REFERAT

BRONKOPNEUMONIA
Oleh :
Juliand Hidayat
030.13.104

Dokter Pembimbing:
dr. Andri Firdaus, Sp.A

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakit Umum Daerah Karawang
Universitas Trisakti
2019
BRONKOPNEUMONIA

• Bronchopneumonia can occur at any age, but those who are

more susceptible are children less than 5 years old.
• Various microorganisms can cause bronchopneumonia,
including viruses, fungi and bacteria.
• Steptococcus pneumoniae is the most common
• In Indonesia, pneumonia is also the second leading cause of
death in children under five after diarrhea, which is estimated at
922,000 children.

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
 Definition

Bronchopneumonia refers to lung inflammation that is focused on the

bronchiole area and alveolus, triggers the production of mucopurulent
exudates which causes small caliber respiratory tracts and causes even
consolidation into adjacent lobules.

Bronchopneumonia  more commonly found in infants and children

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
 Etiology Microorganisms that cause pneumonia by age group:
Usia Etiologi yang sering Etiologi yang jarang
Bakteri Bakteri
E.coli Bakteri anaerob
Streptococcus group B Streptococcus group D
Listeria monocytogenes Haemophilus influenza
Lahir – 20 hari Streptococcus pneumoniae
Ureaplasma urealyticum

• Pneumonia is caused Virus

Virus sitomegalo

by infections of Bakteri
Virus herpes simpleks
Bakteri

microorganisms, Chlamidia trachomatis Bordetella pertusis

Streptococcus pneumoniae Haemophilus influenza tipe
especially viruses and B
3 minggu – 3 bulan Virus Moraxella catharalis
bacteria. Virus adeno Staphylococcus aureus

• Age is an important Virus influenza

Virus parainfluenza
Ureaplasma urealyticum
Virus
factor in the difference Respiratorysyncytial virus Virus sitomegalo
Bakteri Bakteri
in pneumonia in Chlamidia pneumoniae Haemophilus influenza tipe

children. Mycoplasma pneumoniae

B
Moraxella catharalis
Streptococcus pneumonia Neisseria meningitidis
4 bulan – 5 tahun Virus Staphylococcus aureus
Virus adeno Virus
Virus influenza Virus varicella-zoster
Virus parainfluenza
Virus rino
RespiratorySyncytial Virus

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Risk factor

Exposure to cigarette smoke Malnutrition

not exclusive breastfeeding

low economic status low birth weight

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Classification
Infection Predilection Community Pneumonia

Nosocomial Pneumonia

Recurent Pneumonia

Aspiration Pneumonia

Immunocomoramised
Pneumonia

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Classification Pneumonia classification based on WHO:

Baby less than 2 months Children aged 2 months - 5 years

• Severe pneumonia: rapid • Mild pneumonia: rapid

breathing or severe retraction
• Very severe pneumonia: do not
want to suck / drink, convulsions,
lethargy, fever or hypothermia,
bradycardia or irregular
breathing.
• Pneumonia must be treated and
given antibiotics: rapid breathing
(> 60x / minute), retraction
• Not pneumonia: no rapid
breathing, enough symptomatic
treatment
breathing> 50x / minute (2
months - 1 year) or> 40x /
minute (> 1-5 years), given oral
antibiotics
• Severe pneumonia: retraction,
shortness of breath
• Very severe pneumonia: can not
eat / drink, seizures, letargis,
malnutrition
• Not pneumonia: there is no rapid
breathing, only symptomatic
treatment such as fever reducing

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Patofisiology

defense mechanism
virulensi organisme me↑
disturbed
virus
bacteria
Invasion of microorganisms into Me↓ integrity structural
the lower airway (inhalation or sel alveolar tipe II dan i
commensal floral aspiration) surfactan production

Inflammatory response  leukocyte formed hyaline membrane

migration to the focus of infection, and pulmonary edema
release of toxic substances, activation of
the complement cascade Dispnea

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Patofisiology

1. Congestion Stadium 2. Red hepatization

(First 4-12 hours) stadium (48 hours later)

4 Stadium

3. Gray Hepatization
4. Resolution Stadium
Stadium
(8-11 days)
(3-8 days)

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Sign & Symptomps

• General infection • Respiration disorders

 First upper respiratory tract infection  Dispneu

 Temperature: 390-400C  Nasal lobe breathing
 Restless  Cyanosis around the nose and
mouth
 Headache
 Cough
 Malaise  Chest retraction (intercostal,
 Decreased appetite subcostal, and suprasternal)
 Gastrointestinal Disorders  Tachypnea
 Chest pain  Tachycardia

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
 Diagnosis
ANAMNESIS PEMERIKSAAN FISIK PEMERIKSAAN PENUNJANG

• Continual high fever  Temperature ≥ 39c  Darah tepi:

• Shivering (in children)  Dispnue Thrombocytopenia,
• Cough  Takipnu leukocytosis with count
 Chest wall retraction
• Restless shifted to the left
 Nasal lobe breathing
• Fussy  Cyanosis
• Out of breath  Movement of the thoracic  Foto thorax: alveolar
• cyanosis around the wall decreases in the infiltrates that can be
mouth affected area found throughout the
• Seizures (in infants)  Normal / poor percussion lung fields
• Chest pain  Vf decreases
• Children prefer lying on  Decreased breathing sound
 Auscultation: weak breath
the affected side
sounds, soft wet crackles in
the affected lung

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
Kriteria Diagnosis

The diagnosis is made if 3 of the following 5 symptoms are found:

1. Shortness of breath accompanied by nasal lobe breathing and chest
wall pull
2. Body heat
3. Wet Ronkhi is loud (crackles)
4. Chest radiographs diffuse Infiltrate images
5. Leukocytosis (in viral infections not exceeding 20,000 / mm3 with
predominant lymphocytes, and predominant 15,000-40,000 / mm3
bacterial neutrophils)

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
 Tatalaksana

The management of pneumonia patients includes supportive therapy

and etiologic therapy.

 Supportive therapy given to people with pneumonia is:

 Giving oxygen 2-4 L / min through a nasal catheter or nasopharynx. If
the disease is severe and means are available, breathing aids may be
needed especially within 24-48 hours
 Providing adequate fluids and nutrients. The liquid given contains
enough sugar and electrolytes.
 Correction of electrolyte or metabolic abnormalities that occur.
Terapi Antibiotik
Kategori Usia Patogen Rawat Jalan Rawat Inap
(7-10 hari) (10-14 hari)
Neonatus (<1 month) Streptococcus Grup B It should not be done as Ampicillin +
E.Coli an outpatient aminoglycoside added
Streptococcus with anti-staphylococcal
pneumonia preparations if S. aureus
Haemophiluz influenza infection is suspected
(type b)

< 2 month parainfluenza virus, It is not recommended sefotaksim ditambah

influenza virus, to do outpatient dng nafsilin atau
adaenovirus), S. treatment at the oksasilin
Pneumonia, Haemopilus beginning
influenza (type b)

2 month - 5 years (parainfluenza virus, Amoksisilin, eritromisin, beta laktam+amoksisillin

influenza virus, azitromisin/ amoksisillin-amoksisillin
adaenovirus), klaritomisin klavulanat
S.pneumonia, golongan sefalosporin
H.influenza (tipe b), kotrimoksazol
M.pneumonia, makrolid (eritromisin)
Clamydophilia
pneumonia, S. Aureus,
Streptococcus Grup A
 Tatalaksana

*Alternative: Seftriakson chloramphenicol added

Drug of choice for (80-100 mg/kgbb IM atau (25 mg / kgbb / times IV
suspected germs IV sekali sehari
or IM every 8 hours)

when no one is suspected increasingly severe illness

• ` no improvement

initial antibiotics ampicillin /

amoxicillin (25-50 mg / kgbb / times monitor at least 24 hours
Iv or IM every 6 hours) according to until the 3rd day
age group (trial & error)
 Prognosis

• In general, children with uncomplicated bronchopneumonia can

show a good therapeutic response from the start of appropriate and
adequate antibiotic therapy early on
• And also the prognosis is good if quickly treated or quickly given the
right antibiotics. But the prognosis will be bad if there is leukopenia

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
1. Bennett NJ. Pediatric Pneumonia. Accessed on [2019 August 28]. Available at
http://emedicine.medscape.com/article/967822-overview#a5.
2. Kemenkes RI. Profil Kesehatan Indonesia 2015: Pneumonia. Jakarta: Pusdatin.2016; p.172-74
3. Zec LS, Selmanovic K, Andrijic NL, Kadic A, Zecevic L, Zunic L. Evaluation of Drug Treatment of
Bronchopneumonia at the Pediatric Clinic in Sarajevo. Med Arch. 2016 Jun;70(3):177-181.
4. Anwar A, Dharmayanti I. Pneumonia pada Anak Balita di Indonesia. Jakarta: Jurnal Kesehatan
Masyarakat Nasional.2014;8(8):359-65
5. Pudjiadi A, Hegar B, Handryastuti S, Idris NS, Gandaputra EP, Harmoniati ED. Pedoman Pelayanan Medis
Ikatan Dokter Anak Indonesia. Jakarta: Ikatan Dokter Anak Indonesia; 2009.p.250-4.
6. Pabary R, Balfour-Lynn IM. Complicated pneumonia in children. Breathe. March 2013;9(3):211-22.
7. Paks M. Bronchopneumonia. Accessed on [2019 August 28]. Available at
https://radiopaedia.org/articles/bronchopneumonia.
8. Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE. Nelson Textbook of Pediatrics. 20th ed.
Philadelphia; 2016.p.2088-94.
9. Rahajoe NN, Supriyatno B, Setyanto DB. Buku Ajar Respirologi Anak. 1st ed. Jakarta: Ikatan Dokter Anak
Indonesia; 2013.p.350-64.

Kepaniteraan Klinik Ilmu Kesehatan Anak

Rumah Sakitt Umum Daerah Karawang
Universitas Trisakti 2019
THANK YOU!