KULIAH SENIN 13-05-13 Pkl 07.30 – 09.20 BLOK TROPMED RUSDIDJAS, RAFITA RAMAYATI. OKE RINA RAMAYANI dsn HENDY Z Bgn IKA FK-UISU, Jl. SM RAJA No. 2A M E D A N.

POKOK BAHASAN: PENYAKIT INFEKSI PADA ANAK SUB POKOK BAHASAN: 1) POKOK BAHASAN: PENYAKIT INFEKSI PADA ANAK SUB 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

1. KEJANG PADA PENYAKIT TETANUS TETANUS Prof. dr. Rusdidjas, SpA(K) Prof. dr. Rafita Ramayati, SpA(K) dr.Oke Rina Ramayani, SpA Dept. Ilmu Kes. Anak, FK-USU

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

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 3). Abdominal regidity, dinding perut memapan 8. 4).Ophisthotonus , spasme otot panjang dibelakang >270,000 cases worldwide per year

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 kejang 2). Kejang spontan, tanpa rangsang tiba-tiba kejang

2.)TETANUS ANAK / DEWASA 3.

Clostridium tetani 4. 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

Tetanus Pathogenesis 5. 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

Tetanus Clinical Features 1. 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

Neonatal Tetanus 7. Generalized tetanus in newborn infant Infant born without protective passive immunity Unsterile care of umbilical Estimated >215,000 deaths worldwide in 1998

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

TKS