DEMAM

Konsep
Demam/fever/pyrexia
Demam mekanisme pertahanan tubuh terhadap infeksi
Peningkatan suhu tubuh diatas normal 36.537.5 C (98100 F)
Bakteri dan virus penyebab infeksi pada manusia hidup pada suhu
37 C
Stimulasi respon termoregulator di hipotalamus
Hipotalamus berperan sebagai thermostat
Demam mengaktifkan sistem kekebalan tubuh produksi
leukosit, antibodi dan zat-zat lain untuk melawan infeksi
Berhubungan langsung dengan tingkat sitokin pirogen yang
diproduksi untuk mengatasi stimulus
Kontraksi otot dan vaskuler

Faktor-faktor pada suhu tubuh

Faktor

anatomi : hipotalamus, cortex serebral,

vaskuler, otot
Faktor fisiologis:
Age
Sex
Exercise
Circadian

rhythm
Underlying disorders

NORMAL BODY TEMPERATURE

Maximum

At

normal oral temperature

6 AM : 37.2
At 4 PM : 37.7

Fisiologis Demam
Pyrogen:

substansi yang men-trigger demam

Exogenous pyrogenic:
Bacteria,

Virus, Fungus, Allergen

Endogenous

immune system cytokine

Major EPs: IL1 ( dan ), TNF-, IL6
Minor Eps: IL8, TNF-, INF ( dan ), MIP1

Innate

pyrogenic

Patofisiologis Demam

Pyrogens

endogenous
cytokine factors
circumventricular
organs of the brain
blood-brain barrier

exogenous
lipopolysaccharidebinding protein
(LBP)

lipopolysaccharide
(LPS)

LBPLPS complex then

binds to the CD14 receptor

cytokine factors bind

endothelial receptors
on vessel walls

microglial cells

activated
arachidonic acid
pathway

arachidonic acid

phospholipase A2 (PLA2)

cyclooxygenase-2 (COX-2)
prostaglandin E2 synthase
PGE2
preoptic area (POA)

dorsomedial
hypothalamus
(DMH)

prostaglandin E receptor 3
(EP3)

the rostral raphe pallidus

paraventricular nucleus (PVN)
nucleus in the medulla oblongata
of the hypothalamus
(rRPa),

stimulation of the
sympathetic output system
produce body heat and
skin vasoconstriction

pituitary gland and

various endocrine organs
to decrease heat loss
from the body surface

ACUTE PHASE RESPONSE

Metabolic changes
Negative nitrogene balance
Loss of body weight

Altered synthesis of
hormones
Hematologic alterations

Leukocytosis
Thrombocytosis
Decreased erythrocytosis

Altered hepatocyte function

(Acute phase reactants)

C reactive protein(increased)
Serum amyloid A(increased)
Fibrinogen(increased)
Fibronectin(increased)
Haptoglobin(increased)
Ceruloplasmin(increased)
Ferritin(increased)
Albumin(decreased)
Transferrin(decreased)

Usefulness of Fever
Research

has demonstrated that fever assists the

healing process in several important ways:
Increased mobility of leukocytes
Enhanced leukocytes phagocytosis
Endotoxin effects decreased
Increased proliferation of T cells

DISCOMFORT DUE TO FEVER

For

each 1 C elevation of body temperature:

Metabolic rate increase 10-15%

Insensible water loss increase
300-500ml/m2/day

O2 consumption increase 13%

Heart rate increase 10-15/min