MORBILI, VARICELLA, RUBELLA Djauhar Ismail Sub Bagian Tumbuh Kembang Kem bang Anak/ Pediatri Sosial Bagian Ilmu Kesehatan Anak FK UGM/ RSUP Dr. Sardjito
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CAMPAK (measles, morbilli, rubeola)
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Campak (measles, morbilli, rubeola) Disebabkan oleh virus Mudah menular Menyebar seluruh dunia Sebelum era imunisasi semua
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Penyebab : virus golongan paramyxoviridae Cara penularan : * Virus menular melalui jalan pernapasan * Dari sekresi hidung dan tenggorokan bersin, batuk, pernapasan
p
menular ke
orang lain * Ditularkan 1-3 hari sebelum panas dan batuk * Daya tular menurun secara cepat segera
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Gejala Klinis : a. Ta Tahap kata tara rall (berl rla angsung selama 3-7 hari) * mul mulaa-mu mula la pa pana nas, s, le lesu su,, batu batuk k pi pile lek, k, mata merah * akhi akhirr st stad adiu ium m diju dijump mpa ai Ko Kopl plik ik·s ·s sp spot ot p patognomonis b. Ta Tahap erupsi : * suhu suhu me meni ning ngka katt p ti timb mbul ul be berc rcak ak kemera kem erahan han (ra (rash, sh, exa exanth nthem) em)
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e. Tahap konvalesensi : * * * *
bercak kemerahan berkurang hiperpigmentasi hiperpigmen tasi deskuamasi suhu turun menjadi normal, kecuali ada komplikasi
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Epidemiologi Campak di Indonesia Merupakan masyarakat
salah
satu
masalah
kesehatan
Insidens di beberapa daerah masih tinggi SKRT 1986 : 44/10 000 gol umur/bulan 528/10 000
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KLB Campak tahun 1984-1994 Situasi KLB
1989
1990
1991 1992
Jumlah KLB
52
23
27
Jumlah Kasus
4458
2871
2031
1993
1994
62
43
45
1835
1413
2333
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Cakupan Imunisasi Campak th. 1983-1994 Tahun
Cakupan (%)
Tahun
Cakupan (%)
1983
5 ,9
1989
68,4
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Proporsi penderita Campak Terjadi pergeseran umur ke golongan umur yang lebih tua Proporsi penderita Campak menurut umur
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Kompli Komp lika kasi si Ca Camp mpak ak (penderita rawat inap beberapa RS) Pal Paling ing seri sering ng : bron broncho chopne pneumo umonia nia
- (ra (range nge 26,2% 26,2%-85, -85,4%) 4%)
Diare
- (range 3,4%-62,9%)
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Faktor risiko terjadinya
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CFR campak di beberapa RS di di Indonesia
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PENGOBATAN
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Masa kini pada remaja dan dewasa muda Kelainan pada fetus 30% selama minggu pertama kehamilan Risiko tertinggi (50-60%) pada bulan pertama kehamilan Menurun 4-5% pada bulan
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MAN MA NIF IFE ESTA TASI SI KLI LIN NIS Masa inkubasi 14-21 hari ( 12-21 hari) Masa Prodromal (1-5 hari): - dema demam m ringan, ringan, sakit sakit kepala, kepala, nyeri tenggor tenggorok, ok, kemerahan, conjungtiva - ri rini nitis tis,, ba batu tuk k - li limf mfad aden enop opat atii menghilang pada waktu erupsi timbul - 20% timbul timbul enante enantema ma (tanda (tanda Forschh Forschheime eimer): r): makula atau petekie pada palatum molle
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MASA EKSANTEMA Mulai retro-aurikular retro-aurikular atau muska Meluas cepat secara kramiokandul Mula-mula makula berbatas tegas, meluas, menyatu morbilliform
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40% kasus tanpa eksantema Limfadenopati gejala klinis yg penting Pembengkakan kel. Limfe berlangsung selama 5-8 hari
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PENYULIT Jarang pada anak Remaja dan dewasa: artritis dan astralgia sendi kecil, tangan, kaki, lutut, dan bahu Artralgia pada tangan gejala meyakinkan Artritis biasanya hilang dalam 1 bulan Encefalitis sangat jarang 2 minggu
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Purpura trombositopenik Epistaksis, perdarahan perdarahan gusi dan
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RUBELLA KONGENITAL Infeksi rubella ibu hamil
infeksi janin
Tergantung umur kehamilan Infeksi rubella ibu hamil, 50% tidak menunjukkan gejala/ tanda klinis
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lanjutan Infeksi rubella trimester pertama sindrom rubella kongenital: -Trial anomali kongenital: -mata (katarak) - tel teling inga a (ke (ketul tulian ian) ) - de defe fek k jan jantu tung ng
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DIAGNOSA BANDING a. Virus: campak, roseola infantum, eritema mononukleosis, mononuk leosis, infeksiora dan
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DIAGNOSIS Klinis sukar dibuat Perlu anamnesis yg cermat
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DIAGNOSIS RUBELLA KONGENITAL
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