi Berat Lahir Cukup
• III. Bayi Cukup Bulan
• IV. Sesuai Masa Kehamilan

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 Kasus
Penatalaksanaan
I. Rawat Box
II. O2 (-)
III. ASI on demand
IV. Inf D5 ¼ NS 6 tpm micro drip
Inj. Cefotaxim 2 x 160 mg iv
V. Beri zalf Gentamisin 2x sehari tipis-tipis dipermukaan lesi
VI. Bersihkan dan kompres lesi dengan NaCl 0.9% 2 x sehari
VII. Monitor : Keadaan umum, tanda vital.

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 Berat lahir pasien adalah Bayi Berat Lahir Cukup Diskusi Kasus
3100 gr (BBLC)

TEORI
1. BBLL (bayi berat lahir lebih) : bayi yang dilahirkan dengan berat lahir lebih
dari 4000 gram
2. BBLC (bayi berat lahir cukup) : bayi yang dilahirkan dengan berat lahir
antara 2500 gram dan 4000 gram
3. BBLR (bayi berat lahir rendah) : bayi yang dilahirkan dengan berat lahir
antara 1500gr dan 2500gr tanpa memandang usia gestasi
4. BBLSR (bayi berat lahir sangat rendah) : bayi yang dilahirkan dengan berat
lahir antara 1000 gram dan 1500 gram
5. BBLSAR (bayi berat lahir sangat amat rendah) : bayi yang dilahirkan
dengan berat lahir kurang dari 1000 gram.

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 Diskusi Kasus
Pasien lahir dalam usia kehamilan 38-
39 minggu Bayi Cukup Bulan (BCB)

TEORI
1. Bayi Kurang Bulan (BKB) : Bayi dilahirkan dengan masa gestasi <37
minggu (<259hari)
2.Bayi Cukup Bulan (BCB) : Bayi dilahirkan dengan masa gestasi
antara 37 - 42 minggu (259-293 hari)
3. Bayi Lebih Bulan (BLB) : Bayi dilahirkan dengan masa gestasi > 42
minggu (294 hari)

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 Grafik Lubchenco
Diskusi Kasus

Berat lahir pasien

adalah 3100 gr

Usia kehamilan 38-39

minggu

Sesuai Masa Kehamilan (SMK)

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 Impetigo
• Acute, highly contagious gram-positive bacterial
infection of the superficial layers of the epidermis. Skin
lesions such as cuts, abrasions, and chickenpox can also
become secondarily infected (impetiginized) with the
same pathogens that produce classic impetigo.
• Most commonly in children, especially those who live in
hot, humid climates.
• Impetigo occurs in 2 forms: bullous and nonbullous
• Nonbullous impetigo is the more common form,
constituting approximately 70% of impetigo cases. It
tends to affect skin on the face or extremities that has
been disrupted by bites, cuts, abrasions, other trauma,
or diseases such as varicella.
Etiology
Nonbullous impetigo Bullous impetigo

Coagulase-positive group II S aureus, most often

1. GABHS (types 49, 52, 53, 55-57, 59, 61) phage type 71, is the predominant causative
2. S aureus; organism.
3. In approximately 20-45% of cases, both agents are
present. MRSA has been isolated in as many as 20% of
bullous impetigo cases.
S aureus produces bacteriotoxins toxic to
streptococci. These bacteriotoxins may be the reason
that only S aureus is isolated in lesions that are
caused predominantly by streptococci.
 Clinical Presentation
• Nonbullous impetigo : single erythematous macule that • Case :
rapidly evolves into a vesicle or pustule and ruptures; the
released serous contents then dry, leaving a crusted, • Multiple erythematous macule
honey-colored exudate over the erosion. Rapid spread
follows by contiguous extension or to distal areas through • vesicle and pustule and ruptures; the released
inoculation of other wounds from scratching serous contents then dry, leaving a crusted,
• Skin on any part of the body can be involved, but the face honey-colored exudate over the erosion.
and extremities are affected most commonly. Lesions are
usually asymptomatic, with occasional pruritus. Little or • Involved any part of the body, the face and
no surrounding erythema or edema is present. Regional
adenopathy is common. extremities are most affected.
• Bullous impetigo usually consists of small or large, • Bullous small superficial, fragile bullae,
superficial, fragile bullae. Often, these quickly appear,
spontaneously rupture, and drain so that only the spontaneous rupture (+), spread locally in the
remnants, or collarettes, are seen at the time of face, trunk, extremities, buttocks, and perineal
presentation. The lesions usually spread locally in the regions.
face, trunk, extremities, buttocks, or perineal regions and
may reach distal areas through direct autoinoculation.
 Bullous impetigo

Nonbullous impetigo
 Treatment
• Topical Antibiotic Treatment • Case :
• Topical antibiotic therapy is considered the treatment of • Used Gentamicin Skin Ointment
choice for individuals with uncomplicated localized
impetigo. Topical therapy eradicates isolated disease and • Removal of the infected crusts
limits the individual-to-individual spread. The topical and debris with Nacl 0.9%, soap
agent is applied after removal of the infected crusts and and water
debris with soap and water. Disadvantages of topical
treatment are that it cannot eradicate organisms from the
respiratory tract and that applying topical medications to
extensive lesions is difficult.
• Mupirocin ointment (Bactroban).
• Retapamulin (Altabax) ointment.
• Topical sodium fusidate (fusidic acid).
• Clindamycin (cream, lotion, and foam) is useful in several
MRSA.
• Gentamicin ointment or cream.
• Systemic Antibiotic Treatment
• Infections that are widespread, complicated, or are • Case :
associated with systemic manifestations (outbreaks of
poststreptococcal glomerulonephritis) are usually treated • Inj Cefotaxim (cephalosporins)
with antibiotics that have gram-positive bacterial 2x 160 mg/ iv
coverage. Systemic therapy is also recommended if
multiple incidents of pyoderma occur within daycare,
family, or athletic team settings.
• Beta-lactamase‒resistant antibiotics (eg, cephalosporins,
amoxicillin-clavulanate, dicloxacillin) are recommended
as S aureus isolates from impetigo are usually methicillin-
susceptible. [37] Cephalexin appears to be the drug of
choice for oral antimicrobial therapy in children.
• Erythromycin and clindamycin are alternatives in patients
with penicillin hypersensitivity. Macrolide resistance has
been increasing in the United States. Thus, avoid
treatment of impetigo with erythromycin in geographic
regions that are known to have a high resistance rate.
Group A beta hemolytic streptococci (GABHS) and S
aureus resistance to clindamycin has also been reported.
Post Treatment
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