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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.
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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
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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.
http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed/8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed/8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742http://www.ncbi.nlm.nih.gov/pubmed?term=Korppi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=8248742
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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.
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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.
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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 103
memiliki spesifisitas 86% dan 95% , untuk granulosit di tingkat
cut-off10,0 dan 15,0 x 103
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%).