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Sumber: http://www.nlm.nih.gov/medlineplus/ency/article/000079.htm diakses tanggal 25 Desember 2008

Alternative Names Return to top

Walking pneumonia; Chlamydophila pneumoniae

Definition Return to top

Atypical pneumonia refers to pneumonia caused by certain bacteria -- namely,Legionella pneumophila,

Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to

Legionella, in particular, can be quite severe and lead to high mortality rates.

Causes Return to top

Atypical pneumonia due toMycoplasma and Chlamydophila usually cause milder forms of pneumonia and are

characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on morequickly with more severe early symptoms.

Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs

(such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severeforms ofMycoplasma pneumonia have been described in all age groups.

Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a

low mortality rate. In contrast, atypical pneumonia due toLegionella accounts for 2-6% of pneumonias and has a

higher mortality rate.

Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk fthis type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has als

been associated with pneumonia due toLegionella.

Symptoms Return to top

Chills

Fevers

Cough

Headache

Muscle stiffness and aching

Rapid breathing

Shortness of breath

Loss of appetite

Malaise

Confusion (especially with Legionella)
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Rash (especially with Mycoplasma)

Diarrhea (especially with Legionella)

Exams and Tests Return to top

People with suspected pneumonia should undergo a medical evaluation, including a thorough physical exam and achest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or

other respiratory infections.

Depending on the severity of illness, additional studies, such as a complete blood count, blood cultures, and sputum

cultures, may be obtained.

When certain forms of atypical pneumonia are suspected, tests of your urine or a throat swab may be ordered aswell.

Treatment Return to top

The mainstay of treatment for atypical pneumonia is antibiotic therapy. In mild cases, treatment with oral antibioti

at home may be appropriate. Severe cases (especially common with pneumonia caused byLegionella) may require

intravenous antibiotics and oxygen supplementation.

Antibiotics with activity against these organisms include -- erythromycin, azithromycin, clarithromycin,

fluoroquinolones and their derivatives (such as levofloxacin), and tetracyclines (such as doxycycline).

Outlook (Prognosis) Return to top

Most patients with pneumonia due toMycoplasma orChlamydophila do well with appropriate antibiotic therapy,although there is a small chance of relapse if antibiotics are used for too short a period of time (less than two week

In the case of pneumonia due toLegionella, severe illness occurs particularly among the elderly and those with

chronic diseases and weakened immune systems. It is associated with a higher mortality rate.

Possible Complications Return to top

Respiratory failure, mechanical ventilation -- especially in severe forms of pneumonia due to Legionella

Rash and hemolytic anemia -- especially associated with pneumonia due to Mycoplasma

When to Contact a Medical Professional Return to top

Seek medical evaluation if you develop fevers, cough, and/or shortness of breath. While there are numerous cause

for these symptoms, you will need to be evaluated for pneumonia.

Prevention Return to top

There are no proven methods for preventing atypical pneumonia, and no vaccinations are available at this time foratypical pneumonias.

References Return to top

Marx JA, Hockberger RS, Walls RM, eds.Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed.

St. Louis, Mo: Mosby; 2002.
http://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#tophttp://www.nlm.nih.gov/medlineplus/ency/article/000079.htm#top


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Cohen J, Powderly WG.Infectious Diseases. 2nd ed. New York, NY: Elsevier, 2004.

Mandell, GL, Bennett JE, Dolin R, eds.Principles of Infectious Diseases. 5th ed. New York, NY: Churchill

Livingstone, 2000.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Societ

consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar1;44 Suppl 2:S27-72.

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated

and healthcare-associated pneumonia.Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

Sumber: http://en.wikipedia.org/wiki/Atypical_pneumoniadiakses tanggal 25 Desember 2008

Atypical pneumonia

From Wikipedia, the free encyclopedia

Jump to: navigation, searchAtypical pneumonia

Classification and external

resources

ICD-9 486

DiseasesDB 1132

MedlinePlus 000079

Atypical pneumonia is a term used to describe a form ofpneumonia not caused by one of the more traditionalpathogens.

It can be defined as pneumonia without lobar consolidation.[1][2]

The concept of "atypical pneumonia" was introduced in 1934 by Gallagher in his description ofbronchopneumoni

which he considered atypical in comparison to lobar pneumonia.[3][4]

Contents

[hide]

1 Terminology 2 Causes

o 2.1 Bacterial

o 2.2 Viral

3 Symptoms

4 Treatment
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5 Prognosis

6 References

[edit] Terminology

The term "atypical" is used because atypical bacteria commonly affect healthier people, [citation needed] and respond to

different antibiotics than other bacteria.

The term "primary atypical pneumonia" used to explicitly excludebacterial pneumonia.[5] However, in recent yearMycoplasma,Rickettsia, andChlamydia are now usually considered bacteria, albeit unusual types (Mycoplasma is

the only type of bacteria with nocell wall, andRickettsia and Chlamydia are intracellular parasites, which used to

confused with viruses.) As the conditions caused by these agents have different courses and respond to different

treatments, more specific identification of the pneumonia should be used when possible.

InMeSH, "Primary Atypical Pneumonia" is mapped to Mycoplasma pneumonia.[6]

Compared to typical pneumonias, atypical pneumonia is more likely to have effects outside of the lungs.[7]

[edit] Causes

Pneumonia

Infectious pneumonias

Bacterial pneumonia

Viral pneumonia

Fungal pneumonia

Parasitic pneumonia

Atypical pneumonia

Community-acquired

pneumonia

Healthcare-associated

pneumonia

Hospital-acquired

pneumonia
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Ventilator-associated

pneumonia

Severe acute respiratory

syndrome

Pneumonias caused by infectious

or noninfectious agents

Aspiration pneumonia

Lipid pneumonia

Eosinophilic pneumonia

Bronchiolitis obliterans

organizing pneumonia

Noninfectious pneumonia

Chemical pneumonia

This box:viewtalkedit

It can be caused by one or a combination of the following organisms:

[edit] Bacterial

Legionella pneumophilaCauses a severe form of pneumonia with a relatively high mortality rate, known as legionellosis or

Legionnaires' disease.

Mycoplasma pneumoniaeUsually occurs in younger age groups and may be associated with neurological and systemic (e.g. rashes)symptoms.

Chlamydophila pneumoniae

Mild form of pneumonia with relatively mild symptoms. Sometimes, Chlamydophila psittaci orChlamydiatrachomatis.[8]

In one study, a majority of cases where the cause could be identified were due to Mycoplasma, Chlamydia, or

Legionella.[9]

In the past, these organisms were difficult to culture, which is part of the reason they were grouped together.

However, newer techniques aid in the definitive identification of the pathogen,[10]

which may lead to moreindividualized treatment plans.

[edit] Viral

When using the broader, modern definition of bacteria (as described above), term "atypical pneumonia" almost

always implies a bacterial etiology, and is contrasted to viral pneumonia. However, before the SARS coronavirus

was identified, severe acute respiratory syndrome (SARS) was considered a kind of atypical pneumonia. [11]

It is still called so in the Chinese mainland.[citation needed]
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[edit] Symptoms

Symptoms include fever, shortness of breath, laboured breathing, cough and potentially cough fractures, arthralgia

(joint pain), malaise, loss of appetite, confusion, rash, and diarrhea.

[edit] Treatment

Treatment is with oral antibiotics, mainly with those which interfere with protein synthesis e.g. erythromycin, and

diagnosis is confirmed byblood cultures and sputum samples.

[edit] Prognosis

The tone or style of this article may not be appropriate for Wikipedia. Specific concerns may be found thetalk page. See Wikipedia's guide to writing better articles for suggestions. (October 2008)

Prognosis is usually good and is influenced byage andimmunosuppression.

[edit] References1. ^ Hindiyeh M, Carroll KC (June 2000). "Laboratory diagnosis of atypical pneumonia". Semin Respir Infec

15 (2): 10113. PMID 10983928. http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372.

2. ^ Gouriet F, Drancourt M, Raoult D (October 2006). "Multiplexed serology in atypical bacterial

pneumonia".Ann. N. Y. Acad. Sci.1078: 53040.doi:10.1196/annals.1374.104. PMID 17114771.http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-

8923&date=2006&volume=1078&spage=530.

3. ^ "Pneumonia, Atypical Bacterial: Overview - eMedicine".http://emedicine.medscape.com/article/363083overview. Retrieved on 2008-12-21.

4. ^ Gallagher JR. Bronchopneumonia in adolescence. Yale J Biol Med. 1934;7:23-40.

5. ^Primary atypical pneumonia at Dorland's Medical Dictionary

6. ^ MeSHPneumonia,+Primary+Atypical

7. ^ Cunha BA (May 2006). "The atypical pneumonias: clinical diagnosis and importance". Clin. Microbiol.

Infect.12 Suppl 3: 1224. doi:10.1111/j.1469-0691.2006.01393.x.PMID 16669925.

http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-

743X&date=2006&volume=12&issue=&spage=12.

8. ^ Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson.Robbins

Basic Pathology: With STUDENT CONSULT Online Access. Philadelphia: Saunders.ISBN 1-4160-2973-78th edition.

9. ^ Ragnar Norrby S (April 1997). "Atypical pneumonia in the Nordic countries: aetiology and clinical resul

of a trial comparing fleroxacin and doxycycline. Nordic Atypical Pneumonia Study Group".J. Antimicrob.Chemother.39 (4): 499508. PMID 9145823.http://jac.oxfordjournals.org/cgi/pmidlookup?

view=long&pmid=9145823.

10. ^ Tang YW (December 2003). "Molecular diagnostics of atypical pneumonia".Acta Pharmacol. Sin.24(12): 130813. PMID 14653964. http://www.chinaphar.com/1671-4083/24/1308.pdf.
http://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=5http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/w/index.php?title=Cough_fracture&action=edit&redlink=1http://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=6http://en.wikipedia.org/wiki/Antibioticshttp://en.wikipedia.org/wiki/Erythromycinhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=7http://en.wikipedia.org/wiki/Wikipedia:TONEhttp://en.wikipedia.org/wiki/Talk:Atypical_pneumoniahttp://en.wikipedia.org/wiki/Talk:Atypical_pneumoniahttp://en.wikipedia.org/wiki/Wikipedia:Guide_to_writing_better_articleshttp://en.wikipedia.org/wiki/Senescencehttp://en.wikipedia.org/wiki/Senescencehttp://en.wikipedia.org/wiki/Immunosuppressionhttp://en.wikipedia.org/wiki/Immunosuppressionhttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=8http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid10983928_0-0http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372http://www.ncbi.nlm.nih.gov/pubmed/10983928http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid17114771_1-0http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://en.wikipedia.org/wiki/Digital_object_identifierhttp://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1196%2Fannals.1374.104http://www.ncbi.nlm.nih.gov/pubmed/17114771http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-urlPneumonia.2C_Atypical_Bacterial:_Overview_-_eMedicine_2-0http://emedicine.medscape.com/article/363083-overviewhttp://emedicine.medscape.com/article/363083-overviewhttp://emedicine.medscape.com/article/363083-overviewhttp://emedicine.medscape.com/article/363083-overviewhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-3http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-4http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/six/000084218.htmhttp://en.wikipedia.org/wiki/Dorland's_Medical_Dictionaryhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-5http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&term=Pneumonia,+Primary+Atypicalhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid16669925_6-0http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1111%2Fj.1469-0691.2006.01393.xhttp://www.ncbi.nlm.nih.gov/pubmed/16669925http://www.ncbi.nlm.nih.gov/pubmed/16669925http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-Kumar13-7_7-0http://en.wikipedia.org/wiki/Special:BookSources/1416029737http://en.wikipedia.org/wiki/Special:BookSources/1416029737http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid9145823_8-0http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://www.ncbi.nlm.nih.gov/pubmed/9145823http://www.ncbi.nlm.nih.gov/pubmed/9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid14653964_9-0http://www.chinaphar.com/1671-4083/24/1308.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/14653964http://www.chinaphar.com/1671-4083/24/1308.pdfhttp://en.wikipedia.org/wiki/File:Ambox_style.pnghttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=5http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/w/index.php?title=Cough_fracture&action=edit&redlink=1http://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=6http://en.wikipedia.org/wiki/Antibioticshttp://en.wikipedia.org/wiki/Erythromycinhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=7http://en.wikipedia.org/wiki/Wikipedia:TONEhttp://en.wikipedia.org/wiki/Talk:Atypical_pneumoniahttp://en.wikipedia.org/wiki/Wikipedia:Guide_to_writing_better_articleshttp://en.wikipedia.org/wiki/Senescencehttp://en.wikipedia.org/wiki/Immunosuppressionhttp://en.wikipedia.org/w/index.php?title=Atypical_pneumonia&action=edit&section=8http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid10983928_0-0http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372http://www.ncbi.nlm.nih.gov/pubmed/10983928http://linkinghub.elsevier.com/retrieve/pii/S0882054600000372http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid17114771_1-0http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1196%2Fannals.1374.104http://www.ncbi.nlm.nih.gov/pubmed/17114771http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0077-8923&date=2006&volume=1078&spage=530http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-urlPneumonia.2C_Atypical_Bacterial:_Overview_-_eMedicine_2-0http://emedicine.medscape.com/article/363083-overviewhttp://emedicine.medscape.com/article/363083-overviewhttp://emedicine.medscape.com/article/363083-overviewhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-3http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-4http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/six/000084218.htmhttp://en.wikipedia.org/wiki/Dorland's_Medical_Dictionaryhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-5http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&term=Pneumonia,+Primary+Atypicalhttp://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid16669925_6-0http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1111%2Fj.1469-0691.2006.01393.xhttp://www.ncbi.nlm.nih.gov/pubmed/16669925http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1198-743X&date=2006&volume=12&issue=&spage=12http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-Kumar13-7_7-0http://en.wikipedia.org/wiki/Special:BookSources/1416029737http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid9145823_8-0http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://www.ncbi.nlm.nih.gov/pubmed/9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9145823http://en.wikipedia.org/wiki/Atypical_pneumonia#cite_ref-pmid14653964_9-0http://www.chinaphar.com/1671-4083/24/1308.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/14653964http://www.chinaphar.com/1671-4083/24/1308.pdf


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11. ^ "Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak".http://www.who.int/csr/don/2003_03_15/en/. Retrieved on 2008-12-21.

Sumber : http://emedicine.medscape.com/article/363083-overview diakses tanggal 25 Desember2008

Introduction

Background

During the latter half of the 19th century, by which time physicians had embraced autopsy as an essential learning

tool, pneumonia diagnoses were usually made post mortem.

With the discovery of x-rays (1895), chest radiography became part of the routine evaluation of pneumonia inpatients with suggestive signs and symptoms. Patients who presented with fever, shaking chills, and rust-colored

sputum (which under examination showed gram-positive diplococci in chains) and whose chest radiographicfindings were suggestive of pulmonary infection were considered to have typical pneumonia.

History

In 1934, Gallagher described a disease outbreak in 16 boys living in a preparatory school. The youngsters had

bronchopneumonia, which Gallagher considered to be atypical. Four years later, Reimann reported on 8 patients

with chest infection but an atypical presentation, which he referred to as atypical pneumonia. As a result of

Gallagher's and Reimann's work, the concept of typical and atypical pneumonia became established in medicalliterature.

The arbitrary classification of typical versus atypical pneumonia is nonetheless of limited clinical value. Moreoverthe literature now shows that a primary pathogen may coexist with a secondary one, further blurring the distinction

between these terms.

Related eMedicine topics:Pneumonia, BacterialPneumonia, ViralPneumonia, Typical Bacterial

Related Medscape Topics:Resource CenterPneumoniaCME/CE What's New in Ventilator-Associated PneumoniaCME/CE Healthcare-Associated PneumoniaCME Oral Amoxicillin May Be Effective for Children Admitted to Hospital for PneumoniaCME/CE Macrolides Improve Outcomes Among Elderly With Bacteremic Pneumonia

Pathophysiology

Pathogens
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Most pathogens that are responsible for community-acquired pneumonia (CAP) reach the lungs after first colonizinthe oropharynx. Community respiratory pathogens that enter the lungs without oropharyngeal colonization include

Mycobacterium tuberculosis, Legionella species, and certain viruses. See Clinical Details, below.

Radiologic phases

A phase of active hyperemia occurs, lasting approximately 24 hours before radiologic consolidation of the alveoliappears. This phase is characterized by engorgement of the arterial blood vessels. Edematous fluid, which may be

seen in the alveolus, contains few exudative cells.

The next stage is referred to as red hepatization. Neutrophils and fibrin material fill the alveoli, and massive

extravasation of red blood cells produces a homogeneous opacity.

The red hepatization phase is then followed by gray hepatization. Fibrin and exudative cells accumulate, appearing

on radiographs as a clear zone adjoining the alveolar and acinar cells.

If the process extends to the pleural space, associated empyema may be present.

Frequency

United States

CAP affects approximately 5.6 million adults in the United States each year, resulting in approximately 1.1 millionhospital admissions (Garibaldi, 1985; Neiderman, 1998).

Mycoplasma pneumoniae is a frequent cause of community-acquired respiratory infections in adults and children.

This organism is one of the most common atypical pathogens responsible for CAP in adults, but infection-ratefigures vary, depending on the population and on the diagnostic methods used. Studies have shown that the

prevalence of this agent in adults with pneumonia ranges from 2% to over 30% (Mansel, 1989; Pareja, 1992).

The prevalence ofChlamydia pneumoniae infection varies by year and geographic setting. It causes 5-15% of all

cases of CAP (Marrie, 1998).

International

Data are not currently available. The estimated range is 30-220 million cases per year.

Mortality/Morbidity

The overall mortality rate is approximately 15%, ranging from 5% in studies including both ambulatory and

hospitalized patients to 15% in studies of only hospitalized patients.

Mortality rates are as high as 40% in ICU patients. Mortality rates are 20% in the elderly and 30% in nursing-home patients.

Race

In endemic areas, certain zoonotic infections should be considered when patients present with atypical pneumonia

Age

There is a higher incidence of atypical pneumonia in the elderly as a result of associated comorbidities, reducedimmunocompetence, and an increased risk of aspiration in this population.
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Presentation

Pneumonia is predominantly a clinical syndrome.

The classic etiologic agents of atypical pneumonia areLegionella species,M pneumoniae, and C pneumoniae. Maother diseases, caused by various pathogens, should be considered in the differential diagnosis. Such etiologic

agents include fungi, mycobacteria, parasites, and viruses (eg, influenza virus, adenovirus, respiratory syncytial

virus, human parainfluenza virus, measles, varicella zoster,Hantavirus).

In immunosuppressed patients, outbreaks of isolated cases of respiratory virus infections with atypical presentation

are reported. These infections can be severe and may have concomitant bacterial etiologies.

In endemic areas, certain zoonotic infections should be considered when patients present with atypical pneumonia

Noninfectious etiologies must be considered in atypical and nonresolving pneumonias.

Legionella pneumonia

Legionella became recognized as a pneumonia agent following an outbreak ofL pneumophila infections at a 1976

American Legion convention in Philadelphia.

Legionella pneumonia is responsible for 2-15% of all CAPs that require hospitalization.

Outbreaks of nosocomial legionellosis (Legionnaires disease) previously occurred in tertiary care centers. Morerecently, however, sporadic nosocomial cases from community hospitals have predominated.

Risk factors

The risk factors forLegionella pneumonia include cigarette smoking, chronic lung disease, and immunosuppressio

(especially that caused by corticosteroid use).

Surgery is a major predisposing factor in nosocomial infections; transplant patients are at highest risk.

Legionnaires disease can be acquired by aerosol inhalation or by the microaspiration of water contaminated with

Legionella pathogens, although aspiration remains an underrecognized mode of transmission. Sources of

contaminated water include aerosol-generating systems such as cooling towers, respiratory therapy equipment, and

whirlpool baths. Nasogastric tubes are implicated in some cases of nosocomial legionellosis. A high incidence ofLegionella pneumonia is reported in patients who undergo head and neck surgery.

Although 40Legionella species have been identified, fewer than 20 have been implicated as human pathogens.L

pneumophila is the most pathogenic, accounting for 90% of cases of human legionellosis, followed byL micdadei

Clinical manifestations

Early in the course of illness, patients have nonspecific symptoms, including fever, malaise, myalgia, anorexia, andheadache. Temperature often exceeds 40C. Cough is usually only minimally productive. Pleuritic chest pain

occasionally occurs and can be associated with hemoptysis, which may mistakenly suggest pulmonary embolus.

Diarrhea is present in as many as 20-40% of patients and is classically described as watery, rather than bloody.

Relative bradycardia is described, but this condition is most often seen in elderly patients with severe pneumonia.

Hyponatremia with a serum sodium level of 125-130 mmol/L is more commonly associated withLegionella

pneumonia than with other forms of pneumonia.


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Extrapulmonary legionellosis is rare, but the clinical manifestations can be severe. The heart is the most commonextrapulmonary site. Patients with cardiac involvement may present with myocarditis, pericarditis,

postpericardiotomy syndrome, and prosthetic valve endocarditis.

Chest radiographs cannot be used to distinguish Legionnaires disease from other pneumonias. Details are describein Radiograph.

Laboratory diagnosis

Diagnostic laboratory tests for Legionnaires disease are necessary but must be specifically requested.

The definitive diagnosis is made by culturing theLegionella organism. However, a specialized medium is needed

for testing; a lack of this medium delayed diagnosis in the 1976 American Legion outbreak.

Sputum should be cultured regardless of the quality of the specimen. Legionella has been cultured from specimenswith more than 25 squamous epithelial cells and fewer than 25 leukocytes per low-power field. This procedure may

be important because many patients have a minimally productive cough.

TheLegionella urine antigen test can be performed rapidly and relatively inexpensively. This test is commercially

available as both a radioimmunoassay and an enzyme immunoassay. It detects only the serotype 1, but it should be

included in the initial diagnostic work-up because this is the most common serotype that causes clinical infection.The test has a sensitivity of 70% and a specificity of approximately 95%.

Direct fluorescent antibody staining is a rapid diagnostic test, but because a large number of organisms are required

for visualization, it is less sensitive than are techniques employing bacterial cultures.

Serologic tests are useful for epidemiologic purposes. However, they do not help the treating physician, because a

convalescent measurement is required. The diagnosis is based on a 4-fold increase of antibody titer to 1:128 or

higher. A single titer of 1:256 or higher during convalescence is also suggestive ofLegionella infection. If antibodscreening is performed, both immunoglobulin G (IgG) and immunoglobulin M (IgM) levels should be evaluated.

The polymerase chain reaction (PCR) assay has been used to evaluate serum, urine, and bronchoalveolar fluid.Although PCR is highly specific, it is not more sensitive than culturing. Its primary advantage is its ability to rapid

detectLegionella or species other thanL pneumophila.

The sensitivity of culturing or direct fluorescent antibody staining of specimens obtained during bronchoscopy issimilar to that of sputum analysis.

Pleural fluid, if present, should be evaluated by staining and culturing and by performing the radioimmunoassay

used to detect urinary antigen.

Treatment

Delayed treatment ofLegionella pneumonia significantly increases the associated mortality rate.

The newer macrolides, especially azithromycin, have superior in vitro activity, with greater intracellular and lung

tissue penetration than erythromycin. Quinolones, in turn, have greater in vitro activity and intracellular penetratio

than the macrolides.

In severely ill patients, rifampin may be recommended for use in combination with macrolides or quinolones.

The duration of therapy is 10-14 days, with a 21-day regimen for immunosuppressed patients or those withextensive disease, as shown on chest radiographs.
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Mycoplasma pneumonia

M pneumoniae is a frequent cause of community-acquired respiratory infections in adults and children. Thisorganism is one of the most common atypical pathogens responsible for CAP in adults, but infection-rate figures

vary depending on the population and the diagnostic methods used. Recent studies have shown that the prevalence

of this agent in adults with pneumonia ranges from 2% to over 30%.

The class Mollicutes, generally referred to as the mycoplasmas, comprises 5 genera:Mycoplasma, Ureaplasma,Acholeplasma, Anaeroplasma, andAsteroleplasma.

Three well-established causes of human disease areM pneumoniae, M hominis, and U urealyticum.

Mycoplasmas grow on cell-free media, multiplying by means of primary fission. Because, unlike other bacteria,

they lack a cell wall, these organisms are not susceptible to antibiotics that interfere with cell-wall synthesis.

Mycoplasmas may be among the least frequently diagnosed respiratory pathogens in the clinical setting, because oa lack of standardized, specific diagnostic tests for them.

M pneumoniae infection tends to be endemic, punctuated by epidemics occurring at 4- to 7-year intervals. When

these epidemics develop,M pneumoniae may be responsible for up to 50% of all pneumonia cases. The overall

incidence depends on the prevalence and appears to be related to age. The highest prevalence is observed in childraged 5-9 years.

Outbreaks may occur in institutional settings, such as military bases, summer camps, and schools.

Clinical features

M pneumoniae infections may be symptomatic or asymptomatic. The onset is usually gradual, with a prodrome of

flu-like symptoms, including headache, malaise, and low-grade fever, occurring. Chills are common, but rigors arenot. Objective abnormalities on physical examination are minimal in contrast to the patient's reported symptoms.

Symptoms are best divided into pulmonary and extrapulmonary manifestations.

M pneumoniae is most frequently responsible for the pulmonary manifestation tracheobronchitis, which is 30 time

as common as pneumonia. This pathogen is best known as the primary cause of walking pneumonia. Typicalsymptoms include sore throat, headaches, chills, and coryza. Myringitis, including hemorrhagic bullous myringitis

and otitis, may be present, and transient bronchial hyperreactivity can occur as well. The cough associated with

Mycoplasma infection is usually nonproductive or minimally productive.

Extrapulmonary manifestations involve the central nervous system (CNS), blood, skin, heart, joints, orgastrointestinal (GI) tract.

CNS manifestations include aseptic meningitis, cranial nerve palsies, cerebral ataxia, meningoencephalitis,

peripheral neuropathy, and transverse myelitis. These symptoms are infrequent, and when seen, they are usually

found in children. They are most often associated with increased morbidity and mortality rates and are thought torepresent an immune-mediated reaction of the host to theM pneumoniae infection or to an extrapulmonary

manifestation of it. An antecedent respiratory infection is not always present.

Hematologic manifestations include the presence of IgM antibodies to the erythrocyte membrane I antigen. Their

appearance produces a cold agglutinin response that leads to hemolysis.

Dermatologic manifestations include rash, which may be maculopapular or vesicular, and Stevens-Johnson

syndrome. Antimicrobials are known to potentiate the dermatosensitive potential ofM pneumoniae.


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Cardiac involvement may include myocarditis, pericarditis, congestive heart failure, hemopericardium, and variouheart blocks.

Joint manifestations are occasionally described.

Various GI symptoms can include nausea, vomiting, diarrhea, and pancreatitis.

Diagnosis

Culturing, serologic analysis, PCR testing, and determination of cold agglutinin titers can aid in diagnosing anMpneumoniae infection. However, because each of these tests has certain drawbacks, therapy must be empirical.

Because ofM pneumoniae 's fastidious growth requirements and long incubation period, culturing has limited

utility, and most laboratories do not offer it.

IgM and IgG titers are elevated in most cases, but the response is often delayed. Therefore, antibody tests also havlimited usefulness.

Some authorities consider PCR to be particularly promising. However, amplification techniques have some

technical problems because of differences in sample-collection and preparation methods.

Cold agglutinin titers higher than 1:64 support the diagnosis, and the cold agglutinin response is correlated with th

severity of pulmonary symptoms. However, the test lacks both sensitivity and specificity. The antibody responsedevelops approximately 7-10 days after the onset of symptoms and peaks at approximately 3 weeks.

Treatment

In most cases, the recommended treatment includes tetracycline or a macrolide. Fluoroquinolones also may be use

Two to three weeks of therapy is generally recommended to reduce the risk of relapse.

Chlamydia pneumonia

The genus Chlamydia includes 3 species that infect humans: C psittaci, C trachomatis, and C pneumoniae (formercalled the TWAR agent). C trachomatis is seen in newborn infants during delivery. It has also been associated with

pneumonia in adults.

Ornithosis is a systemic infection that is often accompanied by pneumonia and caused by C psittaci, which is

common in birds and some domestic animals. The incubation period is approximately 5-15 days. Pet-shopemployees and poultry workers are at particular risk, and this organism should be considered when these individua

present with pneumonia. Besides the lungs, other major organs and systems that may be affected by C psittaci

infection include the CNS (meningoencephalitis, cranial nerve deficits) and the cardiovascular system (culture-negative endocarditis).

The prevalence ofC pneumoniae infection varies by year and geographic setting. It causes 5-15% of all cases of

CAP. Repeat infection is common.

Chlamydia pneumonia may be associated with acute upper-airway infection, sinusitis, bronchitis, and bronchiolitis

Infection by C pneumoniae can cause prolonged, acute bronchitis with reactive airway disease. Bronchiolitis may seen as a restrictive pattern on pulmonary-function tests. Pneumonia usually tends to be mild. When C pneumonia

is found in association with other pathogens, particularly Streptococcus pneumoniae, the clinical severity is usually

determined by the secondary pathogen. The cough associated with C pneumoniae tends to be nonproductive andprolonged despite appropriate antibiotic therapy. Most patients report headache.


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Diagnosis

Results ofC pneumoniae cultures, PCR, and serologic tests can suggest the diagnosis. Cell culture is not routinely

available except in research laboratories. PCR technology has not been standardized, and serology is problematic

because of its nonspecificity.

The preferred diagnostic result is a 4-fold increase in titers from the acute stage to convalescence, with supportingevidence from PCR or culture tests. Therefore, most laboratories cannot confirm the diagnosis in a timely fashion;

the treatment ofChlamydia pneumonia should be empirical.

Treatment

C pneumoniae may be treated with doxycycline, a macrolide, or a fluoroquinolone.

Differential Diagnoses

Acute Respiratory Distress Syndrome Pneumonia, AtypicalBacterial

Bronchiolitis Obliterans Organizing

Pneumonia

Pneumonia, Pneumocystis

Carinii

Empyema Pneumonia, TypicalBacterial

Lung, Drug-Induced Disease Pneumonia, Viral

Lung, Nontuberculous MycobacterialInfections

Lung, Postprimary Tuberculosis

Lung, Primary Tuberculosis

Sumber: http://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.htmldiaksetanggal 25 Des 08

Atypical pneumonia refers to pneumonia caused by certain bacteria, includingLegionella pneumophila,

Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

This article provides a general overview of atypical pneumonia.

See also:

Legionella pneumonia (Legionnaire's disease)

Mycoplasma pneumonia

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Tests in China Suggest Some With SARS Don't Become Ill

New Worry for China as SARS Hits the Hinterland

Reference from A.D.A.M.

Back to TopAlternative Names

Walking pneumonia; Chlamydophila pneumoniae

Back to TopCauses

Atypical pneumonia due to mycoplasma and chlamydophila bacteria usually cause mild forms of pneumonia, unlik

other types of the disease that can come on more quickly with more severe early symptoms.

Mycoplasma pneumonia often affects younger people and may be associated with anemia, certain types of rashes,and neurological conditions such as meningitis, myelitis, and encephalitis. For more information on this type of

pneumonia, see:Mycoplasma pneumonia

Pneumonia due to chlamydia-related bacteria occurs year round and accounts for 5-15% of all pneumonias. It is

usually mild with a low death rate.

Atypical pneumonia due toLegionella accounts for 2-6% of pneumonias and has a higher death rate. Older adults,smokers, and those with chronic illnesses and weakened immune systems are at higher risk for this type of

pneumonia. Breathing in contaminated air (such as that from infected air conditioning systems) has also been linke

to pneumonia due toLegionella. For more information on this type of pneumonia, see: Legionnaire's disease

Back to TopSymptoms

Chills

Confusion (especially with Legionella pneumonia)

Cough

Diarrhea (especially with Legionella pneumonia)

Fever

General ill feeling

Headache

Loss of appetite

Muscle stiffness and aching

Rapid breathing

Rash (especially with Mycoplasma pneumonia)

Shortness of breath

Back to TopExams and Tests
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Persons with suspected pneumonia should have a complete medical evaluation, including a thorough physical examand a chest x-ray-- especially since the physical exam may not always distinguish pneumonia from acute bronchit

or other respiratory infections.

Depending on the severity of illness, additional studies may be done, include:

Complete blood count (CBC)

Blood cultures

Blood tests for antibodies to specific bacteria

Bronchoscopy

Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other

sources)

Sputum culture

Urine tests or a throat swab may be also be done.

Back to TopTreatment

Antibiotics are used to treat atypical pneumonia. If you have a mild case, you may be able to take antibiotics by

mouth. If you have severe atypical pneumonia, you will likely be admitted to a hospital where you will be givenantibiotics through a vein (intravenously), as well as oxygen.

Antibiotics used to treat atypical pneumonia include:

Azithromycin

Clarithromycin

Erythromycin

Fluoroquinolones and their derivatives (such as levofloxacin)

Tetracyclines (such as doxycycline)

Back to TopOutlook (Prognosis)

Most patients with pneumonia due to mycoplasma or chlamydophila do well with appropriate antibiotic therapy,

although there is a small chance that the infection will return if antibiotics are used for less than 2 weeks.

While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to

Legionella, in particular, can be quite severe, especially among the elderly and those with chronic diseases andweakened immune systems. It is associated with a higher death rate.

Back to TopPossible Complications

Hemolytic anemia (especially with mycoplasma pneumonia)

Lung failure

Back to TopWhen to Contact a Medical Professional
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Contact your health care provider if you develop a fevers, cough, or shortness of breath. There are numerous causefor these symptoms. The doctor will need to rule out pneumonia.

Back to TopPrevention

There is no known prevention for atypical pneumonia. No vaccine is are available at this time for atypical

pneumonia.

Back to TopReferences

Limper AH. Overview of Pneumonia. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. Philadelphia, Pa:

Saunders; 2007:chap 97.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Societconsensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar

1;44 Suppl 2:S27-72.

Sumber:

http://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumon101.html diakses tanggal 25 Desember 2008

Penatalaksanaan Pneumonia Bakteripada Usia Lanjut

Dr Ria Faridawati

Bagian Pulmonologi Fakultas Kedokteran Universitas Indonesia

Unit Paru Rumah Sakit Persahabatan, Jakarta

PENDAHULUAN

Walaupun kini telah banyak kemajuan dalam pengobatan infeksi saluran napas ternyata pneumonia masih

merupakan masalah kesehatan masyarakat secara umum dan khususnya pada golongan usia lanjut(1,2). Pneumoniusia lanjut mempunyai angka mortalitas mendekati 40%. Tingginya angka mortalitas ini disebabkan oleh penyakit

penyerta dan kondisi tertentu seperti diabetes melitus, payah jantung kronik, penyakit vaskuler, penyakit paru

obstruksi kronik (PPOK), peminum alkohol dan penyakit-penyakit lainnya. Penyakit-penyakit tersebut di atasumumnya terdapat pada usia lanjut(3). Pengobatan pneumonia pada usia lanjut harus berhati-hati

terutama pada penderita yang mempunyai fakta yang bermacam-macam, sehingga sering sulit membuat

diagnosis yang tepat.

Dalam tinjauan kepustakaan ini dibahas klasifikasi dan

epiderniologi, patogenesis, diagnosis, gambaran radiologik dan

penatalaksanaan pneumonia pada usia lanjut.

KLASLFIKASI PNEUMONIA

Menurut gambaran klinik pneumonia dibagi atas typicalpneumonia dan atypical pneumonia atau pneumonia yang tidak

khas. Typical pneumonia secara klinik ditandai dengan demam

tinggi, perasaan dingin, nyeri dada dan batuk produktif,terdapat leukositosis, secara radiologis biasanya melibatkan

satu 1obus
http://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.html#tophttp://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.html#tophttp://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumona101.htmlhttp://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumona101.htmlhttp://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.html#tophttp://health.nytimes.com/health/guides/disease/atypical-pneumonia/overview.html#tophttp://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumona101.htmlhttp://www.kalbe.co.id/files/cdk/files/06PenatalaksaanPneumona101.pdf/06PenatalaksaanPneumona101.html


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(1,4). Kuman penyebab yang sering antara lain adalah

Streptococcus pneumoniae, Hemophilus influenzae, Klebsiella

pneumon Staph ylococcus aureus, bakteri aerob gram negatifdan bakteri aerob.

Atypical pneumonia sering tanpa gejala demam, rasa

dingin, batuk tidak produktif, nyeri kepala, mialgia,leukositosis yang tidak terlalu tinggi

(1,4)

. Secara radiologisdidapatkan gambaran bronkopneumonia

(1)

.

Klasifikasi lain dan pneumonia adalah menurut tempat asalinfeksi; dibagi atas:

- Community acquiredpneumonia yaitu pneumonia yang di-

dapat dalam masyarakat.-Hospital acquired(nosokomial) yaitu pneumonia yang di-

dapat di rumah sakit

(1,2,4,5)

.Berdasarkan etiologi, pneumonia dapat dibagi atas:

- Pneumonia bakteri

- Pneumonia virus- Pneumonia mikoplasma

- Pneumonia riketsia

Pada pneumonia bakteri, kuman penyebab yang sering an-tara lain Streptococcus pneumonia dan Staphylococcus pyo-

genes

(6).

EPIDEMLOLOGIPneumonia dapat terjadi di semua negara tetapi data untukperbandingan sangat sedikit, terutama di negara berkembang.

Di Amerika pneumonia merupakan penyebab kematian

keempat pada usia lanjut, dengan angka kematian 169,7 per

100.000 penduduk(1)

. Tingginya angka kematian pada

pneumonia sudah dikenal sejak lama, Osler W menyebutkanpneumonia sebagai "teman pada usia lanjut"

(1)

.Usia lanjut merupakan risiko tinggi untuk pneumonia, hal

ini juga tergantung pada keadaan pejamu dan berdasarkan

tempat mereka berada. Pada orang-orang yang tinggal di rumah

sendiri insidens pneumonia berkisar antara 25 44 per 1000orang dan yang tiaggal di tempat perawatan 68 114 per 1000

orang. Di rumah sakit pneumonia usia lanjut insidensnya tiga

kali lebih besar daripada penderita usia muda(1)

.

Venkatesan dkk mendapatkan dan 38 orang pneumonia usia


18/35

lanjut yang didapat di masyarakat, 43% diantaranya disebabkanoleh Streptococcus pneumoniae, Hemophilus influenzae dan

virus influenza B; tidak ditemukan bakteri gram negatif. Lima

puluh tujuh persen lainnya tidak dapat diidentifikasi karenakesulitan pengumpulan spesimen dan sebelumnya telah diberi

kan antibiotik

(7).

Pada penderita kritis dengan penggunaan ventilator meka

nik dapat terjadi pneumonia nosokomial sebanyak 10% sampai70%

(1)

.

PATOGENESIS

Terjadinya pneumonia berhubungan dengan jumlah bakteri

yang teraspirasi, penurunan daya tahan tubuh pejamu dan vim

lensi koloni bakteri di orofaring(8)

.

Pada penderita pneumonia usia lanjut yang berada di

rumah, umumnya terdapat peningkatan koloni gram negatif.Mekanisme tersebut dihubungkan dengan pemakaian antibiotik

serta tubuh yang lemah dengan adanya penyakit kronik. Secara

kuantitatifaspirasi bakteri dan orofaring mungkin akan mening-kat pada penderita dengan penurunan kesadaran seperti penyakit

degeneratif, kelainan esofagus, CVD, trakeostomi, pemasangan

pipa lambung, dan pemakaian obat-obatan seperti sedatif.Turunnya daya tahan tubuh dihubungkan juga dengan

imunitas humoral dan imunitas seluler, malnutrisi, perokok

berat dan penyakit sistemik. Faktor predisposisi pneumoniaadalah penggunaan pipa endotrakeal, pemakaian nebuhaler,

adanya super infeksi dan malnutrisi.Hampir sebagian besar (50%60%) pneumonia yang didapat di rumah sakit disebabkan oleh hasil aerob gram negatif,

dapat juga disebabkan oleh Streptococcus aureus, Hemophillus

influenzae

(3,10).

DIAGNOSIS

Tidak didapatkan demam pada 20% pneumonia usia lanjutdan dapat tanpa disertai batuk produktif dan perasaan

dingin

(3,4). Pada pemeriksaan fisik, tanda klasik seperti perkusi

yang redup, suara napas bronkial, ronki basah tidak selalu

dijumpai. Frekuensi pernapasan 24 kali per menit cukup

bermakna pada penderita pneumonia usia lanjut(3)

. Pneumonia

usia lanjut dapat bersama sama syok septik yang memberigejala letargi, anoreksi, dan perubahan mental.

Pada sebagian besar penderita didapatkan leukosit yang

normal atau sedikit meninggi, kadang-kadang didapatkan leu-


19/35

kositosis(3)

. Dapat terjadi peningkatan ureum, kreatinin dan

glukosa, terdapat juga hiponatremi atau hipernatremi,hipofosfatemi; dapat terjadi hipoksemi yang disebabkan infeksi

akut dan dapat disertai payah jantung, PPOK atau keduanya.

Pada pneumonia usia lanjut diagnosis radiologik ditegakkanbila didapatkan gambaran infiltrat baru. Tetapi kadang-kadang

sulit menilai gambaran radiologik terutama jika didapatkan

keadaan dehidrasi. Sering kali infiltrat belum terlihat pada 24-48jam setelah perawatan

(3)

. Gambaran radiologi kadang-kadang

masih tampak normal pada pneumonia dini, pneumonia olehbakteri gram negatif dan tuberkulosis endobronkial. Pada pneu-

monia usia anjut sering didapatkan penyakit penyerta seperti

PPOK, gagal jantung dan sindrom gawat napas pada dewasa;pada keadaan ini gambaran radiologi sangat sukar dinilai

(3)

.

Pneumonia oleh pneumococcusPenyakit ini biasanya akut dengan demam tinggi; pada usia

lanjut tidak selalu demam, mungkin disertai keadaan umum

yang lemah, malaise dan dehidrasi berat. Gambaran radiologikmenunjukkan konsolidasi, biasanya unilateral. Buruk

prognosisnya bila terdapat leukopeni, hipotermi, infiltrat

bilateral, dan adanya penyakit di luar paru.

Pneumonia oleh Hemophillus influensa

Umumnya terdapat pada pneumonia di masyarakat dengan

penyakit penyerta dan keadaan tertentu seperti PPOK, keganasan pada paru, diabetes melitus, serta pada peminum

alkohol(3,10). Secara radiologik tampak bercak-bercak infiltrat,

hampir semua pada lobus kanan bawah dengan efusi pleura

(3)

.

Pneumonia oleh Klebsiella

Pneumonia dapat terjadi karena infeksi nosokomial dan

mengakibatkan bakteremi. Umumnya berkembang dengan adanya diabetes melitus, PPOK dan pada peminum alkohol

(3,11)

.Pneumonia oleh Legionella

Pada usia lanjut merupakan keadaan berbahaya terutama

dengan riwayat perokok dan penyakit hati.

Gejala klinik yang penting adalah perasaan dinginberulang; gejala di luar paru seperti diare, nausea dan vomitus

terjadi sebanyak 25%,sakit kepala dan perubahan mental terjadi

lebih dan 30% penderita(3)

.

Diagnosis banding pneumonia legionella pada usia lanjut


20/35

adalah gagal jantung, emboli paru, sindrom gawat napas padadewasa, aspirasi lambung, keganasan di paru, pneumonitis

radiasi, reaksi hipersensitif obat

(3).

PENATALAKSANAAN

Identifikasi etiologi penting untuk pengobatan antibiotika.Pemeriksaan bakteri dapat dengan cara pewarnaan gram dan

sputum, pewarnaan gram cairan pleura, kultur sputum, kultur

darah dan cairan pleura. Kadang-kadang sukar untuk memperoleh sputum yang baik pada pneumoniausia lanjut, karena itu

dapat digunakan antibiotik secana empirik. Dapat juga

dilakukan upaya diagnostik secara invasif seperti aspirasi

transtrakeal, aspirasi endotrakeal dan bronkoskopi. Hasil yangdidapat pada tindakan diagnostik invasif ini tergantung dan

keahlian me lakukan prosedur, dibutuhkan nilai yang akurat

secara mikro biologi(1,3)

.

Pada pneumonia olehpneumococcus, penisilin adalah obat

pilihan utama(1,3,5,6)

. Pada pneumonia ringan dapat diberikan per-

oral, tetapi pada pneumonia berat dengan malabsorbsi perludiberikan dengan cara parenteral, dosis dapat lebih dari 1.2 juta

unit per hari. Pada bakteremi tidak dibenarkan pemberian peni-

silin dosis tinggi guna untuk menghindari efek samping penisilinseperti anemi hemolitik. Pada penderita yang alergi terhadap

penisilin dapat diberikan eritromisin. Pemberian eritromisin

intravena dapat mengakibatkan nausea, vomitus, tromboflebitisdan kehilangan pendengaran yang reversibel terutama pada usia

lanjut dengan fungsi ginjal menurun. Pemberian sefalosporinharus hati-hati pada penderita alergi terhadap penisilin sebabdapat terjadi reaksi hipersensitif si1ang

(2,10)

.

Terjadinya demam berulang umumnya karena reaksi obatatau terjadi superinfeksi yang terjadi hari keempat sampai

ketujuh pengobatan.

Pneumonia oleh Hemophilus influenzae

Obat antibiotik yang terpilih adalah ampisilin. Pada pende

rita yang resisten terhadap ampisilin dapat diberikan cefonicid

atau cefuroxime sodium. Pilihan lain adalah penisilin atausefalosporin. Bila alergi terhadap penisilin dapat diberikan

kloramfenikol atau trimetoprim-sulfametoksasol

(2,3)

.Pada pneumonia oleh gram negatif dianjurkan terapi

dengan dua obat yaitu aminoglikosid dan sefalosporin generasi

ketiga. Efek samping nefrotoksik dan ototoksik dapat dikurangidengan memeriksa kadar dalam serum. Kadar tertinggi dalam

serum pada tobramisin sulfat dan gentamisin sulfat 89 ug/ml

dan 30 ug/ml untuk amikasin sulfat.


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Pneumonia oleh strain staphylococcus

Diterapi dengan oksasilin, nafsilin dan sefalotin. Pada

pneumonia oleh karena Staphylococcus maka vankomisin

adalah obat pilihan utama.

Pneumonia oleh Legionella

Sebagai obat pilihan utama yaitu entromisin. Bila klinis

tidak ada kemajuan dapat ditambahkan rifampisin yang bekerjasinergis dengan eritromisin

(3,6,12)

.Pleuropneumoni oleh bakteri anaerob

Paling baik diterapi dengan penisilin dan pilihan lain yaitu

klindamisin. Klindamisin sering memberi hasil yang cepat dan

baik pada penderita yang sebelumnya diterapi dengan penisilin.Berdasarkan penelitian maka standar lama pengobatan

pada pneumonia olehpneumococcus tanpa komplikasi adalah

7-10 hari; untuk bakteri anaerob 2 minggu, padaHemophilusinfluenza lebih dan 2 minggu karena lesi yang biasanya luas, 2-3

minggu untuk batang gram negatif atau Streptococcus aureus

dan 3 minggu untukLegionella.

Dalam penatalaksanaan harus diperhatikan nutrisi, jumlahkalori yang dibutuhkan baik parenteral atau melalui pipa lam-

bung

(9). Cairan dan elektrolit perlu dinilai karena pada pneumo-

nia dapat terjadi hiponatremi atau hipernatremi. Infeksi

meningkatkan katabolisme protein dan melemahkan sistimimunitas humoral dan seluler.

Sistim respirasi harus diperhatikan, bila terjadi hipoksemi

dapat diberi oksigen. Pemberian oksigen dapat dinilai dengananalisis gas darah, karena keracunan oksigen dapat

melemahkan gerakan mukosiliar dan menyebabkan fibrosisPenting diperhatikan interaksi obat-obat yang dipakai, agardicapai efek obat yang maksimum dengan efek samping yang

minimal. Dalam pemberian obat lebih dan dua macam dapat

terjadi percepatan metabolisme obat, penganuh terhadap pem-

buluh darah perifer atau mempengaruhi sistim saraf sentral(13)

.

Fisioterapi diperlukan untuk pengeluaran sputum dan jugauntuk mencegah terjadinya dekubitus serta mencegah

terjadinya kontraktur

(9).

KESIMPULAN

1) Pneumonia pada usia lanjut sering memberikan gambaran

klinik yang ringan, sehingga kadang-kadang tidak segera diterapi.

2) Pemberian antibiotik pada pneumonia usia lanjut dapat

secara empirik dan data statistik dan epidemiologi sambil menunggu identifikasi bakteri atau bila mendapatkan kesulitan

pada identifikasi bakteri.

3) Dalam penanganan pneumonia usia lanjut harus diperhati


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kan penyakit penyerta yang umumnya terdapat pada usia lanjutseperti diabetes melitus, payah jantung kronik, penyakit

vaskuler, PPOK dan lain-lain.

KEPUSTAKAAN

1. Niederman MS, Sarosi GA. Respiratory infection. In: George RB, Light

RW, Matthay MA, 2nd eds. Chest medicine essentials of pulmonary andcritical care medicine. Baltimore: Williams & Wilkins, 1990; 30709.

2. Gleckman RA, Bergman MH. Bacterial pneumonia: specific diagnosis and

treatment of the elderly. Geriatrics 1987; 42: 2941.3. Cunha BA, Gingrich D, Rosenbaum GS. Pneumonia syndromes: a clinical

approach in the olderly. Geriatrics 1990; 45: 4955.

4. Kiss TG. Infections of the lung parenchyma. In: Diagnosis and

management of pulmonary disease in primary practice. Sydney: Addison-Wesley Pubi Co 1982; 12231.

5. Finegold SM, Johnson CC. Pyogenic bacterial pneumonia, lung abscess

and empyema. In: Murray JF, Nadel JA, eds. Textbook of RespiratoryMedicine. Philadelphia: WB Saunders Co 1988; 80320.

6. Crofton J, Douglas A. Pneumonia. In: Respiratory disease. Singapore: PG

Publ Pte Ltd, 1983; 16587.

7. Ven Katesen Pet al. A hospital study of community acquired pneumonia inthe elderly. Thorax 1990; 5: 25458.

8. Stein D. Managing pneumonia acquired in nursing homes: special con

cerns. Geriatrics 1987; 42: 8190.9. Pemington JE. In: Respiratory infections: diagnosis and management. 2nd

ed. New York: Raven Press, 1989; 17781.

10. Harris GD, Johanson WG. Pathogenesis of bacterial pneumonia. In:Guenter CA, Welch MG. ed. Pulmonary medicine. Second ed.

Philadelphia: lB Lippincott Co. 1982; 34768.

11. Cherniack RM, Cherniack L. Lung parenchymal disease. In: Respiration inhealth and disease. Third ed. Tokyo: WB Saunders Co. 1983; 299301.

12. Hodson ME. Pneumonia. In: Warwick MT. Hodson ME, Corri, Kerr IH.(eds). Clinical atlas respiratory disease. New York: JB LippincottCo. 1989;12229

Cermin Dunia Kedokteran No. 101, 199511

Sumber: http://www.infeksi.com/articles.php?lng=in&pg=48 diakses tanggal 25 Desember 2008

PNEUMONIA

Pengertian PnemoniaPnemonia adalah proses infeksi akut yang mengenai jaringan paru-paru (alveoli). Terjadinyapnemonia pada anak seringkali bersamaan dengan proses infeksi akut pada bronkus (biasa disebubronchopneumonia). Gejala penyakit ini berupa napas cepat dan napas sesak, karena parumeradang secara mendadak. Batas napas cepat adalah frekuensi pernapasan sebanyak 50 kali permenit atau lebih pada anak usia 2 bulan sampai kurang dari 1 tahun, dan 40 kali permenit atau lebpada anak usia 1 tahun sampai kurang dari 5 tahun. Pada anak dibawah usia 2 bulan, tidak dikenadiagnosis pnemonia.Pneumonia Berat ditandai dengan adanya batuk atau (juga disertai) kesukaran bernapas, napassesak atau penarikan dinding dada sebelah bawah ke dalam (severe chest indrawing) pada anakusia 2 bulan sampai kurang dari 5 tahun. Pada kelompok usia ini dikenal juga Pnemonia sangatberat, dengan gejala batuk, kesukaran bernapas disertai gejala sianosis sentral dan tidak dapat
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minum. Sementara untuk anak dibawah 2 bulan, pnemonia berat ditandai dengan frekuensipernapasan sebanyak 60 kali permenit atau lebih atau (juga disertai) penarikan kuat pada dindingdada sebelah bawah ke dalam.Penanggulangan penyakit Pnemonia menjadi fokus kegiatan program P2ISPA (PemberantasanPenyakit Infeksi Saluran Pernafasan Akut). Program ini mengupayakan agar istilah Pnemonia lebihdikenal masyarakat, sehingga memudahkan kegiatan penyuluhan dan penyebaran informasi tentapenanggulangan Pnemonia.Program P2ISPA mengklasifikasikan penderita kedalam 2 kelompok usia:Usia dibawah 2 bulan (Pnemonia Berat dan Bukan Pnemonia)

Usia 2 bulan sampai kurang dari 5 tahun (2 bulan - Pnemonia, Pnemonia Berat dan BukanPnemonia )Klasifikasi Bukan-pnemonia mencakup kelompok balita penderita batuk yang tidak menunjukkangejala peningkatan frekuensi nafas dan tidak menunjukkan adanya penarikan dinding dada bagianbawah ke dalam. Penyakit ISPA diluar pnemonia ini antara lain: batuk-pilek biasa (common cold),pharyngitis, tonsilitis dan otitis. Pharyngitis, tonsilitis dan otitis, tidak termasuk penyakit yangtercakup dalam program ini.Pneumonia merupakan masalah kesehatan di dunia karena angka kematiannya tinggi, tidak sajadinegara berkembang, tapi juga di negara maju seperti AS, Kanada dan negara-negara Eropah. Di Amisalnya, terdapat dua juta sampai tiga juta kasus pneumonia per tahun dengan jumlah kematianrata-rata 45.000 orang.Di Indonesia, pneumonia merupakan penyebab kematian nomor tiga setelah kardiovaskuler dan

tuberkulosis. Faktor sosial ekonomi yang rendah mempertinggi angka kematian. Gejala Pneumoniaadalah demam, sesak napas, napas dan nadi cepat, dahak berwarna kehijauan atau seperti karet,serta gambaran hasil ronsen memperlihatkan kepadatan pada bagian paruKepadatan terjadi karena paru dipenuhi sel radang dan cairan yang sebenarnya merupakan reaksitubuh untuk mematikan luman. Tapi akibatnya fungsi paru terganggu, penderita mengalamikesulitan bernapas, karena tak tersisa ruang untuk oksigen. Pneumonia yang ada di masyarakatumumnya, disebabkan oleh bakteri, virus atau mikoplasma ( bentuk peralihan antara bakteri danvirus ). Bakteri yang umum adalah streptococcus Pneumoniae, Staphylococcus Aureus, Klebsiella SPseudomonas sp,vIrus misalnya virus influensa.

Mengobati PneumoniaAnda mengalami tanda-tanda penumonia ?, Jangan khawatir, kesempatan sembuh masih amat bes

dengan syarat-syarat berikut ini; usia masih muda, dideteksi sejak dini, sistem kekebalan tubuhbekerja dengan baik, infeksi belum menyebar, dan tidak ada infeksi lain.Pengobatan awal biasanya adalah antibiotik, yang cukup manjur mengatasi penumonia oleh baktemikoplasma dan beberapa kasus rickettsia.Untuk pneumonia oleh virus sampai saat ini belum ada panduan khusus, meski beberapa obatantivirus telah digunakan. Kebanyakan pasien juga bisa diobati dirumah. Biasanya dokter yangmenangani peneumonia akan memilihkan obat sesuai pertimbangan masing-masing, setelah suhupasien kembali normal, dokter akan menginstruksikan pengobatan lanjutan untuk mencegahkekambuhan. Soalnya, seranganberikutnya bisa lebih berat dibanding yang pertama. Selainantibiotika, pasien juga akan mendapat pengobatan tambahan berupa pengaturan pola makan danoksigen untuk meningkatkan jumlah oksigen dalam darah.Pada pasien yang berusia pertengahan, diperlukan istirahat lebih panjang untuk mengembvalikan

kondisi tubuh. Namun, mereka yang sudah sembuh dari dari pneumonia mikoplasma akan letih lesdalam waktu yang panjang. Secara rutin, pasien yang sudah sembuh dari pneumonia jangandilarang kembali melakukan aktifitasnya. Namun mereka perlu diingatkan untuk tidak langsungmelakukan yang berat-berat. Soalnya, istirahat cukup merupakan kunci untuk kembali sehat.Untuk menangani pernapasan akut parah ( Severe Acute Respiratory Syndrom/SARS) yang masihmisterius, organisasi Kesehatan Dunia (WHO) menganjurkan para petugas kesehatan untukmenerapkan Universal Precautions. Artinya, mereka harus mengenakan sarung tangan, masker,sepatu boot dan jas yang melindungi seluruh tubuh dari kontak langsung dengan penderita. Buatpenderitanya juga dianjurkan untuk mengenakan masker dan pelindung lain sampai SARS-nyaditanggulangi. Pasien yang dicurigai atau kemungkinan besar terkena SARS harus diisolasi. Ruangperawatannya harus bertekanan rendah dengan pintu tertutup rapat, tidak sharing dengan pasienlain ( termasuk dengan pasien sindrom serupa ) dan punya fasilitas kamar mandi dan kloset sendir


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Semua peralatan yang digunakan sebaiknya sekali pakai dan ruangan dibersihkan denganmenggunakan desinfektans yang mengandung antibakteri, antivirus dan antijamur. Pasiensebaiknya dijaga tidak banyak bergerak. Pasien maupun para petugas kesehatan yang menanganidianjurkan untuk selalu mencuci tangan dengan sabun untuk menghindari penyebaran. Karenaantibiotika berspekturm luas tidak menunjukkan efektifitas menangani SARS, WHO lebihmenganjurkan untuk memanfaatkan suntikan intravena ribavirin dan steroid untuk menstabilkankondisi pasien yang sudah kritis.

Kenali Pneumonia biar tak Terlambat

PNEUMONIA sebenarnya bukan peyakit baru. American Lung Association misalnya, menyebutkanhingga tahun 1936 pneumonia menjadi penyebab kematian nomor satu di Amerika. Penggunaanantibiotik, membuat penyakit ini bisa dikontrol beberapa tahun kemudian. Namun tahun 2000,kombinasi pneumonia dan influenza kembali merajalela dan menjadi penyebab kematian ketujuh dnegara itu.Pneumonia adalah infeksi yang menyebabkan paru ? paru meradang. Kantung-kantung udara dalaparu yang disebut alveoli dipenuhi nanah dan cairan sehingga kemampuan menyerap oksigenmenjadi kurang. Kekurangan oksigen membuat sel-sel tubuh tidak bisa bekerja. Gara ? gara inilah,selain penyebaran infeksi ke seluruh tubuh, penderita pneumonia bisa meninggal. Sebenarnyapneumonia bukanlah penyakit tunggal. Penyebabnya bisa bermacam-macam dan diketahui ada 30sumber infeksi, dengan sumber utama bakteri, virus, mikroplasma, jamur, berbagai senyawa kimiamaupun partikel.

Pneumonia Oleh BakteriPneumonia yang dipicu bakteri bisa menyerang siapa saja, dari bayi sampai usia lanjut. Pencandualkohol, pasien pasca-operasi, orang-orang dengan

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