KULIAH SENIN 13-05-13Pkl 07.30 – 09.20BLOK TROPMEDRUSDIDJAS, RAFITA RAMAYATI.

OKE RINA RAMAYANI dsn HENDY ZBgn IKA FK-UISU, Jl. SM RAJA No. 2A

M E D A N.

POKOK BAHASAN: PENYAKIT INFEKSI PADA ANAKSUB POKOK BAHASAN:1). Penyakit Infeksi Bakteri dan Virus Pada Anak 1. TETANUS = 2. PERTUSIS = 3. MENINGITIS = TBC Indones J. 3 4.POLYOMYELITIS = 5.GASTROENTERITIS = Indonesia Juara 3 6.MORBILLI =2). Mekanisme dan Diagbosis peny bakteri dan virus

TETANUS

Prof. dr. Rusdidjas, SpA(K) Prof. dr. Rafita Ramayati, SpA(K) dr.Oke Rina Ramayani, SpA

Dept. Ilmu Kes. Anak, FK-USU

KEJANG PADA PENYAKIT TETANUS 1.

1. Tetanus neonatorum2. Tetanus anak

Port d entre: 1. Luka kotor (situasi anaerobic 2. Luka tali pusat kotor 3. Tertelan spore (usus) 4. OMP chronic

2.

1.TRISMUS , SPASME OTOT2 PENGUNJAH RAHANG TERKUNCI, LOCK JAW

2. Rhisus Sardonicus (wajah setan), alis mata naik, kening berkerut, otot mimitic muscle [ otot tipis di wajah spasme, otot sekitar mulut spasme, mulut mencucur,

Otot menelan / oro- pharyngeous spame, bayi lapar, rahang spasme, Putting susu ibu tidak bisa masuk rongga mulut, menelan tak bisa, air liur tambah banyak, bayi menangis seharian, karena lapar !

>270,000 cases worldwide per year

8.

4).Ophisthotonus , spasme otot panjang dibelakang

3). Abdominal regidity, dinding perut memapan

KEJANG-KEJANG YG KUAT ;-Compresi fractur pd ruas tul belakang / Corpus Vertebra (Th 5-6) -Gibus angularis ( MEMBENTUK SUDUT), PERDARAHAN dalam otot.

Bangkitan Kejang, spastic: [Bukan Clonic]

1). Kejang rangsang, kl ada rangasang anak kejang2). Kejang spontan, tanpa rangsang tiba-tiba kejang

3.2.)TETANUS ANAK / DEWASA

Clostridium tetani• Anaerobic gram-positive, spore-forming

bacteria• Spores found in soil, animal feces; may persist

for months to years• Multiple toxins produced with growth of

bacteria• Tetanospasmin estimated human lethal dose =

2.5 ng/kg• Tetanolysin produce anemia

4.

Tetanus Pathogenesis• Anaerobic conditions allow germination

of spores and production of toxins• Toxin binds in central nervous system• Interferes with neurotransmitter release

to block inhibitor impulses• Leads to unopposed muscle contraction

and spasm

5.

Tetanus Clinical Features• Incubation period; 8 days

(range, 3-21 days)• Generalized tetanus: descending symptoms of

trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms

• Spasms continue for 3-4 weeks; complete recovery may take months [Rhisus sardonicus, Trismus, Tracheolaryngospasme, nuchal regidity, Longitudinal back muscles, and muscles of extrimities]

• Fatality rate ~90% w/o (without) treatment ~30% w/ treatment

1.

Neonatal Tetanus

• Generalized tetanus in newborn infant• Infant born without protective passive immunity• Unsterile care of umbilical• Estimated >215,000 deaths worldwide in 1998

7.

10.

TKS

Pengobatan: Harus di RS• 1. Atasi kejang : Diazepam + Phenobarbital• 2. ATS therapeutic (kuda) – Hati-hati pakai • (Besretka, lihat buku !!!.,cara mengencerkan_ • dan Tetanus toxoid• 3. Hypertet (ATS manusia)• 2. Antibiotika : Penicillin• 3. Cairan : IVFD• 4, Makanan : dgn NGT • Dipulangkan kl sdh bisa makan per oral)

Tetanus Complications

• Laryngospasm• Hypersalivation• Fractures [Compression fractures]• Hypertension• Nosocomial infections• Pulmonary embolism• Aspiration pneumonia• Intramusclar bleeding• Death

9.

TKS