Pertussis - Presentation Slide

8/10/2019 Pertussis - Presentation Slide

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PLENO PAKAR

25 NOVEMBER 2013

A3

2012/2013


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ANATOMY OF THE RESPIRATORY

SYSTEM


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HISTOLOGY OF THE RESPIRATORY

SYSTEM


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Nasal cavity Vestibulelined with keratinized stratified squamous epithelium. Hairs and sebaceous glands are

also present

Transition from vestibule to respiratory region (respiratory epithelium)stratified squamous ==

pseudostratified columnar == ciliated. Goblet cells also present in this epithelium.

Conchaebony projectionincrease surface area of the nasal cavity and create turbulence in the

stream of passing airfacilitates conditioning of the air.

Lamina propria supplements the secretion of goblet cells. Veins in the lamina propria form thin-

walled cavernous bodies.

Olfactory regiontissue on the superior conchae and nasal septum. Cilia in the epithelium of

olfactory region arise from olfactory cellsno dynein armsdeny motility.

Cell membrane covering the surface of the cilia respond to odorants. The axons of the olfactory cells

collect into bundles in the lamina propria. Supporting cells also present.

Basal cells == olfactory cells or supporting cells


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Pharnyx

Respiratory epithelium (nasopharynx or epipharynx)

Stratified squamous epithelium (oropharynx or meso- and hypo-phraynx)

Lymphocytes usually accumulate beneath the epithelium of the pharynxtonsils

Larynx

Vocal folds lined by stratified squamous epithelium.

Contains the muscle (striated, skeletal) and ligaments needed to control the vocal folds.


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Trachea Lined by respiratory epithelium.

Physical or chemical irritation increase goblet cell number. Prolonged intenseirritationtransformation to stratified squamous epithelium.

Also contains brush cells, endocrine cells, surfactant-producing cells, serouscells.

Mucosaepithelium and lamina propriaSubmucosaelastic membrane (lamina propria) borders mucosa andconnective tissue belows it. Submucosa glands supplement the secretion ofthe cells in the epithelium.

Tracheal cartilagedorsal ends : trachealis muscle and connective tissuefibres.

Annular ligamentsconnect individual cartilages.


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Bronchi Similar to those of the trachea and the main bronchi

Surrounded by a layer of smooth muscle, located between the cartilage andepithelium

Bronchioles Ciliated columnar epithelium

Glands and cartilage are absent

Smooth muscle layer relatively thicker

Alveoli Wallformed by a thin sheet of tissue separating neighbouring alveoli

epithelial cells and intervening connective tissue.

Between the connective tissue, we find dense, anastomosing network ofpulmonary capilaries.

Alveolar poresconnect neighbouring alveoli to each other.

o Alveolar type I cellsextremely flattened

o Alveolar type II cellsirregularly (sometimes cuboidal) shaped. Containcytosomes consisting of precursors to pulmonary surfactant.

Alveolar macrophagesremove particular matters inspired into the alveoli


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FISIOLOGI BATUK

Pada dasarnya mekanisme batuk dapat dibagi

menjadi empat fase yaitu :

I. FASE IRITASI

II. FASE INSPIRASI

III. FASE KOMPRESIIV. FASE EKSPIRASI


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Cough reflex

The bronchi and trachea are so sensitive to light touch that very slightamounts of foreign matter or other causes of irritation initiate the cough

reflex. The larynx and carina (the point where the trachea divides into thebronchi) are especially sensitive, and the terminal bronchioles and even thealveoli are sensitive to corrosive chemical stimuli such as sulfur dioxide gas orchlorine gas. Afferent nerve impulses pass from the respiratory passagesmainly through the vagus nerves to the medulla of the brain. There, anautomatic sequence of events is triggered by the neuronal circuits of the

medulla, causing the following effect.o First, up to 2.5 liters of air are rapidly inspired.

o Second, the epiglottis closes, and the vocal cords shut tightly to entrap the airwithin the lungs.

o Third, the abdominal muscles contract forcefully, pushing against thediaphragm while other expiratory muscles, such as the internal intercostals,

also contract forcefully. Consequently, the pressure in the lungs rises rapidly toas much as 100 mm Hg or more.

o Fourth, the vocal cords and the epiglottis suddenly open widely, so that airunder this high pressure in the lungs explodes outward.


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DD BATUK

Pneumonia : akut dan kronik

TBC Paru

Ca paru lokal Cystic Fibrosis

Abcess Paru

Bronchiektasis


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IMMUNIZATION


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NORMAL GROWTH AND

DEVELOPMENT OF A 7-YEAR-OLDCHILD


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Motor Development hand-eye coordination is well developed

has good balance

can execute simple gymnastic movements, such as somersaults Language and Thinking Development

uses a vocabulary of several thousand words

demonstrates a longer attention span

uses serious, logical thinking; is thoughtful and reflective

able to understand reasoning and make the right decisions

can tell time; knows the days, months, and seasons

can describe points of similarity between two objects

begins to grasp that letters represent the sounds that formwords

able to solve more complex problems

individual learning style becomes more clear-cut


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Social and Emotional Development

desires to be perfect and is quite self-critical

worries more; may have low self-confidence

tends to complain; has strong emotional reactions

understands the difference between right and

wrong takes direction well; needs punishment only rarely

avoids and withdraws from adults

is a better loser and less likely to place blame

waits for her turn in activities

starts to feel guilt and shame


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PERTUSSISETIOLOGY AND PATHOGENESIS


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Humans are the sole reservoir for B. pertussis and B. parapertussis. B.

pertussis, a gram-negative pleomorphic bacillus, is the main causative

organism for pertussis.

B. pertussis spreads by aerosolised droplets produced by the cough of

infected individuals, attaching to and damaging ciliated respiratory

epithelium.B. pertussis also multiplies in the respiratory epithelium,

starting in the nasopharynx and ending primarily in the bronchi.

Pertussis is highly contagious, developing in approx. 80-90% of susceptible

individuals who are exposed to it.

A mucupurulosanguineous exudate froms in the respiratory tract. This

exudate compromises the small airways (esp. those of infants) and

predisposes the affected individual to atelectasis, cough, cyanosis, and

pneumonia. The lung parenchyma and bloodstream are not invaded,

therefore, blood culture results are negative.


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Transmission of pertussis can occur through direct face-to-face contact,

through sharing of a confined space, or through contact with oral, nasal,

or respiratory secretions from an infected source.

Young infants, esp. those born prematurely, and patients with underlyingcardiac, pulmonary, neuromuscular, or neurologic disease are at high risk

for contracting the disease and for complications.

Risk factors :

Non-vaccination in children

Contact with an infected person

Epidemic exposure

Pregnancy

Transmission by contact with contaminated articles is rare. Patients are

usually not infectious after the third week of paroxysmal phase.


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PERTUSSIS

DIAGNOSIS


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The criterion standard for diagnosis of pertussis is isolation of B.

pertussis in culture. However, laboratory confirmation of pertussis is

difficult and delayed.Therefore, clinicians need to make the diagnosis of

pertussis presumptively in patients with a history of intense paroxysmal

coughing, with or without whooping, color changes, posttussive vomiting,incomplete or absent pertussis vaccination, and a finding of lymphocytosis

on a laboratory examination.


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Leukocytosis( 15.00050.000 /microlitre ) with absolute lymphocytosis

occurs during the late catarrhal and paroxysmal phases. It is a non-specificfinding but correlates with the severity of the disease.

Culture specimen should be obtained by using deep nasopharyngeal

aspiration or by holding a flexible swab (Dacron or calcium alginate) in the

patients posterior nasopharynx for 15-30 seconds or until a cough is

produced. The media preferred include Bordet-Gengou agar and modified Stainer-

Scholler media and should be promptly inoculated. B. pertussis usually

grows after 3-4 days. However, negative results can only be considered

until after 10 days.


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PERTUSSISCLINICAL FEATURES


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The incubation period averages 7-14 days (maximum of 3 weeks). B. pertussisinvades respiratory mucosa, increasing the secretion of mucus, which is initiallythin and later viscid and tenacious.

Uncomplicated disease lasts about 6-10 weeks and consists of :

- Catarrhal phase- Paroxysmal phase

- Convalescent phase


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The catarrhal stage begins insidiously, generally with sneezing,

lacrimation, or other signs of coryza; anorexia; listlessness; and a

troublesome, hacking nocturnal cough that gradually becomes diurnal.

Hoarseness may occur. Fever is rare.

Usually lasts for ca. 12 weeks.


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The paroxysmal phase begins with an increase in the severity and

frequency of the cough. Repeated bouts of 5 or more rapidly consecutive

forceful coughs occur during a single expiration and are followed by a

whoopa hurried, deep inspiration.

Copious viscid mucus may be expelled or bubble from the nares during orafter the paroxysms. Posttussive vomitting is characteristic.

In infants, choking spells (with or without cyanosis) may be more common

than whoops.

Usually lasts for 1-6 weeks, but may persists for up to 10 weeks.


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Symptoms diminish as the convalescent phase beginsrecovery is

gradual.

The cough becomes less paroxysmal and disappears in 2-3 weeks.

However, paroxysms often recur with subsequent respiratory infectionsfor many months after the onset of pertussis.


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PERTUSSIS

TREATMENT


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Supportive care

Erythromycin or azithromycin


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PERTUSSIS

PREVENTION


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Active immunization is part of standard childhood vaccination.Five doses

of vaccine are given (usually combined with diphtheria and tetanus [DTP

or DTaP]) at age 2, 4, and 6 mo; boosters are given at 15 to 18 mo and 4 to

6 yr. Significant adverse effects from the pertussis component of the

vaccine include encephalopathy within 7 days; seizure, with or without

fever, within 3 days; persistent, severe, inconsolable screaming or crying

for 3 h; collapse or shock within 48 h; fever 40.5 C within 48 h; and

immediate severe or anaphylactic reaction. These reactions

contraindicate further use of pertussis vaccine; combined diphtheria and

tetanus vaccine is available without the pertussis component.Theacellular vaccine (DTaP) is better tolerated.

Immunity after natural infection lasts about 20 yr. Passive immunization is

unreliable and is not recommended.

Close contacts < 7 yr who have had < 4 doses of vaccine should be

vaccinated. Contacts of all ages, whether vaccinated or not, should receive

a 10-day course of erythromycin 500 mg po qid or 10 to 12.5 mg/kg po

qid.


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CEREBRAL PALSY

PATHOGENESIS


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Cerebral Palsy (CP) ?

A group of disorders of the development of movement and posture

causing activity limitations that are attributed to non-progressive

disturbances that occurred in the developing fetal or infant brain.

The motor disorders of cerebral palsy are often accompanied by

disturbances of sensation, cognition, communication, perception, and/or

behaviour, and/or a seizure disorder.


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Major events in human brains development and their peak times of

occurrence include the following :

Primary neurulationweeks 3-4 of gestaion

Prosencephalic developmentmonths 2-3 of gestation

Neuronal proliferationmonths 3-4 of gestation

Neuronal migrationmonths 3-5 of gestation

Organisationmonth 5 of gestation to years postnatal

Myelinationbirth to years postnatal


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CEREBRAL PALSY

APPROACH CONSIDERATIONS


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TB MENINGITIS

COMPLICATIONS


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TBRM (Tuberculous radiculomyelitis) is a complication of TBM that has

been reported only rarely in the modern medical literature. It develops at

various intervals after TBM, even in adequately treated patients after

strerilization of the CSF.

The most common symptoms are subacute paraparesis, radicular pain,

bladder disturbance, and subsequent paralysis.


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TB MENINGITISPREVENTION


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BCG vaccination offers a protective effect (approx. 64%) against TBM.

Improvement in weight for age was associated with a decreased risk of the

disease.However, further studies are needed to evaluate the association,if any, between nutritional status and vaccine efficiency.

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Pertussis - Presentation Slide