curriculum vitae - pediatricfkuns.ac.id in children (rustam siregar).pdf · morbili / measles /...
TRANSCRIPT
![Page 1: CURRICULUM VITAE - pediatricfkuns.ac.id in children (Rustam Siregar).pdf · Morbili / Measles / Campak Sumber: “The Color Atlas of Pediatric, 2015” Sumber “Pediatric Practice](https://reader030.vdocuments.net/reader030/viewer/2022020305/5cea838d88c9935c028c7006/html5/thumbnails/1.jpg)
dr. H. Rustam Siregar, Sp. A
Pendidikan
• Lulus dokter umum FK UNS tahun 1980
• Dokter Spesialis Anak FK UGM lulus tahun 1989
Organisasi
• Anggota IDI Cabang Surakarta sampai sekarang
• Ketua IDAI Cabang Jawa Tengah Perwakilan Surakarta 2002 - 2005
• Wakil Ketua IDAI Cabang Jawa Tengah 2011-2014
• Ketua IDAI Cabang Jawa Tengah Perwakilan Surakarta 2011 – 2014
• Wakil Ketua IDAI Cabang Jawa Tengah 2014 – 2017
• Ketua IDAI Cabang Jawa Tengah Perwakilan Surakarta 2014 – 2017
• Anggota UKK Infeksi dan Penyakit Tropis IDAI
1
CURRICULUM VITAE
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Demam disertai ruam perlukah obat
antivirus? Rustam Siregar
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Demam dengan ruam
• Kunjungan ke RS meningkat
• Manifestasi sama etiologi berbeda
• Tidak patognomonik, kecuali bentuk klasik:
• Varicella
• Hand, Foot, and Mouth Disease
• Perjalanan penyakit?
Riwayat gigitan serangga?
Riwayat kontak?
Riwayat konsumsi obat?
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(dokumentasi: Rustam Siregar)
Hand, Foot and Mouth Disease
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Penegakan Diagnosis
Penting untuk menentukan tatalaksana
Apakah membutuhkan antivirus
Kesulitan
• Manifestasi sama etiologi berbeda
• Gejala tumpang tindih
• Ruam yang muncul berubah sesuai fase sakit
• Sarana laboratorium kurang memadai
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Penegakan Diagnosis
• Anamnesa: gejala penyerta, riwayat alergi, riwayat kontak
RUAM
Karakteristik
Morfologi
Distribusi
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Klasifikasi
• Ruam makulopapular
• Generalized diffuse erythema
• Vesicular
• Pustular
• Nodular
• Ptechiae
• Purpuric rashes
Perlu untuk diperhatikan distribusi, morfologi, lesi, warna, dan
adanya enanthema 7
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Lokasi • Lokal
• Sistemik
Sebaran • Simetris
• Asimetris
Onset • Akut
• Kronik
Sifat infeksi
• Infeksi
• Non infeksi
Klasifikasi
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Klasifikasi Ruam
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RUAM
9
Makula
• lesi datar
Papula
• lesi dengan peninggian kulit, teraba pada perabaan
Morbiliform
• koalesensi lesi makulopapular
• difus (sheet-like distribution)
Blanched vs non blanched rash
• ekstravasasi pembuluh darah
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Distribusi Ruam
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Lokal
Simetris
Sentripetal
Menyebar
Asimetris
Sentrifugal VS
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Morfologi Ruam
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Morfologi Ruam
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Morbili / Measles / Campak
Sumber: “The Color Atlas of Pediatric, 2015”
Sumber “Pediatric Practice Infectious Disease, 2009”
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Varicella / Cacar air
Sumber: “The Color Atlas of Pediatric, 2015”
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Rubella
Sumber: Medscape
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Roseola
Sumber: Medscape
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Infeksi virus?
Era pra vaksinasi
• 1st disease : campak/measles
• 2nd disease: scarlet fever
• 3rd disease: rubella
• 4th disease : (tidak dianggap karena menyerupai rubella dan scarlet fever)
• 5th disease: eritema infeksiosa
• 6th disease: roseola infantum
17
Saat ini, telah ditemukan 50 organisme sebagai penyebab
penyakit. Klasifikasi tersebut sudah tidak digunakan
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Penggunaan antivirus
18
Infeksi virus manifestasi ruam mirip satu dengan yang lain etiologi sulit ditentukan
Infeksi virus merupakan self limiting disease
Antiviral tidak direkomendasikan, kecuali pada virus herpes (varicella, herpes simpleks, herpes zooster)
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Penggunaan antivirus
Antivirus untuk varicella masih kontroversial
RCT (Klassen dkk, 2002)
• Acyclovir menurunkan lama demam 1-1,3 hari
• (CI 95%)
• Jumlah hari sampai timbul lesi baru, jumlah lesi, hilang rasa gatal tidak menunjukkan hasil yang konsisten
• Komplikasi yang timbul tidak berbeda signifikan
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Penggunaan antivirus
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Pemberian acyclovir dipertimbangkan:
• Tidak ada kendala biaya
• Memberikan rasa nyaman
American Academy of Pediatrics :
• Anak usia >12 tahun yang tidak divaksin
• Pasien dengan penyakit kulit atau paru kronis
• Pasien dengan terapi salisilat jangka panjang
• Pasien dengan terapi kortikosteroid
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Take Home Message
21
Demam dengan ruam disebabkan berbagai macam etiologi
Sebagian besar kasus bersifat Self Limiting Disease
Penggunaan antivirus tidak direkomendasikan diberikan secara rutin
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TERIMA KASIH
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